Cigna SmarterHealth
Cigna HealthCare UK’s SmarterHealth is a new experience rated medical plan designed for employers with from 150 to 400 employees. The plan is based on a core level of cover with options to flex cover up or down. There are two flex up options:
• Four levels (Pearl Plan; Diamond Plan; Oral Health Plus, or Oral Health Optimum) of dental benefit.
• Travel insurance for business and leisure travel that includes winter sports cover.
• And two flex down options:
• Psychiatric cover can be removed.
• The stress helpline can be removed.
• There is also a choice of four underwriting options:
• Medical history disregarded.
• Full medical underwriting—which is standard for virgin (previously not insured) schemes.
• Continued previous medical exclusions. Offered where the membership certificates are available when switching from another insurer.
• Moratorium. This is available on both new and switch schemes.
The core plan pays for hospital charges; parent accommodation with child up to age 12; surgeons’, anaesthetists’ and physicians’ fees; full out-patient benefits; up to £250 a year for chiropractic/osteopathy (full refund if a referral from the patient’s specialist); alternative therapies; home nursing (up to 180 days a year); surgical appliances; psychiatric care (up to £10,000); private ambulance; NHS cash benefit of £100 a night (up to 50 nights), and optical cash benefit of 75% of costs up to £100 a year. Where psychiatric cover is included, the maximum annual benefit is £10,000. The stress helpline includes up to six face-to-face counselling sessions.
Excess and co-insurance options are offered. Cigna manages costs through its nurse-led approach to managed care. It says this approach to micro-managing claims improves clinical outcomes, controls costs and ensures the highest levels of customer satisfaction.
Plus points: What Cigna adds to experience rated PMI plans especially is its managed care approach; This can cut costs and improve outcomes (and patient feedback); Some flexibility to increase or decrease cover, a choice of underwriting options and a high level of core cover – including an optical cash benefit (more usually the kind of benefit that is included in health cash plans).
Not so plus points: Critics of managed care see it as an unnecessary restriction on patients’ right to choose. Some competitors may offer more options.
Website: http://www.cigna.com.
Rating (max 10): Innovation: 6. Overall: 8.