Be a Smart Consumer

They bill your insurance company directly at negotiated rates, saving you time and money. Make sure a service is covered by your insurance company before you receive care. Note: If you’re enrolling in an HMO plan (if available in your area), the plan only pays benefits for care received in network.

It’s fully covered by all of our medical plans and can help detect and prevent potentially costly health issues. You pay nothing for annual physicals, recommended immunizations, routine cancer screenings, and more when you see in-network providers.

Contributing to a Health Savings Account (HSA) and/or a Flexible Spending Account (FSA) is easy and saves you money. You can set aside pre-tax dollars from your paycheck to use for your out-of-pocket costs. Keep in mind that with an HSA, you can only spend contributions actually deposited into your account. With an FSA, you can only carry over up to $570 of unused FSA money to the next year. You will forfeit amounts above $570.

Using generic alternatives will almost always save you money — and they’re just as effective as brand-name prescriptions. It’s also a good idea to compare prices at different pharmacies before deciding where to fill a prescription.

For your ongoing prescriptions, use the home-delivery service to save money and time. You also have access to Cigna’s Retail90 program, which helps you save money when you fill a 90-day supply of your medications at a retail pharmacy. In addition to those savings, you’ll take fewer trips to the pharmacy and pay for your medications once every three months.

CHOC Fit through Virgin Pulse offers valuable resources to improve your health and prevent the need for costly care. Plus, you’ll earn rewards when you participate in wellness activities!

Log in to the Cigna website to see how much of your deductible you’ve met, review claims, find in-network providers, use helpful cost-estimating tools, and more.

Facilities charge different amounts for the same services. Use the guide below to help you save money and choose the most appropriate care for your situation.

Coinsurance is how you and your medical plan share the cost of medical services after you meet the plan’s annual deductible. For example, if your deductible is $3,000 and your coinsurance is 20%, once your out-of-pocket expenses reach $3,000, your plan would start to pay 80% of your covered costs, leaving you responsible for the other 20%. Your provider will usually send you a bill for the 20% you owe after your claim has been processed by your health plan.

A copay is a fixed amount you pay for a covered health care service. For example, you might have a $25 copay when you go to the doctor’s office. Your copay is usually due at the time you receive the service and can vary based on the type of service you receive.

A deductible is the amount of eligible expenses you must pay each year before your plan begins paying for covered services. For example, if your annual deductible is $3,000, you must pay for your non preventive expenses until your costs reach $3,000, after which the plan will start to pay a percentage of costs.

Plans typically have different deductibles for individual coverage and family coverage. Depending on your plan, you might need to meet a separate deductible for each covered family member or one larger family deductible before coinsurance begins for anyone.

Your deductible does not apply to in-network preventive care, which is covered at no cost to you. Depending on your medical plan, the deductible may not apply to other services, too, such as doctor’s office visits and prescriptions.

A Dependent Care FSA allows you to pay for eligible dependent care expenses with tax-free dollars. Since you don’t pay income tax on money you put in an FSA, it’s like getting a discount on your childcare or elder care costs! Eligible expenses for a Dependent Care FSA include day care and summer camps for children under age 13, and day care for elders who you claim as a dependent on your tax return.

You contribute to your FSA through before-tax payroll deductions by selecting how much you want to contribute over the course of the plan year, with a proportionate amount of that annual contribution coming out of each paycheck. You can only use money actually deposited into your account.

Dependent Care FSAs have a “use it or lose it” rule, so typically, any unused money left in your account at year-end is forfeited.

A Health Care FSA is an account you can use to pay for eligible health care expenses with tax-free dollars. Since you don’t pay income tax on the money you put in an FSA, it’s like getting a discount on your medical, dental, vision, and medication costs! Eligible expenses for a Health Care FSA include deductibles, coinsurance, and copays for medical, dental, and vision care, as well as many over-the-counter items like bandages, sunscreen, and feminine care products.

You contribute to your FSA through before-tax payroll deductions by selecting how much you want to contribute over the course of the plan year, with a proportionate amount of that annual contribution coming out of each paycheck. Your entire annual contribution to a Health Care FSA is available to you from the beginning of the plan year.

FSAs have a “use it or lose it” rule, so you may forfeit any unused money. The deadline to submit expenses for reimbursement is March 31 of the following year.

An HMO is a medical plan that provides coverage only when you receive care from providers within the HMO network. You’re required to select a primary care provider (PCP) who will coordinate your care to manage costs.

Generally, HMOs have a low or no deductible and low to moderate premium costs, with copays typically paid at the time of service for non-preventive in-network medical care and prescriptions. Keep in mind that in-network preventive care, like annual physicals and immunizations, is covered in full at no cost to you.

You’re also protected by an annual limit on costs — if you reach the out-of-pocket maximum, the plan pays 100% of any further covered expenses for the rest of the year.

A Health Savings Account, or HSA, is tax-free and only available to participants in a qualified high-deductible health plan. You contribute to your HSA through before-tax payroll contributions to pay for eligible medical expenses — including deductibles, coinsurance, and copays. All the money in your HSA rolls over each year and is always yours to keep. You can even invest the money in your HSA to build up savings you can put towards health expenses in retirement.

You can only use money actually deposited into your HSA. If you don’t have enough in your HSA at the time of your medical expense, you can pay another way and reimburse yourself from your HSA later.

A HDHP is a medical plan that puts you in charge of your spending through higher deductibles and a tax-free Health Savings Account (HSA). You can see any provider, but you’ll generally pay less by staying in-network.

For nonpreventive medical and prescription expenses, you pay 100% of your costs until you meet the annual deductible, after which you and the plan share the cost of covered medical care and prescriptions through coinsurance. If your total deductible and coinsurance expenses reach the plan’s out-of-pocket maximum, you won’t have to pay anything further for the rest of the year. Keep in mind that in-network preventive care, like annual physicals and immunizations, is covered in full at no cost to you.

To help pay out-of-pocket expenses, you can contribute tax-free money from your paycheck to an HSA. The money in your HSA is always yours to keep and can be used now or in the future.

Because the IRS doesn’t allow you to contribute to both a Health Savings Account (HSA) and a Health Care FSA, a Limited Purpose FSA is offered to you if you enroll in a medical plan with an HSA. With a Limited Purpose FSA, you can pay for eligible dental and vision expenses with tax-free dollars. Since you don’t pay income tax on the money you put in an FSA, it’s like getting a discount on your bills!

You contribute to your FSA through before-tax payroll deductions by selecting how much you want to contribute over the course of the plan year, with a proportionate amount of that annual contribution coming out of each paycheck. Your entire annual contribution to a Limited Purpose FSA is available to you from the beginning of the plan year.

FSAs have a “use it or lose it” rule, so you may forfeit any unused money. The deadline to submit expenses for reimbursement is March 31 of the following year.

An out-of-pocket maximum is the most money you would have to pay in a plan year for covered health care expenses. If your out-of-pocket expenses (such as your deductible, coinsurance, and copays) reach your plan’s out-of-pocket maximum, you won’t pay anything further for covered services for the rest of the year.

A PPO is a medical plan that generally has a lower deductible and higher premiums, which keeps your costs more predictable. You can see any provider, but you’ll generally pay less by staying in-network.

Typically, you pay a copay for nonpreventive doctor’s office visits and prescriptions. The cost of other medical services, like hospital stays, must be paid in full before meeting the plan’s annual deductible. Then, the plan will share the cost of these services through coinsurance.

You’re also protected by an annual limit on costs — if you reach the out-of-pocket maximum, the plan pays 100% of any further covered expenses for the rest of the year.

Premiums are the money you contribute from your paycheck to pay your share of the cost of being enrolled in a health plan. CHOC also pays a large percentage of this cost.

Your premium depends on the plan you choose and who you enroll. For example, a medical plan with a low deductible will have a higher premium than a plan with a higher deductible. And you’ll pay a lower premium to enroll yourself, while a higher premium would apply when enrolling your spouse and kids.

Preventive care services include routine physicals, health screenings, routine blood work, and recommended immunizations. In-network preventive care is covered free of charge with all plans.

A qualifying life event is a change in your life that qualifies you to update your benefits enrollment before the next Open Enrollment. For example, if you get married in April and your Open Enrollment is typically in the fall, you wouldn’t need to wait until then to change your benefits. You could add your spouse to your coverage or drop your coverage and join your spouse’s plan within 30 days of your marriage date. Only changes related to your life event are allowed. Life events are:

• Change in legal marital status, including marriage, divorce, or death of a spouse
• Change in number of dependents, including birth, adoption, placement for adoption, or death of a dependent child
• Change in a child’s dependent status, either newly satisfying the requirements as a dependent child status or ceasing to satisfy them
• Change in place of residence or worksite that affects the eligibility for coverage or accessibility of network providers
• Change in your health coverage or your spouse’s/domestic partner’s coverage attributable to your spouse’s/domestic partner’s employment
• Change in an individual’s eligibility for Medicare or Medicaid
• A court order requiring health coverage for your child
• Changes in your coverage impacted by your spouse’s/domestic partner’s employer or employment status
• Change in work schedule or employment status such as an increase or decrease in hours or a switch between a part-time non-benefits eligible position to a benefits eligible position

MDLIVE through Cigna provides convenient, 24/7 access to board-certified doctors by phone or video, wherever you are. MDLIVE through Cigna appointments are typically less expensive than going to an urgent care center, with costs varying depending on your medical plan. In some cases, certain specialist visits are available through telehealth, such as psychiatry and dermatology.