1.) What is a cafeteria plan?
2.) What benefit plans are offered by Cypress-Fairbanks ISD?
3.) Where can I find information and rates for all of these benefit plan options?
4.) Where can I get claim forms?
5.) When is the district’s Annual Enrollment Period?
6.) Do I have to enroll in a district insurance medical plan?
7.) I was just hired by the district. When will my insurance become effective?
8.) Are there pre-existing condition limitations or exclusions for newly enrolled participants in the major medical plan?
9.) I am terminating my employment with Cypress-Fairbanks ISD. When will my benefit coverages be terminated?
10.) Can you change your mind about enrolling yourself or your dependents in the insurance plan during the year? Alternatively, your spouse changed jobs July 18 and lost his/her medical and/or dental insurance, what can our family do?
11.) If I get married what do I need to do?
12.) If I get a divorce what do I need to do?
13.) Who is an eligible dependent?
14.) How do I add a new baby to my medical plan?
15.) Can I insure my Common-law spouse?
16.) Can I insure my domestic partner, dependent parents or grandparents?
17.) What is COBRA?
18.) How much does COBRA coverage cost?
19.) When will I receive notice of the COBRA extension offer?
20.) How long do I have to make a decision to pick up the COBRA extension offer or to decline it?
21.) What are the HIPAA Privacy Rules?
22.) What is Family Medical Leave (FML)?
23.) When is an employee eligible for Family and Medical Leave (FML) benefits?
24.) Who do I need to contact to apply for Family Medical Leave?
25.) What is the difference between a PPO and an HMO plan?
26.) PPO: What provider network is the district’s PPO plan contracted with?
27.) HMO: What provider network is the district’s HMO plan contracted with?
28.) Does the district have a prescription drug benefit?
29.) What is a prescription drug formulary?
30.) PPO: How do I select a PPO provider (doctor, hospital)?
31.) PPO: Do I need a referral to go to a PPO specialist?
32.) PPO: Can I choose a doctor for each member of my family?
33.) PPO: Is emergency care away from home (out of town, state, country) covered?
34.) PPO: How do I file a PPO claim?
35.) What is the difference between the Cypress-Fairbanks ISD PPO Plan and the Cigna HMO- Select Plan?
36.) Do either the Cypress-Fairbanks ISD PPO Plan or the CIGNA HMO-Select Plan have pre-existing condition limitations?
37.) HMO: What is an HMO?
38.) HMO: What is a primary care physician (PCP)?
39.) HMO: How do I select a PCP?
40.) HMO: Can I change my PCP?
41.) HMO: Can I choose a different PCP for each member of my family?
42.) HMO: What do I do in an emergency?
43.) HMO: Am I covered for emergency and urgent care away from home?
44.) HMO: How do I file an HMO claim?
45.) HMO: How do I get a referral to see a specialist?
46.) HMO: Do I need a referral to see my obstetrician/gynecologist (OB/GYN)?
47.) HMO: Do I need a referral to go to a hospital?
48.) Does Cypress-Fairbanks ISD provide basic life insurance to its employees?
49.) Is there additional life insurance available that I can purchase?
50.) Can I buy life insurance for my spouse or children?
51.) What are my Dental plan choices with Cypress-Fairbanks ISD?
52.) Does Cypress-Fairbanks ISD have a vision plan?
53.) What is disability insurance?
54.) Does Cypress-Fairbanks ISD offer disability insurance?
55.) Does Cypress-Fairbanks ISD offer a cancer & dread disease plan?
1.) What is a cafeteria plan?
A cafeteria plan is a benefit plan established by an employer that allows participants to choose from a menu of qualified benefits in order to pay all or a portion of the employee cost on a pretax basis. Cypress-Fairbanks ISD’s plan is known as the Premium Only Plan (POP). All premiums paid by an employee for medical, dental, supplemental life insurance, and the cancer and dread disease insurance plans are deducted from the employee’s gross income before federal income taxes are withheld. Cafeteria plans are sometimes called “125 plans” because they are governed by Section 125 of the Internal Revenue Code. Although the tax savings are substantial, the IRS Code does mandate coverage restrictions. Once coverage is elected, changes to an employee’s coverage can only be made at the annual renewal (enrollment) period each year or no later than 31 days after an employee experiences a “qualified change in family status.” Any change to an employee’s coverage during the plan year must be consistent with, and on-account of, the “qualifying event.”
2.) What benefit plans are offered by Cypress-Fairbanks ISD?
Cypress-Fairbanks ISD has the following plans available for participation by employees to participate in.
· Cypress-Fairbanks ISD Preferred Provider Organization (PPO) major medical plan
· CIGNA Health Maintenance Organization (HMO) major medical plan
· Hospital Indemnity Plan (Not major medical insurance)
· Basic Life Insurance, underwritten by ReliaStar Life Insurance Company
· Supplemental Life Insurance, underwritten by ReliaStar Life Insurance Company
· Fortis Indemnity Dental Plan
· Pinnacle PrePaid Dental Health Maintenance Organization Dental Plan
· MSofA Dent-All Discount Dental Plan
· QCD of America, a scheduled dental plan
· Unum Disability Insurance Plan
· Cancer and Dread Disease Insurance Plan
3.) Where can I find information and rates for all of these benefit plan options?
The plan summaries, monthly rates, agent contacts, and claim forms are all available on the Cypress-Fairbanks ISD Insurance Department web page at http://www.yourbenefitstation.com/html/cy-fair%20ppo.htm
4.) Where can I get claim forms?
Claim forms for all of the district benefit plans are on the Cypress-Fairbanks Insurance Department web page at
http://www.yourbenefitstation.com/html/pdf_files.htm
5.) When is the district’s Annual Enrollment Period?
The Annual Enrollment Period normally is conducted between March 15 and April 15 each year. The effective date of coverage for all enrollments and changes made during that period is May 1.
6.) Do I have to enroll in a district insurance medical plan?
If you are a full-time employee - Yes, it is mandatory. If you are a part-time employee - No, it is voluntary.
The alternative plan for full-time employees who have major medical insurance coverage elsewhere is the Hospital Indemnity Plan. It pays $100.00 per day for each day of hospital confinement with a minimum four-day stay. Maximum benefit is $1,000.00 per confinement. This plan is not major medical insurance and does not cost the employee a monthly premium.
7.) I was just hired by the district. When will my insurance become effective?
A newly hired employee’s major medical and basic life insurance coverage will be effective on his/her first full day of paid employment. Any optional plans a new hire enrolls in will be effective on the first day of the month following employment or following the receipt of his/her enrollment documents, whichever is later.
8.) Are there pre-existing condition limitations or exclusions for newly enrolled participants in the major medical plan?
No, Cypress-Fairbanks ISD has no pre-existing condition limitations or exclusions on the Cypress-Fairbanks ISD PPO Plan or HMO Plan. There may be some pre-existing condition limitations imposed on the district’s indemnity dental plan, please check that plan’s summary of benefits for clarification.
9.) I am terminating my employment with Cypress-Fairbanks ISD. When will my benefit coverages be terminated?
Major medical insurance coverage is terminated on the last paid day of a terminating employee’s employment. If you terminate your employment as of November 13, your medical insurance coverage is terminated November 13. Any optional benefit plans you are participating in will be terminated at the end of the month following your termination of employment (i.e. November 30).
However, if you are a contracted professional employee (teacher, paraprofessional, administrator) and you complete your annual work contract and notify the district of your intention not to return to Cypress-Fairbanks ISD the following school year, your insurance will terminate on the date of your final paycheck. For teachers, that is ordinarily July 31.
10.) Can you change your mind about enrolling yourself or your dependents in the insurance plan during the year? Alternatively, your spouse changed jobs July 18 and lost his/her medical and/or dental insurance, what can our family do?
Employees are generally eligible to enroll him/herself and dependents in the district's group health insurance benefits when they are first hired and once a year thereafter during the annual renewal or open enrollment period. Once an employee elects to enroll, or not to enroll, that election is irrevocable for the entire plan year (May 1 through April 30) because of the district’s Premium Only Plan (see above).
The election can only be changed when the employee or his/her dependent experiences a "qualified change in family status". The request to change coverage must be made within 31 calendar days of the qualifying event, be consistent with and on account of the event and must be submitted with written evidence of the qualifying event. A qualified change in family status is limited to the following events:
· a spouse's change in employment status
· marriage or divorce
· birth, adoption, or placement of a child
· death of a dependent
· a dependent child's loss of eligibility.
If you or your dependent experience something you think may be a qualifying event you should contact the district's Payroll Department as soon as possible. Any change you wish to make in your coverage as a result of a qualifying event must be made within 31 calendar days of the event. The coverage change is normally made retroactively to the date of the qualifying event.
11.) If I get married what do I need to do?
Contact the Personnel Department and ask them to send you a Name Change packet. It will have the following forms you’ll need to officially change your name and/or address with the district.
· Name Change Form (if you have changed your name.)
· W4 Federal Income Tax Withholding Form (if you want to change your filing status and withholding exemptions)
· Texas Teachers Retirement System Beneficiary Change Form
· Cypress-Fairbanks ISD Medical Insurance Plan Change Card (to change your name and/or add new spouse to your coverage)
· Beneficiary Change Card for Basic Life Insurance
· Beneficiary Change Card for Supplemental Life Insurance
· Contact the Payroll Department for the following additional forms if you are participating in any of these other programs.
· Disability Insurance Beneficiary Change Form
· Tax Deferred Investments:
· 403b Plan - Contact you investment firm or agent to change your name, address and/or beneficiary.
· 457 Plan – Contact Invesmart to change your name, address and/or beneficiary
· 401a Plan – Contact the office of the Assist. Superintendent for Finance for a Beneficiary Change Form
If you want to add your new spouse and/or newly acquired stepchildren to your medical and/or dental plan(s) contact the Payroll Department for the appropriate forms. They will need documentation of your marriage. You must present the required change forms to the Payroll Department no later than 31 days after your date of marriage. Coverage for your new spouse and/or newly acquired children will be retroactive to the date of your marriage.
If you want to cancel your own coverage because your new spouse is adding you to his/her employer’s plans you will need to provide the Payroll Department with documentation of your marriage and evidence that your new spouse has added you to his/her coverage. You must present the change forms to the Payroll Department no later than 31 days after your date of marriage. Your coverage will be terminated retroactively to the day before your new coverage took effect.
12.) If I get a divorce what do I need to do?
If you wish to enroll in district coverage or cancel your former spouse’s coverage you must notify the district’s Payroll Department no later than 31 days after your divorce is final. You must present a certified divorce decree (signed by the judge) in order to make changes to your benefit elections. If you wish to enroll in district coverage you must also show evidence that you have been cancelled from your former spouse’s coverage because of the divorce. Coverage change effective dates will be retroactive to the date of your divorce. COBRA extended coverage is offered to your former spouse if he/she is losing coverage because of the divorce. Please provide his/her current address and we will mail the COBRA notice.
13.) Who is an eligible dependent?
Eligible dependents include your spouse, your unmarried, dependent child or grandchild from birth to age 25, and children of your covered dependent children. A child is: your biological child, your stepchild, your adopted child, or a child placed for adoption with you; or any child who is related to you by blood or marriage who is primarily dependent on you for care and support, and lives with you in a parent/child relationship. You must show evidence that the child is a dependent on your federal income tax return.
14.) How do I add a new baby to my medical plan?
If you wish to add your newborn to your medical plan you MUST complete the written change request NO LATER THAN 31 DAYS after the birth. To add newborn coverage you will need to present the child’s birth certificate or some other document that verifies your child’s name and date of birth. You’ll also need to complete a medical plan change card, adding the child to your plan.Your newborn’s coverage will be effective retroactively to the date of birth. We will also need your child’s social security number at the time of enrollment or as soon as you receive it.
15.) Can I insure my Common-law spouse?
A common-law spouse may be insured with the district’s receipt of a Common-Law Affidavit.
16.) Can I insure my domestic partner, dependent parents or grandparents?
No. At this time the district’s policies only cover persons specifically listed as eligible dependents above.
17.) What is COBRA?
COBRA or the Consolidated Omnibus Reconciliation Act is a federal law that mandates employers to offer employees and their families the opportunity to obtain temporary extension of health coverage at the group rate in certain instances where coverage under the plan would otherwise end. The employee and each covered dependent has an independent right to request COBRA coverage.
An employee or an employee's dependent covered by a district health insurance plan (medical or dental), may extend coverage for a period of up to eighteen (18) months if the employee’s/dependent's coverage is lost due to the occurrence of any of the following qualifying events and the employee or dependent is not covered by any other group health insurance plan:
· voluntary termination of employment (e.g. retirement);
· involuntary termination of employment (other than for gross misconduct);
· temporary disability leave; or
· reduction in hours.
COBRA coverage may be extended to a total of twenty-nine (29) months in certain cases of disability.
A covered dependent may elect COBRA coverage for a period of up to thirty-six (36) months if coverage is lost due to one of the following qualifying events:
· the employee's death;
· divorce or legal separation from the employee;
· the employee becomes eligible for Medicare;
· or a dependent child ceases to be dependent because of age, financial dependency status, or marriage.
18.) How much does COBRA coverage cost?
The cost for COBRA extended coverage is 102% of the total premium (the amount you and Cypress-Fairbanks ISD have been paying for health insurance coverage, plus a 2% administration charge). If the cost for COBRA coverage changes during your participation you will be notified of the new premium in writing prior to its due date.
19.) When will I receive notice of the COBRA extension offer?
Both you and Cypress-Fairbanks ISD have responsibilities when certain events occur which qualify you for continued coverage. You or a covered dependent have the responsibility to inform Cypress-Fairbanks ISD of a divorce, legal separation, or a child losing dependent status under the group health plan within sixty (60) days of the qualifying event. Cypress-Fairbanks ISD will then notify any other covered dependents that are affected by the event of their right to elect COBRA coverage. Cypress-Fairbanks ISD has 14 days from the notification of a qualifying event to send notice about the extension option. If your Cypress-Fairbanks ISD employment status changes (employment termination or a change in your hours that results in your ineligibility) the Insurance Department will send you the COBRA notice when they receive notice of your employment status change from the district’s Personnel Department.
20.) How long do I have to make a decision to pick up the COBRA extension offer or to decline it?
You and/or your dependents have 60 days from the date your coverage was terminated or the date the COBRA notice was sent (whichever is later) to enroll for COBRA extended coverage.
21.) What are the HIPAA Privacy Rules?
The Privacy Rules are mandated by the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”). Generally speaking, HIPAA governs many aspects of plan design and operation for group health plans sponsored by employers. The Privacy Rules are part of HIPAA’s Title II, which imposes so-called “Administrative Simplification” on these plans. The Privacy Rules control how a group health plan (and others) may use or disclose “Protected Health Information” (“PHI”), and require these plans to give participants and beneficiaries certain individual rights with respect to their personal PHI. For additional information and a copy of the Cypress-Fairbanks ISD HIPAA Privacy Notice, see the Cypress-Fairbanks ISD Employee Handbook.
22.) What is Family Medical Leave (FML)?
Family Medical Leave is a federally mandated benefit that generally entitles qualified employees up to 12 weeks of unpaid leave per year for the:
· birth of a child
· adoption of a child or placement of a foster child
· care of a spouse, parent or child with a serious health condition, or
· recovery from an employee’s own serious health condition.
Covered employers must maintain any preexisting health coverage during the leave period and, must reinstate the employee to the same or equivalent job position upon conclusion of the leave.
23.) When is an employee eligible for Family and Medical Leave (FML) benefits?
To be eligible for FML an employee must
· have worked for the employer for at least 12 months, even if not consecutive months;
· have worked at least 1,250 hours during the twelve months immediately preceding the commencement of the leave;
·and have certification from a health care provider documenting the serious health condition.
24.) Who do I need to contact to apply for Family Medical Leave?
To apply for FML contact the district’s Personnel Department.
25.) What is the difference between a PPO and an HMO plan?
Both a Preferred Provider Organization (PPO) plan and a Health Maintenance Organization (HMO) plan use provider networks. Medical providers in both types of plan networks have contracted to provide their services and facilities to plan participants at reduced costs.
Participants of a PPO plan have complete freedom in choosing physicians and medical facilities whenever in need of care. If the PPO participant chooses to use a provider outside of the PPO network, there is still insurance coverage available for the services, but the deductibles and co-insurance will be considerably higher than if the services of a network provider had been utilized. In-network providers can be seen for non-surgical office visits for co-payments of $25 to $35. Claims need only be filed for major medical services related to lab, x-ray, surgical, and hospital charges. Calendar year deductibles and co-insurance are out of pocket costs to the participants when major medical services are received.
Participants of an HMO plan MUST use providers in their provider network or risk not having any coverage for the services received. All HMO participants must designate a network physician as their Primary Care Physician (PCP) at the time of enrollment. All care received by the participant must then be directed by the PCP, including all referrals to specialists. When using HMO network providers participants pay co-payments of about $20.00 for most office visit services; $150 a day for hospital confinement. There are no claim forms to file and no annual deductibles or co-insurance charges to pay.
26.) PPO: What provider network is the district’s PPO plan contracted with?
The district has contracted with the Cigna HealthCare Preferred Provider Network PPO for network provider services.
27.) HMO: What provider network is the district’s HMO plan contracted with?
The district has contracted with Cigna Healthcare’s “Houston Select.”network for HMO provider services.
28.) Does the district have a prescription drug benefit?
Yes, both the PPO plan and the HMO plan have their own prescription drug benefits. Advance PCS is the prescription drug provider for the PPO plan. The CIGNA HMO has a Cigna prescription provider. Both plans make prescription drugs available for co-payment charges. Both plans have retail benefits (for up to 30 day supply) and mail service benefits (for up to 90-day supply) available. Both plans use formulary listings of preferred medications.
29.) What is a prescription drug formulary?
A formulary is a list of commonly prescribed medications adopted by a prescription drug plan as its preferred dispensing selections. These drugs are chosen by a team of doctors and pharmacists for their clinical effectiveness, safety, ease of use, and value. The formularies are developed to assist the physicians and patients in selecting medications with the most therapeutic value. The list is distributed to providers, pharmacies, and/or plan participants and offers guidelines for cost-effective prescribing. Cypress-Fairbanks ISD’s PPO Plan formulary can be viewed and printed at the district’s web site at http://www.yourbenefitstation.com/html/pdf/advance_pcs_formulary.pdf.
30.) PPO: How do I select a PPO provider (doctor, hospital)?
To see which physicians participate in the CIGNA HealthCare PPO plan in your area, search the CIGNA online Provider Directory (www.cigna.com), visit the Cypress-Fairbanks ISD website (www.cyfairisd.net) or call the number on the back of your ID card. You may select a network or non-network doctor, but remember that using a participating doctor could save you money. In addition, you eliminate the hassle of claim forms when you choose in-network care.
31.) PPO: Do I need a referral to go to a PPO specialist?
No. If you need to see a specialist, you're free to choose any qualified doctor, inside or outside the CIGNA HealthCare network. Although referrals are never required, the doctor providing your primary care can probably make some helpful suggestions as to which type of specialist you should see. Your out-of-pocket costs may be lower if you see an in-network specialist.
32.) PPO: Can I choose a doctor for each member of my family?
Yes. Each covered family member can choose his or her own doctor from the broad network of participating physicians.
33.) PPO: Is emergency care away from home (out of town, state, country) covered?
Yes. You are always covered wherever you are in the event of a true emergency.
34.) PPO: How do I file a PPO claim?
If you receive care from a CIGNA HealthCare participating provider, your
Doctor's office takes care of filing the claim. You simply pay your office visit co-payment at the time of service. Depending on your type of plan, once CIGNA HealthCare has paid its portion of the charge, the provider will (balance bill) you for any applicable deductible or co-insurance amount. If you go outside the network, your doctor's office will bill you directly, as in a traditional insurance plan. You'll need to submit a claim form to CIGNA HealthCare for reimbursement. The reimbursement will cover a percentage of the bill, after you've met your annual deductible. Claim forms can be obtained from the CIGNA web site (www.cigna.com), the Cypress-Fairbanks ISD website (www.cyfairisd.net) or from the insurance department. Fill out the claim form and send it to the claims address on your CIGNA HealthCare ID card.
35.) What is the difference between the Cypress-Fairbanks ISD PPO Plan and the Cigna HMO- Select Plan?
In the PPO plan, you have in-network and out-of-network benefits. Your benefits are richer (your cost saving are more) for using doctors and medical facilities that are in-network, but you have coverage (benefits) if you use doctors and medical facilities that are out-of-network. You do have to meet a deductible before your benefits begin, except for your doctor visit co-payments.
In the HMO-Select plan, you must choose a Primary Care Physician, who will then refer all your specialty care. You must stay within an Independent Physician's Association (IPA) or if you choose an independent physician, verify with Cigna or the Insurance Department to make sure the doctor is in the HMO-Select network. There are no deductibles to meet in the HMO-Select plan; you pay co-payments at the time of service.
36.) Do either the Cypress-Fairbanks ISD PPO Plan or the CIGNA HMO-Select Plan have pre-existing condition limitations?
No pre-existing limitations or exclusions apply to the Cypress-Fairbanks ISD PPO Plan or the Cigna HMO-Select Plan.
37.) HMO: What is an HMO?
An HMO (Health Maintenance Organization) is a type of health plan in which your care is managed by your Primary Care Physician (PCP). You must choose a PCP who will then direct or refer you to any specialty doctor you might need to see. Your coverage within an HMO only extends to the physicians and hospitals covered within the designated network. The exception to this is an emergency situation and you are always covered, even at an out of network facility or hospital in an emergency. (See: What do I do in an emergency?)
38.) HMO: What is a primary care physician (PCP)?
A primary care physician, or PCP, is your first or primary source of medical care - your personal doctor. The PCP you choose coordinates all of your medical care, from your annual checkups to referrals to specialists, lab and x-ray services, and hospital admissions. PCP-based care is an effective way to maintain better health; regular physician visits build strong, secure doctor-patient relationships.
39.) HMO: How do I select a PCP?
Simply check the on-line Provider Directory at www.cigna.com, or view the "Tips for Finding a CIGNA Physician" (PDF icon) at www.cfisd.net (go to Department, then Insurance) or go to your CIGNA Provider Directory to see a listing of participating PCP's in your area. You can choose from doctors in the fields of Family Practice, General Practice, Internal Medicine or Pediatrics.
Kelsey-Seybold is the largest and most accessible Independent Physicians Association (IPA) in the Cypress-Fairbanks area. There are two facilities in the Cypress-Fairbanks area, one in Copperfield on Highway 6 North and the other on the fourth floor of the Methodist Willowbrook Hospital on SH 249, just north of FM 1960. With a Kelsey-Seybold designated PCP, members can self-refer to Kelsey's large specialist network. Most of their specialists are located at their facility in the Medical Center, located at 2727 W. Holcombe Blvd.
40.) HMO: Can I change my PCP?
Yes, you can change your PCP for any reason - if you move, if your family situation or medical need changes, or if you're just not happy with your present PCP choice. However, changing PCP's often is not recommended. You and your doctor need time to get to know each other and develop a relationship with open communication so your doctor can provide you with the most medically appropriate care. You can change doctors once in a month and the change is effective on the first of the month following the date you notify CIGNA HealthCare. For example, if you notify CIGNA on June 15, the change will be effective on July 1.
Once you select a new PCP, call Member Services at the toll-free number on your CIGNA HealthCare ID card to verify the doctor you've chosen is accepting new patients. You can change your PCP over the telephone at that time or over the Internet from the Provider Directory detail page about that doctor. Simply click on the doctor's name and follow the step-by-step instructions. You can, also access changing a PCP on mycigna.com.
41.) HMO: Can I choose a different PCP for each member of my family?
Yes. Each covered family member can select his or her own PCP from the network of participating general and family practice physicians, internists and pediatricians.
42.) HMO: What do I do in an emergency?
In an emergency, always seek medical care immediately. Go directly to the nearest emergency facility or call 911. As CIGNA HealthCare members, you and your family are covered for emergency medical services anywhere (out of town, state and country), 24 hours a day. An emergency is an accident or sudden illness that a person believes he or she should be immediately treated to avoid loss of life, serious medical complications or permanent disability.
You can go to any emergency facility or hospital, even if the facility is not in the CIGNA HealthCare network and you will be covered. You do not need a referral from your PCP or any authorization before receiving emergency care. You should call your PCP (or have someone call for you within 48 hours) for further assistance and directions on follow-up care.
43.) HMO: Am I covered for emergency and urgent care away from home?
Yes, you're covered for treatment of any life-threatening emergency and any serious illness or injury wherever you are, out of town, state and country. You should call your PCP (or have someone call for you within 48 hours) for further assistance and directions on follow-up care.
44.) HMO: How do I file an HMO claim?
In-network claims do not require claim forms. When you see a network physician or go to the hospital, show your CIGNA HealthCare ID card so the physician knows to bill CIGNA. If you receive a bill from the physician, review the bill to make sure it's not an "information only" statement. Most physicians will send you a statement showing the total amount due and informing you they billed the health plan. If it is a bill, ask the physician if they've submitted the bill to CIGNA HealthCare. Most physicians' offices use systems-generated billing where their computer automatically sends out the bill. Physicians belong to many different health plans and may not have billed CIGNA HealthCare correctly.
45.) HMO: How do I get a referral to see a specialist?
If you need the attention of a specialist, your PCP will provide you with a referral. He or she will also notify your health plan, help you choose a specialist and arrange the office visit. Routine referrals are usually handled within 10 days. In urgent situations, the referral can be approved on the same day, by phone.
46.) HMO: Do I need a referral to see my obstetrician/gynecologist (OB/GYN)?
No. You can visit your CIGNA HealthCare participating OB/GYN for covered obstetrical or gynecological services without a referral from your PCP. You must stay within the Independent Physician Association (IPA) that you have chosen for your primary care. For example, you cannot choose your PCP from Kelsey-Seybold and have your OB/GYN be an Independent Physician.
47.) HMO: Do I need a referral to go to a hospital?
Seek appropriate care immediately in an emergency situation, you don't need a referral or any other authorization to go to an emergency facility. (See: What do I do in an emergency?) For planned hospital stays, prior to your admission you or your doctor must call the number on your ID card to request "pre-admission certification". Pre-admission certification verifies the medical necessity for your hospital stay.
48.) Does Cypress-Fairbanks ISD provide basic life insurance to its employees?
Yes, a district-paid term life insurance benefit, underwritten by ReliaStar Life Insurance Company, is available to all qualified employees covered by a district group medical insurance plan. The plan benefit is for $15,000 life insurance with an additional $15,000 accidental death and dismemberment (AD&D) insurance.
49.) Is there additional life insurance available that I can purchase?
Yes, you may purchase the optional supplemental life insurance for an additional $15,000 or an additional $35,000. The supplemental life policy does not have added accidental death and dismemberment coverage.
50.) Can I buy life insurance for my spouse or children?
No, the supplemental life insurance is only available for employees.
51.) What are my Dental plan choices with Cypress-Fairbanks ISD?
There are four dental choices for the current plan year.
Fortis Indemnity Dental Plan – This is traditional insurance with deductibles ($50.00 per plan year) and co-insurance (100%, 80% or 50%) payments. However, it allows you complete freedom to choose any dentist you want. The plan may have pre-existing conditional limitations or exclusions and waiting periods for some services. Please read the plan summary and call the agent if you have questions before enrolling.
Pinnacle DHMO Dental Plan – This plan is a pre-paid plan. Approximately 60% of your monthly premium is paid to the primary care dentist you enroll with. You must choose a primary care dentist at the time of enrollment. Each member of your family can enroll with a different primary care dentist. You can change your dentist selection at any time by contacting the plan’s customer service department. When you receive dental services you will be charged co-payments. There are no annual deductibles to be met; no claims to file. The co-payment schedule and network provider list is included with the plan’s summary of benefits in the enrollment packet.
Ms of A Dent-All Plan – This is a discount dental plan offering a discounted fee schedule for services received from participating providers. The participating providers are listed in the enrollment packet.
QCD of America Dental – This is a scheduled plan offering; scheduled (discounted) fees for services received from participating providers. The QCD provider network directory is available on line at www.qcdofamerica.com.
52.) Does Cypress-Fairbanks ISD have a vision plan?
No, however, all four of the dental plans have vision discount programs attached to them.
53.) What is disability insurance?
Disability insurance is protection for your paycheck. The insurance pays you an income benefit in the event you become disabled and are unable to work. Remember, the district can only pay you for sick and personal days that you have earned. If you are unable to work because of an illness or accidental injury and you have expended all of your available earned sick days you will not receive a paycheck.
54.) Does Cypress-Fairbanks ISD offer disability insurance?
Yes, it is an optional employee paid benefit available to all employees who work 15 or more hours a week. Unum Life Insurance Company of America has underwritten the disability insurance. The plan is guaranteed issue, meaning no health questions to answer, for those that enroll within 31 days of their initial hire date (subject to 12-month pre-existing condition exclusion). Disability due to pregnancy or complications of pregnancy is covered on the same basis as a sickness. Benefits may be purchased for up to 66% of your monthly earnings, to a maximum monthly benefit of $7,500. Late entrants, those applying for coverage after their 31 days of eligibility period (such as during the annual enrollment period), must complete a health questionnaire and be approved for the coverage by the insurance company.
55.) Does Cypress-Fairbanks ISD offer a cancer & dread disease plan?
Yes, it is an optional employee paid benefit that is available to all Cypress- Fairbanks ISD employees. Hartford Life Insurance Company has underwritten the cancer & dread disease plan. Coverage becomes effective the 1st of the month following the insurance company's approval of the employee's application. The plan pays a cash benefit to the insured for medical services received for the diagnosis or treatment of cancer or any of the covered named diseases.
[Insurance Home Page]
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