PPO transition FAQs
What changes have been made to the Health Plan’s PPO provider network?
As of Jan. 1, 2011, CIGNA HealthCare is the AFTRA Health Plan’s single nationwide Preferred Provider Organization (PPO) provider network. The Health Plan will no longer use Anthem Blue Cross’ PPO network in California for dates of service after Dec. 31, 2010. After this date, only services rendered by CIGNA network providers will be reimbursed by the Health Plan at the network rate.
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What remains the same after this network change?
It is important to note that this change does not impact the Health Plan’s benefits or features. This change also does not affect any other vendors that provide administration services for other Health Plan benefits, including prescription drug benefits (Medco), mental health and chemical dependency benefits (ValueOptions), dental benefits (The Guardian) and life insurance benefits (Aetna). Also, CareAllies, a subsidiary of CIGNA, continues to pre-certify all inpatient hospital admissions and private duty nursing services, as well as continue to provide case management services.
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Why did the Health Plan change its PPO provider network in California?
This change offers simplicity for both participants and health care providers (particularly providers who operate in multiple states) while allowing AFTRA H&R to streamline administration and better manage certain Health Plan costs.
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How extensive is CIGNA’s PPO network in California?
CIGNA Shared Administration PPO is a broad, comprehensive network of health care providers. Before AFTRA H&R’s Trustees decided to make this change, research was conducted to confirm that the CIGNA network has sufficient numbers of providers throughout California, and the network includes the major California hospital systems most utilized by AFTRA Health Plan participants.
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How do I verify if my provider is in CIGNA’s network?
To identify providers in the CIGNA network, visit the "Find a provider" page on AFTRA H&R's Web site and search CIGNA's Shared Administration PPO Network. Participants are encouraged to confirm as soon as possible if California based health care providers they are seeing -- or plan to see in the future -- participate in the CIGNA network.
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What if my health care provider is not in CIGNA’s network?
If you learn that one of your health care providers is not in the CIGNA network, you may nominate your provider to become a member of the network. However, unless the provider you nominate actually becomes a member of the CIGNA network, services from that provider after Dec. 31, 2010 will be reimbursed at the non-network rate.
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Is this why I received a new Health Plan ID card?
Yes. As a result of the network change, all Health Plan participants were mailed new simplified Health Plan ID cards in late 2010. The new ID cards contain updated information – such as how to submit claims or obtain pre-authorization for inpatient hospital care – for those enrolled in the Plan and for providers who submit claims on their behalf. Participants should take the following steps to begin using the new card:
- Destroy all copies of the old bi-fold format AFTRA Health Plan ID card that may remain in your possession and carry your new ID card.
- Present your new Health Plan ID card on your first visits to all medical or hospital care providers on or after Jan. 1, 2011 to ensure that they have your current information. Tell your providers that CIGNA is not the insurer (the Health Plan only utilizes the CIGNA PPO network), and so all questions regarding benefits or eligibility should be directed to AFTRA H&R at (800) 562-4690.
- Previously you were issued a separate ID card for prescription drug, dental, mental health and chemical dependency benefits (identified by the Medco logo in the lower left corner). Continue to carry this card along with your new Health Plan ID card. To request additional copies of either card for you or an enrolled dependent, call Participant Services at (800) 562-4690.
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