Choosing Medical Benefits
With two medical options to choose from, you have the flexibility to select the approach that best suits your needs. Only you can decide which type of plan — BCBS PPO or CIGNA Choice Fund — is right for you and your family. Be sure to read all plan information carefully. To help you evaluate your options, consider the four “C’s” of choosing coverage:
- Cost — Premiums are not your only expense. Consider all plan costs, including deductibles, copays and out-of-pocket maximums.
- Coverage — Some plans cover certain services, while other plans may not. For example, HMOs usually cover routine physical examinations for adults at 100%, after a small office-visit copay. PPOs, however, may not cover routine physicals.
- Coordination of care — Under an HMO, a primary care physician (PCP) coordinates care and treatment for you and your family. If necessary, your PCP may refer you to a specialist for care, and will inform the specialist of your needs. Under a PPO, responsibility for coordinating your care falls on you. You may have to find your own specialist and coordinate care between your doctors.
- Choice of physicians — In general, HMO plans pay higher benefits, but you must use doctors and caregivers within the HMO network. In a PPO, you can choose a doctor inside or outside of the PPO network, but if you go outside the PPO network, your benefits will be lower.
- Consider the plan's Prescription Drug Lists and Limits -- Each medical plan offered has different prescription drug formularies and limitations. As a result, some prescriptions may be covered at a cost, limit, or prior authorization different than another plan offered. If you or your dependents take prescription drugs, consider all costs and coverage levels as well as possible quantity limits or prior authorizations that may be required. Before choosing a medical plan, please check with that plan to see how any drugs that you or your covered family members take on a regular basis are handled.