Page 11 - QSC EE Guide 01-20 SLO

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

Plan Differences HSA HMO Full PPO
Employee Premiums $ $$ $$$
Health Savings Account ✓
Cost Sharing 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 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 (Full): Refer to the “Cigna HealthCare of Educational Video
California, Inc. - So. CA HMO/Network” plan Health Insurance Terms
http://video.burnhambenefits.com/terms