THE COLLEGE CHOICE HEALTH PLAN (CCHP)

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CCHP is a medical indemnity plan which offers a comprehensive range of benefits. Under the CCHP, plan participants can choose any physician or hospital for medical services and any pharmacy for prescription drugs. Plan participants receive enhanced benefits resulting in lower out-of-pocket amounts when receiving services from a Preferred Provider Organization (PPO). The nationwide PPO networks consist of physicians, hospitals, ancillary providers (CIGNA PPO network), pharmacies (Medco retail pharmacy network) and behavioral health services (Magellan behavioral health network).

Plan participants can access plan benefit and participating PPO network information, Explanation of Benefits (EOB) and other valuable health information online. To access online links to plan administrators, visit the Benefits website at www.benefitschoice.il.gov.

	Plan Year Maximum and Deductibles
	Out-of-Pocket Maximums
	CCHP - Medical Plan Coverage
	CCHP - Avoiding Monetary Penalties Through Notification
	CCHP - Cigna Healthcare PPO Networks
	CCHP - Hospital Preferred Provider Organizations (PPO)
	CCHP and College Choice Dental Plan (CCDP) Privacy Pratices
	Contacts for Plan Components

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Plan Year Maximum and Deductibles (From FY 2007 CIP Booklet)

 

Plan Year Maximums and Deductibles

Plan Year Maximum Lifetime Maximum	$1,000,000 $1,000,000
Plan Year Deductible	CCHP Primary Participant (Non-Medicare) $500 Medicare Primary Participant                       $300
Additional Deductibles* * These are in addition to the plan year deductible	Each Emergency Room Visit         $300 Non-PPO Hospital Admission      $300 Note: There is no additional deductible for admission to a PPO Hospital

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Out-of-Pocket Maximums

 

Deductibles and eligible coinsurance payment accumulate toward the annual out-of-pocket maximum. After the out-of-pocket maximum has been met, coinsurance amounts are no longer required and the plan pays 100% of eligible charges for the remainder of the plan year. There are two separate out-of-pocket maximums: a general one and one for non-PPO hospital charges. Coinsurance and deductibles apply to one or the other, but not both.

General: $1,000 per individual

Non-PPO Hospital: $4,000 per individual

The following do not apply toward out-of-pocket maximums:  Prescription Drug benefits or co-payments. Behavioral Health Benefits, coinsurance or co-payments. Notification penalties. Ineligible charges (amounts over Usual and Customary (U & C) and charges for non-covered services). After Medicare pays, CCHP pays 80% of the balance after the CCHP deductible.

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CCHP - Medical Plan Coverage (From FY 2007 CIP Booklet)

 

Hospital Services

Preferred Provider Organization (PPO) Hospitals

80% after annual plan deductible.  No admission deductible.

Non-Preferred Provider Organization (PPO) Hospital

>> $300 per admission deductible >> If the Benefit Recipient resides in Illinois or within 25-miles of a  PPO hospital and they  choose to use a non-PPO and/or voluntarily travels in excess of 25-miles when a PPO hospital is available within the same travel distance, the Plan pays 60% after the annual plan deductible. >> If the Benefit Recipient resides in Illinois and has no PPO hospital available within 25-miles and voluntarily chooses to travel further than the nearest  PPO, the plan pays 60% after the annual plan deductible. >> If the Benefit Recipient does not reside in Illinois or within 25-miles of  a PPO hospital  the plan pays 70% after the annual plan deductible.

Outpatient Services

Lab/X-Ray	80% of Usual & Customary (U&C) after annual plan deductible.
Approved Durable Medical Equipment (DME) and Prosthetics	80% of U&C after annual plan deductible.
Licensed Ambulatory Surgical Treatment Center	80% of negotiated fee or 80% of U&C, as applicable, after plan deductible.

Professional and Other Services

CIGNA Healthcare Physician PPO Network	90% of negotiated fee after the annual plan deductible. U&C charges do not apply.
Physician and Surgeon Services not included in CIGNA's PPO Network	80% of U&C after the annual plan deductible for inpatient, outpatient & office visits.
Chiropractic Services - medical necessity required (limit of 30 visits per plan year)	90% of negotiated fee or 80% of U&C, as applicable, after plan deductible.

PPO networks are subject to change throughout the plan year. Always call the respective plan administrator to verify participation of a specific provider.

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CCHP - Notification and Penalties

Notification is the telephone call to the health plan notification administrator, informing them of an upcoming admission to a facility such as a hospital or skilled nursing facility, for an outpatient procedure/therapy. Notification is required for all plan participants including those who may have benefits available from other primary payer insurance or Medicare. Intracorp can be reached by calling 1.800.962.0051.

Upon notification, a medically qualified reviewer will contact the plan participant's physician or provider to obtain specific information and evaluate the procedure, the setting and the anticipated initial length of stay for medical appropriateness. Failure to contact Intracorp within the required time limits will result in a $1,000 penalty and the risk of incurring non-covered charges for services not deemed to be medically necessary.

A "reference number" will be assigned and should be maintained by the plan participant should there be any questions regarding notification; however, it is not a guarantee of benefits. For benefit confirmation, Intracorp, the Notification Administrator, can transfer the plan participant to CIGNA for assistance.

Notification is required for the following:

Elective Surgical or Non-Emergency Admission. The plan participant must contact Intracorp at least seven days prior to admission.  .

Maternity. It is recommended that the notification process occur as early in the pregnancy as possible in order to enable Intrcorp to assist in the monitoring the progress of the pregnancy. Notification should occur no later than the third month. Notification of a maternity admission is not automatic enrollment of the newborn. Contact the SURS to enroll the newborn within 60 days of birth.

Skilled Nursing. In a Skilled Nursing Facility, Extended Care Facility or Nursing Home - The plan participant must contact Intracorp at least seven days prior tofore admission. A review will be conducted to determine if the services are skilled in nature.

Emergency or Urgent Admissions. The plan participant or physician must contact Intracorp within two business days after the admission.

Notification for Outpatient Surgery or Procedures/Therapies. The plan participant must contact Intracorp to receiving services, such as, but not limited to, speech, physical and occupational therapies and imaging  (MRI, PET, SPECT and CAT Scan). Failure to notify Intracorp of outpatient surgery or procedures may result in reduction of benefits.

Behavioral Health Services Notification and Authorization Requirements

Contacting the Behavioral Health Plan Administrator, Magellan, begins the authorization process for services at all levels of care to avoid penalties or non-authorization of benefits. In an emergency or life-threatening situation, call 911, or go to the nearest hospital emergency room. Contact Magellan within 48 hours to avoid a financial penalty.

A licensed behavioral health professional will conduct a review to determine if treatment meets medical necessity criteria and appropriate level of care. If treatment is authorized, services are eligible for benefit coverage. Services determined not medically necessary will not be eligible for coverage.

For authorization procedures for behavioral health services, see the Behaviorl Health Services section of the Benefits Handbook or call Magellan at 1.800.513.2611.

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CCHP - Cigna Healthcare PPO Networks

CCHP  non-Medicare Participants have available nationwide CIGNA HealthCare PPO providers, hospitals and facilities. An enhanced 90% benefit for professional fees and an 80% benefit for hospitals and facility services is available by using a participating network provider. The questions and answers below provide more information about this benefit feature. If you have additional questions click HERE to access CIGNA telephone numbers and Web site.

 

	What is the CIGNA HealthCare PPO Network? The CIGNA HealthCare PPO Network is a nationwide network of physicians, hospitals and facilities that have agreed to participate at negotiated rates offering members an enhanced benefit.
	What are the advantages of using CIGNA HealthCare PPO Network provider? The advantages of using providers participating in the network are that benefits for covered services are paid at 90% of a negotiated fee and usual and customary limits will not be applied.
	How do I access services from a CIGNA HealthCare PPO Network provider? Just make an appointment with a network provider and present your CCHP identification card at the time of service.
	What if I do not use a CIGNA HealthCare PPO Network provider? Standard plan benefits, coinsurance levels, and usual and customary limits apply.
	How can I find out which providers are participating in the CIGNA HealthCare PPO Network? Access the participating provider list on the website at http://provider.healthcare.cigna.com/soi.html   Or, call CIGNA at 1.800.962.0051.

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CCHP and CCDP Notice of Privacy Practices

See page 17 and 18 of your booklet, of visit www.benefitschoice.il.gov

Contacts for Plan Components

Vision Care Benefit Plan

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