Frequently Asked Questions

Transcription

1 Frequently Asked Questions Central Florida HMO Medical Options WHAT TO PRIMARY Eligible Disney employees and Cast Members in Central Florida* who want to enroll in an HMO for will have a choice of two separate medical options HMO Orlando Health and HMO Florida Hospital. These HMO medical options will work mostly the same as the 2017 preferred networks under the Cigna HMO. Click on one of the topic areas above to learn more.

2 PRIMARY What to expect in 1. How do the HMO medical options compare to last year? Like last year, the HMO medical option you choose for will need to be used exclusively for in-network care. The HMO networks likely will have most of the same doctors as the preferred networks under Cigna HMO in However, because doctors sometimes change networks, it s important that you check to ensure the doctors you visit will be in-network next year some may be in one HMO network but not the other. If you elect... HMO Florida Hospital HMO Orlando Health Then your network will be... Florida Hospital doctors, hospitals and other facilities services received outside the Florida Hospital network will be considered out-of-network and not covered (except in emergency situations) Orlando Health doctors, hospitals and other facilities services received outside the Orlando Health network will be considered out-of-network and not covered (except in emergency situations) Note: Cigna HMO will no longer be available in the ZIP codes eligible for the new HMO options: HMO Orlando Health or HMO Florida Hospital. 2. Do I need a referral from my PCP to go to another doctor? Referrals are an essential part of the network model of care. Your PCP will refer you to and work as a team with specialists, hospitals and other facilities within the HMO network in order to deliver highly coordinated, quality care that enhances your experience as a patient. 3. Will my contributions differ if I select HMO Florida Hospital or HMO Orlando Health? Contributions for both HMO options are the same and will not increase for. This reflects the focus of both HMO Orlando Health and HMO Florida Hospital to offer high-quality medical services and exceptional care as efficiently as possible to help better manage costs for patients. 4. Is Cigna administering the HMO options for? No. During Benefits Enrollment, eligible employees and Cast Members in Central Florida will have two new HMO medical options HMO Orlando Health and HMO Florida Hospital, instead of Cigna HMO. The new HMO medical options will be administered by Allegiance, which is a subsidiary of Cigna. Just like Cigna has done in previous years, Allegiance will manage referrals to determine when services are covered in-network, handle claim payments, explanations of benefits, appeals and other claim-related communications to patients. This means that employees and Cast Members who select one of these HMO options will use the Allegiance website to access their claim information and forms. Allegiance will also be responsible for pre-certification and pre-treatment reviews before care is administered.

3 PRIMARY Receiving care 1. Can I go to doctors outside the HMO Florida Hospital or HMO Orlando Health network? No. Like all HMOs, the medical option you choose for will need to be used exclusively for in-network care: Your PCP will coordinate referrals to specialists or other providers. If your PCP refers you to a provider outside your HMO network, the claim will not be covered. While your PCP should know which HMO network you and your covered dependents are enrolled in, it is your responsibility to ensure the care you receive is in-network. 2. How will I know if my doctor is in the network? You can use the Find a Provider Tool on D Life My Benefits to see if your doctor is in the network. The HMO networks likely will have most of the same doctors as the preferred networks under Cigna HMO in However, because doctors sometimes change networks, it s important that you check to ensure your doctors will be in-network for the medical option you want to enroll in next year some may be in one HMO network but not the other. 3. Do I need a referral to go to a specialist? Yes. Your PCP directs your care, including providing referrals for specialists and other services. If you receive care from a specialist without a referral, it will not be covered. Note that referrals have a duration of care limit (a specified number of visits), and must be renewed when the duration of care expires. If you currently are seeing a specialist and are not sure if a new referral is required, contact your PCP to confirm. 4. If I enroll in HMO Florida Hospital and my PCP directs me to an Orlando Health hospital (or vice versa), will the care I receive there be considered in-network? No. Your PCP should know if you are an HMO Florida Hospital or HMO Orlando Health participant and direct you to an in-network hospital affiliated with your HMO option. Some exceptions may apply, such as some emergency services or highly specialized care. 5. Can I still use the Center for Living Well, regardless of my HMO option? Yes. You can continue to use the Center for Living Well no matter which HMO option you choose. The Center for Living Well doctors are PCPs for both HMOs and can refer you to specialists in your HMO network. 6. What urgent care centers are available in the HMO Florida Hospital network? The Centra Care urgent care centers are part of the HMO Florida Hospital network. To find other facilities in the HMO network, use the Find a Provider Tool on D Life My Benefits. Continued on next page

4 PRIMARY Receiving care 7. What urgent care centers are available in the HMO Orlando Health network? The Care Spot Urgent Care centers are part of the HMO Orlando Health network. To find other facilities in the HMO network, use the Find a Provider Tool on D Life My Benefits. 8. If I need care while I m traveling away from HMO Florida Hospital or HMO Orlando Health, will my treatment be covered? The HMO options do not cover care that you receive out-of-network, except in emergency situations and certain exceptions. All out-of-network care and special accommodations for students require approval. 9. What if I receive emergency medical care from a facility that s not in-network? Emergency services are covered regardless of the facility. If you need immediate treatment of a serious or life-threatening condition, always go to the emergency or urgent care facility nearest you, even when you are traveling outside the area. 10. Can I still use my current Cigna HMO and Express Scripts ID card? If you enroll in HMO Florida Hospital or HMO Orlando Health, you will receive a new combined medical/pharmacy identification card to use during medical visits and when filling prescriptions. Be sure and present it at your first visit to the doctor s office in.

5 PRIMARY Eligibility 1. Will I be eligible to elect one of these HMO options? Eligibility* to elect HMO Orlando Health or HMO Florida Hospital during Benefits Enrollment will be based on ZIP code. You will be eligible to choose one of these HMO options if your permanent residential address on file with the Company as of September 8, 2017, is in a ZIP code where both Orlando Health and Florida Hospital offer a full scope of health care services. If you live in a ZIP code where either Florida Hospital or Orlando Health, or both, do not offer a full scope of health care services, you will be eligible for Cigna HMO instead. Confirm the medical options available to you by using the ZIP code lookup tool on D Life My Benefits or, starting October 19, 2017, reviewing your coverage information on Fidelity NetBenefits. Hourly employees will also receive a Personal Fact Sheet in the mail. 2. My HMO medical options are different this year than last year. Why? Eligibility* to elect HMO Orlando Health or HMO Florida Hospital is based on whether your permanent residential address on file with the Company as of September 8, 2017, is in a ZIP code where both Orlando Health and Florida Hospital offer a full scope of health care services. Because the service areas are reviewed annually, only a few ZIP codes that were eligible in 2017 will no longer eligible in, and vice versa.

6 PRIMARY Selecting a medical option 1. What does enrolling in HMO Florida Hospital or HMO Orlando Health mean for me and my enrolled dependents? Whether you choose Florida Hospital or Orlando Health, you ll work closely with your PCP to get care within the designated network, which is expected to: Be more personalized. Your PCP will work as a team with the specialists, hospitals and other facilities within the plan. The team will share information and make recommendations together to provide you with the best care possible. Take less time. In another plan, your doctor may refer you to a specialist without passing along your test results or X-rays. That legwork could fall on you and without it your appointment with the specialist might not be as productive as you want. If you elect Florida Hospital or Orlando Health, your providers will coordinate those steps for you, so you can make the most of every appointment. Mean fewer hassles. More coordinated care means better communication among your providers, fewer administrative issues and less paperwork for you to complete 2. How do I decide which medical option to choose? Choosing a medical option is a very personal decision and it s one that you should make after carefully considering which one best meets your family s unique needs. If you are interested in choosing either HMO Florida Hospital or HMO Orlando Health, you should: Use the Find a Provider Tool on D Life My Benefits before you enroll to see if your PCP and any specialists you visit will be in the Orlando Health or Florida Hospital network for Learn more about Orlando Health at OrlandoHealth.com/Disney and Florida Hospital at FloridaHospitalNetwork.com/Disney Attend a Benefits Showcase, October at the ESPN Wide World of Sports Complex to talk with Orlando Health and Florida Hospital representatives Talk to your PCP to identify any special considerations that may make one of the HMO options more appropriate for you and your family Continued on next page

7 PRIMARY Selecting a medical option 3. What should I do if my enrolled dependents and I use providers in different HMO options? Each HMO option offers a full range of providers, including internists, pediatricians and gynecologists, in its network. You might consider: Choosing the one that is affiliated with the providers necessary for the care your family needs Talking to your PCP to identify any special considerations that may make HMO Orlando Health or HMO Florida Hospital more appropriate for you and your family Enrolling in one of the other medical options available to you, Consumer Choice or Basic PPO, which would allow you to see doctors in either network. 4. What should I do if I have providers, including specialists, affiliated with both HMO Florida Hospital and HMO Orlando Health? Review the providers in each HMO option carefully, and consider choosing the one that is affiliated with the providers most important to you and your enrolled dependents. Talk to your PCP to identify any special considerations that may make HMO Orlando Health or HMO Florida Hospital more appropriate for you and your family. You might also consider enrolling in one of the other medical options available to you: Consumer Choice or Basic PPO. Remember that when you select one of the HMO options, you are choosing where you want your PCP to refer you for care. The one you choose for will need to be used exclusively for in-network care. If you receive services from a doctor, hospital, facility or specialist outside of the network, those services will be billed as out-of-network, except in emergency situations. You should partner with your PCP to make sure your referrals are in-network. If your PCP refers you to a provider outside your network, the claim will not be covered

8 PRIMARY Selecting a primary care physician 1. Will I be able to choose any doctor affiliated with my HMO option as my PCP? As long as the doctor falls under the designation of Primary Care Physician, and is in your plan s network and accepting new patients, you will be able to select that doctor as your PCP. The Find a Provider Tool on D Life My Benefits will indicate if the PCP is accepting new patients. If you do not choose a PCP, or if you choose someone who is not a designated PCP in your plan s network or currently accepting new patients, your HMO option may assign a new PCP to you. 2. Can I choose different PCPs for myself and my enrolled dependents? Yes; however, all of the PCPs you select for yourself and your enrolled dependents must be in your plan s network. 3. I already selected a PCP. Do I have to do it again? No. If you and your enrolled dependents are currently enrolled in Cigna HMO and chose Florida Hospital or Orlando Health as your preferred network for 2017, your designated PCP on file as of September 8, 2017, will be pre-populated if you elect the same network when you enroll via Fidelity NetBenefits. 4. Can I change my PCP during? Yes; however, your new PCP must be in your plan s network. After Benefits Enrollment ends, you can change your PCP by calling member services at Florida Hospital at or Orlando Health.

9 PRIMARY Enrolling 1. When is Benefits Enrollment? Benefits Enrollment is October 19 November 3, Go to D Life My Benefits for everything you need to know. You and your spouse or domestic partner can also access it directly at Benefits.Disney.com. 2. What do I need to do if I want to enroll in HMO Florida Hospital or HMO Orlando Health for? Disney strongly encourages you to actively elect your benefits each year. If you already enrolled in Cigna HMO and elected a preferred network for 2017, you ll see the corresponding HMO option pre-populated when you enroll via Fidelity NetBenefits. You will have the opportunity to change your election online or by phone October 19 November 3, You also will need to choose an in-network PCP for you and each of your enrolled dependents all within the same network, based on which HMO option you choose. If you do not make changes by the deadline, your coverage will remain the same and take effect January 1,. 3. Can I choose different HMO options for myself and my enrolled dependents? No. You must choose one medical option for yourself and your enrolled dependents. 4. I plan to enroll in Consumer Choice or Basic PPO for. Do the HMOs affect me? No. The Consumer Choice and Basic PPO medical options will work the same way they do today. Continued on next page

10 PRIMARY Enrolling 5. What happens if I don t actively elect benefits during Benefits Enrollment? If you elected either Florida Hospital or Orlando Health as your preferred network for 2017, and you live in an eligible ZIP code area, you automatically will be enrolled in the corresponding HMO option for. (If you enrolled in Consumer Choice or Basic PPO, you will default to your current coverage.) It s important to note that your PCP may not be in your HMO option s network next year. Because doctors sometimes change networks, doctors who may have been in one or both networks last year may be participating in a different HMO network for. Because you know what s best for you and your family, please make every effort to elect your benefits. You won t be able to change your elections (even if we make them for you) until 2019 Benefits Enrollment, unless you experience a qualified life event. Call the Disney Benefits Center at for more information about qualified life events. 6. Can I change my medical option during? No. Your medical option election applies for the entire year, unless you experience a qualified life event. For example, if you get married, have a baby or move outside the eligible ZIP code area, you will be able to change your election during. Call the Disney Benefits Center at for more information about qualified life events.

11 PRIMARY Resources 1. Where can I learn more about Allegiance? Learn more about Allegiance and Florida Hospital at Askallegiance.com/disneyfh. Learn more about Allegiance and Orlando Health at Askallegiance.com/disneyoh. 2. How can I find out if my PCP is in the HMO Orlando Health or HMO Florida Hospital network? Use the Find a Provider Tool on D Life My Benefits to see if your PCP and any specialists you go to will be in-network under Orlando Health or Florida Hospital for. Note that PCPs at the Center for Living Well will be available under both options. 3. Where can I learn more about HMO Florida Hospital and HMO Orlando Health? Learn more about Florida Hospital at FloridaHospitalNetwork.com/Disney or (language assistance is available). Learn more about Orlando Health at OrlandoHealth.com/Disney or (language assistance is available). Additionally, both Florida Hospital and Orlando Health will be onsite for Benefits Showcases at ESPN Wide World of Sports Complex from October 26 to October 28. Watch for details. During Benefits Enrollment, please call the Disney Benefits Center at if you have questions about any of your medical options or the enrollment process. 4. Is language assistance available? The Disney Benefits Center at can provide language assistance, or call and press 1 for Haitian Creole or press 2 for Vietnamese.