Health Management Programs
Additional integrated programs are available to you and your family members, 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. The Health Management tools and resources available to Cigna participants include a 24 Hour Nurse Line, Medical and Behavioral Health Advocates, Condition Management Programs, Cancer Care Program, Expert Medical Opinion Services, and Centers of Excellence.
Health management tools and resources are available to you at no additional costs. However, health care claims (e.g., doctor's fees or facilities charges) are processed according to the Plan’s provisions.
24-Hour nurse line
Trained, licensed nurses are available by telephone at 1-800-564-9286, 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.
Health Advocate Program
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 or a family member is identified as having an illness or condition or if you have signs or symptoms that indicate that you are at risk for contracting a serious illness or condition and you have primary coverage under the Retiree Medical Plan, the Health Advocates may contact you to provide support, information, and guidance. In addition, you may contact Cigna Customer Service to reach a Health Advocate if you have any questions.
Condition Management Program
If you have certain chronic illnesses and meet certain eligibility criteria, you may be contacted by a licensed registered nurse through the Condition Management Program offered by Optum or you can contact Optum directly at 1-800-557-5519. These specifically trained nurses focus on helping participants with conditions in which education, daily choices, and lifestyle decisions can have a significant effect on health and the progression of the condition. If you elect to work with a condition management nurse, you will receive educational materials, assistance in managing your condition, and personal support.
Condition management programs available through Optum include congestive heart failure, coronary artery disease, diabetes, chronic obstructive pulmonary disease (COPD), and orthopedic health support programs.
Cancer Care Program
If you are newly diagnosed with cancer, undergoing active treatment for cancer, or are experiencing a recurrence, you may be referred to a specifically trained Cancer Care nurse through your Health Advocate or Condition Management nurse. Referrals will be made to Optum for support to those undergoing treatment or you can contact Optum directly at 800-557-5519.
Expert Medical Opinion Services
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
800-223-2273 ext. 43223 (7 a.m. – 4 p.m. CT)
MyCigna.com (click the MyConsult link)
Centers of Excellence
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 illnesses 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 Retiree 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 Retiree Medical Plan will reimburse reasonable transportation costs for you and a caregiver. The Retiree 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.
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.