Page 11 - QSC EE Guide 01-20 CA

Cigna | HSA PPO Plan Cigna | HMO Plan
With the HSA PPO plan, you can pay for qualified Two HMO network options are available
healthcare expenses now and grow your savings With the HMO plan, you must choose a primary care
for future healthcare needs. This plan combines a physician (PCP) or medical group within the network. All of
High Deductible Health Plan (HDHP) with a special, your care must be directed through your PCP or medical
tax-qualified Health Savings Account (HSA). The group. Any specialty care you need will be coordinated
money in your account is yours to pay for current through your PCP and will generally require a referral or
healthcare expenses - or you can save for future authorization. You will receive benefits only if you use the
healthcare expenses. doctors, clinics, and hospitals that belong to the medical
group in which you are enrolled, except in the case of an
You have the freedom to choose your doctor emergency.
without the requirement of selecting a PCP and
you may self-refer to specialists. You may use a Cigna | PPO Plan
network provider whose negotiated rates provide Similar to the HSA PPO plan, the PPO plan allows you to
richer levels of benefits with claim forms filed by direct your own care using the same network as the HSA
the providers. You may also obtain services using a PPO plan. If you receive care from a physician who is a
non-network provider; however, you will be member of the network, a greater percentage of the entire
responsible for the difference between the covered cost will be paid by the insurance plan. However, you are
amount and the actual charges and you may be not limited to the physicians within the network and you
responsible for filing claims. may self-refer to specialists. If you obtain services using a
non-network provider, please note that you will be
Once eligible for the plan, QSC will make biweekly responsible for the difference between the covered amount
contributions toward your employee/family health and the actual charges, and you may be responsible for
savings account. In addition to the company filing claims.
contributions, you may elect to make contributions
into your account up to IRS maximums. See page
15 for more information.

Plan Differences HSA HMO Select HMO Full PPO
Employee Premiums $ $ $$ $$$
Health Savings Account ✓
Cost Sharing Contribution, Copay, Contribution, Copay Contribution, Copay Contribution, Copay,
Deductible, Deductible,
Coinsurance Coinsurance

Network
- Network Size    
- In-Network Benefits ✓ ✓ ✓ ✓
- Non-Network Benefits ✓ ✓
Access to Providers Managed by You Managed by Your PCP Managed by Your PCP Managed by You

Finding a Medical Provider
Go to www.cigna.com.
• HSA & PPO: Refer to the “Open Access Plus, OA
plus, Choice Fund OA Plus” plan
• HMO (Select): Refer to the “Southern California
Select (St Joseph Hoag Health, Scripps Health,
HealthCare Partners, PrimeCare)” plan Educational Video
• HMO (Full): Refer to the “Cigna HealthCare of Health Insurance Terms
California, Inc. - So. CA HMO/Network” plan http://video.burnhambenefits.com/terms