Welcome to CIGNA Global Health Benefits

Transcription

1 Welcome to CIGNA Global Health Benefits We re Making A World of Difference for US Expatriates, Third Country Nationals & Their Families Research Triangle Institute

2 How we support you 24/7/365 Access Customer Service Toll-free access 24 hours a day, seven days a week, 365 days via telephone, fax, and/or online (collect calls are accepted). Support Services Direct access to multilingual medical advice, second opinions, referrals, and assistance in local admissions. Toll-Free Telephone: Collect Calls Accepted:

3 How we support you Customer Service Fast Turn Around 10-business-day claim turn around with translation of claims - regardless of language or currency reimbursement options in more than 100 currencies range of reimbursement methods payment guarantees

4 Direct Provider Payment Capabilities Direct Settlements Alleviates Pay and Claim Burden from Members in Many Cases Check website to see if Direct Settlements are listed for a particular provider Real-time Guarantees of Payment Nearly 100% Success Rate in Establishing Guarantees of Payment Reimbursement to All Types of Health Care Providers and Facilities - Including Physicians, Dentists, Pharmacies, Clinics Show your ID Card when you receive services from a provider If you need assistance with paying for services, don t hesitate to contact us Providers may also call Customer Service to verify coverage: AT&T Access Code or (call collect)

5 Claim Submission Made Easy Claim Forms Why a Claim Form? The form provides us with important reimbursement instructions, such as where to send reimbursement, type of currency, method of reimbursement (check, EFT, wire, etc.) When submitting via the secure website, a claim form is not required. Multiple Submission Methods Toll-free Fax Scanned Postal Mail Toll-Free Fax: Direct Fax: Providers can directly bill Cigna

6 Filing a Claim Your provider may file a claim directly with CIGNA Global Health Benefits and charge you for your portion of the charges. To file a claim yourself: Obtain a CIGNA Global Health Benefits claim form included in the Welcome Kit or you can obtain the form from the CIGNA Global Health Benefits website at Attach itemized bills to the claim form, that include the diagnosis or explanation of treatment, name and address of the provider, date of service, name of the patient, type of service provided and the amount charged. If you are to receive the reimbursement, be sure indicate currency and location where reimbursement should be sent. Fax the claim form and itemized bills to Customer Service to the toll-free fax: AT&T Access Code or You can your claim directly to Customer Service through the secure member Web site ( Claims may be submitted within 12 months from date of service.

7 Reimbursement Options Multiple Payment Methods Direct check reimbursement to the provider Reimbursement check in US dollars or local currency to address shown on claim form International Wire Transfer into your bank account outside of the US Direct Mail / Check Deposit (into US bank accounts only) Electronic Funds Transfer (available to bank accounts in: US, UK, Hong Kong, Spain, Singapore, Germany, France, Portugal, Canada, and Belgium) Cigna Global Health Benefits Charges No Fees Regardless of the Method of Reimbursement

8 How we support you Valuable International Provider Directory Accessible Self-registration Prompt access to claims status Multilingual Claim forms available Informative Worldwide, country-specific cultural, security, medical, general, and pre-travel information. Secure Member Web Site

9 Secure Member Web Site: Members have access to: Eligibility Paid Claims Plan of Benefits Country Guides for 190+ countries Global Provider Directory Claim Forms, EFT Enrollment Forms Health & Wellness Resources Secure Mailbox Subscribers can self-register for the website by visiting and entering data elements that appear on their CIGNA ID card

10 How we support you No matter where you are located... you re covered. If you re sick, injured or need medical advice, contact CIGNA Global Health Benefits 24 hours a day. Our Customer Service Center will advise and help you select the correct doctor and/or hospital...

11 CIGNA Global Health Benefits Contact Numbers Toll Free Phone: (US & Canada) International Calls: ATT Access Code Telephone (Collect): Toll Free Fax: International Fax: ATT Access Code Fax: (inside the US) (Always refer to Policy #04806A or your Member ID Number that appears on your ID Card)

12 You can also Mail your claims Ground Delivery Cigna Global Health Benefits Customer Service Center P.O. Box Wilmington, DE USA Courier Delivery CIGNA Global Health Benefits Customer Service Center 300 Bellevue Parkway Wilmington, DE 19809

13 Medical and Prescription Drug Program International/ In-Network US Out of Network US Deductible Individual $300 $1,200 Family Maximum $600 $3,600 Plan Coinsurance 80% 60% Out of Pocket Limit: Individual $1,200 $9,000 Family Maximum $3,600 $18,000 (OOP Limits cross apply and exclude the deductible) Lifetime Maximum Unlimited

14 Medical and Prescription Drug Program International/ In-Network US Out of Network US Office Visits Plan Coinsurance subject to the deductible Outpatient Laboratory and X-ray Services (including preadmission testing) Plan Coinsurance subject to the deductible Inpatient Hospital Services Room and Board The most common semi-private room rate covered at Plan Coinsurance (private outside the US if there is no intermediate level between ward and private) subject to the deductible Inpatient Hospital Services Plan Coinsurance subject to the deductible

15 Medical and Prescription Drug Program International/ In-Network US Out of Network US Prescription Drugs Plan Coinsurance subject to the deductible (Internationally or Out of Network in the United States) Cigna Pharmacy Management A co-pay of $15/$35/$50 for services provided through CIGNA Pharmacy Management. A managed pharmacy benefit plan for prescription drugs purchased in the United States at participating retail pharmacies. Not subject to the deductible, Pharmacy co-pays do not count towards the out of pocket. Pre-existing As of January 1, 2014, the pre-existing limitation will be removed from this policy.

16 Medical and Prescription Drug Program Preventive Care ( Adult & Child Preventive Care Services)100% Coinsurance not subject to the deductible The following services are included: health history, physical examination, development assessments, anticipatory guidance, appropriate immunizations, and laboratory tests. Travel Immunizations100% Coinsurance not subject to the deductible For Employee and Dependent immunizations required for travel are included.* Papanicolaou Screening100% Coinsurance not subject to the deductible up to one test per calendar year for all eligible females* Prostate Cancer Screening100% Coinsurance not subject to the deductible up to one test per calendar year for all eligible males* Mammograms100% Coinsurance not subject to the deductible per the following schedule: Ages 35 39: one baseline exam Ages 40 49: one exam every one or two years for asymptomatic women, but no sooner than two years after a woman s baseline. Age 50 & Over: one exam annually Any Age: Whenever prescribed by a physician

17 Dental Program Classes I, II, III Combined Calendar Year Maximum $1,500 per person Calendar Year Deductible Individual $25 Family Maximum $75 (waived for Class I) Class I Preventive Care 100% Coinsurance not subject to the deductible for Diagnostic and Preventive services including oral examination, diagnostic x-rays and periodontal maintenance. Class II Basic Restorative 80% Coinsurance subject to the deductible for Basic Restorations, Endodontics, Periodontics, Prosthodontic Maintenance and Oral Surgery including Fillings, Root Canal, Periodontal Scaling and Root Planning and repair to Bridgework and Dentures. Class III Major Restorative 50% Coinsurance subject to the deductible for Major Restorations, Dentures and bridgework including Crowns. Class IV Orthodontia (Limited to dependent children under age 19)50% Coinsurance subject to a $50 lifetime deductible subject to $1,500 lifetime maximum.

18 Long Term Disability Monthly Benefit 60% of base monthly earnings to a maximum benefit of $8,500. Covered Earnings Definition Employee's base monthly gross wage or salary as reported by employer, excluding bonuses, commissions, overtime pay or extra compensation. Elimination Period 90 days Benefit Period Reducing Benefit Duration Age at Disability Max Benefit Period <60 to age months months months months months months months months months 69 and over 12 months

19 Long Term Disability Definition of Disability Partial Disability Recurrent Disability Survivor Benefits Offsets Mental Illness Limitation Minimum Monthly Benefit $50 Maternity Benefit Full coverage Pre-existing Exclusion 3/6/12 Cost of Living Freeze Cost of Living Adjustment Waiver of Premium 24 month Own Occupation A disability in which you are able to perform one or more, but not all material and substantial duties of an occupation full or part time; or you are able to perform all material and substantial duties part time. A disability which is related or due to the same cause as a prior disability for which a monthly benefit was payable. A recurrent disability will be treated as part of the prior disability if after receiving benefits under this policy the insured returns to his or her occupation on a full-time basis for less than six months. 3 months US Social Security, Canadian Pension Plan (CPP), Quebec Pension Plan (QPP), Local Country Social Programs and other standard offsets. Maximum benefit period of 24 months After the initial deduction for each Other Income benefit, the monthly benefit will not be further reduced for cost of living adjustments made under these other income benefits.none Premium payments are waived during any period for which benefits are payable. If coverage is to be continued, premium payments may be resumed following a period during which they were waived.