The enrollment form is not available.
The underwriter for the plan has changed from Nationwide Life Insurance Company to National Guardian Life Insurance Company. Claims are still submitted to Cigna and, subsequently, processed by Consolidated Health Plans (CHP).
There is now only one in-network deductible of $50 and one out-of-network deductible of $50 per policy year, regardless of how many conditions are treated. If the deductible is applicable for a medical service, it can be waived by receiving a referral from the Health and Wellness Center.
A referral from the Health and Wellness Center is not required for the 2016-17 policy year. A Health and Wellness Center referral may be used to waive the deductible, if applicable, for a medical service.
Unless stated otherwise in the brochure, the plan will pay at 95% of the Preferred Allowance for in-network services and 85% of Reasonable & Customary Charges for out-of-network services.
The out-of-pocket maximum for eligible expenses in-network is $1,500. There is no maximum for out-of-network services.