CIGNA HMO Vs. PPO
Health insurance companies, such as CIGNA, offer many different plans determined by a customer's wants, needs and financial situation. HMO (health maintenance organization) plans present options for comprehensive health care with a low cost initiative to provide insurance for those who may otherwise be without. PPO (preferred provider organization) plans provide more flexibility with a higher out-of-pocket cost.
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History
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CIGNA, previously known as the Insurance Company of North America, or INA, began offering insurance for marine use in 1792. In the late 1800s, the company expanded overseas. It is the first American company to provide insurance in China. The Connecticut General Life Insurance Company, a part of INA since 1865, introduced the first major medical insurance policies in America in 1950. The two insurance companies combined, creating the shared name CIGNA in 1982.
HMO Plans
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CIGNA provides two different HMO, or health maintenance organization, plans to clients. The HMO and Network plan gives patients access to health care through its network using participating physicians. During enrollment, a patient must choose his primary care physician, who will then provide routine care to the patient as well as referrals to specialists within the network. Approval is needed to use out-of-network facilities during emergency or urgent care visits.
CIGNA also offers a plan called HMO Open Access. It provides the patient with more choice throughout the network, as it does not require a referral to a specialist within the network. CIGNA encourages but does not require members to choose a primary care physician. The plan provides a patient with more freedom of choice in selecting a doctor, but he must use doctors within CIGNA's network. A member must get approval to use out-of-network facilities during emergency or urgent care visits.
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PPO Plan
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CIGNA's PPO, or preferred provider organization, plan gives the patient freedom to use any facility or physician he would like. He is not required to declare a primary care physician or to obtain a referral before visiting a specialist, and emergency and urgent care visits are covered at the in-network benefit level. If using an out-of-network physician or service, the patient must submit a claim to CIGNA to receive reimbursement for his payment.
Considerations
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A member must consider the advantages and disadvantages of each plan before choosing his insurance policy. HMO plans provide low cost comprehensive health care; however, they also place restrictions on the member as to where he may go to receive care. HMO Open Access plans provide a slightly more flexible network to the patient, but also come at a higher premium cost. PPO plans give a patient the freedom to choose where he will receive care, but the cost is significantly higher.
CIGNA Facilities and Staff
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CIGNA has a large network across the United States, as well as facilities overseas. As of December 2008, the insurance network included more than 5,000 hospitals and nearly 575,000 participating physicians. The company has operating facilities in all 50 states, as well as Puerto Rico and the District of Columbia.
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References
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- Photo Credit doctor with patient 4 image by Paul Moore from Fotolia.com
