Health Insurance Information

Employees who work at least 75 percent of full time are eligible.

Medical benefits start the 1st of the month following date of employment.

The university shares the cost of medical insurance premiums with the employee.

For 2008 employees have the following options with CARES:
Open Access Plus - OAPIN (In Network – 90%)
Open Access Plus - OAP90 (In/Out Network - 90%- 70%)
Open Access Plus - OAP80 (In/Out Network - 80% - 60%)
Open Access Plus - OAP70 (In/Out Network - 70% - 50%)

The third party administrator for the plan is CIGNA Healthcare.

Participants should indicate when obtaining services from doctors and other providers that they are a member of CARES and CIGNA Open Access Plus.

Medical & RX Plans PowerPoint Presentation

CARES Notice of Privacy Practices

CIGNA sends letters asking for other insurance information to help ensure claims are processed correctly.  CIGNA will request this information annually, because your coverage may change from year to year, and they want to make sure they have the most accurate information for your and your covered dependents. If they receive a claim that could be paid by another insurer they may ask for information regarding that claim.
 
If you have another medical plan in addition to CIGNA, CIGNA will coordinate with the other health plan so each plan pays an appropriate amount and you can get the most out of your coverage.  To update your plan coverage information:

1. Online go to http://www.mycigna.com/ , click on “Medical” (under My Plans) , click on See Who’s Covered (on the left side, under Plan Summary), click on Update other insurance information,  than click on each member that has other insurance and follow the instructions on the screen.
2. Call Customer Service (see number 4 above).
3. If you have a letter requesting the information fill it out and return to CIGNA.
   Not updating this information may delay processing of your claim. Remember to inform your providers and other insurance carrier of all the medical coverage for you and /or your covered dependents.  This enables carriers to coordinate your coverage, eliminate over-insurance and duplication of benefits and reimburse your out-of-pocket costs to the fullest extent possible under the terms of the plans.

Medical Claim Form

For in-network services show your CIGNA HealthCare ID card and the provider/ hospital/facility will complete and submit the paperwork. If you used out-of-network services, you or the provider/ hospital/ facility will need to file a paper claim. Allow approximately three weeks from the time the claim form is mailed to receive an Explanation of Benefits identifying the costs covered by your plan and the charges you must pay.
To file a claim:

1. Download and print the ready-to-use claim form with instructions that will guide you through the steps required to help ensure your claim is processed correctly.
2. Mail your completed claim form(s), with original itemized bill(s) attached, to the CIGNA  HealthCare Claims Office printed on your CIGNA HealthCare ID card. That address is CIGNA,  PO Box 182223, Chattanooga, TN  37422-7223  
3. Type or print in black ink.
4. Use a separate form for each participating family member each time you submit a claim. For  example, don't include your spouse's medical receipts on the same claim form with yours.
5. You can submit two or more health care bills together on the same claim form if they're for  treatment of the same illness. For example, if you have bills from a specialist, an X-ray lab, and a  pharmacy that are all for the treatment of an injury, you can submit one claim form.
6. Please don't submit canceled checks or cash receipts as proof of payment. They don't contain  the information needed to properly process your claim.
7. Always use original claim forms because they scan better than photocopied versions.
8. Before you submit your claim...
   1. Verify that printing is legible.
   2. Be sure that all required fields are completed.
   3. Make photocopies of all receipts and completed claim forms. Receipts will not be returned to you.
   4. Write your CIGNA HealthCare ID number from your member ID card on all paperwork or  bills you submit.
   5. If you have questions about filling out the form you can call CIGNA customer service or go  to http://www.mycigna.com/, click on Download Forms (top right corner) and it will give you the rest  of the details that were not printed above (ex. Required fields, and how to read an Explanation of Benefits).

Behavioral Health/ Substance Abuse tools & Plan  Information
Behavioral health claim or benefit questions call CIGNA Behavioral Health Customer Service at 1.800.926.2273.

CBH staff are available 24 hours a day to help obtain information on anything from urgent clinical needs to Work/Life issues, and would be happy to help with any needs you have. Also, if you have CBH's employee assistance (EAP) or integrated programs, continue to call CBH first to gain full access to your available benefits and the help of our Personal Advocates.

CIGNA Behavioral Health website www.cignabehavioral.com has more information that will help you use this benefit. Example FAQs, Provider lookup, Behavioral Articles/ Information, Lookup Benefits, Education and Resources Center, access to a variety of discounts on health and wellness products through Healthy Rewards (Healthy Rewards are not a part of you medical benefits so you will need to call 1.800.870.3470 for more information or locate a participating provider.)

Behavioral Health/Substance Abuse Claim Form
In Network Claim Form - use the Medical Claim Form in Section 3 above

Out of Network Claim Form   

For Mental Health/ Substance abuse claims mail to CIGNA Behavioral Health, Inc. , Attn: Claims Service Dept. , P.O. Box 46270, Eden Prairie, MN 55344-6270