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What is an HMO?
- The HMO, or Health Maintenance Organization, is an Open Access Plan that does not require members to select a PCP or obtain referrals to see other providers or specialists in the Cigna network. Doctors in the Cigna network are called participating providers.
- Except in cases of emergency, enrollees must use participating providers to be eligible for benefits. An enrollee can verify whether a doctor or health care facility is in the Cigna network by either calling Member Services (the phone number is on the back of their SchoolCare ID card), or using the Web site, www.Cigna.com and click on “Provider Directory.”
- While not required to select a primary care physician (PCP), members are encouraged to establish and maintain a relationship with a PCP to meet preventive and basic health care needs. Also, a PCP may be helpful in coordinating your care and initially arranging referrals to specialists.
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What is a POS (Open Access)?
- The POS or Point of Service is an Open Access plan that does not require members to select a PCP or obtain referrals to see other providers or specialists in the Cigna network. Doctors in the Cigna network are called participating providers.
- Enrollees receive the highest level of benefits if services are obtained using participating providers.
- If an enrollee chooses to use a doctor or facility that is not part of the Cigna network, coverage will be provided at a lower level, requiring the enrollee to pay a larger portion of the cost out-of-pocket.
- POS enrollees can choose to use in or out-of-network providers each time they receive medical care.
- Except in cases of emergency, enrollees must use participating providers to be eligible for benefits. An enrollee can verify whether a doctor or health care facility is in the Cigna network by either calling Member Services (the phone number is on the back of their SchoolCare ID card), or using the Web site, www.Cigna.com and click on "Provider Directory."
- While not required to select a primary care physician (PCP), members are encouraged to establish and maintain a relationship with a PCP to meet preventive and basic health care needs. Also, a PCP may be helpful in coordinating your care and initially arranging referrals to specialists.
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What is an Open Access +?
- The Open Access + Plan is similar to the HMO. It is an Open Access plan that does not require members to select a PCP or obtain referrals to see other providers or specialists in the Cigna network. Doctors in the Cigna network are called participating providers.
- The plan emphasizes wellness and prevention through $0 copays for preventive care (including mental health benefits) and generic maintenance medications.
- Other benefits are subject to a deductible and coinsurance.
- Except in cases of emergency, enrollees must use participating providers to be eligible for benefits.
- While not required to select a primary care physician (PCP), members are encouraged to establish and maintain a relationship with a PCP to meet preventive and basic health care needs. Also, a PCP may be helpful in coordinating your care and initially arranging referrals to specialists.
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What is the SCHOOLCARE 65+ Plan?
- SchoolCare 65+ is a plan for retirees enrolled in Medicare Parts A and B. Medicare is the primary plan and SchoolCare 65+ is secondary, filling in some of the gaps not covered by Medicare and providing additional benefits, such as prescription drug coverage.
Note: Prescription drug coverage may be waived when enrolling in the 65+ Plan
- You can reside anywhere in the United States and use any provider. To receive the highest level of benefits, you should use a provider that accepts Medicare assignment; otherwise you will be responsible for charges above the Medicare approved amount. For questions about Medicare, contact your nearest Social Security office or call 1-800-633-4227, or visit www.medicare.gov.
- United American and Express Scripts (Rx) administer the benefits for SchoolCare 65+.
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Health Benefit Booklet Standard Plans
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