591795 p 11/13 QUICK gUIde to CIgna Id Cards

2012 Starbridge - CIGNA HealthCare PPO
2012 Starbridge - CIGNA HealthCare PPO
Primary Network: CIGNA Primary HealthCare Network: PPO CIGNA HealthCare PPO
Secondary Network: Beech Secondary TPV Street / Alliance Network: Beech Street
Connecticut TPV / Alliance General Connecticut Life Insurance LogoGeneral Company Life Insurance Company
Logo
www.starbridge.com
Primary Network: CIGNA HealthCare PPODoctor Visit Doctor $25 Visit $25
Coverage Effective Date: Coverage 00/00/0000 Effective Date: 00/00/0000
Secondary Network: Beech Street Specialist 7
www.starbridge.com Specialist $25
$25 4
Primary Network: CIGNA HealthCare PPO
Secondary
ID: AMI Network: Beech ID: Connecticut Street AMIGeneral Life Insurance Company Network Coinsurance: Network Coinsurance:
Connecticut General Life Insurance Company
In
Name:
Doctor
In
Visit
80%/20%
$25
80%/20%
Name: Name Coverage Name Effective Date: 00/00/0000 Out
Doctor Visit Specialist
Out
$25 SM80%/20%
3 SM $25
80%/20%
Coverage Effective Date: 00/00/0000
Account Number: Account ID: 2466518 AMI Number: 2466518 Specialist Network $25 Coinsurance:
ID: AMI
Network Coinsurance: In 80%/20%
Name: Name
Group Name:
In Out 80%/20% SM 80%/20%
Name:
Group Name:
Group Number: Group Out
Account Number: Number: 2466518 SM 80%/20%
Account Number: 2466518
Fundamental Care
TPV / Alliance
Logo
Group Name:
Group Number:
TPV / Alliance
Logo
11
Group Name:
A V I A N T N E T W O
A
R K
V I A N T N E T W O R K
Group Number:
• No PCP selection required
A V I A N T N E T W O R K
• No referrals required
• In-network and out-of-network coverage
2012 FundamentalCare 2012 FundamentalCare - CIGNA - HealthCare CIGNA HealthCare PPO PPO
5
A V I A N T N E T W O R K
www.fundamentalcare.com www.fundamentalcare.com
You may be asked to You present may this be asked card when to present you receive this card care. when The you card receive does not care. guarantee The card does not guarantee
coverage. You must comply coverage. with You all must terms comply and conditions with all terms of the and plan. conditions Willful misuse of the of plan. this Willful card ismisuse of this card is
considered fraud. considered fraud.
This plan does not require This plan pre-certification does not require of coverage pre-certification for inpatient of coverage or outpatient for inpatient services. or Claims outpatient will services. Claims will
be paid according to be terms You paid may and according be conditions asked to to terms of present the and plan. this conditions In card the when case of of the you an plan. receive emergency, In the care. case seek The of card care an emergency, does not guarantee seek care
coverage. You must comply with all terms and conditions of the plan. Willful misuse of this card is
You immediately, may be asked then to call present
immediately, your family this card physician then
when
call your
you for further receive
family assistance physician
care. The
for
card and further direction does not
assistance regarding guarantee
and follow direction up care. regarding follow up care.
considered fraud.
coverage. You must comply with all terms and conditions of the plan. Willful misuse of this card is
considered Send Claims fraud. to: TPV Send / This Alliance Claims plan does Mailing to: not TPV Address require / Alliance pre-certification 13Mailing Address of coverage for inpatient or outpatient services. Claims will
This All others plan does to: CIGNA not require HealthCare, All be others paid
pre-certification
according to: P.O. CIGNA Box to 188004, HealthCare, of
terms
coverage
and Chattanooga, P.O. conditions
for Box inpatient 188004, TN of 37422 the
or outpatient Chattanooga, plan. In the Payor services.
case TN 62308 of 37422 Claims
an emergency,
willPayor seek 62308 care
be paid according to terms
immediately,
and conditions
then call
of
your
the plan.
family
In
physician
the case of
for
an
further
emergency,
assistance
seek
and
care
direction regarding follow up care.
immediately, Customer then Service: call Customer your family physician 1.800.XXX.XXXX
Service: for further assistance 1.800.XXX.XXXX 14and direction regarding follow up care.
Send Claims to: TPV / Alliance Mailing Address
CIGNA 24-hour CIGNA Nurseline: 24-hour 1.866.XXX.XXXX
Nurseline: 1.866.XXX.XXXX
Send Claims to: TPV / Alliance others Mailing to: CIGNA Address HealthCare, P.O. Box 188004, Chattanooga, TN 37422 Payor 62308
All others to: CIGNA HealthCare, P.O. Box 188004, Chattanooga, TN 37422 Payor 62308
Customer Service: 1.800.XXX.XXXX
Customer Service: CIGNA 1.800.XXX.XXXX
24-hour Nurseline: 1.866.XXX.XXXX
CIGNA 24-hour Nurseline: 1.866.XXX.XXXX
Provider: Participant Provider: is enrolled Participant in a limited-benefit is enrolled plan. in a limited-benefit For hospital services, plan. For collect hospital patient services, collect patient
responsibility when responsibility service is rendered when service or make is financial rendered arrangements or make financial with the arrangements patient in with the patient in
accordance with your accordance policies. with your policies.
Provider: Participant is enrolled in a limited-benefit plan. For hospital services, collect patient
Provider: Participant responsibility is enrolled in when a limited-benefit service is rendered plan. For or hospital make financial services, arrangements collect patient with the patient in
responsibility when service accordance is rendered with your or make policies. financial arrangements 15 AWAY with the FROM patient HOME in CARE AWAY FROM HOME CARE
accordance with your policies.
AWAY FROM HOME CARE
AWAY FROM HOME CARE
012412
012412
2012 Starbridge 2012 Starbridge - Beech Street - Beech Street
PPO Plans
A V I A N T N E T W O R K
A V I A N T N E T W O R K
Primary Network: Beech Street
Primary Network: Beech Street
Connecticut General Life Insurance Company
Connecticut General Life Insurance Company
Starbridge ® Beech Street
Doctor Visit $25
Coverage Effective Date: 00/00/0000Doctor Visit $25
Coverage Effective Date: 00/00/0000
Specialist
Specialist
$25
$25
ID: Use Primary Insured’s Social Security Number
ID: Use Primary Insured’s Social Security Number
Network Coinsurance:
Network Coinsurance:
In 80%/20%
Name: Name
In 80%/20%
Name: Name
Out Out 80%/20%
80%/20%
Group Name:
Group Number:
Group Name:
Group Number:
11
• No PCP selection required
• No referrals required
• In-network and out-of-network coverage
www.starbridge.com
www.starbridge.com
SM
3 SM
For Benefits, Claim Status, For Benefits, Eligibility Claim or Customer Status, Eligibility Service, or Call Customer Service, 1-8XX-XXX-XXXX Call 1-8XX-XXX-XXXX
7
5
4
You may be asked to present this card when you receive care. The card does not guarantee
You may be asked to present
coverage.
this
You
card
must
when
comply
you receive
with all
care.
terms
The
and
card
conditions
does not guarantee
of the plan. Willful misuse of this card is
coverage. You must comply
considered
with all
fraud.
terms and conditions of the plan. Willful misuse of this card is
considered fraud.
This plan does not require pre-certification of coverage for inpatient or outpatient services. Claims will
This plan does not require pre-certification of coverage for inpatient or outpatient services. Claims will
be paid according to terms and conditions of the plan. In the case of an emergency, seek care
be paid according to terms and conditions of the plan. In the case of an emergency, seek care
immediately, then call your family physician for further assistance and direction regarding follow up care.
immediately, then call your family physician for further assistance and direction regarding follow up care.
13
Send Claims to:
Send Claims to:
Connecticut General Life Insurance Company, PO Box 55270, Phoenix, AZ 85078-5270 Payor 59225
Connecticut General Life Insurance Company, PO Box 55270, Phoenix, AZ 85078-5270 Payor 59225
Customer Service: Customer 1.800.XXX.XXXX
Service: 1.800.XXX.XXXX
CIGNA 24-hour CIGNA Nurseline: 24-hour 1.866.XXX.XXXX
Nurseline: 1.866.XXX.XXXX
14
Provider: Participant Provider: is enrolled Participant in a limited-benefit is enrolled plan. in a For limited-benefit hospital services, plan. For collect hospital patient services, collect patient
responsibility when service responsibility is rendered when or service make financial is rendered arrangements or make financial with the arrangements patient in with the patient in
accordance with your accordance policies. with your policies.
AWAY FROM HOME CARE AWAY FROM HOME CARE
2012 FundamentalCare 2012 FundamentalCare - CIGNA - HealthCare CIGNA HealthCare PPO PPO
2012 Starbridge 2012 Starbridge - CIGNA - HealthCare CIGNA HealthCare PPO PPO
012412
TPV / Alliance TPV / Alliance
TPV Logo / Alliance TPV / Logo Alliance 11
www.fundamentalcare.com www.fundamentalcare.com
Logo
Logo
Primary Network: CIGNA Primary HealthCare Network: PPOCIGNA HealthCare PPO
www.starbridge.com
www.starbridge.com
Secondary Primary Network: CIGNA Beech Primary HealthCare
Secondary Street Network: PPOCIGNA HealthCare PPO
Network: Beech Street 5
Connecticut Secondary Network: General Life Beech Secondary
Connecticut Insurance StreetNetwork: General Company Beech Street
Life Insurance Company
Connecticut General Life Connecticut Insurance General Company Life Insurance Company
Doctor Visit
Coverage Effective Date: Doctor $25 Visit $25
Coverage
00/00/0000
Effective Date: 00/00/0000 Doctor
Coverage Effective Date: 00/00/0000 Specialist Visit Doctor $25
Coverage Effective Date: 00/00/0000
Visit
Specialist $25
$25
$25
ID: AMI
Specialist 7
ID: AMI
Network Coinsurance: Specialist $25
4
$25
ID: AMI
Network Coinsurance:
ID: AMI
Network In Coinsurance: Network
Name: Name
In
80%/20% Coinsurance:
80%/20%
Name: Name Name: Name
In
Name: Name
Out In 80%/20%
SM Out
80%/20% 80%/20%
Out 80%/20%
Out
Account Number:
Account
2466518
SM 80%/20% 3 SM 80%/20%
Account Number: Number: 2466518
Account 2466518 Number: 2466518
Starbridge ® Cigna PPO
Group Name:
Group Group Number: Name:
Group Number:
012412
Group Name:
Group Name:
Group Number:
Group Number:
A V I A N T N E T W O R K
A V I A N T N E T W O R K
A V I A N T N E T W O R K
A V I A N T N E T W O R K
• No PCP selection required
• No referrals required
• In-network and out-of-network coverage
You may be asked to present You may this be card asked when to present you receive this card care. when The card you does receive not care. guarantee The card does not guarantee
coverage. You may be You asked must to comply present You
coverage.
may with this be
You all card asked terms must
when to and comply
present you conditions receive
with
this
all
card care. of terms the when The plan. and
card you
conditions Willful receive does misuse not care.
of
guarantee
the of The this plan.
card card Willful
does is not
misuse
guarantee
of this card is
considered coverage. You fraud. must comply coverage.
considered
with You all
fraud.
terms must comply and conditions with all of terms the and plan. conditions Willful misuse of the of plan. this card Willful is misuse of this card is
This considered plan does fraud. not require considered
This pre-certification plan does
fraud.
not require of coverage pre-certification for inpatient of coverage or outpatient for inpatient services. or Claims outpatient will services. Claims will
be This paid plan according does not to require terms This
be paid
plan pre-certification and according conditions does not
to
require of of
terms the coverage pre-certification plan. and conditions In for the inpatient case of
of coverage
the an or emergency, outpatient
plan. In
for
the
inpatient services. seek case of care or Claims
an
outpatient will
emergency,
services.
seek care
Claims will
immediately, be paid according then call to terms be your immediately,
paid family and according conditions physician then
to of
call
terms for the
your further and plan.
family
conditions assistance In the case
physician
of and of
for
the an direction further
plan. emergency, In
assistance regarding the case seek
and
of care follow an
direction
emergency, up care. regarding
seek care
follow up care.
immediately, then call immediately, your family physician then call for your further family assistance physician and for further direction assistance regarding and follow direction up care. regarding follow up care.
Send Claims to: TPV / Send Alliance Claims Mailing to: Address TPV Alliance Mailing Address
Send Claims to: TPV /
All others to: CIGNA HealthCare, Send Alliance Claims Mailing
All others
P.O. to:
to: CIGNA
Box TPV Address
188004, / Alliance
HealthCare,
Chattanooga, 13 Mailing Address
P.O. Box 188004,
TN 37422
Chattanooga,
Payor 62308
TN 37422 Payor 62308
All others to: CIGNA HealthCare, All others to: P.O. CIGNA Box 188004, HealthCare, Chattanooga, P.O. Box 188004, TN 37422 Chattanooga, Payor TN 62308 37422 Payor 62308
Customer Service: Customer 1.800.XXX.XXXX
Customer Service: Customer 1.800.XXX.XXXX
Service:
Service:
1.800.XXX.XXXX
1.800.XXX.XXXX 14
CIGNA 24-hour CIGNA Nurseline: 24-hour 1.866.XXX.XXXX
CIGNA 24-hour CIGNA Nurseline: 24-hour 1.866.XXX.XXXX
Nurseline:
Nurseline:
1.866.XXX.XXXX
1.866.XXX.XXXX
2012 Starbridge 2012 Starbridge - Beech - Street Beech Street
Provider: Participant is enrolled in a limited-benefit plan. For hospital services, collect patient
Provider: Participant is enrolled in limited-benefit plan. For hospital services, collect patient
responsibility Provider: Participant when service Provider: is enrolled is rendered Participant in a limited-benefit or make is enrolled financial plan. a arrangements limited-benefit For hospital services, with plan. the For patient collect hospital patient in services, collect patient
responsibility when service is rendered or make financial arrangements with the patient in
accordance responsibility with when your service responsibility policies. is rendered when or service make is financial rendered arrangements or make financial with the arrangements patient in with the patient in
accordance with your accordance with your policies.
accordance policies. with your policies.
15
AWAY FROM HOME CARE
AWAY FROM HOME CARE AWAY FROM HOME CARE
AWAY FROM HOME CARE
65
A V I A N T N E T W O R K
A V I A N T N E T W O R K
Primary Network: Beech Street
Connecticut General Life Primary Insurance Network: Company Beech Street
Connecticut General Life Insurance Company
www.starbridge.com
www.starbridge.com
You may be asked to present this card when you receive care. The card does not guarantee
coverage. You must comply
You may
with
be
all
asked
terms
to
and
present
conditions
this card
of
when
the plan.
you
Willful
receive
misuse
care. The
of this
card
card
does
is
not guarantee
considered fraud.
coverage. You must comply with all terms and conditions of the plan. Willful misuse of this card is
This plan does not require
considered
pre-certification
fraud.
of coverage for inpatient or outpatient services. Claims will
be paid according to terms This plan and does conditions not require of the pre-certification plan. In the case of of coverage an emergency, for inpatient seek care or outpatient services. Claims will
immediately, then call be your paid family according physician to terms for further and conditions assistance of and the direction plan. In the regarding case of follow an emergency, up care. seek care
immediately, then call your family physician for further assistance and direction regarding follow up care.