Health Plan Information

This link leads to the machine readable files that are made available in response to the federal Transparency in Coverage Rule and includes negotiated service rates and out-of-network allowed amounts between health plans and healthcare providers. The machine-readable files are formatted to allow researchers, regulators, and application developers to more easily access and analyze data.

Effective July 1, 2022

Cigna Pre-Enrollment Line - Before you enroll in coverage you can call Cigna's pre-enrollment line 24/7 at 1-888-806-5042. Cigna's team of dedicated live representatives can help you understand the medical plan options, answer questions, confirm in-network providers, and more.

Cigna's Easy Choice Select a Plan Tool - Cigna's easy choice tool is available. The College's employee medical plan contributions are tiered in 4 annual salary bands.

The access code to use the Cigna tool are:

• Annual salary of $43,000 and under - QAKGTAT7
• Annual salary of $43,001—$85,000 - WAVGATLA
• Annual salary of $85,001— $140,000 - 9CPTCNLH
• Annual salary of $140,001 and over - WC4HPJTW

Cigna’s online directory – Before you are enrolled go to Cigna.com and click on “Find a Doctor” at the top of the screen. Under “How are you Covered?” select “Employer or School.” When prompted to select a network use: Open Access Plus, OA plus, Choice Fund OA Plus. You can use any in-network healthcare provider, medical facility, or pharmacy in Maine and across the United States with no referrals required by the plans. We urge you to establish a relationship with a primary care provider to help guide your care, but you do not need to provide this information in the enrollment process.

In-Network – Cigna contracts with many providers in Maine and across the United States, known as “in-network” providers. Cigna has special rates with these providers, so if you go to an in-network doctor or hospital you will be able to pay less out of pocket.

Out-of-Network – With the Cigna Open Access Plus Health Plan, you do not have to go to an in-network provider if you do not wish to. However, because out-of-network providers do not have a contract with Cigna, it will cost more for both you and the College. It is important to understand that if you receive services from an out-of-network doctor or hospital, the health plan will pay benefits based on the “maximum allowances.” This means that any amount that an out-of-network doctor or hospital charges that is above the maximum allowance will be billed to you directly before the out-of-network benefits begin to pay. This can mean significantly higher out-of-pocket costs to you. For example, if an out-of-network doctor charges $175 for an office visit and the maximum allowance is $100, you will have to pay $75 before the deductible and coinsurance are applied.

Deductible - The deductible is the amount of money you need to pay before the insurance pays. The in-network deductible is $750 for an individual and $1,500 for a family. For many of the services covered by the health plan, you will need to meet your deductible before the benefit applies.

Copayment (Copay) – For some services and for prescription drugs, you will have to pay a copay. A copay is the amount of money you pay for a service, separate from your deductible. Your copay is usually a small percentage of the overall cost. For example, if you go to an in-network primary care doctor for an office visit, you pay $20 and the insurance company pays the rest. Copays are a set dollar amount.

Coinsurance – Coinsurance is the percent of the cost of your care that you need to pay after you have paid your deductible. For in-network services it is 20% and for out-of-network services it is 40%.

Out-of-Pocket Maximum – The “out-of-pocket” maximum is the total amount of money (deductible plus coinsurance plus medical co-payments) that you will pay for medical services in a benefit year (calendar year). Benefits are paid at 100% for the remainder of the calendar year once you have reached your out-of-pocket maximum. There is a separate out-of-pocket maximum for prescription drug copayments: $5,700/individual and $11,400/family. Out-of-network charges that are in excess of the maximum allowance do not count toward your out-of-pocket maximum. The in-network out-of-pocket calendar year limit is $3,000 per individual/$6,000 per family.