DePaul University Human Resources

Part III: Using the Consumer Driven Health Plan (CDHP)

A. How to Find an In-Network Provider

Even though the CIGNA Choice Fund HSA Plan allows participants to use any provider, if you use network providers, claims expenses are applied to a much lower deductible. In addition, eligible preventive care benefits are covered at 100% with no deductible and no limit on an in-network basis. Preventive care services are described in the CIGNA Preventive Health Guidelines.

Steps:

Go to www.cigna.com;
select Provider Directory from the menu on the left;
select the type of provider you're looking for, enter your zip code, and select the distance you're willing to travel;
choose the Open Access Plus ONLY and make no network selection;
you will now be prompted to complete your search criteria.

Once you identify a doctor in the network, you should contact him or her to ensure he or she is taking new patients.

B. How to Use the Mail Order Pharmacy for Maintenance Medications

If you are on a maintenance medication, you can save a significant amount of money by using the mail-order pharmacy program. See the mail order brochure for more information.

To Initialize or to Refill a Prescription:

Option I: Use the mail order application in the brochure. You must include payment or payment information, i.e. credit card. Include your prescription; keep a copy for your records. Obtain the CIGNA Tel-drug Prescription Order Form.

Option II: Use mycigna.com.

Click the pharmacy tab.
To order a new prescription, click on order a new prescription.
To refill a prescription, click QuickClick to refill.

You must include payment or payment information.

C. How to Submit Claims

Type of Claim	Who Submits Claim?	Pre-payment Required?
In Network	Provider	Not Necessary
Out of Network	Member	Provider can request payment up front.
In Network Preventive	Provider	Not Applicable – No Cost.
Out of Network Preventive	Member	Provider can request payment up front.
Retail Pharmacy	Member*	Member will need to pay for prescriptions at the point of purchase(s).
Mail Order Pharmacy	Provider	Yes – payment will be required when placing the order.

Note: All claims must be submitted by the provider or member to CIGNA Healthcare to apply to the deductible, coinsurance and out of pocket.

*If you receive your prescriptions from a retail pharmacy, you will need to submit the prescription drug claim to CIGNA HealthCare to have it applied to the deductible. You will need to take the following steps:

Fill out a pharmacy claim form (located on mycigna.com or cigna.com under important forms)
Submit the claim form with a clear copy of receipt to the address on the claim form.

Note: once you set up a Health Savings Account, you will receive a CIGNA Choice Fund debit card in the mail for use with your account.

Note: only qualified expenses on or after the date that the Health Savings Account is established are eligible for reimbursement on a tax-advantaged basis.

For claim payment methods (HSA, Automatic Claim Forwarding, personal funds), see the Claim Payment Methods Instructions

For Mail-order instructions, see the Teledrug Program description
Important:

Keep copies of all receipts. These will be needed in the event of an IRS audit to verify that HSA funds were used for qualified medical expenses and are therefore not taxable.
See Section VI for information regarding the type of expenses that can be paid with your Health Savings Account.

D. How to Make Mid-year Changes if Necessary

Changes can be made to your Consumer Driven Health Medical Plan if you experience a qualifying family status change (such as adding a spouse or new child) as defined in the General Information Section of the Health Plans Summary Plan Description found on the DePaul University HR web-site.

Maximum Employee Contributions

The new maximum employee contribution allowed in the event of a plan coverage level change will be the annual contribution amount allowed based on the new level of coverage. Employees who coverage level is decreasing should ensure they do not exceed the annual maximum allowed by the IRS.

Employee HSA contribution changes are entered on-line as described above in Part IID.

Employer Contribution Changes in the Event of a Change of Coverage Level

If an employee switches from Employee-only to [Employee plus Spouse, Employee plus Children or Family Coverage] then DePaul will make a pro-rated additional employer contribution. For instance, if an employee began the year with single coverage and hence received a $500 contribution in January and switched to family coverage effective July 1st, then an additional contribution will be made. The additional amount in this example would be the difference between the family contribution made on January 1st and the employee-only contribution ($1,000 - $500 = $500) divided by 12 month ($500/12 = $41.67) and multiplied by the number of months the employee will be in the family coverage level for the year ($41.67 * 6 = $250). In this case the additional employer contribution would be $250.

Conversely, DePaul will not attempt to have employer contributions returned from employees who switch from family coverage (or employee plus spouse, or employee plus child) to single coverage during the year, but received a family contribution for the full year on January 1st. Employees who participate in the CDHP are responsible for monitoring all contributions to his or her HSA account and ensuring that the Statutory Maximum Annual Contribution as stipulated by IRS guidelines is not exceeded. If it is, the employee is responsible for taking corrective distributions and reporting the excess to the IRS.

Employees who Terminate before the End of the Calendar Year

DePaul does not attempt to have employer contributions returned for employees who leave the plan before the end of the year, yet already received the entire employer contribution. For example, if an employee who had family coverage ($2,400 deductible) received a $1,000 employer contribution for the year on January 1st, terminated on June 30th, then DePaul does not attempt to recover the $500 of the contribution already made for the second half of the year.
If there are excess contributions to your Health Savings Account for any reason, including your termination of employment resulting in you not being covered by a High Deductible Health Plan as defined by the IRS, DePaul will not report this on your W2. You, the CDHP member, are responsible for reporting all excess contributions to the IRS and taking corrective distributions.