The Pulse of SchoolCare, August 2020

Your top 5 health plan questions answered

Published August 4, 2020

Taking charge of your health care is an important part of staying healthy and saving money. However, understanding the details of your health benefits can seem complicated at times. Your SchoolCare Group Relations Team has collected the 5 top health care questions (based on your feedback) and provided answers they hope will help guide you through the plan year:

1. What if I receive a claim denial or a service is not approved for coverage?

Receiving a claim denial or rejection for coverage can be frustrating. The good news is there are resources available to help you understand coverage and next steps. To start, please contact Cigna at 800-244-6224 to confirm if anything can be done to have your claim or service approved and reprocessed.  If Cigna cannot assist, your next step is to contact SchoolCare at 603-836-5031 Press 3 for Coverage & Benefits or grouprelations@schoolcare.org.

2. What if I'm on the Yellow or Orange plan, what's my co-pay for a doctor's visit?

Both the SchoolCare Yellow and Orange plans are Consumer-driven health plans, meaning they have a higher deductible with lower premiums. They are often offered with a Health Reimbursement Account (HRA) or a Health Savings Account (HSA). If you are on a SchoolCare Yellow or Orange plan, it’s important to note that you do NOT have a co-pay. Preventive care services are covered at 100%. All other services are subject to the deductible and or coinsurance up to the out-of-pocket maximum. After receiving a service your provider should bill Cigna (do not pay at the desk) to ensure you do not overpay for your visit.

3. I just got a bill; how much do I have to pay?

If you receive a bill from a medical provider, refer to your Explanation of Benefits (EOB) for the claim before paying the bill. Comparing the EOB with your bill will help to determine how much you owe versus what your insurance covered. Access your EOB by logging into your myCigna.com account under Claims > Explanation of Benefits. Learn more about how to read your EOB here.  

4. How do I estimate the cost of a procedure?

Being a conscious health care consumer means you may want to do research and compare costs before scheduling a medical service. Don’t hesitate to request a cost estimate from your provider before a procedure to determine expected expenses. Additionally, you can log into myCigna.com under Find Care & Costs, then choose to look up services by Reason for Visit to view estimated costs.  

5. Have I met my deductible yet?

To keep track of your deductible throughout the year Refer to your myCigna.com account for tracking your Health Reimbursement Account (HRA), deductible, and out of pocket maximums. Once logged in, you will see your Medical Coverage Status with the In-Network Deductible Remaining and Spending Account (HRA) total right on your home page. If you have earned any Good For You! Wellness program incentives so far during the plan year, they will also be reflected.  

Have a question or topic you want to learn more about in The Pulse of SchoolCare news? Please email Josephine Therrien, SchoolCare Marketing Communications Specialist at jtherrien@schoolcare.org.

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