855166 d Commitment to Quality Newsletter v2.indd

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1 COMMITMENT TO QUALITY Convenient, supportive, responsive and satisfying health services Commitment to quality* Commitment to quality 01 Focusing on quality to improve health Quality Outcomes 03 We believe quality is critical to protecting and improving your health and Management well-being, which is why we are committed to: Chronic condition 05 access to quality health care professionals. Offering convenient management › you and your doctor to help you stay healthy or return to Supporting 06 How your health care › physically or emotionally ill. health if you become professional gets paid with our services. Making sure you are satisfied Utilization management – 08 › How Cigna makes coverage responsive Providing customer service. › decisions quality management committees With the help of our , we maintain 09 Customers’ rights and standards for service and quality medical and behavioral care from network responsibilities statement health care professionals. The committees include doctors and other health care professionals in our network. They meet regularly to discuss health care Know how to voice your 11 trends and how they affect the services network health care professionals concerns or complaints provide. They then recommend ways we can improve those services. Here 12 Your privacy is our priority are some of the systems that we have in place to help provide you with How we assess medical 13 access to quality services. technology Access to quality health care professionals 14 Prescription drug coverage We monitor the quality of independent doctors in our network. We review Preventive health coverage 15 each candidate’s credentials and practice history before considering him or 15 Health assessment – her for inclusion in our network. Each doctor’s credentials are reevaluated 15 minutes can change . every three years to be sure he or she still qualifies for participation your health * “Commitment to Quality” addresses Cigna medical plan customers who have behavioral health benefits through Cigna Behavioral Health (CBH). Medical plan customers who have behavioral health benefits from other companies should disregard the behavioral references outlined herein. Offered by: Cigna Health and Life Insurance Company, Connecticut General Life Insurance Company or their affiliates. 855166 d 12/15

2 Commitment to quality 2 Helping you stay healthy Finding health care solutions Clinical calls can be transferred › to the Health Information We pay attention to how well Need emergency care Line (HIL) for medical, or to a immediately? Go directly to any health care professionals in our behavioral health advocate for network meet your preventive emergency facility or call 911. CBH customers. Emergencies exist when you or your care needs. We regularly collect data from network doctors to health care professional reasonably You can ask Customer Service › find out if customers are taking feel that medical or behavioral for help getting or giving written treatment is needed to prevent advantage of covered preventive or spoken information in your care services. We regularly provide serious harm to yourself or others. preferred language. In addition, information to you about our They may include major accidents Cigna uses TDD/TTY-type wellness screening, and preventive or illnesses, uncontrolled bleeding, services to communicate with seizure, loss of consciousness, chest care programs. hearing-impaired customers. pain or shortness of breath, among other things. Making sure you are satisfied Patient safety resources Need after-hours care and not sure One way to offer quality customer Cigna encourages practices that what to do? Call your doctor or an service is to make sure you have the can help ensure your safety as on-call health care professional to chance to give us feedback. Here a patient, and we offer a variety provide advice or urgent treatment. are two ways we ask for your views. of tools and services to help you You can also call our Health make smart, safe decisions about Several times a year, we › Information Line or the number your health. randomly survey our customers on your benefit card to speak with and doctors to ask how we are Well Informed program Our › one of our nurses or a behavioral doing. We use this information to alerts you and your doctor to health advocate. help us improve our services. possible dangerous gaps in care, Need urgent care that requires such as missing preventive care Our Customer Service › Call your prompt attention? screenings or delays in filling representatives are available personal doctor and request your prescriptions. to answer your questions to be seen within 24 to 48 hours, and address your concerns, You can find quality and cost › or visit an urgent care center complaints or suggestions. Just ratings on hospital care, and or convenience care clinic call us at the toll-free number find doctors, specialists and for symptomatic illnesses on your health care ID card. hospitals through our online and infections. provider directory. In addition, Need symptomatic regular and Responsive customer service myCigna.com compares quality routine care? Schedule a visit so and cost ratings of doctors and We need to hear from you, but you that you’re seen within 7 to 14 days specialists in our network and also need to hear from us. Here are or within the time frame specified indicates which hospitals are just a few of the ways we provide by your treating doctor. You can deemed “Centers of Excellence.” you with information about your also find and select a treatment health plan and how it works. provider using our online directories websites Our have resources › of medical or behavioral treatment such as online health care professionals. professional and facility Need preventive screenings and a directories, and useful tools to physical? Schedule a visit so that help you get the most from your you’re seen within 30 days. health plan. Need to transition from pediatric We offer an interactive voice › care to adult care? Ask your response system available pediatrician for a recommendation 24/7, and for more complex or call our customer service to help issues, there are call center staff you select an adult primary care available to assist. practitioner or adult behavioral health professional.

3 Commitment to quality 3 As we continue to improve and align with new technology, our online options for your health assessment › continue to expand. The health assessment offers the ability to learn about the top risk factors that could hurt your health, and it can direct you to resources and support to help you reduce these risks. Online options are available in English or Spanish. Our CBH behavioral website offers online assessment that can help you to determine when behavioral care › may be needed. guidelines and reminders, offered by the “SPEAK UP” We also support and encourage you to follow these Joint Commission on Accreditation of Healthcare Organizations, to help ensure you are an active participant in your health care. Speak up if you have questions or concerns – don’t hesitate to talk with your doctor. S Pay attention to the care you are receiving. P E Educate yourself about your diagnosis, medical tests and treatment plan. A Ask a trusted family member or friend to be your health care advocate. Know the medications you take and why you take them. K Use a health care organization that has undergone a rigorous onsite evaluation by an independent U accrediting agency. Participate in all decisions about your treatment. P Quality Outcomes Measurement Measurement of the satisfaction Accreditation by URAC, an Cigna measures the effectiveness of › › of our medical customers independent, not-for-profit our program activities in a variety organization whose mission is to annually by utilizing the of ways. Consumer Assessment of ensure consistent quality of care External approval of our medical › Health Care Professionals and for customers of Cigna’s medical and behavioral quality programs Systems Case Management, Utilization (*CAHPS®) survey, a through ongoing accreditation public-private initiative that Management, and Pharmacy by the National Committee for Benefit Management programs. develops standardized surveys (NCQA), Quality Assurance of customers’ experiences with Utilization of the NCQA a not-for-profit organization › outpatient and facility-level Healthcare Effectiveness Data dedicated to measuring the care, and implementation of and Information Set (*HEDIS®), quality of America’s health care. appropriate actions to improve a tool used by more than 90% Cigna has a strong history with the customers’ experience. of America’s health plans the NCQA process. (See additional information to measure performance on Cigna’s 24-hour health › on the next page.) important levels of care and information line, disease service, to compare our health Annual evaluation of behavioral › management, wellness and improvement outcomes to the customers’ experience with health promotion programs, industry standards established the care and services received medical and behavioral by NCQA, and to look for areas through Cigna Behavioral screening, and care coordination of opportunity for quality Health. This annual survey services are included in the improvement. (See additional helps us identify opportunities NCQA accreditation process. information on the next page.) for improvement based on your feedback. urance (NCQA) * HEDIS® (Healthcare Effectiveness Data and Information Set) is a registered trademark of the National Committee for Quality Ass ch and Quality (AHRQ). * CAHPS® (Consumer Assessment of Healthcare Providers and System) is a registered trademark of the Agency for Healthcare Resear

4 Commitment to quality 4 CAHPS ® – Medical Customer satisfaction measurements – Measurements of ® HEDIS of success clinical success Rating questions Cigna uses HEDIS® clinical metrics Cigna is committed to promoting quality service. We participate in to measure the results of many Rating of personal doctor (Q21) clinical interventions. Annually, to Member Satisfaction Survey the Rating of specialist seen most we measure and report clinical obtain your feedback on how we are often (Q25) effectiveness results for our medical doing. This annual survey measures Rating of all health care (Q13) performance in key areas of care and plans, and submit these results to Rating of health plan (Q42) service delivery. NCQA to be included in developing Composite measures national benchmark data. Our Cigna attempts to maintain and strong results demonstrate our Getting needed care improve results each year by taking success in supporting quality care Getting care quickly action on opportunities identified for our customers. How well doctors communicate from your feedback. For example, we Customer service made information easier to obtain, more helpful and understandable. Claims processing With your help over the last We did this by launching a new Shared decision making several years, we have seen simple-to-navigate website. The Cigna Plan information on cost an increase in the number “Cost of Care Estimator Tool” was of customers having created for health care professionals to use with you to identify treatment important preventive care choices for your care that better fit your budget. Your personalized website screenings and doctor offers teaching tools to increase your understanding of various health follow-up. topics. We also updated the letters and postcards we mail to you. Cigna Health Matters, a suite of health coaching tools, was designed to Initiatives by Quality program help you set and meet health goals by matching you to the right tool at staff are actively pursued in order the right time. The digital tools include online, mobile, social media, and to promote improved health, web-based applications to help you and your family get the most out of well-being and a sense of security. your benefits, by improving your health and informing you about lower These initiatives include, but are cost alternatives. not limited to, HEDIS® measures: You told us you want increased access to care and service. We improved Asthma, cholesterol management access to Customer Service by opening call centers 24 hours a day, 7 days following a cardiac event, breast a week. You can now use web-enabled mobile phones to get immediate cancer screening, childhood answers in both English and Spanish that are customized to your health plan immunizations, and depression, . We also actively work to myCigna.com benefits through Cigna Mobile on alcohol and other drug use. We increase our network of qualified health care professionals and convenience promote preventive care through care clinics to make sure you can get needed care quickly. telephone outreach and mailings to people who are identified , or would like specific If you have questions about HEDIS ® or CAHPS ® through claims data as potentially information on your plan’s scores, please call 800.591.9407. not having had recommended screenings, vaccines or physician follow-up. We partner with your doctor, community organizations and select employers to offer educational opportunities. To learn more about our Quality Management program or to request a report on our progress in meeting our goals, call Customer Service at the toll-free number on your ID card.

5 Chronic condition management 5 Chronic condition management Our chronic condition management programs offer valuable, confidential support for you and your covered family members with specific medical conditions. Educational materials help you learn more about your health condition, in order to make educated decisions about treatment options. In addition, we share information with your doctor when appropriate. How it works Our chronic condition management programs include a number of services designed to help you better understand and manage your condition. We work with you to create a plan that helps you To ensure you have the confidential successfully reach your health goals. You can take charge of your health support you need, you have We do this through coaching by using online tools. Self-service toll-free access to clinical coaches telephone, and online self-guided tools include tools to help you Monday through Friday (available support tools. You choose a path understand your condition, make at least 12 hours a day) to speak that is right for you. more informed treatment decisions, with you one-on-one, or you can log and work towards personal in to your personalized customer Personal interventions goals. Go to the home page tab website for additional information and coaching My Health and find multiple for and resources. Please note that programs and resources on your You have access to the Personal hours of operation may vary based customer personalized website. Health Team who specializes in your on your individual program. condition to help you: Fast and accurate assistance In the event you need Recognize worsening symptoms › identification , our 24-hour Health after hours and when to see your doctor. Information Line is a support To see if you are eligible for Establish questions to ask › program in which nurses can participation in a chronic condition your doctor. empower you to better manage management program, Cigna your health. You can get this uses a broad range of information Understand the importance of › support 24 hours a day, 7 days such as medical and pharmacy following your doctor’s orders. a week. claims, and Health Assessment Develop health habits related to › results. We perform this review nutrition, sleep, exercise, weight, regularly in case your health status tobacco and stress. changes. If you are identified with a For emergency care, Make educated decisions about › chronic condition, you will receive immediately dial 911. treatment options. information from us on benefits For a non-emergency, of the program, and you may be Throughout the program, you call the toll-free Customer invited to use a personalized online follow your doctor’s direction and Service number listed on program or to connect with a treatment plan. your ID card. For additional coach by phone. Of course, you can or self-service resources, choose not to accept our always go to your personalized assistance. You may also call us to customer website. self-enroll or your physician may refer you to the program.

6 How your health care professional gets paid 6 How your health care professional gets paid and may receive a bonus or on the provider type (physician/ The Cigna network of health penalty if actual costs are over practitioner, hospital or ancillary care professionals includes or under the target. All capitated service provider). The amount and physicians/practitioners, services are monitored using type of compensation may also vary hospitals, and ancillary service criteria that may include patient based on the type of coverage plan providers (Ambulatory Surgical access to care, quality of care, (HMO, PPO, etc.). Centers, Physical Therapy or satisfaction, and appropriate and Urgent Care Centers, etc.). Cigna Discounted fee-for-service: › cost-effective use of medical its network of health compensates This payment method applies services and supplies. ways that care professionals in to all health care professional are intended to motivate them to Cigna also works with separate, types: physicians/practitioners; practice preventive care, promote third-party administrative hospitals; and, ancillary service quality care, provide medically entities to administer payments providers (Ambulatory Surgical necessary care and ensure the to health care professionals Center, Physical Therapy or –effective appropriate and cost in our networks. Under these Urgent Care Centers, etc.). use of covered medical services arrangements, Cigna may Payment for services is based and supplies . Compensation may pay the third party a fixed on a discounted fee schedule as also include additional payments to monthly amount per customer compared with the usual amount health care professionals based for these services and health billed for health care services. on their performance in these care professionals are then same areas. In addition, Cigna may Capitation: This payment › compensated by the third promote the use of certain health method generally applies to party for services from that care professionals in our network physicians or various types of fixed amount. based on their superior quality of physician groups. This payment method Salary: › care and cost-effective measures. The physician or physician applies to “employed” health Cigna does not offer incentives to group is paid a fixed amount care professionals of all types. encourage doctors and other health (capitation) at regular intervals In some very limited areas, care professionals to limit the use for each Cigna customer Cigna-owned medical groups of health care services, nor do we who selects them as his/her or affiliates employ health care reward our medical directors for primary care doctor. These professionals who are paid a issuing denials of coverage for care. fixed payments generally cover salary for their services. These Cigna considers the doctor’s quality all services provided by that health care professionals may of care, quality of service, and physician, with no additional be eligible for year-end bonuses appropriate use of medical services payments being made. based on performance in areas prior to awarding any bonuses Capitation offers predictable such as quality of care, quality and incentives. income, encourages health care of service, and appropriate and professionals to keep people well Cigna reinforces this philosophy cost-effective use of medical through preventive care, and through decisions made by our services and supplies. eliminates the financial incentive medical directors and Health This payment method Per diem: to provide services that will not › Services staff, which encourages applies to hospitals and similar benefit the patient. and promotes the appropriate use facilities. of covered health care services. Health care professionals paid A specific amount is paid on a capitation basis may also The methods by which health care to the hospital each day participate in a risk-sharing professionals in our network agree (“per diem”) for all health care arrangement with Cigna; that is, to be compensated are described received on that day. The per they agree on a target amount in general below and vary based diem payment varies based for the cost of certain services

7 How your health care professional gets paid 7 This is a general overview of hospitals; and, ancillary services upon a number of factors the most common forms of (Ambulatory Surgical Center, which may include type of compensation to our health care Physical Therapy or Urgent Care service or length of stay, and professionals; it is not meant to Centers, etc.). the resulting payment, in some be all-inclusive. As health care cases, could be greater than the Some health care professionals evolves, compensation methods hospital’s actual billed charges. may receive additional payments may be modified to drive further based on their performance This payment applies Case rate: › improvement in quality, affordability in areas such as practicing to hospitals and certain ancillary and patient satisfaction. preventive care, promoting services (e.g., Ambulatory If you have questions about which quality care, providing medically Surgical Centers). compensation method applies necessary care, and ensuring the A specific amount is paid for to services you receive from appropriate and cost-effective all health care received based a doctor, hospital or ancillary use of covered medical on a given period of time health care professional, please services and supplies. They (length of stay) or based on discuss this with the health care may also receive financial and/ the procedure/service provided professional or their staff, as Cigna or non-financial incentives to (e.g., an appendectomy or a cannot discuss specific health promote their use of referrals to maternity delivery). care professional contract details. other high-quality, cost-effective Bonuses and incentives: › questions However, if you have health care professionals in This method can apply to about your coverage, including our network (such as certain all health care professional your co-pays and/or co-insurance hospitals, labs, specialists types: Physicians/practitioners; obligations, please contact Cigna and vendors). Customer Service at the toll-free number listed on your ID card.

8 Utilization management – How Cigna makes coverage decisions 8 Utilization management – How Cigna makes coverage decisions When making a coverage decision, Utilization management includes A limited number of outpatient › Cigna’s medical or behavioral the evaluation of potential coverage services and drugs. professionals will consider not of health care services based The services that require only evidenced-based guidelines, upon the terms of your benefit precertification vary based on but also your unique clinical plan, medical appropriateness of your benefit plan. Check your circumstances and the terms of health care services, procedures coverage materials, ask your your health plan. In the process, and the places where care is doctor, or call Cigna Customer they will use Cigna’s publicly received according to established Service for information about your posted medical, behavioral, and evidence-based criteria and/or plan’s particular precertification pharmacy Coverage Policies, standard guidelines. requirements. as well as additional resources, Cigna requires precertification Your doctor or other health such as independent utilization (prior approval) for a limited care professional can request management guidelines. number of health care services, precertification of coverage by Some services may not be covered drugs or procedures before the telephone, fax, online submission, by your health plan, according to services are delivered. Services that or email. When we receive the your specific medical benefit plan require a health care professional request, we may ask for additional requirements and exclusions. If you to obtain precertification of information about your condition obtain non-covered services, you coverage include: and the treatment planned to may be billed directly for the full Non-emergency hospital and determine if the services are › cost. Check your coverage materials other facility admissions. covered by your health plan or for more information. to identify coverage that your Services for which coverage is › Utilization management decisions treatment professional may not be limited or may be excluded by are based upon the existence of aware of. Check with your treatment the health plan. This is done to an available benefit, and then, if professional before receiving ensure you know your potential the benefit is available, upon the services to see if precertification is out-of-pocket (costs that your medical necessity for that service. required and if it is in place. plan doesn’t cover, and that Cigna does not reward health care you’re responsible for) costs professionals or other individuals in advance. involved in coverage determinations for denials. In addition, there are no financial incentives for utilization management decision makers to make decisions that result in coverage for inappropriate care or underutilization. If you have questions, call Customer Service at the toll-free number on your ID card.

9 Customers’ rights and responsibilities statement 9 Customers’ rights and responsibilities statement Rights You have the right to: Receive coverage for the › benefits and treatments available under your health benefit plan when you need it and in a way that respects your privacy and dignity. Receive the understandable › about information you need your health benefit plan, including information about services that are covered and not covered, and any costs that you will be responsible for paying. Obtain understandable the confidentiality of customers’ › of who is available Be advised › information about Cigna’s information and adheres to all to assist you with any special programs and services, including federal and state regulations Cigna programs or services the qualifications of staff that regarding confidentiality and you may receive and who can support Cigna wellness and the release of personal health assist you with any requests similar programs and any information. to change or disenroll from contractual relationships related programs or services offered by with your health care Participate › to such programs. or through Cigna. professional in health decisions, Have access to current and have your health care › Be heard. Our complaint-handling › on in-network information professional give you information process is designed to: Hear and doctors, health care professionals, about your medical condition act on your complaint or concern hospitals and places you can and your treatment options, about Cigna and/or the quality receive care, and information regardless of coverage or cost. of care you receive from health about a particular health care You have the right to receive care professionals and the various professional’s education, training this information in terms and places you receive care in our and practice. language you understand. network; provide a courteous, prompt response; and guide you Select a primary care doctor about any care you Learn › › through our grievance process for yourself and each covered receive. You should be asked if you do not agree with our member of your family, and for your consent for all care, decision. Cigna strives to resolve change your primary care doctor unless there is an emergency your complaint on initial contact for any reason. H owever, many and your life and health are in and in a manner that is consistent benefit plans do not require that serious danger. with your applicable benefit plan. you select a primary care doctor. Refuse medical or behavioral › Language interpretation and Have your personal identification care . If you refuse care, your › TTY services are available for data and medical information health care professional should complaint and appeal processes. kept confidential by Cigna and tell you what might happen. Know and make recommendations › your health care professional, We urge you to discuss your regarding our policies that affect know who has access to your concerns about care with your your rights and responsibilities. information, and know the doctor or other health care If you have recommendations or procedures used to ensure professional. Your doctor or concerns, please call Customer security, privacy and health care professional will give Service at the toll-free number on confidentiality. Cigna honors you advice, but you will have the your ID card. final decision.

10 Customers’ rights and responsibilities statement 10 a comfortable relationship with Keep scheduled appointments › Responsibilities your health care professional; ask and notify the health care You have the responsibility to: questions about things you don’t professional’s office ahead of Review and understand the › understand; and follow your time if you are going to be late information you receive about health care professional’s advice. or miss an appointment. your health benefit plan. Please You should understand that all charges for missed Pay › call Customer Service when you your condition may not improve appointments and for services have questions or concerns. and may even get worse if you that are not covered by don’t follow your health care Understand how to obtain › your plan. professional’s advice. services and supplies that are your opinions, concerns or Voice › covered under your plan – your health Understand › complaints to Cigna Customer including any emergency condition and work with your Service and/or your health care services needed outside of health care professional to professional. normal business hours or develop treatment goals that your plan administrator Notify › when you are away from your you both agree upon. and treating health care usual place of residence or Provide honest, complete › professional as soon as possible work, by using the indicated information to the health care about any changes in family size, number on your Cigna ID professionals caring for you. address, phone number or status card or by accessing Cigna Know what medicine you take, with your health benefit plan, or › on-line resources. and why, and how to take it. if you decide to disenroll from Show your ID card before you › Cigna’s programs and services. all copays, deductibles and Pay › receive care. coinsurance for which you are Schedule a new patient › responsible, at the time service is appointment with any in-network rendered or when they are due. health care professional; build

11 Know how to voice your concerns or complaints 11 Know how to voice your concerns or complaints Your request will be reviewed by that your doctors or 1. Confirm someone who was not involved in other health care professionals, Cigna wants you to be satisfied the initial decision and who can take hospitals, equipment suppliers, with your health benefit plan corrective action according to the etc. are in-network by visiting and the many services and terms of your plan. A doctor will your personalized website programs we provide to you. be involved in any denial decision or calling Customer Service That’s why we have a process* involving medical judgment. If (check your ID card for the to address your concerns your situation requires urgent website address and the toll-free and complaints. care, the review and response will number to call). If your plan be expedited. covers out-of-network services, You can submit your › know that your costs will likely complaint by telephone, You will be notified in writing of be higher than if you choose letter or fax at the toll-free the appeal decision. If you are not in-network services. number provided on your satisfied with the appeal decision, ID card. depending on the type of plan that 2. Read the exclusions and your employer has chosen and the in your plan materials limitations Your complaint will › state and/or federal rules that apply to confirm services are covered be acknowledged to that type of health plan, you may prior to receiving treatment. and handled on initial have the right to request another contact or investigated in Review the Schedule of 3. internal appeal review. The appeal accordance with the type Coverage in your plan reviewer will not have been involved of issue reported. materials for details on copays, in any prior decision related to your coinsurance, deductibles, etc. In most situations involving › appeal nor be a subordinate of a quality of care concerns, we previous decision maker. How to request an appeal of a will be unable to disclose coverage decision the final resolution because An independent external of confidentiality issues. The specific appeal process,* that review may be available applies to you is determined by You will be notified in writing of the health plan your employer has the final internal appeal decision. chosen and follows state and/or Customer service can help If you are not satisfied with the federal rules that apply to that type with complaints or appeals decision, additional options may of plan. To better understand the be available to you, depending on If you have questions or concerns appeal process available to you, the type of plan that your employer about coverage or claim payments, refer to your coverage materials or has chosen and the state and/or call Customer Service at the call Customer Service. federal rules that apply to that type toll-free number on your ID card. To begin the appeal process, of health plan. If the appeal involves If Customer Service cannot send your request to the address a coverage decision concerning resolve your concern, ask for more shown in the notice of adverse medical judgment, you may be able information about how to have determination, coverage materials to request an external review by an your concerns addressed. or provided by Customer Service. independent review organization Following are some steps you can Indicate why you believe the after your final internal appeal. take to help ensure you receive decision should be reviewed If external review is available to you, maximum coverage under your again and include any supporting your final appeal decision letter plan and possibly avoid the need documentation. will include instructions on how to to appeal. request this review. * If you are covered under an insurance policy or by an HMO, we address your concerns, complaints and appeals according to appl icable state and federal rules. Those rules may vary from our national process described here. Please check your coverage materials for more information.

12 Your privacy is our priority 12 Your privacy is our priority Cigna is committed to maintaining If Cigna provided the Notice, you dentiality of your protected the confi nd a copy on your personalized will fi health information (PHI). We website by clicking on the Privacy have established policies and link at the bottom of the home safeguards to protect oral, written page. The Notice describes how we The Notice is available and electronic information about use and disclose protected health in English, Spanish and you across our organization. information and advises individuals Traditional Chinese. When you enrolled, you should of their rights – such as how to If you prefer, you can get have received a Notice of Privacy receive your health information at a a copy of our Notice, or Practices (“Notice”) from Cigna or location that you specify, how to you can ask to receive your employer, depending on your give someone authorization to the information in other health plan. access your PHI, or how to name a languages, by calling personal representative to handle Customer Service at the Your Notice may be provided by your medical aff airs – under federal toll-free number on your your employer. If it is, you can ask and state law. ID card. your employer for a copy.

13 How we assess medical technology 13 How we assess medical technology Cigna has a specific process to review new and emerging medical products, procedures, devices, therapies, pharmaceuticals, biologicals and behavioral health procedures. The Cigna Medical Technology Assessment Committee is made up of physicians of different types, including multiple medical, surgical, and behavioral health specialties. It reviews literature, policies, technology assessments, and evidence-based medicine summaries from external experts in the field to ensure that new products and procedures recommended for coverage are proven to be safe and effective for our customers. Cigna also consults with its internal professional subject matter experts as part of the committee review process. Generally, the committee will not consider a new technology for coverage until U.S. Food and Drug Administration (FDA) regulatory approval is obtained. In making its recommendations, the Cigna Medical Technology Assessment Committee looks to authoritative sources, including published peer-reviewed medical articles and clinical studies, approval from governmental bodies such as the U.S. FDA, medical professional specialty society positions and independent reviews from experts in the field. After a new technology receives final approval from the appropriate governmental regulatory body (if needed), the committee reviews the technology by looking at a number of questions, including: Is the technology safe and effective? › Are the studies, if any, well conducted with sound study › methodology? Are health outcomes positive and/or do they have a › beneficial effect? Do positive outcomes outweigh any harmful effects? › Is the technology available outside of the investigational/ › research setting? The coverage of a product or procedure also depends on the terms of your health plan.

14 Prescription drug coverage 14 Prescription drug coverage the market or medications being of your ID card. You can also use The information described here removed from the market by the the Prescription Drug Price Quote applies to customers who have manufacturer. Tool to compare prices at local prescription drug coverage retail pharmacies and Cigna Home through Cigna. To find out if you Does my doctor know what Delivery Pharmacy. have prescription drug coverage medications are on the through Cigna, please check your Who decides which prescription drug list? plan materials. medications are on the list? Doctors in our network should The Cigna Prescription Drug List check the online drug list on The drug list is developed in is an extensive list of generic and when prescribing Cigna.com cooperation with Cigna’s Pharmacy brand-name medications that are medications for you. and Therapeutics Committee, a covered under your prescription panel of practicing doctors and drug plan. The list is split into three What if I need a medication pharmacists, most who work categories: Generics, preferred that is not on the prescription outside of Cigna. Every medication brands and non-preferred brands. drug list? available on the drug list has been approved by the US Food and Drug How can I see if a drug is If your doctor wants you to take Administration (FDA). covered on the prescription a medication that’s not on the drug list? prescription drug list, he or she can The drug list is updated regularly to call Cigna to request approval for reflect clinical recommendations of You can search for medications on coverage as an exception. Cigna’s Pharmacy and Therapeutics the prescription drug list by name Committee and changes in or drug class. You can view the drug Am I covered for all the the market like new generic list using your personalized website medications on the list? medications being introduced to , or you can call myCigna.com on the toll-free number on the back Certain medications need prior authorization (approval) from Cigna before they are covered. Your doctor will need to submit a Prior Authorization Form requesting approval for coverage. Once submitted, we’ll let you and your doctor know if your medication is approved. If approved, your medication will be covered for up to one year. If not approved, we will send you information on how to appeal the decision. * Cigna offers several options for prescription drug coverage. Costs vary by plan, and some medications require prior authorization. Please check your plan materials for more information, including any benefits that are required by state law.

15 Preventive health coverage / Health assessment – 15 minutes can change your health 15 Preventive health coverage Your Cigna plan covers designated preventive care services to help keep you well, not just services needed to treat an illness or injury. Your plan includes coverage for wellness services for women, men and children. During a wellness exam, you and your doctor will determine what tests and health screenings are right for you based on your age, gender, personal health history and current health. Cigna’s preventive care coverage complies with the Patient Protection and Affordable Care Act (PPACA). Services designated as preventive care include periodic well visits, Health assessment – 15 minutes can change your health routine immunizations and certain designated medical or behavioral Your health is your most important screenings for symptom-free or Based on your answers, you › asset. Now there’s a tool accessible disease-free individuals. They also may be able to participate from your personalized website include designated services for in an online health coaching that can help you take care of it. individuals at increased risk for a program that shows you how Use your health assessment as particular disease. Cigna provides to make lifestyle changes over a quick, confidential survey that a reference guide for services the course of a few weeks, or examines your health status so you considered preventive care under you may be referred to other can get answers to pressing health your plan. For more information online tools to help you manage questions. Want to know which regarding preventive services, visit health concerns. preventive screenings to consider? myCigna.com and select “Review You can review your health › Need to lower your cholesterol? My Coverage” then select “Medical benefit plan to see if you are Interested in losing weight? Here’s Coverage.” The Preventive Care eligible for personalized health how your individual survey results Reference Guide is posted on this coaching to help you manage can help. page under Preventive Care. Just any health risks. click on the title. You may also call When you answer questions › You can discuss your risks with › the toll-free number on your ID card about your lifestyle, habits, your doctor and develop steps to request a copy. health history, weight, for lowering your risk factors. cholesterol, blood pressure, etc., you will get customized feedback that explains your risks for certain health conditions, and how to maintain or improve your health. All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including C igna Health and Life Insurance Company, Connecticut General Life Insurance Company, Cigna Behavioral Health, Inc., and HMO or service company subsidiaries of Cigna Health Corporation. The Cign a name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. All pictures are used for illustrative purposes only. 855166 d 12/15 © 2015 Cigna. Some content provided under license.

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