Published on May 30, 2014

Cigna-HealthSpring’s Termination of the Agreement with Crozer-Keystone Health System

FREQUENTLY ASKED QUESTIONS

Am I entitled to change health plans?

  • Some patients may already have the right to change health plans before the next open enrollment period. Others may only be able to change plans mid-year by  requesting permission from the federal Centers for Medicare & Medicaid Services (“CMS”)  
  • Medicare open enrollments are limited by federal rules. The next scheduled Medicare Open Enrollment is October 15th through December 7thof this year for changes effective on January 1, 2015 and you are entitled to switch to a new Medicare Advantage plan at that time. Some people are able to switch plans midyear for certain reasons, such as:
    • Dual Eligible members (individuals with both Medicare Advantage and Medicaid coverage) are entitled to switch to other plans or to original Medicare now or at any time.
    • Members with a severe or disabling condition can join a Medicare Chronic Care Special Needs Plan (SNP). You can join anytime, but once you join your chance to make changes using this Special Enrollment Period (SEP) ends.
    • The Medicare and You handbook describes in detail when and for what reasons you have the right to switch plans at times other than during the regular open enrollment period. 

If I don’t have the “right” to return to original Medicare or to switch plans outside of a regular open enrollment period, can I get permission to do so now?

  • Yes. There are CMS rules and guidance that spell out the kinds of things that would cause CMS to grant permission to switch plans outside of a regular enrollment period. You would need to contact Medicare and request an individual Special Enrollment Period (SEP) to switch to a different Medicare Advantage plan or to return to original Medicare now, so that you do not have to wait until the next open enrollment period. That request would be considered based on the Medicare rules.

What factors are considered by CMS to justify switching plans before the open enrollment period?  

Factors Medicare would consider include the following:

  • you believe the Medicare Advantage Plan you are enrolled in has misrepresented or lied to you about its provisions and/or actions;
  • you believe the termination of Crozer-Keystone Health System from Cigna HealthSpring’s provider network has a significant, negative impact on your Provider Network and your ability to receive needed medical care under the plan;
  • you believe the timing of the termination has thwarted your ability to switch plans or return to original Medicare;
  • you believe you did not receive adequate and timely notice of the termination;
  • any other reasons you are negatively impacted by the termination.

How can I get more information about switching plans or returning to original Medicare?

  • If you are interested in changing plans, you should check with Medicare to see if you already can, or if you qualify for a Special Enrollment Period (SEP). Special Enrollment period criteria information is available in the Medicare & You 2014 handbook, you can request this from Medicare or see it on their website at  http://www.medicare.gov/Pubs/pdf/10050.pdf
  • You can contact Medicare at http://www.medicare.gov/  or call 1-800-MEDICARE (1-800-633-4227), 24 hours a day/seven days a week. TTY/TDD users should call 1-800-325-0778

What if I want to remain with Cigna-HealthSpring?

  • If you remain a Cigna-HealthSpring member, the plan may not authorize coverage for care by your Crozer-Keystone physician or at a Crozer-Keystone facility and may require you to pay a higher out-of-pocket cost – except in an emergency or urgent care situation, or for a limited continuity of care period.
  • Some patients may qualify to receive continued coverage of care for conditions already being treated by a Crozer-Keystone provider under Continuity of Care provisions. You will need to request authorization from Cigna HealthSpring for this Continuity of Care coverage, please contact Cigna HealthSpring at 1-888-454-0013 to request this authorization. 

If you have any additional questions regarding this communication, you can also call the CKHS Patient Service Center at 888-525-4772, option # 3, Monday to Friday, 8 am to 4:30 pm.

 

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