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Frequently Asked
Questions about Benefits
 Q.
What is a co-pay?
Q.
What is a
deductible?
Q.
What is the
difference between the individual deductible and the family
deductible?
Q.
What is
coinsurance?
Q. What is an
Out-Of-Pocket Maximum?
Q. Do the charges I
pay for my prescriptions count toward my deductible or Out-of-Pocket
Maximum?
Q. How does the change in the
prescription drug plan work?
Q. How do I find the lowest
cost of prescriptions?
Q. What will I have to pay for
my surgery (childbirth)?
Q. What happens if I am in
the hospital on Dec. 31st?
Q.
I just took my child to the doctor and paid the office visit copay.
Why have I now received a bill for lab work done?
Q.
How do I add my new
baby to the Health Plan?
Q. I
just found out I am pregnant, are there any special programs
available to me?
Q. Does Irving ISD provide
discounts for gym memberships or lasik surgery?
Q. What is a Health Risk
Assessment and how do my family and I take it?
Answers:
Q.
What is a co-pay?
A.
A co-pay is a set dollar amount that is
your portion to pay for specific health care expenses such as for
doctor office visits: $30 on Base Plan, $50 for a Specialist.
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Q.
What is a deductible?
A. A
deductible is a dollar amount that you must meet by paying for
medical services before the insurance company will begin to pay for
your health care expenses. Our plans cover your expenses for an
office visit, after co-pay, without requiring you to first meet your
deductible.
For all
three district plans, there is a $1000 Individual Deductible and a
$2000 family deductible.
The
district’s plan has a Calendar year deductible (Jan through Dec).
On January 1 of each year you will have a new deductible to satisfy before
coinsurance will begin.
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Q.
What is the difference between the
individual deductible and the family deductible?
A. Individual
deductibles is the amount of money that one person in your family
must meet (by paying for health care services) before the health
plan will begin paying a part of the charges. If there is more than
one person on your health plan, after two people have met their
deductible, all other individuals will be able to use the services
without meeting another deductible.
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Q.
What is coinsurance?
A. After
you have met your deductible, coinsurance is the percentage of
health care cost for which you are responsible (30%) and also the
percentage the health plan is responsible for (70%). You continue
to pay a percentage of all charges up to the Out-of-Pocket Maximum.
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Q.
What is an Out-Of-Pocket Maximum?
A. The Out-of-Pocket Maximum (OOP) is the
dollar amount that is the greatest amount of coinsurance (% of
bills) that you will have to pay in one plan year. Your office
visit, ER, Hospital and Urgent Care copays do count toward
your OOP. The OOP does not include your deductible.
For the Base plan, the OOP
is $7000 for an individual and $14,000 for a family.
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Q. Do the charges I pay for my
prescriptions count toward my deductible or Out-of-Pocket Maximum?
A. No, your prescription charges do not count
toward the deductible or the out-of-pocket maximum. The only limit
on the cost of prescriptions is new $1000 threshold for each
refill. Maximum you pay per refill is 30, 40 or 50 percent of the
first $1000 of cost of the medication.
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Q.
How does the prescription drug plan work?
A. There is a limit to the amount employees
have to pay each time they fill a prescription. The limit is set at 30, 40 or 50% of the first $1000
of cost for medications. This means that employees would pay up to
$300 for generic; $400 for preferred brand name where no generic is
available and $500 for non-preferred brand name medications where no
generic is available.
For Example: Keppra
(500 mg) costs $1,224.79 for a 90 day supply
Preferred Brand Name Drug 40% coinsurance
$1,000 * .40 = $400
You pay $400 total for this refill.
Note
that a penalty equaling the difference in the cost between preferred
or non-preferred brand name and an available generic must be paid
before the application of the coinsurance toward the cap. This is
intended to encourage employees to utilize generic medications when
available. If an employee can provide medical documentation showing
that the brand name medication is the only option for them,
contact Cigna as the penalty might be waived.
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Q.
How do I find the lowest cost of prescriptions?
A. The amount you have to pay for
prescriptions depends on what the medication is and where you choose
to shop.
Take
a look at the Prescription Drug List to determine what your
medication is classified as. If it is a Non-Preferred Brand Name
drug, review the list to see if there are any Generic or Preferred
Brand Name alternatives available. Also, take the list to the
Doctor’s office and ask them to see if there are alternatives that
would cost you less. (Cigna
Prescription Drug List 2006.)
To shop around to find the
lowest price for your medications, you can call Cigna Customer
Service 1-800-244-6224 to get assistance in pricing your medication
at area pharmacies or you can log into
www.mycigna.com to search prices at area pharmacies using the
Drug Compare tool. More ideas on pricing are available on our
website at (Where to Shop for RX).
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Q.
What will I have to pay for my surgery (childbirth)?
A. The amount you will have to pay for a
surgery or child birth will depend on the charges billed by the
hospital and physicians involved. The most you would be responsible
for would be your Deductible and Out-of-Pocket Maximum (combined
total of $8000). The lower the cost of the surgery, the lower your
payment responsibility will be.
If you
are planning a surgery that will
be performed in a Hospital, you will be responsible for
meeting the following payments.
Base
Plan Example:
$20,000 surgery and hospital stay charges
You Pay $1000 Deductible
+ $1500 Admission
copay
$2500
$20,000 - $2500 = $17,500 remaining charges
You Pay 30% of $17,500
= $5,250 your coinsurance
Total paid for $20,000 surgery: $2500 + $5,250 =
$7,750
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Q.
What happens if I am in the hospital at the end of the year on Dec. 31st?
A. Your hospital charges will apply to the
deductible and coinsurance of the year you were admitted for the entire length of your stay.
As soon as you are released from the hospital, all future
charges/medical needs will be applied to the new year’s deductible
and out-of-pocket maximum.
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Q. I
just took my child to the doctor and paid the office visit copay.
Why have I now received a bill for lab work done?
A.
Many doctors’ offices will process
their own blood work, urine analysis and possibly their own x-rays.
Sometimes they must send these tests out but will charge for all
services under their own billing. If the doctor’s office sends the
lab work or x-rays off and they are billed separately through the
other vendor (hospital, Quest ect.), you will be responsible for the
charges. These charges will work to satisfy part of your
deductible and/or out-of-pocket maximum.
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Q.
How do I add my new baby to the Health
Plan?
A.
Contact the Benefits Office by calling
972-215-5241 or emailing Maria G. Perez
mgperez@irvingisd.net .
You must provide a copy of the baby’s birth certificate (or copy of
the birth facts provided at the Hospital). Your premium deductions
will be adjusted to reflect any additions if needed. You will also
receive an id card on the new baby within two (2) weeks of adding
the child.
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Q.
I just found out I am pregnant, are
there any special programs available to me?
A.
Cigna has a special program called the
Healthy Babies Program that is for Mothers-to-be. The program
provides special education, access to a toll-free information line
staffed by registered nurses and online encouragement. To enroll in
the program, contact Cigna Customer Service 1-800-244-6224.
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Q. Does Irving ISD provide discounts for gym
memberships or lasik surgery?
A.
Cigna provides discounts on health
programs and services often not covered by many traditional health
plans. The Healthy Rewards program is separate from the Health Plan
and merely provides discounted rates for services. The program
works by seeking Health Services through participating providers.
To find them call 1-800-870-3470 or visit
myCIGNA.com. Sample discounted
programs include:
-
Weight Watchers
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Jenny Craig
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Tobacco Cessation Programs
-
Fitness Club Memberships
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Curves
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Eye exams, frames, lenses and Lasik Vision Correction
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Hearing Exams and Aids
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Acupuncture, Chiropractic Care and Massage Therapy
-
And much much more.
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Q. What is a Health Risk Assessment and how
do my family and I take it?
A. A Health Risk Assessment (Health Quotient) is an
online questionnaire that can help you identify and monitor your
health status. You can also find out how your family health history
may affect you, learn about preventative care and check your
progress toward healthy goals. Click on the link below to get
directions on how to take the survey.
Your Health &
Well Being: Health Risk Assessment
Or you can log into
www.mycigna.com and then look for the questionnaire under
“Health Resources”.
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