Cigna definitions

Authorization Authorization means approval. Many health plans require you to get authorization before certain medical services, like a hospital stay or outpatient procedure. Authorization can also be called prior authorization or pre-certification. To make sure that your care is authorized, call us at the number on the back of your ID card—or chat with a representative on myCigna.

Beneficiary A beneficiary is a person who is eligible to receive health coverage under a plan. It could be the person who signed up for the plan, or their covered dependents, like their spouse or kids. For life insurance plans, a beneficiary is the person who will receive payment should the person who bought the plan die. Benefit This is an important term to know. For example, preventive care is a benefit under most health plans.

Claim A claim is a payment request from you or your health care provider to your health plan for covered services. Coinsurance Coinsurance is the portion of the cost you pay for covered health services after your health plan starts to pay.

This usually happens once the deductible has been met. Coinsurance can also refer to the percentage of covered expenses paid by your health plan. Copay A copay is the dollar amount you have to pay for a covered health care service under the terms of your health plan.

Copay is a flat fee. Coinsurance is a percentage of the total. For example, if your plan includes 20 percent coinsurance for treatment, then your bill will be different each time. Your 20 percent of the total will change as the total cost of the care changes. Your deductible is an amount that you have to pay before your health plan will begin paying a portion of covered expenses. Coverage Coverage is the benefits a health plan provides you, and any covered dependents, for certain health expenses.

Your customer ID is usually printed on your health plan ID card. Deductible A deductible is the amount you pay each year before your plan begins to pay. Once the deductible has been met, your health plan starts to pay a share of the covered costs. Dependent A dependent is a person who depends on you for health coverage. Effective date Your activation date, also called your effective date or coverage start date, is the date your health plan starts.

Exclusions and limitations Exclusions and limitations are exceptions to your insurance policy or plan coverage. An exclusion is a condition or situation that is not covered by your plan. A limitation may limit benefits to a certain amount or for a certain amount of time.

Explanation of benefits An explanation of benefits, or EOB, is a statement sent by the health plan carrier that explains what medical treatments and or services were paid for. Identification ID card This is the card given to all health plan customers by their health insurance company or health plan carrier. In-network In-network refers to the doctors, hospitals, labs, and other providers that a health plan contracts with to provide discounted rates to its health plan customers.

You typically pay less when you see in-network providers. Network A network is a group of doctors, hospitals, labs, and other health care professionals that have contracted with a health plan to deliver health care services to its customers. Usually, the providers in a network offer a discounted rate to health plan customers.

Some plans provide coverage when using a non-network provider. Open enrollment Open enrollment is a time during the year when you can buy or change your health care coverage, either through your employer or on your own. The dates for open enrollment vary, depending on how you get your coverage. For many people, open enrollment takes place sometime during the fall. Depending on the plan, this amount may include money spent on deductibles, copays, and coinsurance.

Once you meet your out-of-pocket maximum, your health plan pays all covered health care costs for the rest of the year. Plan year A plan year is the 12 months during which your health plan is active and providing you with benefits.

For example, your plan year can be from July 1 to June Premium A premium is the required monthly payment you make to your health insurer for your health plan. If you have coverage through your employer, your premium cost is typically deducted from your paycheck each pay period.

Primary care provider PCP A primary care provider, or PCP, is a health care provider that provides a broad range of routine medical services. A primary care provider refers patients to specialists, hospitals, and other health care providers as necessary. American health services organization. Cigna's corporate headquarters in Bloomfield , Connecticut.

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