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The Wesleyan Open Access Plus and Open Access Plus In-Network plans have an annual deductible of $500 for individuals and $1,000 for families.

The following services fall under this deductible:
Lab work
Imaging (X-ray, MRI, PET, CT, and ultrasound)
Durable medical equipment
Inpatient procedures and services
Outpatient procedures and services
Home health care
Prosthetic devices
Hearing aids
Gene Therapy
Skilled Nursing (OAP Plan)

Once the deductible is met, these services are covered at 100% for the rest of the plan year.

The deductible also counts toward your annual out-of-pocket maximum.

All preventive services that are coded as preventive are covered at 100%. A diagnostic procedure is subject to the applicable deductible and copay. Make sure you talk with your provider about the procedure so you know how it is being billed.

Cigna (Health and Vision coverage) – Refer to this flyer for instructions.
Delta Dental – Go to . Log in to MySmile and download your ID card from your dashboard.
EyeMed (lenses and frames) – Go to . Log in and follow the instructions to print an ID card.  You can also load the EyeMed Members App through App Store or Google Play instead.

As long as you are an active, benefits-eligible employee, you and your spouse/partner may remain on the Wesleyan benefit plan, regardless of age. Employees covering a Medicare-eligible domestic partner may want to consult a tax or insurance adviser regarding possible penalties if delaying Medicate B and D enrollment.

Call Cigna at 1-800-244-6224 or log into your portal to look up the date of service correlating to the bill. Many times, bills are sent by the provider before Cigna has fully processed the claim. Always check your Explanation of Benefits (EOB) to see how the claim is being processed. A representative at Cigna is available to help you resolve any eligibility or claim issues you have.

Your doctor should be able to help you with an appeal to Cigna. If you have a medical need, they should be able to document this with Cigna to help with an approval. Have your provider’s office contact Cigna to initiate the appeal process for you.

See page 6 of the Benefit Guide for information on qualifying life events and how to make changes to your benefits.

Call Cigna at 1-800-244-6224 to have someone walk through the denial with you. It is important to receive clarification. There are facilities that contract with Cigna for lower costs, and you may be required to have your procedure or test at one of these facilities.