What is copayment/coinsurance?
A copayment is the amount of money the person
receiving the services must pay toward an expense
that is not fully covered by the benefit plan.
This could be a percentage of the overall charge
(coinsurance) or a flat dollar amount
(copayment). The amount is based on the benefit
plan offered by your employer.
Employee Assistance Program (EAP): An EAP
is an assessment and referral program or a
short-term counseling program that is
pre-purchased by some employers and is available
to all the employees of the company, their
dependents and household members. Visits to the
EAP are separate from your behavioral health care
benefits plan — with no
copayment required. When you contact CIGNA
Behavioral Health for a referral, ask if your
employer has an EAP in place.
Managed Behavioral Health: This is a program of benefits that
covers your mental health and substance abuse care needs. In most
cases in-network benefits do not need to be pre-authorized. The
services that are typically covered and do not need pre-approval
include: individual therapy, family therapy, group therapy,
psychiatric evaluation and psychiatric medication management. Those
that do require pre-authorization include: intensive outpatient
services, in-patient and partial hospitalization. Benefit plans vary
by employer (covered services and number available outpatient visits
and in-patient days each year.) To check on your particular benefits
and annual limits, call the Mental Health/Substance Abuse toll-free
number on you insurance ID card.
Preferred Provider Organization (PPO):
This program gives members greater choice of
behavioral health professionals — although
inpatient and partial hospital stays have to be
pre-authorized in order to determine if benefits are available under the plan.
What is Coordination of Benefits (COB)?
Benefits under one plan are coordinated with
benefits from another insurance plan (that covers
the same benefits), so payments won't be
duplicated. All families must submit COB
information annually, if using benefits, in order
to expedite the claims paying process. If you
have questions, please contact our Customer
Service Department at the number on the back of your ID card.
What is COBRA (Consolidated Omnibus Budget
Reconciliation Act of 1985)?
COBRA is a federal law that allows an individual
to continue paying for health coverage if they lose
their job or eligibility (i.e., child who no
longer meets the definition of a dependent per
the benefit plan). Check with your Human
Resources Department to see if your employer is
subject to this law, and if you are eligible for
COBRA coverage if you or your dependents'
eligibility status changes.
What are transitional benefits/plans?
When an employer changes behavioral health care
companies, transition plans enable participants
already in treatment to transition to an
in-network behavioral health professional. It
gives the client and their current professional a
specific number of days to contact CIGNA
Behavioral Health in order to discuss the benefits available for the
client's treatment plan, and obtain authorization for benefits
to continue treatment at the network level for a
specified period of time — or to transition
to a contracted professional.
What does "medical necessity" mean?
"Medical necessity" is a term used to refer to a
course of treatment seen as the most helpful for
the specific behavioral health symptoms you are
experiencing. The course of treatment is
determined jointly by you and your behavioral health
professional. CIGNA Behavioral Health works with you and your provider
to explain benefits available for treatment options. This
course of treatment strives to provide you with
the best care in the most appropriate setting.
For further explanation of medical necessity,
review our
Level of Care Guidelines.
Do I need to receive pre-authorization to use the Employee Assistance Program(EAP)?
Yes, in order to receive your work life services, along with a
referral to a provider, you do need to contact us prior to a visit
with a provider. Calling for pre-approval will insure you are
maximizing your available benefits.
How do you define confidentiality? Who will have
access to my personal information?
Information on mental health or substance abuse
treatment of adults* served by CIGNA Behavioral Health is
confidential and will not be disclosed to any
person(s), with the following exceptions:
-
CIGNA Behavioral Health will communicate with
your treating therapist/psychiatrist regarding
your diagnosis, symptoms, treatment goals, and
treatment plan in the process of
administering behavioral health benefits
or EAP services.
-
When an appropriately written release of
information document is completed with your
signature that instructs CIGNA Behavioral
Health to disclose your specific information
to the person named.
-
CIGNA Behavioral Health will communicate the
name of your treating therapist/psychiatrist
to your primary care physician – and the
name of your primary care physician to your
treating therapist/psychiatrist – with
your verbal or written approval. This is
performed as a courtesy to encourage
coordination of care between the two. You can
expect your primary care physician and/or your
treating therapist/psychiatrist to ask you to
sign a written consent to release information.
The consent to release information will allow
for the disclosure of specific details
regarding your behavioral health and/or
medical care, when this type of collaboration
is expected to improve the outcome of your
overall treatment.
-
Mandatory reporting is required when someone
is in imminent danger of hurting themselves or
others.
- As otherwise required by law.
NOTE: Being a subscriber does not give you
access to information about the access or care
received by another individual on the policy who
is not your legal responsibility, or also, a
biological parent or legal guardian who does not
have to be "on the policy" to have access to
information about the benefit utilization and
services rendered for his/her child, unless court
documentation is provided to CIGNA Behavioral
Health demonstrating the parent has no legal
rights to such information about his/her child.
*Adult age of consent is defined by state law.
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