Skip to main content

MEDICAL INSURANCE

cigna

Dartmouth College offers three medical plan options through Cigna Health Care for all benefits eligible employees. Below is important information regarding all three plans.  Please take the time to review this information carefully comparing plan structure to your medical premium costs.

Choosing a Plan Global Out of Pocket Preventive Care
Coinsurance Infertility Benefit Retiree Medical
Comparison Chart Medical Cost Status Changes
Contact Info Medical Plan Options Summary Plan Descriptions
Copayments Out of Network Tier Levels
Deductibles Pharmacy Benefits Tracking Claims
Durable Medical Equipment Phone Ap Wellness Benefit
Find a Doctor Plan Summaries Videos
Forms Pre-Certification Vision Program

 

 

MEDICAL INSURANCE PLAN OPTIONS

You have the option of selecting one of three plans through Cigna Health Insurance:

•  Open Access Plan 1 (OAP1) - A $250 deductible plan.
•  Open Access Plan 2 (OAP2) - A $500 deductible plan.
•  High Deductible Health Plan (HDHP) - A $2,500 deductible health plan with Health Savings Account (HSA) eligibility.

An overview of the three plans can be found on the Comparison Chart

Top of page

 

MEDICAL INSURANCE COSTS

The cost of your medical insurance is determined by your benefit plan and you should refer Employee Medical Plan Cost Estimator to help determine the cost of medical insurance

Top of page

 

TIER LEVELS

Employees can pick from four tier levels in 2014.  They are as follows:

•  Single - The employee only 
•  Employee plus child(ren) - The employee plus one or more children
•  Employee plus Spouse - The employee plus their Spouse, Civil Union Partner or Same Sex Domestic Partner
•  Family coverage - The employee plus their Spouse, Civil Union Partner or Same Sex Domestic Partner and one or more children of the covered parents.

Top of page

 

COPAYMENTS

Copayments are a fixed amount of money that the member pays, each time they visit their in-network Primary Care Physician (PCP) or a Specialist.  When utilizing a PCP or specialist outside the Cigna network, costs are subject to out-of-network deductibles and co-insurance.  The High Deductible Health Plan does not have copayments, and you will need to pay the full cost of each visit until the annual deductible has been satisfied. 

TYPE OF VISIT OAP1 OAP2 HDHP
Primary Care Physician $20 $20 N/A
Physical/Occupational/Speech Therapy $20 $20 N/A
Chiropractor $20 $20 N/A
Mental Health Provider $20 $20 N/A
Cardiac Rehab $20 $20 N/A
Specialist $30 $30 N/A
Emergency Room $100 $100 N/A

An overview of the three plans can be found on the Comparison Chart

Top of page 

 

DEDUCTIBLES

A Deductible is an annual amount that each member must pay toward certain services before the insurance will begin to pay.  Each plan option has a different Deductible level.  Once the deductible has been satisfied for the year, then the these claims will be paid at the coinsurance level until the global out of pocket maximum has been met.  Please note, that the deductible is tallied on an individual basis.  It is not until the second, third or fourth member of the family starts utilizing services will it count toward the family deductible limit. When there are only two people on a plan, you will only need to meet two individual deductibles, not the family limit.

The Deductible limits for 2014 will be as follows:

 TIER LEVEL OAP1 OAP2 HDHP
Individual $250 $500 $2,500
2 People $500 $1,000 $2,500
Family $750 $1,500 $5,000

An overview of the three plans can be found on the Comparison Chart

Top of page

 

COINSURANCE

Coinsurance is your share of the costs for certain health care services, once your annual deductible has been met. Coinsurance is calculated as a percentage of the allowed amount for these services.  What this means, is that once the annual deductible for an individual has been satisfied, you will pay either 10% or 20% of the remaining balance due (OAP1 and OAP2), and the insurance company will be pay the remaining 90% or 80% of the cost.  You will continue to pay 10% or 20% of the cost of these services until the global out of pocket maximum has been met.  The High Deductible Health Plan does not have coinsurance, so once the $2,500 deductible on this plan has been satisfied, all expenses are covered in full.

The Member Coinsurance levels for each plan for 2014 will be as follows:

NETWORK OAP1 OAP2 HDHP
In-Network 10% 20% N/A
Out-Of-Network 30% 40% N/A

An overview of the three plans can be found on the Comparison Chart.

Top of page

 

GLOBAL OUT OF POCKET MAXIMUM

New for 2014, Dartmouth College will be introducing a new global out-of-pocket maximum.  What this means is that your copayments will now apply toward your annual out-of-pocket maximum.  Previously there was not a limit to the number of copayments that member could pay in a plan year.  Now, the deductible, coinsurance and medical copayments will all count toward this maximum.  After which time, all costs on the medical plan will be covered at 100%.  Please note that the out-of-pocket maximum is tallied on a per individual basis, so it is not until the second, third or fourth member of the family starts to use services, will it count toward the family out-of-pocket maximum.  When there are only two people on a plan (employee plus spouse or employee plus one child), you will only need to meet two individual out-of pocket maximums, not the family max. In 2015, Prescription Drugs will also count toward the global out-of-pocket maximum. 

The Global Out of Pocket Limits for 2014 will be as follows:

TIER LEVEL OAP1 OAP2 HDHP
Individual $1,750 $3,000 $2,500
2 People $3,500 $6,000 $5,000
Family $5,250 $9000 $5,000

An overview of the three plans can be found on the Comparison Chart

Top of page

 

OUT OF NETWORK CLAIMS

It is always important to use in-network providers whenever possible. When using out-of-network providers, the member faces additional deductibles, coinsurance and out of pocket maximums above and beyond what they are required to pay, using in-network services. **The member may also be balanced billed the remainder of the charges.

**Balance Billing is when an out-of-network provider does not agree to take a discount for their services, and is allowed to charge the member the full cost of services, above and beyond the reasonable and customary amounts that the insurance company is willing to pay. A provider is allowed to balance bill, even if the members out-of-pocket maximum has been met for the year.

Top of page

 

PREVENTIVE CARE SERVICES

With the implementation of the Health Care Reform Bill, preventive care services are available to you at no cost (i.e. no co-pay, deductible, or coinsurance).  The United States government has determined the list of preventive care services and further information is available at the links below:

•  Preventive Services Covered Under the Affordable Care Act
•  U.S. Preventive Services Task Force Recommendations
•  Cigna Preventive Health Care Services

Top of page

 

PRE-CERTIFICATION PROCESS

Pre-certification is the process of determining in advance whether a procedure, treatment or service will be covered under your health care plan. It also helps ensure you get the right care in the right setting – potentially saving you from costly and unnecessary services.  Click here to learn more about Cigna's Pre-certification process.

Top of page

 

VISION COVERAGE

As part of the preventative care services under your Dartmouth College medical insurance plan (OAP1, OAP2 or HDHP), each covered member of your family receives one eye exam per year at no cost. (i.e. no co-pay, deductible, or coinsurance), when using in-network providers.  You pay 30% of provider costs when using out-of-network providers for routine eye exams in 2014.

Corrective lenses (ex. glasses or contact lenses) are not covered.  However, a $50 hardware reimbursement toward the cost of frames, lenses and contacts is offered to members of the Open Access Plan 1 (OAP1).

Types of Vision Providers
•  Routine Eye Care Providers - Cigna uses VSP as their Vision Vender.  For the most up-to-date list of Routine Eye Care Providers in your area; select "Find a Cigna Vision Network Eye Care Professional", then click "Search as a guest", and enter your location.
•  Medical Eye Care Providers - Medical related eye claims go through Cigna's network of Medical Eyecare professionals.  For the most up-to-date list of Medical Eye Care Providers; click on "Eye Doctor" then click on the type of Eye Professional required.

Vision Discounts
•  Healthy Rewards - Cigna's Vision Network Savings Program
•  Delta Dental's Vision Discount Program - If you are enrolled in the dental plan, you may also be eligible for vision discounts.

Top of page

 

DURABLE MEDICAL EQUIPMENT

Cigna uses a National network of contracted venders as a convenient way to get you the necessary medical equipment supplies that you need.  Your Doctor provides the appropriate vender with a prescription and the vender will make all of the arrangements to deliver the supplies right to your front door.  If supplies are needed immediately, your doctor can indicate overnight delivery on the provided prescription.  Click here for a full list of DME providers and contact numbers.

Top of page

 

CHOOSING A PLAN

It is always important to compare your families historical usage of your medical plans to your monthly or biweekly paid premium costs.  Below is a diagram showing the specific differences between each of the three plans.

IN-NETWORK

OAP1

OAP2

HDHP

Vision Eyewear

$50 Reimbursement

N/A

N/A

Lab, X-Ray, Ultrasound

Deductible and Coinsurance

Covered at 100%

Subject to Deductible

Durable Medical Equipment

Covered at 100%

Deductible and Coinsurance

Subject to Deductible

Copayments

$20 PCP and $30 Specialist

$20 PCP and $30 Specialist

N/A

Deductible

$250

$500

$2,500

Coinsurance

10%

20%

N/A

Premium Cost

Highest Premiums

Mid-Range Premium

Lowest Premiums

Top of page

 

WELLNESS REIMBURSEMENT

Dartmouth is expanding the Fitness Benefit to a Wellness Benefit in 2014.  The benefit will maintain the current $200 reimbursement via Cigna, but will be expanding the types of wellness-related categories that can be submitted under the benefit, including weight management, stress management, tobacco cessation and others.  Effective 1/1/14.  Watch for more information on the Wellness at Dartmouth website.

Top of page

 

INFERTILITY REIMBURSEMENT

An Infertility Reimbursement is available for expenses not covered by your medical plan.  Details on the program are available here.  It is recommended that you contact Cigna prior to submitting for reimbursement to find out what benefits are covered by your medical plan.

Top of page

 

MAKING CHANGES TO YOUR MEDICAL INSURANCE

You may only elect or make changes to your medical insurance as a new hire, as part of the annual Open Enrollment process, or with a qualifying mid-year Status Change Event. 

Top of page

 

RETIREE MEDICAL INSURANCE

Retirees under age 65 may elect from the Open Access Plan 1 (OAP1) the Open Access Plan 2 (OAP2) or the High Deductible Health Plan (HDHP) and may be eligible for some of the benefits outlined on this page.

Retirees age 65 and over may elect the Dartmouth College Medicare Supplement (DCMS) Plan. Click here for more information on the DCMS plan.

Fore more information on retiree benefits please visit our retiree webpage.

Top of page

 

FINDING A DOCTOR

If you are new to the area, or new to Cigna, you may need assistance finding a healthcare provider.  There are a number of ways that may assist you in doing this:

•  Contact Cigna
•  Visit Cigna's Website and choose "Find A Doctor", or click here for instructions on how to find a doctor in the Cigna Open Access Plus Carelink (OAPC) network.
•  Visit Dartmouth Hitchcock Medical Center's Find A Doctor website or call the Provider Finder line at (603) 653-3211
•  Consult with your friends, co-workers or family in the area, who may be able to recommend a provider.

In your search for a provider, you should remember to ask the following:

•  Are you a Cigna Participating Provider? (i.e. in the Cigna Network?)
•  Are you accepting new patients?

Top of page

 

UNDERSTANDING YOUR CLAIMS

When you seek services, Cigna may send you a document called an Explanation of Benefits (EOBs).  This is not a bill for services.  You should compare the EOB to the providers bill, once it arrives to ensure that your claim was submitted to Cigna, and paid correctly.  For guidance on how to read your Explanation of Benefits (EOB's) please click here. We would also recommend that you set up an account through mycigna.com.  Here you are able to manage and track your claims, order cards, check your paid to date global out of pocket limits, find a doctor, estimate medical costs, compare hospitals and doctors, take a health assessment, use the interactive medical library, find information on health conditions, and much more.  Mycigna.com is completely personalized, so it's easy to quickly find exactly what you're looking for.  If you have further questions, you should contact Cigna.

•  Mycigna.com Instructions

Top of page

 

FORMS

All forms can be found on the Human Resources website in the Forms section

Top of page

 

ADDITIONAL INFORMATION

The following list of resources may be beneficial to some employees:

•  HealthCare.gov
•  Vermont Health Assistance Program
•  Service Link (for NH residents)

Top of page

 

CIGNA EDUCATIONAL SESSIONS - RECORDED

The following are links to Cigna Educational Sessions:

       •  2014 Medical Changes 
       •  Understanding Your Cigna Benefits

Top of page

 

CIGNA PLAN SUMMARIES

MEDICAL SUMMARY OF BENEFITS AND COVERAGE

DC Medicare Supplemental

Open Access Plan 1
High Deductible Health Plan Open Access Plan 2

Top of page

 

MEDICAL SUMMARY PLAN DESCRIPTION

(Detailed Description of Benefits)

 

DCMS - Medicare Supplemental
High Deductible Health Plan
Open Access Plan 1
Open Access Plan 2

 

Massachusetts Certificate Rider
Massachusetts Certificate Rider - DCMS

Top of page

 

VISION SUMMARIES 

High Deductible Health Plan
Open Access Plan 1
Open Access Plan 2

Top of page

 

VISION SUMMARY PLAN DESCRIPTION

(Detailed Description of Benefits)

High Deductible Health Plan
Open Access Plan 1
Open Access Plan 2

Top of page

 

CONTACT INFORMATION

CIGNA

Customer Service: 1-855-869-8619
Send Claims To: PO Box 182223, Chattanooga, TN  37422-7223
Website: http://www.cigna.com/
MyCigna Mobile App: Get the App Here

Top of page

BENEFITS OFFICE

For questions on enrolling in medical insurance or making changes to your medical insurance:

Phone: (603) 646-3588
Website: http://www.dartmouth.edu/~hrs/benefits/
E-mail: human.resources.benefits@dartmouth.edu
Fax: (604) 646-1108
Mailing Address:
   Office of Human Resources Office 6042,
   7 Lebanon Street, Suite 203,
   Hanover, NH 03755

For questions on your membership, coverage, or to request new ID cards, you should contact Cigna directly

Top of page

 

Last Updated: 6/23/14