Beginning January 1, 2008, the University of California will offer all employees another health plan choice - CIGNA Choice Fund.

CIGNA Choice Fund combines a Health Reimbursement Account (HRA), with a coinsurance plan (similar to a Preferred Provider Organization, or PPO). The Choice Fund was designed to provide UC employees with a new and different approach to making and managing effective health care choices.

The decision to offer this plan relates to a successful pilot of the Definity Health Plan, a similar HRA-based plan, which UC has been offering at UC San Francisco and UC Santa Barbara for the past three-and-a-half years. Participants in the pilot have been very satisfied with this approach and are changing the way they think about health care. In 2008, CIGNA Choice Fund will be offered systemwide and will replace Definity at UCSF and UCSB for those who choose to remain in a HRA-based plan.

How the CIGNA Choice Fund Works
CIGNA Choice Fund is comprised of five key components:

1. 100% Preventive Care Coverage
   Important preventive care services such as exams, immunizations and screenings are covered 100% with in-network providers. You don't need to use your HRA, and expenses are not subject to the deductible.
2. Health Reimbursement Account (HRA) - UC provides you with an allowance of benefit dollars that pay 100% of eligible medical and pharmacy expenses until it is used up. Any HRA dollars used apply toward your annual plan deductible. If you don't use all of your HRA during the plan year, then you will have no out-of-pocket costs for eligible expenses. The unused amount rolls over and will be added to next year's HRA allowance.
3. Member Responsibility - If you use all the dollars in your HRA, you pay for eligible medical and pharmacy expenses out of your pocket up to the amount of your deductible. This amount will be less if you roll over HRA dollars from the previous plan year. The Health Reimbursement Account (HRA) + Member Responsibility = Your Deductible.
4. Health Coverage - If you satisfy the deductible, you and UC share the cost of eligible medical expenses through coinsurance. This is similar to how a PPO plan works. There's a limit to the amount of coinsurance you will pay each year.
5. Out-of-Pocket Maximum - For your protection, there are in- and out-of-network maximums to the amount you pay out of pocket each year. If you reach this amount, then your medical and prescription drugs are covered 100% for the rest of the plan year.

Here's how the plan works for a non-preventive care doctor visit: After a member sees a doctor, the doctor sends a claim to CIGNA for the visit and any tests or other expenses.

1. If there are dollars in the member's HRA, the bill is paid from that account.
2. If the HRA has been used, then the member is billed for the full amount, which is discounted if the member sees an in-network doctor.
3. If the member has met the deductible, the UC Choice Fund and the member share the costs of covered services, (80/20 for in-network services; 60/40 for out-of-network services), up to the annual out-of-pocket maximum.

Freedom to Choose
Choice is a key component of the CIGNA Choice Fund. Members can choose, for example, to use an out-of-network doctor and pay the higher cost using their HRA. The freedom to choose his own doctor and to see a specialist without a referral is one of the reasons Reza Heydarpour, a computer and network technologist in the Computer Center at UC Santa Barbara, has been a satisfied member of Definity Health for the past year. "When I have a rash and want to see my dermatologist, I don't have to see my primary doctor first and pay for that office visit to get a referral. I just go to the dermatologist," he says.

In order to make good choices, members of HRA-based plans such as CIGNA Choice Fund find they often approach health care as they do other important consumer purchases-they stay informed in order to manage their health care expenses wisely. Professor Ronald Tobin, Associate Vice Chancellor of Academic Programs at UCSB and another satisfied Definity Health member from UCSB, agrees, pointing out that members pay the full cost of expenses including prescription drugs until the deductible (which includes the HRA amount and the Member responsibility amount) has been met. "If you take expensive prescription drugs, you can use up your HRA amount pretty quickly. Professor Tobin said. "I take medication, and I shopped around to find where I could get the best price in order to make my HRA last longer."

CIGNA Choice Fund also provides web tools to help members find a doctor or specialist and get pricing information to help them manage their health care expenses. The website also provides a personalized site for each employee member where they can see their HRA balance and the status of current billing. UC employees interested in considering the CIGNA Choice Fund can preview the web tools beginning in October. Look for the link to the CIGNA website on the UC Open Enrollment website.

Pamela Hayes, Benefits Manager at UCSF, and Laura Morgan, Health Care Facilitator at UCSB, were involved in implementing the Definity Health pilot program on their campuses and continue to work with employees in the plan. They recommend that employees interested in the CIGNA Choice Fund compare the costs of the plan (premiums plus out-of-pocket costs) to the costs of their current plan, consider the importance of having more control over doctor choice and health care expenses, and consider the time required to understand the plan and become a better educated health care consumer.

Take Time to Evaluate Your Options This Fall
More information about CIGNA Choice Fund, including employee premiums, will be available in the Open Enrollment packet mailed to employees in mid-October and on the Open Enrollment website. Also, CIGNA will provide an educational web site and pre-enrollment phone line beginning in early October to help you learn more about CIGNA Choice Fund.

In the meantime, you can check to see if your doctors are part of the CIGNA network, by visiting online. First, type in the doctor's name and location in the "Find a Doctor" section of the page. Click Next. Then, select "Open Access Plus Only" and click Search. Or, simply ask at your doctor's office. UC is offering CIGNA's premier network, so be sure to specify CIGNA Open Access Plus when inquiring.