Another Way To Help Pay For Medical Expenses

A Cigna Choice Fund^® plan combines an Open Access Plus or Preferred Provider Organization (PPO) medical coverage plan with a consumer health care account. The Open Access Plus or PPO medical plan typically has a deductible, coinsurance and an out-of-pocket maximum.

Options and Coverages

There are two Choice Fund options:

1. Health Reimbursement Account (HRA)
2. Health Savings Account (HSA)

Both options include a consumer account that can help your patients pay the share of health care expenses not reimbursed by their medical plan. This can include pharmacy, dental and vision expenses.

Your patients with this coverage can keep unused HRA or HSA account dollars and apply them to covered health care costs the following year. Careful management enables patients with Cigna administered Choice Fund plans to build their HRA or HSA accounts to help pay for future health care costs.

Reimbursement

Many patients in Cigna administered Choice Fund plans select a feature called AutoPay to pay claims. With this feature, the HRA or HSA account is automatically accessed to pay your claims. This feature helps alleviate the need for your office to pursue patients for applicable coinsurance/deductible payments.

• Choice Fund HRA and HSA
  When AutoPay is selected, the HRA or HSA account is available for eligible services. During the medical claim process, you’ll receive payment directly from Cigna (from both the medical plan and the Choice Fund account) on behalf of your patient. Once the HRA or HSA account is empty, you may bill your patient directly.
  
• Choice Fund HSA
  Your patients with Cigna administered Choice Fund HSA plans also have an option to pay you with a debit card, online bill pay or a checkbook that draws directly from their HSA.
  

There are other Choice Fund programs that aren’t identified on the member ID card. These include FSA plans and incentive award plans. To avoid duplicate payment or patient reimbursement situations, you should not collect deductibles or coinsurance at the time of service, unless you have accessed the Cigna Cost of Care Estimator^® to obtain an estimate of the patient's costs and provide a copy of the Explanation of Estimate to the patient.

Debit Cards: For a patient that has both an HRA and FSA, one debit card can provide patients easy access to account dollars.

The best experience with debit cards is when paired with copay plans. A copay plan allows quick and instant approval of transactions, as opposed to coinsurance plans, which can be more challenging to substantiate. It is not recommended a debit card be used at point of sale for a coinsurance/deductible plan design.

Due to a change in IRS Regulations, over-the-counter (OTC) drugs and medicines no longer qualify for reimbursement from health plan spending accounts.

If you have patients with a HRA, HSA or FSA, and you determine they need an OTC medicine (other than insulin and diabetic supplies), they may ask you to provide a prescription* for that medicine. Under the latest legislation, patients need a prescription to receive reimbursement for any qualified OTC purchases made with funds from their health account.

For a list of eligible IRS 213d expenses you can visit https://www.cigna.com/qualified-health-care-expenses

*The U. S. government defines "prescription" as a written or electronic order for a medicine or drug that meets the legal requirements of a prescription in the state in which the medical expense is incurred and is issued by an individual legally authorized to dispense prescriptions in that state.

Reimbursement Process

The claim submission process is basically the same as the process for any plan with deductibles and coinsurance:

• Coinsurance/deductible amounts should not be collected at the time of service unless you have accessed the Cigna Cost of Care Estimator^® to obtain an estimate of the patient’s costs and provide a copy of the Explanation of Estimate to the patient.
• Submit the claim as usual.
• The amount the patient owes is determined by the claim settlement process under the medical plan’s terms.
• You receive an Explanation of Payment (EOP) or Explanation of Benefit (EOB) from the medical claim system.
• For most of the claims process, a single remittance EOP or EOB will reflect the claim processing for the medical plan. It will also provide access to the available account dollars as authorized through ACF.
• Sometimes, to ensure timely claim processing, the medical plan and the health account processing are separate. See if the medical plan EOP or EOB has this remark code: “Final payment determination will follow the review of available funds in a Cigna Choice Fund Health Reimbursement Account or Flexible Spending Account.” That code means the remaining amount the patient owes has been sent to their account for consideration.
• In these cases, you receive a second EOP or EOB (and a check, if funds are available) from Cigna Choice Fund along with the final amount your patient owes. You receive EOPs or EOBs on the same day or a few days apart. In rare situations, you may receive the Choice Fund EOP or EOB before the medical plan EOP or EOB.
• Then you may bill your patients for the final amount they owe as shown on the Cigna Choice Fund EOP.