What exactly is a PPO Style plan?
A health plan in which members can choose to see any provider in the PPO provider network without a referral. Members also have the freedom to use non-network providers for most services if they are willing to pay a higher share of the cost.
What does max out of pocket mean?
The most you are required to pay in combined deductible, copayment, and coinsurance amounts for all of the covered services each plan year (Sept 1 – Aug 31).
A group of providers – including hospitals, doctors, specialists and other healthcare providers – that have agreed with Cigna PPO to provide benefits for a specified amount. We have a search portal link on our website. You need to use this portal as we have a couple of instructions that are important before searching the network.
What is a deductible?
The amount you pay each plan year for most benefits before your PPO Plan begins to pay. Some benefits, such as preventive care, are covered before you meet your deductible.
What is Coinsurance?
A fixed percentage of the cost of your services that you’re responsible for. This is usually after you’ve met your deductible.
I am a policyholder and I am turning 65 soon. My spouse is younger than me and is on my policy. What happens to my spouse’s coverage when I go onto a medicare plan?
Unlike just about every plan out there on the market, your spouse can actually stay right in place on your current plan with us. We will change your spouse to become the primary policyholder and re-rate the premium to the individual level. Simply let us know when your’e making the change.
What is my plan year?
Our renewal month is September. This means that in late July you are noticed of any upcoming changes that will occur September first. You do not have to do anything unless you would like to make a plan change or to exit the plan. A qualifying event is needed to exit the plan mid-year ( new job with proof of insurance coverage, going to medicare, etc
How do I know if my current doctor is in the network?
You may check the provider network on our site. Open the specific plan youre looking at and scroll down to the provider search link button and follow the simple instructions for the search.
Cigna has a million providers including 6000 hospitals nationwide. It is huge.
I am a retired law enforcement officer. I am covered on my own policy ( or have moved onto Medicare), but my spouse is not covered. Can my spouse have a policy?
Yes. You ( the retired officer) simply need to join Thin Blue Line Benefits Association as a member ( list your spouse on that membership form). You will also need to ensure that you are or become an FOP member. Your spouse enrolls into a policy as the primary policyholder.
Can I pay my premiums with a credit card?
No. We only utilize ACH automatic payments from you bank account.
I have a vacation home in another state where I reside part of the year. Does my plan work there?
Yes. You have full Cigna PPO network access anywhere in the country!
I receive a stipend for retiree health plans from my former employer. Can I use that here?
We have thousands of policyholders that receive reimbursements from their former employer or from their pension fund that are allowed to be used on ACA compliant qualified health plans. While we do not accept direct third party payments, if you get reimbursed you should have no problems at all. Please check with your employer.
I am a retired law enforcement officer and it looks like a need to join the FOP if I want this insurance?
Yes. Our plans are marketed exclusively through the FOP nationwide. If you’re not currently an FOP member, you will need to join the FOP as a retired member in order to purchase benefits. It is no different that joining a retail club membership such as Costco or joining the AARP in order to obtain their exclusive member benefits. The FOP offers retirees fantastic benefits including legal defense for CCW at an outstanding value. You simply join your local lodge. Details are on our website, or see thinbluelinebenefits.com/nfop/
How do I know if my medications are covered?
If you are a current policyholder, simply contact Orchestra Rx ( listed on your card and in your dashboard) to ask. If youre not a policyholder email us at [email protected]. Most generic meds are in the formulary across all three plansand have a copay between $0-$15. Many name brand drugs are covered on PRIME and ULTRA plans. Some specialty meds are covered on the ULTRA plan. Copays and deductible may apply with Tier II-IV Rx.
Prescription (Rx) formularies change constantly. Drug pricing can fluctuate and drugs themselves can go in and out of a drug formulary. This is the case no matter what coverage you have anywhere in the country.
Can all of my family members be covered?
Immediate dependent family members can be covered ( dependent children under age 26).
How and when do I receive my Health ID Cards?
Your cards come in two ways. On the first day that your policy becomes effective, you will have digital cards in your portal. Go to you dashboard and open “ID Cards.” You will also receive a card/s in the mail within several days of your effective date. They are mailed from the plan administrator, Kentucky Health Advisors ( don’t throw any mail from them away by accident).
Can I cancel my policy at any time?
No. We have a plan year that runs Sept 1 through Aug 31. In July we send out notifications regarding any changes to our plans that will take place as of September 1. This is also the period of time that you may make a change to your plan ( remove dependents, change to a different plan, or terminate your plan). There is an exception that allows you to terminate your plan outside of this period of time and that is a qualifying life event. This could be a new job that covers your insurance ( we will need proof of coverage ) or you could be going onto Medicare due to you turning 65.