To help ease the transition for employees whose providers are out-of-network, FCPS will subsidize these claims for 2024. This means that for 2024, no employee will need to change their primary care doctor if they are out of network. This gives Cigna time to reach out to those out-of-network physicians to encourage participation or for employees to seek other medical providers if they remain out of network. 

If your current provider is out-of-network, you can nominate them to join the Cigna network. To begin the process, you can fill out the Provider Nomination Form on Cigna's website or have your doctor call 877-501-7992. 

Each practitioner determines their billing practices, so before submitting your claims for reimbursement please talk with your provider (or their billing manager) to see if they are willing to file claims on your behalf. Some providers will do this as a courtesy for their patients and delay billing in order to minimize cash flow impact to their patients.

If your provider is not willing to bill the plan and will require payment at time of service, you can submit out-of-network claims for reimbursement in one of two ways:

1. Online via your MyCigna account at https://my.cigna.com. If you have not already done so, please set up your online MyCigna account, as that will reduce some of the processing time when submitting your out-of-network claims. 

• Once logged in, hover over the “Claims” link in the upper part of the webpage.
• Click on “Forms Center”.   
• Click on “Submit a Claim Online”.
• Review and gather the information you will need to file your claim, then click “Start”.
• Ensure you have your itemized statement from the provider, as you will need to upload this document as part of your claims submission.  

2. U.S. mail, by submitting a paper claim to Cigna. To submit a paper claim, complete the required items on the Medical Claim Form, print and sign the form, and attach the itemized billing statement you received from the provider. Mail your claim to the address on your Cigna identification card (P.O. Box 182223, Chattanooga, TN 37422-7223). Be sure to keep a copy for your records. 

The Cigna system is programmed with the FCPS plan design (most out-of-network services covered at 90%). There is nothing additional you must do to receive the higher out-of-network benefit.

Also, if you have not already done so, consider completing the Provider Nomination Form so that Cigna can reach out to the provider to discuss recruitment in the network. Provider recruiting efforts are often more effective when the provider knows their patients have made the request. 

For 2024, out-of-network claims will continue to be processed by Cigna at the higher in-network level. If you are seeing a provider that is not in the Cigna network, we recommend the following:

• First, search the Cigna website to confirm that your provider is not in the network. Search the Cigna provider directory.
• If you don’t find your provider listed in the network, we encourage you to nominate your provider to be recruited into the Cigna network. Get the Provider Nomination Form.
• Discuss with your out-of-network provider their payment policies and whether they will file the claim on your behalf. Below is a hypothetical example of how the claims filing process works for an out-of-network provider:

* In cases where the allowed amount is lower than the billed amount, some claims could have residual balances that are added to the member’s bill (known as balance billing). For 2024, FCPS has set the out-of-network reimbursement rate at a level where balance billing should not occur with most claims.

Please note that balance billing does not apply to all claims. The No Surprises Act passed by Congress in 2021 does not permit provides to balance bill in the following instances:  

1.  When an individual receives covered emergency services from an out-of-network provider or at an out-of-network emergency facility; 

2. When non-emergency services received from an out-of-network provider are delivered as part of a visit to an in-network healthcare facility; or 

3. When an individual receives covered air ambulance services that are provided by an out-of-network air ambulance provider.

The Cigna Open Access Plus Plan (OAP) is a National Network Plan that offers access to a nationwide network of providers. Regardless if you live in the metropolitan Washington D.C. area or if you are traveling throughout the U.S., you will easily be able to locate a provider that participates in the Cigna OAP plan network. 

In this network, you do not have to designate your primary care provider. Should you need to see a specialist like an orthopedist, neurologist, or dermatologist, you do not need a referral from your primary care physician.

A few key features with the Cigna Open Access Plus Plan:

• Preventive care services remain covered at 100%, not subject to the deductible
• Nationwide network of providers for both routine and emergency care
• Access to Cigna’s national network of labs, x-ray, and radiology centers
• No prior authorization is required for complex radiology services
• Like most plans, your plan does have an annual deductible that will need to be met before your health plan will begin to pay toward covered services 

Yes. CVS Caremark will continue to manage the prescription drug plan.

FCPS has made significant efforts to ensure the new provider network included as many of our employees’ current providers. In fact, 97% of primary care physicians and specialists used by FCPS employees are in-network. 

You can call the Cigna member services line at 877-501-7992 and speak with a Cigna OneGuide Customer Service Advocate who can look up that information for you.

Or, you can access Cigna’s website to use the “Find a Doctor” search tool. To use the online search tool, access the Cigna website using the instructions below:    

• Go to www.cigna.com
• Click on the blue box “Find a Doctor, Hospital, Facility, Vision Service” at the top of the page
• Under How are you Covered, select “Employer or School”
• In Search Location, enter your zip or city/state

Once you have completed these steps, choose a search category: 

To search Doctor by Type:

• Enter the type of provider (such as Primary Care Physician)
  • Click “Continue as guest”
• When prompted to select a plan, look under “OAP” and select 
  • Open Access Plus, OA plus, Choice Fund OA Plus

You will then see a list of providers for your area. If desired, you can sort or filter providers to narrow down your search. 

For access to language assistance services call 877-501-7992 (TTY: Dial 711).

To help ease the transition for employees whose providers are out-of-network, FCPS will subsidize these claims for the first year of the new plan. This means that for 2024, no employee will need to change their primary care doctor if they are out of network. This gives Cigna time to reach out to those out-of-network physicians to encourage participation or for employees to seek other medical providers if they remain out of network. 

If your current provider is out-of-network, you can nominate them to join the Cigna network. To begin the process, you can fill out the Provider Nomination Form on Cigna's website or have your doctor call 877-501-7992. 

Each practitioner determines their billing practices, so before submitting your claims for reimbursement please talk with the provider (or their billing manager) to see if they are willing to file claims on your behalf. Some providers will file on your behalf and delay billing until the payment is received in order to minimize cash flow impact to their patients.  

If the provider is not willing to bill the plan and will require payment at time of service, you will need to obtain an itemized statement from the provider and submit a claim for reimbursement.  If you have not already done so, please set up your online MyCigna account, as that will reduce some of the processing time when submitting your out of network claims. Go to https://my.cigna.com to register for your online account. Once logged in, hover over the “Claims” link in the upper part of the webpage, then drop down to “Forms”. You will then see the link to submit claims online. You can also complete and mail in a paper claim form to Cigna. 

The Cigna system is programmed with the FCPS plan design so there is no special claims filing process you must use in order to access the 90% out-of-network benefit.  The 90% out-of-network benefit applies to most out-of-network services (not restricted to primary care physicians). The benefits summary can be found here.

Also, if you have not already done so, consider completing the Provider Nomination Form so that Cigna can reach out to the provider to discuss recruitment in the network. Provider recruiting efforts are often more effective when the provider knows their patients have made the request. 
 

For 2024, out-of-network claims will continue to be processed by Cigna at the higher in-network rate. If you are seeing a provider that is not in the Cigna network, we recommend the following:

• First, search the Cigna website to confirm that your provider is not in the network. Search the Cigna provider directory.
• If you don’t find your provider listed in the network, we encourage you to nominate your provider to be recruited into the Cigna network. Get the Provider Nomination Form.
• Discuss with your out-of-network provider their payment policies and whether they will file the claim on your behalf. Below is a hypothetical example of how the claims filing process works for an out of network provider. 

  	Billed Amount	Allowed Amount	Member’s responsibility (amount member must pay)
  First claim of 2024	$200	$180	$200 ($180 toward deductible +  $20 balance billed amount)
  Second claim of 2024	$200	$180	$158 ($120 deductible + $18 coinsurance + $20 balance billed amount)
  Third claim of 2024	$200	$180	$38 ($18 coinsurance + $20 balance billed amount

   

Please note that balance billing does not apply to all claims. The No Surprises Act passed by Congress in 2021 does not permit provides to balance bill in the following instances:  

1.  When an individual receives covered emergency services from an out-of-network provider or at an out-of-network emergency facility; 

2. When non-emergency services received from an out-of-network provider are delivered as part of a visit to an in-network health care facility; or 

3. When an individual receives covered air ambulance services that are provided by an out-of-network air ambulance provider.
    

No referrals are needed to see a specialist.

No prior authorizations are required for complex radiology.

Yes. Starting in 2024, infertility benefits under the Cigna plan will be managed by WINFertility (WIN), a leading provider of infertility benefits management. Benefits will continue to be offered at a $100,000 lifetime maximum. This is allocated in two parts: $50,000 toward eligible medical expenses related to fertility treatment and a separate $50,000 lifetime maximum benefit toward related fertility medications.

Most providers used by FCPS employees are in the Cigna network. Use the "Find a Doctor" provider search tool to check.

If your provider is out-of-network, you may continue to see your current provider at in-network costs for 2024. This gives Cigna time to reach out to those out-of-network physicians to encourage participation in the Cigna network or for employees to seek other medical providers if they remain out of network. 

To nominate a provider who is not currently in the Cigna network, you can fill out the "Provider Nomination form" or have your doctor call 877-501-7992 to start the process.

Cigna One Guide Dedicated Service Team helps you make informed choices and get the most from your plan. The team offers personalized support to help you stay healthy, answer questions about your plan benefits, check your providers’ network participation status, or answer questions about the continuation of care. You may contact the Cigna One Guide Dedicated Service Team 24 hours a day, 365 days a year at 877-501-7992.

For questions about eligibility and enrollment, contact the Office of Benefit Services at 571-423-3200, option 3, option 2, or by email at [email protected].

MDLIVE offers a comprehensive suite of convenient virtual care options — available by phone or video whenever it works for you. MDLIVE board-certified doctors, dermatologists, psychiatrists, and licensed therapists have an average of over 10 years of experience and provide personalized care for hundreds of medical and behavioral health needs.

Virtual care services are not to replace emergency room care for true medical emergencies.  Please call 911 or go to your nearest emergency room in the event of a true medical emergency.
 

Conditions that can be diagnosed and treated using MDLIVE virtual care include the following:  

Urgent Care – On-demand care for minor medical conditions

• On-demand 24/7/365, including holidays
• Care for hundreds of minor medical conditions
• A convenient and affordable alternative to urgent care centers and the emergency room
• Prescriptions available, if appropriate

Behavioral Care – Talk therapy and psychiatry from the privacy of home

• Access to psychiatrists and therapists
• Schedule an appointment that works for you
• Option to select the same provider for every session
• Care for issues such as anxiety, stress, life changes, grief, and depression

Primary Care - Preventive care, routine care, and specialist referrals

• Preventive care checkups/wellness screenings are available to identify conditions early
• Routine care visits allow you to build a relationship with the same primary care provider (PCP) to help manage conditions
• Prescriptions are available through home delivery or at local pharmacies, if appropriate
• Receive orders for biometrics, blood work, and screenings at local facilities (limited to labs that contract with MDLIVE for virtual wellness screenings)

Dermatology* - Fast, customized care for skin, hair, and nail conditions – no appointment required

• Board-certified dermatologists review pictures and symptoms; prescriptions available, if appropriate
• Care for common skin, hair, and nail conditions including acne, eczema, psoriasis, rosacea, suspicious spots, and more
• Diagnosis and customized treatment plan, usually within 24 hours

*Virtual dermatological visits through MDLIVE are completed via asynchronous messaging. Diagnoses requiring testing cannot be confirmed. Customers will be referred to seek in-person care. Treatment plans will be completed within a maximum of 3 business days, but usually within 24 hours.

Schedule an appointment via video or phone. Follow the steps below:   

• Access MDLIVE by logging into myCigna.com and clicking on “Talk to a doctor.”
• You can also call MDLIVE at 888-726-3171. (No phone calls for virtual dermatology.)
• Select the type of care you need: medical care or counseling; cost will be displayed on both myCigna.com and MDLIVE
• Follow the prompts for an on-demand urgent care visit, to make an appointment for primary or behavioral care, or to upload photos for dermatology care

MDLIVE provides services for the hearing impaired (TTY/TTD).  Dial 711, and then enter 800-770-5531.

The cost of MDLIVE Virtual Care visits is listed below. Members will have full-price transparency throughout the scheduling process to understand what they will owe for a visit.

Cigna Vision

No, you will not receive a separate ID card for vision. Vision information will be located on the back of your Cigna Medical ID Card.  
•    Remember to present your Cigna ID card when you go for your routine eye care appointment.

With Cigna Vision, you have access to one of the largest specialty national networks of quality eye doctors through the Cigna Vision VSP Network. From private practice ophthalmologists and optometrists to nationally recognized retail eye care stores, you can find a convenient, trusted doctor in your area. If you choose one of our in-network eye doctors, you’ll get the most savings and virtually no paperwork. 
You do have the option to see an eye doctor who is out of the network. If you do, you’ll have to pay for the service in full at the time of the appointment, and you’ll need to submit a claim form to get reimbursed for your services. You will also be responsible for paying any charges that are not covered under your plan.

Inside the Cigna Vision VSP network:

• Over 80,000 Total Eye Care Providers 
• Over 75,000 Optometrists (O.D.)
• Over 9,000 Ophthalmologists (M.D./D.O.)    

Examples of Retail Locations:

• Visionworks
• JC Penney optical
• Pearle Vision
• Sears Optical
• Target Optical
• MyEyeDr.
   

Please be aware that the Cigna Vision network is different from the network supporting your medical plan. You can call the Cigna OneGuide dedicated service line at 877-501-7992 and speak with a OneGuide Team member who can help you to find a provider within the network. The service team is available 24 hours a day, 365 days a year.  

• Visit Cigna Vision Provider Search
• Update Required Fields for search
• Choose your preference of search by Preferred Language, Gender,  Doctor by Type, Doctor Type
• Click “Search” 
• Your list will populate and you will be able to sort by specialties

Call the Cigna OneGuide team to confirm that your doctor is in the network at 1-877-501-7992 (Available 24/7), or you can check using the Cigna Vision Provider Search

Make sure to present your new ID card at the time of service.

Submitting a claim for reimbursement is easy! Follow the instructions below:

1. Fill out the Cigna Vision claim form.
2. You can find it online on Cigna.com, or on myCigna.com, under “Forms.” Make sure to download the Cigna Vision claim form and not the medical form.
3. Attach your itemized receipt.
4. Send to: Cigna Vision, Claim Department, P.O. Box 385018, Birmingham, AL 35238-5018

If you have any questions, call 877-501-7992

Question related to Cigna Vision, such as how to access your ID card, claims, search for providers, and explain plan details, may be directed to the Cigna OneGuide dedicated service line at 877-501-7992. The service team is available 24 hours a day, 365 days a year. 

For new members, ID cards will be mailed to you in mid-December. They will also be available electronically on the myCigna app and online through https://my.Cigna.com. Remember, you will need to present either the hardcopy or electronic ID card to all your treating providers.

Yes, every participant in your family will receive their own ID card. Cards are mailed in packs of four (4) – so if you have five or more (5+) people in your family, you will receive multiple envelopes with ID cards. You will use the same card for medical and vision coverage. Remember to present your new ID card to all of your treating providers beginning January 1, so they are aware of your insurance coverage.

You can register for and start using myCigna.com or the myCigna App to download, print, fax, or email a temporary ID card. Or you can call your dedicated Cigna One Guide representative at 877-501-7992.

You will use the same card for Cigna Medical Open Access Plus (OAP) and Cigna Vision.

FCPS health and dental plans allow a child to remain covered on the employee's plan through the end of the month in which the child turns age 26, regardless of student status. (NOTE: Your child may be eligible to remain enrolled past age 26 if the child is wholly dependent on the employee for support and maintenance due to a disability that occurred prior to age 26.)

Cigna's 'overage disabled dependent' recertification process occurs every July. If your child's status is due to be recertified, you will receive a letter at your home address in July 2023 explaining how to begin the recertification process.

An eligible dependent spouse is a person to whom you are legally married. FCPS requires documentation demonstrating all dependents meet the eligibility criteria for coverage under the plans. For more information, please view the Dependent Eligibility Chart.