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CIGNA Choice Fund

As a member of the CIGNA Choice Fund, you have flexibility to choose your physician or other health care provider. Each time you need care, you may choose to receive services from a:

• CIGNA Choice Fund provider (in the Open Access Plus Network)
• Non-CIGNA Choice Fund provider (outside of the Open Access Plus Network)

The Open Access Plus network is a group of health care professionals that have agreed to special pricing arrangements for CIGNA Choice Fund participants.  Open Access Plus providers also agree to follow guidelines that, where medically appropriate, encourage the use of alternatives to costly hospitalization.

How CIGNA Choice Fund Works - For pensioners who are not eligible for Medicare Part A and Part B

CIGNA Choice Find combines a medical plan with a fund called the Health Reimbursement Arrangement (HRA). The fund is set up by Metro to help you pay for eligible medical and pharmacy expenses. It is important that you plan carefully for any medical expenses you may have throughout the year.

You can also participate in a health assessment and/or several programs and earn additional dollars, referred to as incentives, that Metro will contribute to your HRA.

For detailed information on how the Choice Fund works and what services are covered, contact CIGNA.

NOTE:  The CIGNA Choice Fund works differently if you are a pensioner who is eligible for Medicare Part A and Part B. If you are eligible for Medicare, then Metro does not contribute money to the Health Reimbursement Arrangement fund for you.

In-Network Benefits
To receive maximum plan benefits, you should choose a provider who participates in the Open Access Plus Network. Although in-network providers are listed in the directory published by the plan, it is important that you call the provider before you receive care and verify that he or she participates in Open Access Plus Network.

Physician Visits
When you visit an in-network health care provider, you will present your CIGNA Choice Fund Member ID card. The CIGNA healthcare provider will not collect money from you at the time of service. The provider will bill CIGNA directly. Once CIGNA receives the bill from the provider, CIGNA will send you an Explanation of Benefit (EOB.)  The EOB will include the amount paid to your provider, the balance remaining in your CIGNA Choice Fund HRA, and the amount (if any) that you owe to your provider. 

• If you have funds remaining in your HRA, CIGNA subtracts the amount owed to the provider from your available HRA funds and sends payment to your provider.  You pay nothing.
• If you have used all of your HRA funds, CIGNA will notify you on the EOB and you will be responsible for paying 100% of your medical expenses until you have met your deductible gap.
• If you have met your deductible gap, CIGNA will notify you on the EOB and you will be responsible for paying your 10% share of coinsurance for medical expenses until you have met your annual out-of-pocket maximum.
• If you have met your annual out-of-pocket maximum, CIGNA will notify you on the EOB.  CIGNA will pay 100% of your medical expenses and you pay nothing.  

Pharmacy Coverage
Once you select a pharmacy that participates in the CIGNA network, you will present your CIGNA Choice Fund Member ID card. The pharmacy determines the amount you owe, if any, for the prescription drug. Pharmacy expenses are deducted from your HRA fund. You will make a payment ONLY if there are no dollars remaining in your HRA fund to pay your covered pharmacy expenses or you have not yet met your annual out-of-pocket maximum. [Pharmacies not participating in the CIGNA network will ask you to pay the full amount of the prescription at the time of purchase.  It is your responsibility to file a claim with CIGNA for reimbursement, if you are eligible.]

• If you have money in your HRA – your prescription will be paid 100% by the plan.  You pay nothing.
• If you have used the funds in your HRA and you have not met your share of the deductible (which is $400 single or $800 family) – you must pay 100% of the full discounted cost of your prescription at the time of purchase
• If you have met your share of the deductible – you pay 10% (of the discounted cost) for generic drugs and 30% (of the discounted cost) for brand name drugs
• If you have met your annual out-of-pocket maximum – your prescription will be paid 100% by the plan.  You pay nothing.

Discounted Costs – CIGNA has negotiated discount prices of drugs with pharmacies in their network.

Out-of-Network Benefits
Non-CIGNA HealthCare providers may ask you to pay at the time of service.