getting ready tennessee 2020 - tn.gov · getting ready ... tennessee 2020 u.s. individual sales...

GETTING READY ... TENNESSEE 2020

U.S. Individual Sales Training

887258 a 08/18

Offered by: Cigna Health and Life Insurance Company or its affiliates.

Agent/Broker Use Only

Welcome

Cigna’s value

2020 overview

• 2020 market footprint

• Pharmacy

• Cigna Telehealth Connection

• Value-added programs

• Renewals

Billing and Enrollment reminders

Contacts

Agenda

2 Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2019 Cigna


“In a world of many millions, we see each person

defining a healthy life on his or her own terms.

It’s our aim to be part of that journey, helping people

achieve better health and peace of mind along the way.”

— David Cordani, CEO

Our vision

Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2019 Cigna 3


To improve the health, well-

being and peace of mind of

those we serve.

Our mission



Why Cigna?


WE OFFER CUSTOMERS:

– Affordable rates. Health plans with a $0 deductible if the customer

qualifies for federal financial assistance.1

– Online Tools. Easy-to-use tools estimate the cost of prescription

drug prices and health care visits.

– $0 Telehealth visits. Customers can talk to a board-certified doctor

about minor health issues no matter where they are in the United

States, anytime – day or night.2

– Patient Assurance ProgramSM . Ensures eligible customers with

diabetes pay no more than $25 out-of-pocket cost for a 30-day

supply of Tier 3 preferred brand insulin.3

1. Depending on household size and income, customers may qualify for federal financial assistance through Healthcare.gov. Qualifying plans are the Cigna

Cigna Connect 0-3 and Cigna Connect 0-4.

2. Telehealth providers participating in the Cigna Telehealth Connection program are independent contractors and separate from Plan network providers. Not all

providers have video chat capabilities. Video chat is not available in all areas. PCP referral is not required. Refer to plan documents for a complete description of covered

services, including other telehealth/telemedicine benefits. Program availability may vary by location and plan type. See vendor sites for details.

3. Discounts available with the Cigna Patient Assurance Program. $25 is the maximum out-of-pocket cost for a 30-day supply of covered, eligible insulin.

Our Individual and Family

insurance plans offer customers:

A range of coverage options

Quality care

Helpful, easy-to-use tools

and services


Plans, programs, services

A LOOK AT 2020



Medical - Tennessee

2020 PRODUCT OFFERINGS



Individual medical offered in the following counties

• Chattanooga: NEW for 2020!

– Bledsoe, Bradley, Franklin, Grundy, Hamilton, Marion, McMinn, Meigs, Polk, Rhea, and Sequatchie counties

• Jackson: NEW for 2020!

– Benton, Carroll, Chester, Crockett, Decatur, Dyer, Gibson, Hardeman, Hardin, Henderson, Henry, Lake, Madison, McNairy, Obion, Weakley

• Knoxville:

– Anderson, Blount, Campbell, Claiborne, Cocke, Grainger, Hamblen, Jefferson, Knox, Loudon, Monroe, Morgan, Roane, Scott, Sevier, Union

• Memphis:

– Fayette, Haywood, Lauderdale, Shelby, and Tipton counties

• Nashville:

– Cheatham, Davidson, Montgomery, Robertson, Rutherford, Sumner, Trousdale, Williamson, and Wilson counties

• Tri-Cities:

– Carter, Greene, Hancock, Hawkins, Johnson, Sullivan, Unicoi, and Washington counties

Sales areas


Connect Plans Available

No Plans Available


Sales areas


All plans will be available on and off the Federal Facilitated Marketplace (FFM)

Cigna Connect EPO (Five plans available in each area; 2 bronze, 2 silver, 1 gold)

– Notably reduced deductibles (up to $750 on some plans), from 2019 plan offerings

– National network for pharmacy, urgent care, and retail clinics

– $0 Cigna Telehealth Connection program copays

– Pediatric dental is bundled

Network partners1

– Knoxville/Chattanooga - PCP required, referral required for Specialist

– Knoxville Network partners: UT Medical Center and Covenant Health

– Chattanooga Network partners: Erlanger Health and Galen Medical Group

– Nashville/Tri-Cities: PCP required, referral required for Specialist

– Tri-Cities Network partners: Mountain State Health Alliance, Holston Medical Group, State of Franklin Associates, Johnson

City Medical Center, and Indian Path Community Hospital

– Nashville Network partners: Synergy IPA, HCA TriStar Hospitals, Saint Thomas Health, and Vanderbilt

– Memphis/Jackson: PCP required, referral for Specialist encouraged

– Memphis Network partners: Health Choice Physician Hospital Organization and Methodist Health System (only payer with

these)

– Jackson Network partners: The Jackson Clinic and West Tennessee Healthcare

1.Please note that this provider list may not be complete. Visit Cigna.com/ifp-providers to verify a provider’s network status.


VALUE PROPOSITION

Cigna’s Connect health insurance plans

deliver quality care, centered around the

customer, because we give them access

to personal care and attention from the

quality providers in the Connect Network

in your local area.

The customer will choose an in-network

primary care provider (PCP) who will get

to know their needs, direct them to

specialists when needed, and ensure that

all of their providers are communicating

and coordinating their care.

Cigna.com\ifp-providers

Cigna’s Connect Network


https://www.cigna.com/ifp-providers


Accessing care

PHARMACY



2020 pharmacy:

Benefit design


Member Pay Difference: A Member Pay Difference requirement is in all states for 2020. As a reminder: Member Pay Difference is when a customer

requests a brand-name drug that has a generic equivalent. The customer will be financially responsible for the amount by which the cost of the brand-

name drug exceeds the cost of the generic drug, plus the generic copay or coinsurance shown in the Benefit Schedule.

All states/plans use a

five-tier benefit design

(retail and home delivery)

Tier 1

Tier 2

Tier 3

Tier 4

Tier 5

Preferred Generic

Generic

Preferred Brand

Non-preferred Brand

Specialty & other high cost medications

(oral and self-injectable)


IN-NETWORK – Array Pharmacy network

(FL, NC and VA)

2020 Cigna pharmacy network

13

• Provides customers access to more than 67,000 pharmacies to have their

prescriptions filled.

• Customers can obtain a 30-day supply of a medication at any in-network retail

pharmacy.

• Our plans provide customers with the convenience to obtain a 90-day supply of most

medications, however, they will have to use a pharmacy that is contracted to dispense

a 90-day supply or use our Home Delivery Pharmacy.

• Customers can access our pharmacy directory to find an in-network pharmacy that is

convenient for them, including a 90-day pharmacy.

• Specialty (Tier 5) medications are limited to a 30-day supply, retail & home delivery.

IN-NETWORK – Cigna 90 NowSM

pharmacy network

Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2019 Cigna

No 2020 plans have an out-of-network Rx benefit. OUT-OF-NETWORK


2020 pharmacy formularies


• These are closed formularies; if drug is not on the list, it is not covered

• Multisource brands where a generic is available are typically not covered

• Medically necessary procedures are in place for exceptions as required under EHB

PRESCRIPTION DRUG FORMULARIES

Cigna.com/ifp-drug-list

• Formularies are designed to meet

Essential Health Benefits (EHB)

and state benchmark drug count

requirements, which vary by state

https://www.cigna.com/individuals-families/member-resources/prescription/ifp-drug-list.html?consumerID=cigna&indicator=IFP&pdlYearType=CD&effectiveDate=2018-01-01


Effective 1/1/20 - Diabetics will now save on their insulin medications by paying no more than $25 out-of-pocket cost for a 30-day supply of Tier 3

preferred brand insulin1!

INTRODUCING the Patient Assurance ProgramSM


1. Discounts available with the Cigna Patient Assurance Program. $25 is the maximum out-of-pocket cost for a 30-day supply of covered eligible insulin.

• The program is an approach to alleviate the high

cost of insulins incurred to the diabetic population.

• Tier 3 insulin drugs (preferred insulins) will be

capped at $25 out-of-pocket cost per 30-day

supply and will not be subject to the deductible. A

member will not be responsible for more than the

capped amount.

• Additional member level materials/communications

are in the works and will be available in the

myCigna® portal.


The care you need – when, where and how you need it

CIGNA TELEHEALTH CONNECTION



Cigna Telehealth Connection

Choose when:

Day or night, weekdays,

weekends and holidays

Lets customers get

the care they need –

for minor acute

medical conditions

NEW for 2020: Cigna

Telehealth visits are

Free with most health

plans2

Access board-

certified health care

providers via secure

video chat or phone,

without leaving home

or office

Choose where:

Home, work, on the

go or when traveling in

the US

Choose how:

Phone or secure

video chat1

Choose who:

MDLive® or American

Well®


1. Telehealth providers participating in the Cigna Telehealth Connection program are independent contractors and separate from Plan network providers. Not all providers have

video chat capabilities and it is not available in all areas. This program differs from virtual visits that may be offered by your PCP or specialists. PCP referral is not required.

2. CTC benefits vary by state. For IFP medical plans with a copay, $0 copay applies in CO, FL, KS IL, MO, NC, TN, UT, VA. $50 or less in AZ. Where telehealth benefit is

subject to a deductible, plan deductible must be met first. Refer to plan documents for details.


18

• Acne

• Allergies

• Asthma

• Bronchitis

• Colds & flu

• Diarrhea

• Earaches

• Fever

• Headaches

• Infections

Conditions treated by Cigna Telehealth Connection

health care providers

• Insect bites

• Joint aches

• Nausea

• Pink eye

• Rashes

• Respiratory infections

• Sinus infections

• Skin infections

• Sore throats

• Urinary tract infections

• Colds & Flu

• Constipation

• Earaches

• Nausea

• Pink eye

Health care services are delivered by MDLIVE or American Well participating health care providers and not by Cigna. MDLIVE and American Well do not guarantee that a

prescription will be written. Not all prescriptions are available.


General health Pediatric care


Cigna Telehealth Connection – Easy to use


1. MDLIVE and American Well are independent companies/entities and are not affiliated with Cigna. The services, websites and mobile apps are

provided exclusively by Amwell and MDLIVE and not by Cigna. Providers are solely responsible for any treatment provided.

2. The downloading and use of the myCigna Mobile App is subject to the terms and conditions of the App and the online store from which it is

downloaded. Standard mobile phone carrier and data usage charges apply.

To access Telehealth via myCigna®:

• Click “Find Care & Costs” icon on the

home screen

• Select “Talk to a doctor or nurse 24/7”

• Click “Connect Now” under Online Doctor

Visits

On the go? No problem. Download the

myCigna® App2

Or call directly:

• MDLIVE 888.726.3171

• Amwell 855.677.9722

TIP: Save time when you aren’t feeling well

by registering ahead of time


Value-added programs: Commitment to customer value

HEALTHY REWARDS®



Cigna Healthy Rewards®

21

Eyeglasses

Reduced rates at over 15,000 participating retailers and

providers. Discounts on eyeglasses, prescription

sunglasses and vision exams.

Just Walk 10,000 Steps-A-Day walking program and

fitness devices

Eight-week online program allows you to log your daily

steps, track your progress and receive coaching tips and fun

facts. Members receive pedometer and related materials

($29.95 + S&H) Option to extend online program by

purchasing the 52-week step-up maintenance program.

Complementary and alternative medicine

Reduced rates from over 32,5002 participating providers

including acupuncturists, chiropractors, massage therapists,

physical and occupational therapists, podiatrists and

registered dieticians.

Weight management discount programs

Online, at home, telephone-based and traditional meeting options.

Low-cost Fitness Center Memberships

American Specialty Health’s Active & Fit Direct network

provide access to over 9,0002 facilities.

Health and wellness discounts1

Health and wellness products

Gaiam® also offers yoga-related products.

Laser Vision Correction (LASIK)

Reduced rates at over 1,000 participating facilities3.

Hearing exams, aids and protection devices

Through Amplifon, save 40% on hearing exams and 20% on aids4.

Enjoy a 60-day trial with a money-back guarantee. Screening is

free and there is no charge for follow-up visits for the first year.


1. Healthy Rewards programs are separate from any insurance benefits. A discount program is NOT

insurance, and the customer must pay the entire discounted charge. Some Healthy Rewards

programs are not available in all states and programs may be discontinued at any time.

Participating providers are independent contractors who are solely responsible for any care or

services provided.

2. American Specialty Health: June 2018. Subject to change.

3. LasikPlus; July 2018. Subject to change.

4. Amplifon: July 2018. Subject to change.

.

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http://www.pearlevision.com/webapp/wcs/stores/servlet/PearleVision/StoreContent/index/index.jsp?langId=-1&catalogId=10001&storeId=10001


Strategy and updates for 2020

RENEWALS



Plan available in 2020 • Mailed by 11/1

• No action required if they want to stay in the same

plan – except to pay the bill. (Changes require

action by customer.)

Discontinued with mapping • Mailed on 9/26/2019

• 2019 plan isn’t being offered in 2020

• Mapped to a new plan for 2020

• If they like the new plan, they don’t have to take

action – except to pay the bill

• If they do not like the new plan then they will

actively need to choose a new one

Timing and action

23

Letters directed those who want to

choose a different plan, to call or go to

Cigna.com/renew or the state-

based/federal exchange to explore their

options.

If a medical and dental policy are bundled

together and the medical policy is

cancelled, the dental policy will also be

cancelled.


RENEWAL LETTERS – TWO TYPES


Updates for 2020

BILLING AND ENROLLMENT



For the 2019 Open Enrollment Period, the first effective date for a medical plan is January 1, 2020

Effective dates

25

For enrollment between: 2020 effective date:

11/1/19–12/15/19 1/1/2020

12/16/19 and after Based on qualifying life event

1. This excludes those customers who receive discontinuation notices as deemed by CMS. Customers applying under a SEP have until 12/31/2019 to submit for a

1/1/2020 effective date.

Applications signed after 12/15/19 will be accepted under the Special Enrollment Period (SEP) if the

applicant has a qualifying life event.1

SEP rules still apply for 2019 if shopping for a plan during the 2019 SEP period.



Initial payment “binder”

• On Exchange –Until the effective date or up to 30 calendar days after the

application date

• Off Exchange – Initial payment is required with the submission of the

application

Renewals

• On/Off Exchange – Due date for the renewal payment is 01/02/2020r

the renewal payment is 01/02/2019

Ongoing monthly payments

• On/Off Exchange – Due date for all ongoing payments is the day before

the coverage period begins (example: 1/31 for February coverage month)

Reoccurring bank drafts

• Off Exchange – EFT drafts occur on the fifth of the month for the current

coverage month

(example: 2/5 for February coverage month)

• On Exchange – EFT drafts occur the day before the due date

(example: 1/31 for February coverage month)

Ongoing monthly billing options

• Electronic funds transfer – EFT

• eBill (Electronic bill that is

emailed)

• Monthly paper bill

• Pre-paid debit card (On Exchange

only)

• Credit card is NOT an ongoing

payment method

Initial payment options

• Credit card (MC or Visa)

• Electronic funds transfer – EFT

• Check (with paper applications)

• Pre-paid debit card

(On Exchange only)

2020 Enrollment billing options



Thank you for your time today!

CONTACTS



Contacts


Binder Payment Portal • Cignaindividual.com/payment

Federally Facilitated Exchange (FFE)

State-based Exchanges • Healthcare.gov

Cigna.com

Broker Support Team: 8:00AM–8:00PM EST, Monday–Friday.

877.Cigna.15 (877.244.6215)


Contacts


Claims and Benefits Customer Support

Mail: Cigna

PO Box 5200

Scranton, PA18505

Telephone: 1-800-Cigna24 / 800-244-6224

Premium Payment

Mail: Cigna

PO Box 105551

Atlanta, GA 30348-5551

Telephone: 1-877-484-5967


APPENDIX



2020 CSR PLAN BREAKDOWN



2020 Tennessee Plans – Memphis



2020 Tennessee Plans – Nashville



2020 Tennessee Plans – Knoxville



2020 Tennessee Plans – Tri Cities



2020 Tennessee Plans – Chattanooga



47

Base Plan Name Cigna Connect 3200 Cigna Connect 4750

CSR

73% AV

200-250% FPL

Plan name ends in - 2

CSR Level/ Plan Name (200-250% FPL)

Cigna Connect 2200-2

(200-250% FPL)


Deductible

$2,200

$2,500

OOP $6,500 $6,500

Coinsurance 60% 60%

PCP/Spec PCP:$15

Spec:$65

PCP:$15

Spec:$40

CSR

87% AV

150-200% FPL



Cigna Connect 450-3

(150-200% FPL)

Cigna Connect 0-3

Deductible

$450

$0

OOP $2,600 $2,700

Coinsurance 70% 60%

PCP/Spec PCP:$5

Spec:$30

PCP:$5

Spec:$20

CSR

94% AV

100-150% FPL



Cigna Connect 75-4

(100-150% FPL)

Cigna Connect 0-4

Deductible

$75

$0

OOP $1,200 $1,700

Coinsurance 90% 85%

PCP/Spec PCP:$0

Spec:$10

PCP:$0

Spec:$10

For internal use only.

2020 Tennessee Chattanooga – Silver Connect EPO

plans



48


CSR

73% AV

200-250% FPL




(200-250% FPL)


Deductible

$2,200

$2,500

OOP $6,500 $6,500

Coinsurance 60% 60%

PCP/Spec PCP:$15

Spec:$65

PCP:$15

Spec:$40

CSR

87% AV

150-200% FPL



Cigna Connect 450-3

(150-200% FPL)

Cigna Connect 0-3

Deductible

$450

$0

OOP $2,600 $2,700

Coinsurance 70% 60%

PCP/Spec PCP:$5

Spec:$30

PCP:$5

Spec:$20

CSR

94% AV

100-150% FPL



Cigna Connect 75-4

(100-150% FPL)

Cigna Connect 0-4

Deductible

$75

$0

OOP $1,200 $1,700

Coinsurance 90% 85%

PCP/Spec PCP:$0

Spec:$10

PCP:$0

Spec:$10


2020 Tennessee Jackson – Silver Connect EPO plans



49


CSR

73% AV

200-250% FPL




(200-250% FPL)


Deductible

$2,200

$2,500

OOP $6,500 $6,500

Coinsurance 60% 60%

PCP/Spec PCP:$15

Spec:$65

PCP:$15

Spec:$40

CSR

87% AV

150-200% FPL



Cigna Connect 450-3

(150-200% FPL)

Cigna Connect 0-3

Deductible

$450

$0

OOP $2,600 $2,700

Coinsurance 70% 60%

PCP/Spec PCP:$5

Spec:$30

PCP:$5

Spec:$20

CSR

94% AV

100-150% FPL



Cigna Connect 75-4

(100-150% FPL)

Cigna Connect 0-4

Deductible

$75

$0

OOP $1,200 $1,700

Coinsurance 90% 85%

PCP/Spec PCP:$0

Spec:$10

PCP:$0

Spec:$10


2020 Tennessee Knoxville – Silver Connect EPO plans



50


CSR

73% AV

200-250% FPL




(200-250% FPL)


Deductible

$2,200

$2,500

OOP $6,500 $6,500

Coinsurance 60% 60%

PCP/Spec PCP:$15

Spec:$65

PCP:$15

Spec:$40

CSR

87% AV

150-200% FPL



Cigna Connect 450-3

(150-200% FPL)

Cigna Connect 0-3

Deductible

$450

$0

OOP $2,600 $2,700

Coinsurance 70% 60%

PCP/Spec PCP:$5

Spec:$30

PCP:$5

Spec:$20

CSR

94% AV

100-150% FPL



Cigna Connect 75-4

(100-150% FPL)

Cigna Connect 0-4

Deductible

$75

$0

OOP $1,200 $1,700

Coinsurance 90% 85%

PCP/Spec PCP:$0

Spec:$10

PCP:$0

Spec:$10


2020 Tennessee Memphis – Silver Connect EPO plans



51


CSR

73% AV

200-250% FPL




(200-250% FPL)


Deductible

$2,200

$2,500

OOP $6,500 $6,500

Coinsurance 60% 60%

PCP/Spec PCP:$15

Spec:$65

PCP:$15

Spec:$40

CSR

87% AV

150-200% FPL



Cigna Connect 450-3

(150-200% FPL)

Cigna Connect 0-3

Deductible

$450

$0

OOP $2,600 $2,700

Coinsurance 70% 60%

PCP/Spec PCP:$5

Spec:$30

PCP:$5

Spec:$20

CSR

94% AV

100-150% FPL



Cigna Connect 75-4

(100-150% FPL)

Cigna Connect 0-4

Deductible

$75

$0

OOP $1,200 $1,700

Coinsurance 90% 85%

PCP/Spec PCP:$0

Spec:$10

PCP:$0

Spec:$10


2020 Tennessee Nashville – Silver Connect EPO plans



52


CSR

73% AV

200-250% FPL




(200-250% FPL)


Deductible

$2,200

$2,500

OOP $6,500 $6,500

Coinsurance 60% 60%

PCP/Spec PCP:$15

Spec:$65

PCP:$15

Spec:$40

CSR

87% AV

150-200% FPL



Cigna Connect 450-3

(150-200% FPL)

Cigna Connect 0-3

Deductible

$450

$0

OOP $2,600 $2,700

Coinsurance 70% 60%

PCP/Spec PCP:$5

Spec:$30

PCP:$5

Spec:$20

CSR

94% AV

100-150% FPL



Cigna Connect 75-4

(100-150% FPL)

Cigna Connect 0-4

Deductible

$75

$0

OOP $1,200 $1,700

Coinsurance 90% 85%

PCP/Spec PCP:$0

Spec:$10

PCP:$0

Spec:$10


2020 Tennessee Tri Cities – Silver Connect EPO plans



All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance

Company.The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc.

887258 a 09/19 © 2019 Cigna. Some content provided under license.

getting ready tennessee 2020 - tn.gov · getting ready ... tennessee 2020 u.s. individual sales...

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