The pandemic-related work stoppage affected many members’ eligibility for benefits under the Health Fund. This was especially difficult for people about to gain eligibility and those about to lose coverage. To help address this hardship caused by the shutdown, we are offering a new Cigna Silver plan, effective June 1. This is an in-network-only medical plan that includes coverage for generic drugs.

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• Cigna Ppo Er Copay
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• Cigna Copay Plan
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Cigna Silver plan eligibility

Cigna Silver plan cost

Emergency Room / Urgent Care Facility Outpatient Professional Services.Ambulance Benefit In-Network Out-of-Network In-Network Out-of-Network In-Network Out-of-Network Emergency Care $75 per visit (copay waived if admitted) Plan pays 100% Plan pays 100% Urgent Care $25 per visit (copay waived if admitted) Plan pays 100% Plan pays 100%.

Cigna Silver plan coverage

How to enroll

Enrollment deadlines

• Outpatient Surgery $700 copay $1,400 copay Life Emergency Room Visit ThreateningER Visit: $500 copay/visit then deductible applied Non-Life ThreateningER Visit: $750 copay/visit then deductible applied (copay waived if admitted) Urgent Care $100 copay/visit. Prescription Drug Benefits — Administered by Cigna Retail Pharmacy.
• Just got hosed by Cigna over ER bill, sharing so others understand hidden costs. I have Cigna Open Access Plus through an employer. The card lists the co-pay for PCP, Specialist, Hospital ER, and Urgent Care, and the three levels of prescriptions. Great, that's fine and normal. Then it lists the 80%/20% for both in and out of network.
• Cigna Pharmacy Management. Nevirapine ER5 Odefsey5 Pifeltro5 Prezcobix5 Reyataz powder packet5 Selzentry5 Stribild5 Symtuza5 tenofovir5 Viread 150mg, 200mg, 250mg, powder5 ATTENTION DEFICIT HYPERACTIVITY DISORDER Adderall7 amphetamine7 dexmethylphenidate7.
• Cigna will reimburse the COVID-19 vaccine administration without cost-share. Cigna will reimburse the administration of the vaccine at the established national CMS rates. No additional modifiers are required for billing. Cigna will not reimburse providers for the cost of the COVID -19 vaccine product when it is provided by the government.

Cigna Silver plan eligibility

You are eligible if either of the following scenarios applies to you.

On the date your employment ended because of a COVID-19 related shut down, you: were working in covered employment; did not have Health Fund coverage; and had at least nine weeks earned toward Equity-League Health Fund eligibility for the 12-month period ending with the COVID-19 shutdown.

OR

You are currently covered under the Health Fund and will lose coverage due to insufficient work weeks. In this case, you are also eligible for and may elect COBRA continuation under the current Health Fund plan instead of enrolling in the Cigna Silver plan.

You can continue coverage under the Cigna Silver plan until December 31, 2020.

Cigna Silver plan cost

You’ll pay $250 per month for individual coverage under the Cigna Silver plan. Your premium reflects about one-third of the total cost of your coverage; the Fund pays the other two-thirds. You may also cover your dependents under this plan, but their monthly premium cost would be at a full, unsubsidized amount:

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• $741 additional for one dependent (total monthly premium: $991)
• $1,186 additional for two or more dependents (total monthly premium: $1,436)

Cigna Silver plan coverage

Plan Feature	What You Pay1
Annual deductible	$1,000 individual/$2,000 family
Out-of-pocket maximum	$5,000 individual/$10,000 family
Coinsurance (for most services, including inpatient hospital and emergency room visits)	30% of in-network expenses after deductible; no coverage for out-of-network expenses
Preventive visit copay	$0 (in-network, no deductible or copays)
Office visit	$20 copay (in-network, no deductible)
Specialist visit	$40 copay (in-network, no deductible)
Prescription drugs through OptumRx	20% ($10 minimum); generic drugs only2; no deductible
Separate prescription drug out-of-pocket maximum	$3,150 individual/$6,300 family3

1. Benefits are payable only when care is received from in-network providers. You are responsible for 100% of the cost of care received out-of-network.
2. There is no coverage under the plan for brand-name prescription drugs.
3. If you have lost or are losing Health Fund coverage, amounts previously accumulated under OptumRx in 2020 apply to this year’s out-of-pocket maximum.

For more plan details, review the Summary of Benefits and Coverage. If you have questions about the new plan before enrolling, call Cigna’s Silver plan pre-enrollment line at (888) 806-5042.

Does the Cigna Silver plan include the same network of doctors and hospitals as the Equity-League Health Fund plan?

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Yes, both plans feature the same Cigna provider network.

How to enroll

To enroll for the Cigna Silver Plan, email the Benefit Services Department at health@equityleague.org. Provide your name, telephone number, and Actors’ Equity Association membership ID number. One of our representatives will contact you for payment by credit card and finalize your enrollment.

If I initially elect the Cigna Silver plan, will I have the opportunity to continue coverage under COBRA?

Yes. You can still elect COBRA continuation coverage under the Health Fund plan, even if you first enrolled in the Cigna Silver plan. Normally, you would have 60 days to elect COBRA. However, under a temporary enrollment extension issued by the Department of Labor (DOL), you now have a longer window for returning your COBRA election form. The additional time to make your election will continue to be extended as long as the declared COVID-19 national emergency is in effect. The temporary enrollment extension will end 60 days after the end of the national emergency. As the official end date has not yet been determined, it is not known how long the extended deadline will be available.

You can continue Cigna Silver coverage plus COBRA continuation for up to a combined total of 18 months.

Example: Mariel is eligible for COBRA continuation coverage as of October 1 but enrolls in the Cigna Silver plan first. If the national emergency ends on October 31 2020, the temporary enrollment extension would end on December 30, 2020 (60 days later). The last day of Mariel’s COBRA election period would be February 27, 2021. She would then have an additional 45 days to submit her COBRA payment. So, if she waits until February 27 to elect COBRA and pays for coverage 45 days later (in mid-April), her COBRA continuation coverage would go retroactive back to January 1, 2021. Assuming Mariel continues to pay for the Cigna Silver plan coverage, she will have been covered for three months under the Cigna Silver plan and will be eligible for 15 months of COBRA continuation coverage (a combined total of 18 months) beginning January 1, 2021.

Can I elect both the Cigna Silver plan and COBRA continuation at the same time?

No. To enroll in the Cigna Silver plan, you must first agree to reject COBRA coverage. A Rejection of COBRA waiver form is included with your Cigna Silver enrollment materials. If you reject COBRA continuation coverage now, you can change your mind later. If that happens, submit a completed COBRA election form to the Health Fund within the deadline (including the DOL extension described above). Your COBRA election would be effective prospectively once a premium payment has been made.

If I enroll in the Cigna Silver plan now, may I switch to a different plan later if I can no longer afford Cigna Silver?

While you may end your participation in the Cigna Silver plan at any time, in general, you can only enroll in another plan during a specified enrollment period or if you have a qualifying event, such as a change in your employment status. Depending on your personal situation, you could qualify for an individual insurance plan or Medicaid through the public Health Insurance Marketplace. You’ll need to start an application to learn if you’re eligible.

If I can’t afford the Cigna Silver plan and I’m losing Fund coverage, what other choices do I have?

If you’ll be losing coverage under the Health Fund, you’ll receive a COBRA notice that describes your options under COBRA and the public Health Insurance Marketplace. If you qualify to enroll in the Cigna Silver plan, you’ll get information and enrollment instructions from the Fund Office.

You may also learn about other options available to you by joining the Actors Fund’s weekly webinar, Every Artist Insured: Getting & Keeping Affordable Health Insurance During COVID-19. It provides step-by-step guidance for the health insurance options currently available to you.

How does health plan COBRA continuation coverage compare to the Cigna Silver plan?

The following chart compares COBRA continuation coverage (i.e., continuing coverage under the standard Equity-League Cigna health plan) with the Cigna Silver plan:

COBRA Continuation Coverage1	Cigna Silver Plan2
Monthly premium	$1,028/individual $2,047/individual + 1 $2,679/family	$250/individual3 $991/individual + 1 $1,436/family
Who’s eligible for coverage	Members and dependents who were covered under the ELBF plan	Members who meet the eligibility requirements and their dependents
Maximum coverage duration	18 months	Through December 31, 2020
Annual deductible for in-network services	None	$1,000/individual; $2,000/family; does not apply to services for which a copay is charged
What you pay for some in-network services	Preventive items and services—no cost sharing Office visit—$25 copay4 Emergency room—$50 copay4 Prescription drugs—20% generic ($10 minimum); 25% specialty and preferred ($20 minimum)	Preventive items and services—no cost sharing Office visits—$20 copay Emergency room—30% coinsurance Prescription drugs (generic only)—20% ($10 minimum)

1. Premium cost before any available subsidies. HMO premiums not included in this comparison.
2. Generally, in-network coverage only. You are responsible for 100% of out-of-network expenses, with certain exceptions.
3. Your individual premium reflects about one-third of the total cost of your coverage; the Health Fund pays the remaining two-thirds.
4. In-network copays. Out-of-network services may cost more or require a deductible and coinsurance.

Enrollment deadlines

If you meet the eligibility requirements, Cigna Silver plan eligibility, your enrollment deadline and coverage effective date depend on whether or not you were covered at the time of the shutdown.

You have until the first of the of each month - i.e. October 1 - to enroll for Silver plan coverage that would begin at the start of a monthly period. You may enroll for the coverage after those dates, but enrollments from the 2^nd through the 31^st (December 1 for November coverage) will be subject to an additional $100 penalty.

As of the first day of your coverage, you can register with Cigna at mycigna.com and Optum Rx at optumrx.com for online access to your personalized health plan information.

If you have any questions, please contact the Benefit Services Department at (212) 869-9380, or toll free (800) 344-5220, Monday—Friday, from 9:30 a.m. to 5:30 p.m. ET.

Knowing when and why to go for an emergency room visit can help you plan for care in the event of a medical emergency.

How much does it cost to go to an emergency room?

Emergency room costs can vary greatly depending on what type of medical care you need. How much you pay for the visit depends on your health insurance plan. Most health plans may require you to pay something out-of-pocket for an emergency room visit. A visit to the ER may cost more if you have a high-deductible health plan (HDHP) and you have not met your plan’s annual deductible. HDHPs typically offer lower monthly premiums and higher deductibles than traditional health plans. Your plan will start paying for eligible medical expenses once you’ve met the plan’s annual deductible.

When should I go to an emergency room?

Emergency rooms are often very busy because many people don’t know what type of care they need, so they immediately go to the ER when they are sick or hurt. You should make an emergency room visit for any condition that’s considered life-threatening. Life-threatening conditions include, but are not limited to, things like a serious allergic reaction, trouble breathing or speaking, disorientation, a loss of consciousness, or any physical trauma.

If you need to be treated for problems that are considered non-life threatening, such as an earache, fever and flu symptoms, minor animal bites, mild asthma, or a mild urinary tract infection, consider seeing your doctor or visiting an urgent care center or convenience care clinic.

What is the cost of an emergency room visit without insurance?

Emergency room costs with or without health insurance can be very high. If you have health insurance, review your plan documents for details on the costs associated with your plan, including your plan deductible, coinsurance, and copay requirements.

If you don’t have insurance, you may be required to pay the full cost of your treatment, which can vary by facility and the type of treatment required. Always plan ahead for sudden sickness, injury, or other medical needs, so you know where to go and how much it could cost. If you need medical care, but it’s not life-threatening you may not have to go to the ER—there are other more affordable options:

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• Urgent care center: Staffed by doctors, nurses and other medical staff who can treat things like earaches, urinary tract infections, minor cuts, nausea, vomiting, etc. Wait times may be shorter and using an urgent care center could save you hundreds of dollars when compared to an ER.
• Convenience care clinic: Walk-in clinics are typically located in a pharmacy (CVS, Walgreens, etc.) or supermarket/retail store (Target, Walmart, etc.). These clinics are staffed with physician assistants and nurse practitioners who can provide care for minor cold, fever, flu, rashes and bruises, head lice, allergies, sinus/ear infections, urinary tract infections, even flu and shingles shots. No appointments are needed, wait times are usually minimal, and a convenience care clinic costs much less than an ER.

Plan ahead for when you need medical care. You may not need an emergency room visit and the bill that could come with it.

What are common emergency room wait times?

Emergency room wait times vary according to hospital and location. Patients in the ER are seen based on how serious their condition is. This means that the patients with life-threatening conditions are treated first, and those with non-life threatening conditions have to wait.

To help reduce ER wait times, health care facilities encourage you to plan ahead for care, so when you’re sick or hurt, you know if the ER is right for your medical condition.

An emergency room visit can take up time and money if your problem is not life-threatening. Consider other care options, such as an urgent care center, convenience care clinic, your doctor, or a virtual doctor visit (video chat/telehealth)—all of which could be faster and save you money out of your own pocket if the medical problem is non-life threatening.

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If you have health insurance, be sure to check your plan documents to see what types of care options are eligible for coverage under your plan, including whether or not you need to stay in your plan’s network.

Is taking an ambulance to the ER free?

An ambulance ride is not free, but your insurance may cover some of the costs for the ride, as well as the emergency room visit. Check your plan benefits to see what out-of-pocket expenses you are responsible for when it comes to an ambulance ride and a visit to the ER.

Cigna Copay Schedule

Plan ahead for times you may need immediate medical care. Review the details of your health plan so you know the costs for an ER visit should you ever need it. Know when it’s best to go to the emergency room and when going somewhere else, like an urgent care center, convenience care clinic, your doctor, or even a virtual doctor visit (video chat/telehealth), is the right option that may save you time and money.