Medical
Q: I am enrolled in the Base PPO or Network Plan for 2004. Can I stay in that plan for 2005?
A: No, the Base PPO and Network Plan are not offered in 2005.

Q: Is the Catastrophic Plan the same as in 2004?
A: No, the Catastrophic Plan has been completely redesigned for 2005.

Q: What is the Open Access Plus Plan?
A: This is a medical plan, administered by Cigna with high benefits coverage for in-network services and lower benefits for out-of-network services.

Q: Why is there a different plan in California?
A: In California, we are offering the Cigna CA Open Access POS Plan, rather than the Cigna Open Access Plus Plan. The two plans are nearly identical. However, California insurance regulations require certain features in the medical plan.

Q: I don’t work at our Pennsylvania locations – can I elect the Keystone Plan anyway?
A: No, the Keystone plan is a local HMO, and is only available to employees working at Duncansville and Huntingdon, PA.

Q: What does in-network mean?
A: In-network refers to any medical service you obtain from a doctor, hospital or other facility that is part of the Cigna Open Access Plus Network. Cigna contracts with a select group of providers who agree to adhere to Cigna standards of care and to provide services for a lower cost.

Q: What is a deductible?
A: If your health plan has a deductible, then you are required to pay the first portion of your health plan expenses, until you have paid an amount equal to your deductible. For example, let’s assume your plan had a $1,000 deductible and covered 80% of the cost of a particular procedure, which cost $2,000. In this case, you would pay the first $1,000 of the cost and the plan would pay 80% of the remaining $1,000 of the cost and you would pay the remaining $200. Once you have satisfied your deductible, you do not have to satisfy it again for the remainder of the calendar year.

Q: What is a copay?
A: A copay is a payment you make each time you obtain a service. For example, you might be required to pay a $20 copay each time you visit your doctor’s office. Generally, if there is a copay, the plan pays the remainder of the cost, in full.

Q: What is coinsurance?
A: Coinsurance is a percentage you pay for a medical procedure. If the plan covers 80% of a procedure, the coinsurance is the 20% you pay.

Q: What is reasonable and customary?
A: Reasonable and customary refers to the typical fees charged for a particular service in a particular geographic region by the vast majority of doctors. In order for a service to exceed the reasonable and customary limits, the fees for that service would have to exceed that charged by most of the doctors in that area. In-network providers are not subject to reasonable and customary limits, since they are bound by fee arrangements with the medical carrier. Generally, if you use an out-of-network doctor or facility and they charge more than what is reasonable and customary, you will be responsible for any amounts over these limits.

Q: What is a maximum out-of-pocket limit?
A: Your maximum out-of-pocket limit is the most you can pay out of pocket for your medical expenses in a plan year. Generally, coinsurance includes your deductible payments and coinsurance. It does not generally include copays or any amounts that exceed reasonable and customary limits.

Dental
Q: I didn’t enroll in the dental plan in 2004. Can I elect the High Plan for 2005?
A: Yes, there is no restriction or penalty for late enrollees (someone who didn’t sign up with the dental plan when they first became eligible).

Q: Can I visit any dentist?
A: Yes, the in-network and out-of-network benefits are the same. However, in-network dentists may charge a lower fee because of pre-arranged fees. Also, out-of-network dentists will be subject to reasonable and customary limits.