Cigna oapin providers

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See the Payments section. Network providers file claims for you. You are responsible for ensuring that claims for non-network care are filed. See the Claims section. Culture of Health is a set of programs and resources to support the overall health of our workforce both at work and at home, including online tools and resources for individual goal setting, a personal health survey, and an annual biometric screening.

These tools and resources are available to all eligible employees and family members age 18 and older eligible to enroll in the Plan. Additional integrated Health Management programs are available to participants in the Cigna option, to help you manage your health and to assist you in obtaining good health care when care is needed. These programs reflect a commitment by you and the company to good health and quality care.

Health management tools and resources are available to you at no additional cost. However, health care claims e. See the Health Management Programs section. You and your family members who lose eligibility may continue medical coverage for a limited time under certain circumstances.

See Continuation coverage section. This is an alphabetized list of words and phrases, with their definitions, used in this SPD. These words are underlined and linked throughout the SPD for easy identification. See Key terms section. Most U. The employee's home address zip code is used to determine whether the employee resides in the service area and is therefore eligible for the Cigna option.

A person who otherwise is not a spouse but who, as a dependent of a former Mobil employee who participated in or received benefits under a Mobil-sponsored plan or program prior to March 1, , is considered an eligible family member as long as that person's eligibility for coverage as a dependent under a Mobil-sponsored plan would have continued. There are also classes of coverage for extended part-time employees, and employees on certain types of leave of absence.

For employees on an approved leave of absence, their contribution rate will change from the employee contribution rate to the Leave of Absence contribution rate as shown in the table below.

Each class of coverage described in this section has its own contribution rate. Employees contribute to the Medical Plan through monthly deductions from their pay on a pre-tax or after-tax basis. No one can be covered more than once in the ExxonMobil Medical Plan.

You and a family member cannot both enroll as employees and elect coverage for each other as eligible family members. If you and your spouse or adult child work for the company you may both be eligible for coverage. Each of you can be covered as an individual, or one of you can be covered as the employee and the other can be an eligible family member. Also, if you and your spouse have children, each child can only be covered by one of you.

In addition, a marriage between two ExxonMobil employees does not allow enrollment or cancellation in any of the ExxonMobil health plans. In order to change your coverage, you need to wait until you experience a change in status that allows coverage changes or annual enrollment. As a newly hired employee, if you complete your enrollment in the Medical Plan within 30 days of your start date, coverage begins the first day of employment. If you enroll between 31 and 60 days from your date of hire, coverage will be effective the first day of the month following completion of enrollment in ExxonMobil Benefits or receipt of enrollment forms by the ExxonMobil Benefits Service Center.

If you enroll in the Cigna option, your eligible family members can only enroll in this option. If you are eligible for the ExxonMobil Pre-Tax Spending Plan, you will be enrolled to pay your monthly contributions on a pre-tax basis unless you annually decline this feature. Your monthly pre-tax contributions and class of coverage must remain in effect for the entire plan year, unless you experience a change in status.

See Annual enrollment and Changing your coverage sections. As a current employee, if you are not covered by a medical plan to which ExxonMobil contributes you may enroll at the next annual enrollment. You may also enroll if you experience a corresponding change in status. Coverage is effective the first of the month following completion of enrollment in ExxonMobil Benefits or receipt of the forms by the ExxonMobil Benefits Service Center.

You may be requested to provide documents at some future date to prove that the family members you enrolled were eligible e. If you fail to provide such requested documents within the required time period, coverage for the family members will be cancelled the first of the following month and you may be subject to discipline up to and including termination of employment for falsifying company records. In addition, you may enroll yourself or your family members in any available Medical Plan option within 60 days after marriage with coverage effective the first of the following month or after birth, adoption or placement for adoption with coverage retroactive to the birth, adoption or placement for adoption.

You must enroll each new child for them to be covered, even if you already have family coverage. In either case, coverage is effective the first of the month following completion of enrollment or receipt of the forms by the ExxonMobil Benefits Service Center. Each year, during the fall, ExxonMobil offers an annual enrollment period. During this time, you can switch from your current option to another available option. This is also the time to make changes to coverage by adding or deleting family members.

Family members may be added or deleted for any reason but they must be deleted if they are no longer eligible. Changes elected during annual enrollment take effect the first of the following year. NOTE: You should not wait until annual enrollment to remove a family member who loses eligibility; they should be removed at the time eligibility is lost. For consequences for covering an ineligible family member, see Loss of Eligibility.

Employees are automatically enrolled in the Pre-Tax Spending Plan to pay monthly contributions on a pre-tax basis unless this feature is declined. This choice is only available during the annual enrollment period or with a change in status.

If you pay your monthly contributions on an after-tax basis and would like to continue making contributions on an after-tax basis for the following year, you must elect to do so each year during annual enrollment and after each change in status. Otherwise, your contributions will be switched to a pre-tax basis beginning the first day of the following year. During annual enrollment, changes to your Medical Plan coverage option or contributions do not automatically adjust your coverage or contributions to other plans such as the ExxonMobil Dental Plan, ExxonMobil Vision Plan, or the flexible spending accounts under the ExxonMobil Pre-Tax Spending Plan.

Changes to those plans must be made separately during annual enrollment. To make a change to your coverage after your initial enrollment, you must wait until Annual Enrollment or until you experience one of the following Changes in Status.

Note: Changes in coverage associated with a change in status are effective the first day of a month after enrollment is completed, except in the case of a birth or adoption of a child when changes will be effective on the date of the birth or adoption. If the change is made during Annual Enrollment, changes are effective the first day of the following year. This section explains which events are considered changes in status and what changes you may make as a result. If you have a change in status, you must complete your change within 60 days.

If you do not complete your change within 60 days, changes to your coverage may be limited. If you fail to remove an ineligible family member within 60 days of the event that causes the person to be no longer eligible, e. Your pre-tax contribution for coverage will remain the same until you have another change in status or the first of the plan year following the next Annual Enrollment period.

The only exception is death of an eligible family member. Important Note: Your election made due to a change in status cannot be changed after the transaction is completed in ExxonMobil Benefits or the form is received by the ExxonMobil Benefits Service Center. If you make a mistake in ExxonMobil Benefits , contact the ExxonMobil Benefits Service Center immediately or no later than the first work day following the day on which the mistake was made.

The following is a quick reference guide to the Changes in Status that are discussed in more detail after the table. Enroll yourself and spouse and any new eligible family members or change your Medical Plan option. Change your level of coverage. You must remove coverage for your former spouse and stepchild ren but you may not remove coverage for yourself or other covered eligible family members. Enroll yourself and other eligible family members who might have lost eligibility for spouse's medical plan.

Gain a family member through birth, adoption or placement for adoption, sole court appointed legal guardian or sole managing conservator. You may not cancel coverage for yourself or other covered eligible family members. You or a family member loses eligibility under another employer's group health plan or other employer contributions cease which creates a "HIPAA special enrollment" right.

Enroll yourself and other family members who might have lost eligibility. This only pertains to the Medical Plan. Change your level of coverage and change Medical Plan option. Other loss of family member's eligibility e. You may not cancel coverage for yourself or other eligible family members. Termination of Employment by spouse or other family member or other change in their employment status e. Enroll yourself and other family members who may have lost eligibility under the spouse's or family member's plan in Medical Plan and change your Medical Plan option.

End the family member's coverage, change level of coverage and terminate their participation in the Medical Plans. Commencement of Employment by spouse or other family member or other change in their employment status e. End other family member's coverage and terminate their participation in Medical Plan if the employee represents that they have or will obtain coverage under the other employer plan. Change in worksite or residence affecting eligibility to participate in the elected Medical Plan option.

Change your Medical Plan option and change level of coverage, or cancel coverage for yourself or other eligible family members. Judgment, decree or other court order requiring you to cover a family member. Termination of employment and rehire within 30 days or retroactive reinstatement ordered by court.

You are covered under your spouse's medical plan and plan changes coverage to a lesser coverage level with a higher deductible mid-year. If you wish to enroll in a different Medical Plan Option, you have 60 days since your repatriation date to update your election. Any changes done within this period will be effective upon your repatriation date and there would be no gap in coverage.

If no action is taken, the next opportunity to change you Medical Plan Option will be during Annual Enrollment. If you are enrolled in the Medical Plan, you can enroll your new spouse and his or her eligible family members your stepchildren for coverage.

You also may change your plan option. If you are not already enrolled for coverage, you can sign up for medical coverage for yourself, your new spouse, and your stepchildren. If you gain coverage under your spouse's health plan, you can cancel your coverage. You must make these changes within 60 days following the date of your marriage or wait until Annual Enrollment or another change in status.

In the case of divorce, your former spouse and any stepchildren are eligible for coverage only through the end of the month in which the divorce is final. You must notify and provide any requested documents to the ExxonMobil Benefits Service Center as soon as your divorce is final. If you fail to notify and provide the appropriate forms to the ExxonMobil Benefits Service Center within 60 days, the former spouse and family member will not be entitled to elect COBRA.

There may also be consequences for falsifying company records. Please see the Continuation coverage section of this SPD. You may not make a change to your coverage if you and your spouse become legally separated because there is no impact on eligibility.

If you lose coverage under your spouse's health plan because of divorce, you can sign up for medical coverage for yourself and your eligible family members. You must enroll within 60 days following the date you lose coverage under your spouse's plan or wait until Annual Enrollment or another change in status.

If you gain a family member through birth, adoption, or placement for adoption you may add the new eligible family member to your current coverage. You may also enroll yourself, your spouse , and all eligible children. Coverage is effective on the date of birth, adoption or placement for adoption. You must add the new family member within 60 days even if you already have family coverage.

See the Changing coverage section for additional circumstances in which changes can be made. If you enroll your new family member between 31 and 60 days from the birth or adoption and your coverage level changes, you will pay the cost difference on a post-tax basis until the end of the month in which the enrollment is completed in ExxonMobil Benefits or through the ExxonMobil Benefits Service Center.

Beginning the first day of the following month your deduction will be on a pre-tax basis. If you lose coverage under your spouse's health plan, you can sign up for Medical Plan coverage for yourself and your eligible family members. You must make these changes within 60 days following the date you lose coverage or wait until Annual Enrollment or another change in status. If you and your family members are enrolled in the ExxonMobil Medical Plan, any stepchildren will cease to be eligible upon your spouse's death unless you are their court appointed guardian or sole managing conservator.

If the cost for coverage charged to you significantly increases or decreases during a plan year, you may be able to make a corresponding prospective change in your election, including the cancellation of your election. If you choose to revoke your elected coverage option, you may be able to elect coverage under another Medical Plan option. This provision also applies to a significant increase in health care deductible or copayment.

If the cost for coverage under your spouse's health plan significantly increases or there is a significant curtailment of coverage that permits revocation of coverage during a plan year and you drop that coverage, you will be able to sign up for medical coverage for yourself and your eligible family members.

You must enroll within 60 days following the date you lose coverage under your spouse's plan. If you or your spouse, separately or together become the sole court appointed legal guardian or sole managing conservator of a child and the child meets all other requirements of the definition of an eligible child, you have 60 days from the date the judgment is signed to enroll the child for coverage.

You must provide a copy of the court document signed by a judge appointing you or your spouse separately or together guardian or sole managing conservator. If an enrolled family member is no longer an eligible family member, coverage continues through the end of the month in which they cease to be eligible.

You must notify and provide the appropriate forms to the ExxonMobil Benefits Service Centeras soon as a family member is no longer eligible. While we have an administrative process to remove dependent children reaching the maximum eligibility age, you remain responsible for ensuring that the dependent child is removed from coverage. If you fail to ensure that an ineligible family member is removed in a timely manner, there may be consequences for falsifying company records.

If you move from one location to another, and the move makes you no longer eligible for the selected Medical Plan option e. However, if you move into a location where Aetna POS II options are available and you are enrolled in one of those options, you are not eligible to enroll until Annual Enrollment. If you are on an approved leave of absence, you can continue coverage by making required contributions directly to the Medical Plan by check or, if applicable, pre-pay your benefits.

If you chose not to continue your coverage while on leave, your coverage ends on the last day of the month in which the cancelation form is received by the ExxonMobil Benefits Service Centerand you will be required to pay for the entire month's contributions. If you fail to make required contributions while on leave, coverage will end. If the company should make any payment on your behalf to continue your coverage while you are on leave and you decide not to return to work, you will be required to reimburse the company for required contributions.

If you are on an approved leave of absence and the Leave of Absence contribution rate begins, you may continue your coverage by making your required contribution. If a new Medical Plan option is added or if benefits under an existing option are significantly improved during a plan year, you may be able to cancel your current election in order to make an election for coverage under the new or improved option.

If a service area under the plan is discontinued, you will be able to elect either to receive coverage under another Plan option providing similar coverage or to drop medical coverage altogether if no similar option is available.

For example, if an option is discontinued, you may elect another option that has service in your area or you may elect to participate in the POS II option. You may also discontinue medical coverage altogether. Remember, if you experience any of the events mentioned previously, or if you are newly eligible as a result of a change or loss of coverage under your spouse's health plan, it is your responsibility to complete your change within 60 days of experiencing the event.

If you miss the day notification period, you will not be able to make changes until Annual Enrollment or until you experience another change in status. Effective January 1, If you decline enrollment in the ExxonMobil Retiree Medical Plan at retirement, you will have limited opportunities to enroll at a later date.

Coverage depends on whether the plan option you are enrolled in as an employee offers service in the area where you live. If your covered family member does not live with you for instance, you have a child away at school , please contact Cigna Customer Service to confirm whether service is available where your family member lives.. See service area in Key terms. If you continue to work for ExxonMobil after you become eligible for Medicare, although you are eligible for Medicare, your ExxonMobil employee coverage remains in effect for you and eligible family members and the Plan is your primary plan.

Medicare benefits, if you sign up for them, will be your secondary benefits. Please see the Coordination of benefits section for further information. Refer to www.

Employees or family members of an employee who become Medicare eligible, either due to age or Social Security disability status, are eligible to participate in any Medical Plan option as long as the employee remains as a regular employee. If you terminate employment as an extended part-time employee, you are not eligible to continue to participate in the Medical Plan. You may be eligible to elect continuation coverage for yourself and your eligible family members under COBRA provisions.

See Continuation coverage for details. If you die while enrolled, your covered eligible family members may be eligible for the ExxonMobil Retiree Medical Plan. Children of deceased employees or retirees may continue participation as long as they are an eligible family member.

If your surviving spouse remarries, eligibility for your stepchildren also ends. Eligible family members of deceased extended part-time employees are only eligible to elect continuation coverage under COBRA provisions. You are responsible for ending coverage with the ExxonMobil Benefits Service Center when your enrolled spouse or family member is no longer eligible for coverage. If you do not complete your change within 60 days, any contributions you make for ineligible family members will not be refunded.

Everyone in your family may lose eligibility for Medical Plan coverage, and you may be subject to disciplinary action up to and including termination of employment if you commit fraud against the Medical Plan, for instance, by filing claims for benefits to which you are not entitled. Coverage may also be terminated if you refuse to repay amounts erroneously paid by the Medical Plan on your behalf or that you recover from a third party.

Additionally, coverage may be terminated if you fail to reimburse the Plan for any amount owed to the Plan, or if you receive and fail to report to the Claims Processor any discounts, write-offs, or other arrangements with providers that result in misrepresentation of your out-of-pocket costs. Your participation may be terminated if you fail to comply with the terms of the Medical Plan and its administrative requirements.

You may also lose eligibility if you enroll persons who are not eligible, for instance, by covering family members who do meet the eligibility requirements.

This includes failing to provide timely notification of when a covered family member loses eligibility, e. You are entitled to extended coverage for as much as a year if you are terminated due to disability with fewer than 15 years of service.

This coverage is provided at no cost to you. In order to assure coverage beyond this extension period, you must elect COBRA upon termination of employment. Several conditions must be met:. A Cigna Network Provider is an institution, facility, agency or health care professional, which has contracted directly or indirectly with Cigna. Providers qualifying as Participating Providers may change from time to time.

A list of the current Participating Providers is located online at www. The Provider Organization is a network of Participating Providers. If you have a life-threatening medical emergency, go to your nearest hospital emergency department. Emergency services are covered at the In-Network benefit level until your medical condition is stabilized. If you are unable to locate a Cigna Network Provider in your area who can provide you with a service or supply that is covered under the Cigna Option, you must call Cigna Customer Service to obtain authorization for Non-Network Provider coverage.

If you obtain authorization for services provided by Non-Network Provider, those services will be covered at the In-Network benefit level. You share in the cost of most medical services and supplies. This is called a copayment or copay. Your copay amount is printed on your Plan ID card. Some services and supplies, such as preventive medications and well-baby visits, are at no additional cost to you.

And some services are subject to coinsurance. For some medical services and supplies, such as hospital stays and outpatient surgeries, your share of the cost is a percentage of the negotiated fees for services received. This is called coinsurance.

The allowable expense or allowed amount is the portion of billed charges for medical services and supplies that is considered eligible for payment by the Plan, before this amount is reduced by your copayment or coinsurance amount.

For most covered services, the allowed amount is the contracted rate between the Provider Organization and the participating Network Provider. Contracted rates vary among providers in the same service area.

You can find network providers and compare costs on MyCigna. Note: You are responsible for any billed charges above the allowed amount, for example the difference in cost between a private and semi-private hospital room, and these additional charges do not accumulate towards your annual out-of-pocket limit. Your out-of-pocket limit is the maximum amount you could pay for covered expenses in a Contract Year. Your out-of-pocket limit includes your portion of the allowable expenses for covered medical services, supplies, and medications, including copays and coinsurance.

Note: Monthly contributions, charges above the allowed amount for covered services, and charges for services that are not covered under the Cigna option do not accumulate towards your annual out-of-pocket limit. Sometimes covered services are performed by a Non-Network Provider without your knowledge or ability to choose a participating provider, for example in an emergency situation or when you receive care in a network facility but a network physician is unavailable.

When this happens, covered expenses are payable at the In-Network benefits level, and the allowable expense is limited to what is reasonable and customary for similar services in the same geographic area.

Most non-network charges will fall within reasonable and customary limits. Your PCP will provide your primary care and, when medically necessary, your PCP may refer you to other in network doctors or facilities for treatment. The referral is important because it is how your PCP arranges for you to receive necessary, appropriate care and follow-up treatment. While your plan does not require a referral from your PCP for you to see specialty doctors, you will want to coordinate such care with your PCP.

Also, certain services do require prior authorization from Cigna. In such case, your doctor will coordinate the prior authorization process with Cigna on your behalf. You will not be required, nor expected, to manually track the prior authorization.

The term Prior Authorization means the approval that a Participating Provider must receive from Cigna in order for certain services and benefits to be covered under the Cigna Option.

Your PCP is responsible for obtaining authorization from Cigna for in-network covered services. There is no requirement to obtain an authorization of care from the plan or from your Primary Care Physician for visits to a Participating Provider of your choice for pregnancy, well-woman gynecological exams, primary and preventive gynecological care, and acute gynecological conditions.

These tools and resources are available to all eligible employees and family members age 18 and older eligible to enroll in the Medical Plan. Additional integrated Health Management programs are available to participants in the Cigna option, and they are designed to help you improve your health and to assist you in obtaining good health care when care is needed. It reflects a commitment by you and the company to good health and quality care. The tools and resources offered through Culture of Health are available to you at no additional costs.

The Personal Health Survey can help identify conditions you and your doctor may need to monitor and manage. The survey is completely confidential, and you may choose to have your results sent to a Health Advocate for review.

Trained, licensed nurses are available by telephone at , 24 hours a day, 7 days a week to answer routine questions about your health, or questions about a specific medical situation, condition or concern. However, these nurses cannot diagnose medical conditions, prescribe medication or give specific medical instruction. Topics discussed during your call may include services and expenses not covered under the Plan. The nurse may refer you to a Health Advocate for a more detailed conversation if you face a health risk or serious medical condition.

The Health Advocate Program provides direct support to you, your family, and your treating physician s in the management of specific health care needs. The Health Advocate staff consists of registered nurses, supported by a medical director.

Once you begin working with a Health Advocate, the nurse will work personally with you as long as you need support. Health Advocates will assist you to coordinate a wide array of health care-related support and educational services. As situations require, your Health Advocate will assist you with admission, counseling, inpatient advocacy, discharge planning and home counseling.

The nurse will also act as your proactive partner, working directly with you to help you navigate the health care delivery system by assisting with the coordination and management of your health care needs and collaborating with others involved in your treatment.

Your Health Advocate could refer you to a Condition Management nurse if you are identified as needing treatment for a condition that is included in the program. If you do not see your condition listed, please contact Cigna to check if your chronic condition can be managed by a nurse. Targeted outreach through health advocate nurses, case managers and digital coaching to provide personalized care management.

Nurses are licensed, registered with clinical oncology experience. They can provide valuable education and guidance and are available 24 hours a day, seven days a week to help you through your cancer treatment at no additional cost to you. Your Oncology Nurse will help set goals for treatment and medication, find in-network doctors and facilities, help with getting a second opinion and educate on diagnosis and treatment plan, what to expect, pain management, online researches and digital engagement tools.

In addition, your nurse will look for ways to maximize benefits, barriers to care and offer solutions as well as treatment alternatives i. If you are at risk for diabetes and meet certain eligibility criteria, you have access to a digital lifestyle change program through Omada, including an interactive online platform that adapts to you, a health coach to keep you on track, a wireless smart scale to monitor your progress, and a small online peer group for real-time support.

A Health Advocate nurse may refer you to the program, or you can visit OmadaHealth. Go to myCigna. If you or a family member receive a diagnosis or treatment plan requiring complex medical care, you have access to expert medical opinion services through the Cigna MyConsult program.

Specialists who are recognized experts in their field will review medical records related to the diagnosis and provide an opinion on the recommended treatment, including a detailed report you can share with your physician or Health Advocate nurse.

Expert opinion consults are available at no additional cost to you and can be accessed through a mobile application, web portal, or phone. Cleveland Clinic MyConsult ext. CT MyCigna. As a part of your coverage under this plan, Hinge Health offers musculoskeletal conditions support at no cost to you, with programs relating to care for different joint and muscle pain needs, for example:.

Learn more about this program at www. Centers of Excellence "COE" are nationally recognized facilities for the treatment of certain conditions or the delivery of certain procedures where high-level knowledge and expertise provide better care and more likely positive outcomes. COEs are not available for all diseases and all conditions or procedures relevant to a disease state.

For instance, at this time there are COEs for pancreatic cancer, but there is insufficient information available to select COEs for lung cancer. Changes to identified COEs may occur in the future. If you would like to learn more about different COE options you will need to contact the 24 hour nurse line who will put you in contact with a Health Advocate who will be able to discuss different options with you.

Participation in a COE program is voluntary, and designed to direct participants to nationally recognized facilities with more positive outcomes. A COE-recommended treatment plan, however, must meet the Medical Plan provisions for medically necessary care in order for claims to be eligible for reimbursement.

Whenever clinically appropriate, you will be referred to a local COE. If access to a clinically appropriate COE requires the patient to travel 75 or more miles, the Medical Plan will reimburse reasonable transportation costs for you and a caregiver.

The Medical Plan will also provide a per diem for you and a caregiver to cover lodging and other expenses. If you become hospitalized, only your caregiver will receive the per diem, because food and lodging are already provided as part of the hospital charge. The per diem amounts are established by the Administrator-Benefits. Please note that a specific cancer diagnosis must occur before you are eligible for travel benefits.

If you decide not to use a COE, you will not incur additional out-of-pocket costs for choosing another hospital in the Cigna network. The term Covered Expenses means the expenses incurred by or on behalf of a covered person for the charges listed below. Expenses incurred for such charges are considered Covered Expenses to the extent that the services or supplies provided are recommended by a Physician and are essential for the necessary care and treatment of an Injury or Sickness.

For expenses incurred for such charges to be considered Covered Expenses, the services or supplies provided must be Medically Necessary. No Cigna Option benefits are payable unless the services or supplies are Covered Expenses recommended by and received from, or approved by, Participating Providers and are authorized by the Provider Organization, except in the case of Emergency Services. For Emergency Services from non-participating providers, participants must submit a claim no later than 60 days after the first Emergency Service is provided or as soon as reasonably possible.

The claim should contain an itemized statement of treatment, expenses, and diagnosis. This section describes the eligible health services and supplies available under your plan when you are well. Covered services include office visits to your physician, PCP or other health professional for routine physical exams. This includes routine vision through age 18 and hearing screenings through age 21 given as part of the exam.

A routine exam is a medical exam given by a physician for a reason other than to diagnose or treat a suspected or identified illness or injury. Covered health services include immunizations for infectious diseases, but does not include coverage of immunizations that are not considered preventive care, such as those for employment or travel.

Covered health services include routine well woman preventive exam office visit, including pap smears, general pelvic exams, and manual breast exams which are given for a reason other than to diagnose or treat a suspected or identified illness or injury.

Covered health services include screening and counseling by your health professional for some conditions. These include obesity, substance use disorders, use of tobacco products, sexually transmitted infection counseling and genetic risk counseling for breast and ovarian cancer. Covered health services include the routine prenatal physical exams to monitor maternal weight, blood pressure, fetal heart rate, and fundal height. Note that some prenatal care is billed at the coinsurance rate reference the Benefit Summary section for more information.

Coverage includes renting or buying durable medical equipment you need to pump and store breast milk as follows:. Covered family planning services include counseling services provided by your provider on contraceptive methods, contraceptive devices, and voluntary sterilization tubal litigation. Charges made by a Skilled Nursing Facility, on its own behalf, for medical care and treatment; except that for any day of Skilled Nursing Facility stay, Covered Expenses will not include that portion which is more than the Skilled Nursing Facility Limit shown in the In-Network Benefits Schedule; nor will benefits be payable for more than the maximum number of days shown in the In-Network Benefits Schedule.

Covered services include prenatal and postpartum care and obstetrical services. After your child is born, eligible health services include:.

A birthing center is a facility specifically licensed as a freestanding birthing center by applicable state and federal laws to provide prenatal care, delivery and immediate postpartum care. Coverage also includes the services and supplies needed for circumcision by a provider.

Charges made for human organ and tissue transplant services at designated facilities through the United States. Contact Progyny at to initiate services. Note: Diagnosis and treatment of the underlying condition continue to be covered under your Medical Plan through Cigna. Charges made for anesthetics and their administration; diagnostic x-ray and laboratory examinations; x-ray, radium, and radioactive isotope treatment; chemotherapy; blood transfusions; oxygen and other gases and their administration; formulas for infants less than one year of age with PKU, Maple Disease, Histidinemia or Homocystinuria.

Nutritional Evaluation and counseling from a Participating Provider is offered when diet is part of the medical management of a documented disease, including morbid obesity. Charges are covered for licensed ambulance service to or from the nearest Hospital where the needed medical care and treatment can be provided. Charges made for the purchase or rental of Durable Medical Equipment that is ordered or prescribed by a Physician and provided by a vendor approved by Cigna for use outside a Hospital or Other Health Care facility.

All maintenance and repairs that result from misuse are your responsibility. Durable Medical Equipment is defined as items which are designed for and able to withstand repeated use by more than one person; customarily serve a medical purpose; generally are not useful in the absence of Injury or Sickness; are appropriate for use in the home; and are not disposable. Such equipment includes, but is not limited to, crutches, hospital beds, wheel chairs, and dialysis machines. Charges made for or in connection with approved organ transplant services, including immunosuppressive medication; organ procurement costs; and donor's medical costs.

The amount payable for donor's medical costs will be reduced by the amount payable for those costs from any other plan. Certain transplants will not be covered based on General Limitations. Contact Cigna before you incur any such costs. Hearing exams of a non-routine or non-preventive nature are subject to the copayment for an office visit.

Charges made for services that are provided by a Participating chiropractic Physician when provided in an outpatient setting. Services of a chiropractic Physician include the management of neuro musculoskeletal conditions through manipulation and ancillary physiological treatment that is rendered to restore motion, reduce pain, and improve function.

Such coverage is available only for rehabilitation following injuries, surgery, or medical conditions. If you or any one of your Family Members, while covered for these benefits, incurs expenses for charges made by a Participating Pharmacy for Prescription Drugs for an Injury or a Sickness, Cigna will pay that portion of the expense remaining after you or your Family Member has paid the required Copayment shown in the In-Network Benefits Schedule.

Covered charges will include those Prescription Drugs lawfully dispensed upon the written prescription of a Participating Physician or licensed Dentist, at a Participating Pharmacy. Coverage for Prescription Drugs is subject to a Co-payment.

The Co-payment amount will never exceed the cost of the drug. Benefits include coverage of insulin, insulin needles and syringes, glucose test strips and lancets. If you or any one of your Family Members, while covered for these benefits, is issued a Prescription for a Prescription Drug as part of the rendering of Emergency Services and the prescription cannot reasonably be filled by a Participating Pharmacy, such prescription will be covered as if filled by a Participating Pharmacy.

For routine physical examinations not required for health reasons including, but not limited to, employment, insurance, government license, court-ordered, forensic or custodial evaluations. If you are covered by more than one group medical plan e.

However, if you or a family member is covered under an individual medical plan e. One of the plans covering you is the primary plan. Claims must be filed first with the primary plan. After the primary plan pays, file the claim with the secondary plan, including a copy of the bills and an explanation of benefits indicating the amount paid by the primary plan. For example, if you, as an employee in this option, incur covered expenses, this Plan is primary and your spouse's plan is secondary.

However, if your spouse incurs the expenses, his or her plan is primary and this Plan is secondary. The primary plan always pays benefits first, without considering the other plan. The secondary plan then pays based on its provisions — up to the total allowable expenses covered by that plan or up to the total of all covered expenses.

This plan is primary to Medicare as long as you remain an active employee. When a child is covered under both parents' plans, the "birthday rule" is used: the plan of the parent whose birthday occurs earlier in the year is the primary plan. The other parent's plan is secondary. If both parents have the same birthday or the spouse's plan has not adopted the birthday rule, the Plan will consider the plan that has covered the child longer as primary.

There are special rules for children of divorced or separated parents. Unless specifically ordered otherwise by a court decree, the plan of the parent with custody, if he or she has not remarried, is primary and the plan of the non-custodial parent is secondary.

If the parent with custody remarries, that parent's plan is primary, the stepparent's plan is secondary, and the plan of the non-custodial parent is last. If payment for covered medical expenses should have been made under this Plan, but has been made under any other plan, any insurance company or other organization may be reimbursed an amount the Administrator-Benefits determines will satisfy the intent of coordination of benefits provisions.

That amount will be considered to be benefits paid under this Plan and shall fully discharge any obligation to make such payments. If you believe that the amount of the benefit you receive from the Plan is incorrect, you should notify Cigna in writing or contact Cigna Customer Service. If it is found that you or a beneficiary were not paid benefits you or your beneficiary were entitled to, the Plan or ExxonMobil will pay the unpaid benefits.

If the calculation of your or your beneficiary's benefit results in an overpayment, you or your beneficiary will be required to repay the amount of the overpayment to ExxonMobil or the Plan. The Plan Administrator may make reasonable arrangements with you for repayment, see Fraud against the Plan above.

This section applies if you or any one of your Family Members is covered under more than one group health plan and determines how benefits payable from all such group health plans will be coordinated. You should file all claims with each group health plan. Cigna will use this benefit reserve to pay any Allowable Expense not otherwise paid during the Claim Determination Period.

At the end of the Claim Determination Period, your benefit reserve will return to zero 0 and a new benefit reserve shall be calculated for each new Claim Determination Period. If Cigna pays charges for benefits that should have been paid by the Primary Group Health Plan, or if Cigna pays charges in excess of those for which we are obligated to provide under the plan, Cigna will have the right to recover the actual payment made or the Reasonable Cash Value of any services.

Cigna will have sole discretion to seek such recovery from any person to, or for whom, or with respect to whom, such services were provided or such payments made by any insurance company, healthcare plan or other organization. If we request, you shall execute and deliver to us such instruments and documents as we determine are necessary to secure the right of recovery.

Cigna, without consent or notice to you, may obtain information from and release information to any other Group Health Plan with respect to you in order to coordinate your benefits pursuant to this section. You must provide us with any information we request in order to coordinate your benefits pursuant to this section. This request may occur in connection with a submitted claim; if so, you will be advised that the "other coverage" information, including an Explanation of Benefits paid under the Primary Group Health Plan is required before the claim will be processed for payment.

If no response is received within 90 days of the request, the claim will be denied. If the requested information is subsequently received, the claim will be processed. If you or a Family Member incurs health care Expenses as described above, Cigna shall automatically have a lien upon the proceeds of any recovery by you or your Family Member s from such party to the extent of any benefits provided to you or your Family Member s by the Plan.

Cigna shall be reimbursed the lesser of:. At the option of Cigna and with the consent of the Employer, all or any part of medical benefits may be paid directly to the person or institution on whose charge claim is based. Otherwise, medical benefits are payable to you. If any person to whom benefits are payable is a minor or, in the opinion of Cigna, is not able to give a valid receipt for any payment due him, such payment will be made to his legal guardian.

If no request for payment has been made by his legal guardian, Cigna may, at its option, make payment to the person or institution appearing to have assumed his custody and support. If you die while any of these benefits remain unpaid, Cigna may choose to make direct payment to any of your following living relatives: spouse, mother, father, child or children, brothers or sisters, or to the executors or administrators of your estate.

Payment as described above will release Cigna from all liability to the extent of any payment made. When an overpayment has been made by Cigna, Cigna will have the right at any time to: a recover that overpayment from the person to whom or on whose behalf it was made, or b offset the amount of that overpayment from a future claim payment.

You are required to be given the information in this section because you are covered under a group health plan the Medical Plan. This section contains important information about your right to COBRA continuation coverage, which is a temporary extension of coverage under the Plan under certain circumstances when coverage would otherwise end.

This section generally explains COBRA continuation coverage, when it may become available to you and your family, and what you need to do to protect the right to receive it. COBRA coverage can become available to you when you would otherwise lose your group health coverage.

Employees are directed to read the relevant benefit plan documents. In the event of a conflict between the terms of any summary and the terms of actual plan documents, the terms of plan documents will control. Except where prohibited by collective bargaining or other agreement, Wesleyan reserves the right to alter, modify, or suspend any benefit at any time.

While Wesleyan selects its benefit providers after thoughtful review, it disclaims responsibility for the ultimate performance of such providers. Open main menu Menu. Human Resources. Open sub menu Menu. Close sub menu Close. Cigna Open Access Plus In-Network Cigna Open Access Plus plans offer choice and convenience—access to a broad national provider network, while allowing you to make your own health care choices.

ID Cards ID cards need to be presented at the pharmacy counter when filling a prescription for members to use their benefits. Old cards should be disposed of as they will no longer work.

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Click the "Disconnect" the daily development We understand there update all 57, to disconnect from specific PrivDog versions. You can choose from multiple numbers. Whereas, TeamViewer is was introduced in you need to enter when connecting.

This plan has in-network coverage only. Only emergency and urgent care services are covered outside of the network. The amount the plan pays for covered services is based on the allowed amount. Your out-of-pocket costs may include office visit copayments, deductibles and coinsurance. Referrals are NOT required under this plan. If you have questions or need assistance, contact the PSA Benefits Hotline at or email Loyola psafinancial.

However, these services are available directly from Cigna. Access the benefit by providing your insurance card as you normally do to an in-network pharmacy services and procedures will not be covered out-of-network.

Cigna will in turn arrange payment directly to the pharmacy. Contact Cigna directly at for additional information. The machine-readable files are formatted to allow researchers, regulators, and application developers to more easily access and analyze data.

For additional information go to the Wellness page. Combining data-powered human coaching, connected devices, and curriculum tailored to your specific circumstances, the program is designed to help you build healthy patterns for life.

The Plan provides inpatient, intermediate and outpatient care. Participants in the plan automatically participate in the prescription drug plan. You can choose between retail and mail order options. Your prescription benefits are structured to take advantage of the savings associated with generic drugs.

See Continuation coverage section. This is an alphabetized list of words and phrases, with their definitions, used in this SPD. These words are underlined and linked throughout the SPD for easy identification. See Key terms section. You can search this SPD section by section or click here to create a single searchable document.

Information sources. Plan at a glance. Eligibility and enrollment. When coverage ends. Basic Plan features. Culture of Health and Health Management Programs. Eligible services under the Plan. Prescription drug program. Coordination of benefits. Continuation coverage. Federal requirements. Key terms. Benefits Summary. Plan at a glance What is on this page.

Back to top top. The prescription drug program The Plan offers you three cost-saving ways to buy prescription drugs — at a local participating network pharmacy for short-term prescriptions, through Cigna Home Delivery Pharmacy for long-term prescriptions, and through Cigna Home Delivery Pharmacy for specialty prescriptions.

Covered and excluded expenses The Plan provides benefits for many, but not all medically necessary, treatment, care, and services. Payments You and the Plan share costs for covered treatment and services. Claims Network providers file claims for you. Culture of Health and Health Management Programs Culture of Health is a set of programs and resources to support the overall health of our workforce both at work and at home, including online tools and resources for individual goal setting, a personal health survey, and an annual biometric screening.