1 2018 . Health care Handbook Making the most of your medical benefits 2 0 1 8 H E A LT H C A R E H A N D B O O K. This guide is intended to help you understand your high deductible Health plan's medical and prescription drug coverage and Health savings account. Share it with any family members covered under your MassMutual medical benefits. See page 16 for phone numbers and websites. You may view this booklet online anytime on FieldNet > My Practice > Benefits (look under Health and Welfare). R E A D O N TO M A K E T H E M O S T O F YO U R M E D I C A L B E N E F I T S , I N C L U D I N G : 1 Going to the doctor 13 Making use of your medical 4 Filling a prescription coverage extras.
2 7 Understanding your medical and 15 Maximum Reimbursable Charge:'. prescription drug coverage Is that a thing? 9 Getting your preventive care 16 Get answers to your benefit questions 10 Using your Health savings account (HSA). DISCLAIMER: This communication provides some basic 2018 benefits information. It has been prepared for career contract agents, sales managers, General Agents and General Managers of the Massachusetts Mutual Life Insurance Company who are enrolled in or eligible for a MassMutual high deductible Health plan option. It is not for agents covered under MCS or Cigna PPO Hawaii, nor is it for retired career agents, field staff or MassMutual employees.
3 This is not a summary plan description (SPD) or summary of material modifications (SMM). Your receipt of this material is not a promise or guarantee by the company of your eligibility for any one or all the benefits and programs described. The company reserves the right to terminate, modify, amend or suspend any or all of its benefit plans and programs at any time, and from time to time. In case of conflict between this information and the plan terms, the plan terms and documents shall govern. Provisions are based on current law and regulations, which are subject to change.
4 Going to the doctor Talk to your doctor's office Present your about your coverage Cigna ID card Use to see whether or not When you arrive for your appointment, your doctor is in the Cigna Open Access Plus present your Cigna ID card. Your card network. As a participant in MassMutual 's identifies you as a Cigna medical participant high deductible Health plan Option 1 or and signals the doctor's office to bill Cigna Option 2, you can receive services from directly for services rendered. providers regardless of whether they're Generally, an in-network provider's office will in- or out-of-network.
5 If you use in-network not require payment at the time of your visit. providers, it'll likely cost you less. Certain Why? Because the exact amount you owe is preventive care is covered at 100% in network, usually not known until your claim is processed. and covered at 100% up to the maximum Typically, your provider's office will send reimbursable charge (MRC) out-of-network the claim directly to Cigna. However, an (see page 15 for more about MRC). out-of-network provider's office may require When you call your doctor's office to make an you to pay at the time of service and submit appointment, let the office know that you have the claim to Cigna yourself.
6 A high deductible Health plan through Cigna and ask to be billed after your claim has been processed by Cigna. 1. Review your EOB Before you've met your annual deductible, you'll pay 100% of Once your claim has been submitted, Cigna Cigna's negotiated rate for eligible will calculate any applicable discounts, pay the in-network care , and 100% of eligible plan's portion of covered services (if any), and out-of-network charges. send you and your provider an Explanation of After you've met your deductible, you'll Benefits (EOB). EOBs explain Cigna discounts, pay only coinsurance for in-network how much the plan has paid and how much care , or coinsurance plus any charges you'll be expected to pay.
7 EOBs are not bills; over the MRC for out-of-network care . your doctor's office will send you a separate If you reach your annual out-of-pocket bill based upon this information. maximum, the plan will pay 100% of charges for eligible in-network care , or Pay your portion of the bill 100% of charges up to MRC for eligible out-of-network care . When you get the bill, pay your portion of the cost for services. If you choose to pay for If you use an out-of-network provider who qualified Health expenses using your Cigna will not submit the insurance claim on your Choice Fund Health savings account (also behalf, you'll need to submit a claim form to referred to as an HSA), there are several ways Cigna.
8 Cigna will then pay the plan's share (if to do so as long as you have enough money in any) of covered services and apply eligible your HSA. See page 10 for details. amounts toward your annual deductible With a high deductible Health plan, the and out-of-pocket maximum. You will be plan begins to pay a portion of covered responsible for paying your portion of any medical expenses after you've met your covered services and any charges above the annual deductible. MRC (see page 15 for more about MRC). Contact Cigna for details. Download the free myCigna Mobile App from the App Store or Google Play.
9 Call Cigna anytime, day or night at 1-800-548-3980 and visit Use their web tools and expertise! 2. I F Y O U ' R E A S K E D T O P AY AT T H E. TIME OF SERVICE, ASK QUESTIONS. T O U N D E R S TA N D Y O U R O P T I O N S. There may be times when you're asked to pay while you're in the office before you get your EOB. Asking the provider or office staff a few questions (like those below). can help you make payment arrangements that you're comfortable with. Would you please use the Cigna Cost of care Estimator to print out an Explanation of Estimate for me? (This tool will show your provider your estimated bill, what the plan will pay, and any charges subject to deductible or coinsurance.)
10 Can you check my deductible status and my coverage for this service? . Can I pay a portion now and have you bill me for the rest once you've submitted the claim? . Questions about payments? Call Cigna anytime, day or night at 1-800-548-3980. 3. Filling a prescription If you're covered by a MassMutual medical option, your prescription drugs are covered by Express Scripts (not Cigna). Present your Maintenance medications: Express Scripts Two ways to save ID card Long-term prescriptions, called maintenance When you go to the pharmacy to fill a medications, include prescription drugs that prescription, the pharmacist will check your are generally taken on a long-term basis for a benefits with Express Scripts, then tell you the variety of chronic conditions.