County Health Contract for 2014
Because Fairfax County’s current health insurance contract expires December 31, 2013, the Department of Human Resources (DHR) rebid the contract for our self-insured medical plans. As a result of that process, Cigna has been selected to manage the county’s self-insured medical plans for retirees and employees, beginning January 1. 2014. Cigna will now be the county’s only self-insured plan vendor as the county will no longer have a contract with CareFirst beginning in 2014. The fully insured Kaiser Permanente plan will also continue to be available for employees and non-Medicare eligible retirees.
Retirees who are currently enrolled through CareFirst will find that over 98 percent of the doctors and facilities in that network are also included in the Cigna network. Cigna has committed to actively recruiting the remaining 2 percent of doctors and facilities. Additionally, Cigna’s national network of care providers means that regardless of where you live or travel within the United States, in-network services are available. To locate providers in your area go to www.cigna.com and click on “Find a Doctor.”
To answer questions retirees may have about the change, numerous outreach efforts will take place up to and through Open Enrollment, Oct. 7 to Nov. 15. On Thursday, August 29, from 11 a.m. to 1 p.m. all current CareFirst participants are invited to participate in Cigna’s phone-in Town Hall Meeting. Call in to get information about how to find a doctor or hospital in the Cigna Network, information on prescriptions and the Cigna formulary, and much more. The call-in number is 877-860-3058 and the passcode is 489 225 0313#
Retiree-specific information presentations are scheduled to take place at locations throughout the county, beginning in early October. A pre-enrollment hotline manned by Cigna Customer Service will also become available in September.
While the number of plan vendors will be reduced, retirees will still have four plan options to choose from, as Cigna will offer three different plan options under the new contract in addition to the Kaiser plan.
In reviewing the five medical plan proposals, emphasis was placed on plans that: helped manage service and prescription costs, assisted the county in offering flexible plan designs and provided high quality care with emphasis on wellness, prevention and chronic condition management.
Below are some FAQs that may be of particular interest to retirees.
1. How does Cigna determine coordination of Medicare Benefits for Fairfax County Government Retirees and Employees?
The Coordination of Medicare benefits type utilized for Fairfax County Government’s plan with Cigna is called Maintenance of Benefits. With this contract provision, total benefits payable for a service are limited to the total plan benefit Cigna would have paid as the primary carrier using Medicare’s allowable less the amount paid by the primary carrier, Cigna.
When Cigna’s normal liability is equal to or less than Medicare’s payment, Cigna does not make an additional payment as the secondary payer, even if Medicare did not pay 100% of the allowable charge.
2. When does Coordination of Medicare Benefits apply?
Coordination of Medicare benefit provisions are only used when Cigna is not considered the primary plan/primary payer. When Cigna is the secondary payer, Cigna will pay the difference between what Medicare pays and what would be payable under the Cigna plan. Insurance carriers will coordinate with each other using the industry standard primacy rules to correctly consider benefits for all services payable. The insurance carriers adjust payments so that the total payment never exceeds 100% of medical expenses.
3. If Medicare excludes a service, will Cigna pay the charges?
Yes! For services excluded by Medicare, but covered by Cigna, Cigna would pay as the primary payer. Common, frequently utilized services excluded by Medicare but covered by Cigna include:
Routine immunizations. Medicare will consider charges for the vaccines
for: flu, pneumococcal pneumonia and hepatitis B only.
Some fees associated with chiropractic care. Medicare will consider
charges associated with the manipulation of the spine for treatment of
subluxation (partial dislocation) of the spine only.
Hearing aids and services associated with hearing aids.
Home infusion performed by a home health agency.
Interpretation charges from a physician reading lab tests done by an
- Independent speech therapists not affiliated with an approved outpatient rehabilitation center.
- Some over-the-counter preventive medications, unless you have elected Medicare Part D.
- Prescriptions from a pharmacy, unless you have elected Medicare Part D.
- Prescription drugs that are self-administered, unless you have elected Medicare Part D.
If you have specific questions not answered above, Cigna representatives are available 24 hours a day 7 days a week at 800-244-CIGNA24. And look for more information in the coming months about the new plans and premiums, along with details about enhanced offerings under the new contract, in advance of open enrollment this fall.
To make sure that you receive all the upcoming information on the plans available during the Annual Open Enrollment period, please verify that the Retirement Administration Agency has your current mailing address. Your current contact information can be reviewed by logging in to Web Member Services and viewing the “Demographic” screen under Payee Information.