Read this first!
In order to understand many of the questions and answers below, you must first understand that the State of Montana Benefit Plan (State Plan) is self-funded. That means member contributions, taxpayer dollars in the form of State Share, and State Plan reserves pay for members' medical, dental, and prescription expenses. The State bears all the risk of the costs for the 33,000 State Plan members across Montana. Click HERE learn more about self-funding.
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PO Box 3018 Missoula, MT 59806
Cigna Related Questions
Going to the Doctor
Vision and Vision Hardware
Q: How are State Plan rates set?
A: The Health Care and Benefits Division works with an independent actuary to set the rates every year. Remember, the State of Montana Benefit Plan is self-funded. In order to make sure there is always enough money available to cover State Plan costs, we project claims expenses, administrative fees, and other plan costs for the coming plan year, and determine the amount of contributions needed to cover these estimated costs and maintain an adequate reserve.
Q: How was it possible to decide the members' monthly rates before the State had chosen Allegiance?
A: Since the State Plan is self-funded (see above), the third party administrators, like Allegiance, bear no financial risk related to claims expense. Therefore, the State is able set the rates, knowing the historical plan costs.
Q: Why did State Plan rates go up so much?
A: Rates did not increase enough to cover plan expenses over the past few years. For 2013 through 2015, we project a net loss over $30 million. Therefore, rates had to increase to cover the projected 2016 expenses, as well as build up the lower plan reserves.
Cigna related questions:
Q: Why are we leaving Cigna?
A: We are at the end of Cigna’s 3 year contract and decided to look into what options were available in the marketplace to save money to our self-funded plan and add some enhanced services.
Q: How did we choose Allegiance?
A: The State of Montana sent out a request for proposal (RFP). Nine companies bid to be the State’s new third party administrator. The bidders included Allegiance, Blue Cross Blue Shield of Montana, Continental Benefits, EBMS, First Choice Health, Health Smart, Pacific Source Health Plans, Sanford Health Plan, and UMR. The bids were scored by a neutral panel of judges. Allegiance was awarded the most points.
Q: Doesn’t Cigna own Allegiance?
A: Allegiance is a wholly owned subsidiary of Cigna. From Allegiance’s website, “ In 2008, Allegiance became a wholly-owned subsidiaries of Connecticut General Life Insurance Company (CGLIC), a subsidiary of Cigna Corporation, when CGLIC purchased Allegiance’s holding company Benefit Management Corp. Allegiance Benefit Plan Management, StarPoint, Allegiance Life & Health Insurance Company and Allegiance COBRA Services are all subsidiaries of Benefit Management Corp. Allegiance represents Cigna’s strategy to compete in the market segment that desires TPA rather than fully bundled large carrier products. As a result, Allegiance has seen significant growth across the nation as a result of our affiliation with Cigna.”
Q: What is the difference between Cigna and Allegiance?
A: Allegiance's business model is focused on third party administration of self-funded plans. CIGNA is a very large corporation that offers many more products and services, including fully insured products for the individual and group markets, self-funded plan administration, international insurance products, and other specialized products. Allegiance offers the State Plan the best of both worlds – Allegiance's focus on self-funded plans allows administration to be more flexible and Allegiance is able to access the specialties of CIGNA to provide a well-rounded level of service.
Q: How long will I have access to my EOBs, etc. from Cigna?
A: You will be able to log into www.mycigna.com and view your account until Dec. 31, 2017.
Going to the Doctor:
Q: Will my provider network change?
A: No. The medical and vision provider networks will remain the same from 2015 to 2016.
Q: Will my medical benefits change?
A: No. The State of Montana decides the covered benefits of our plan. If there is a material modification in benefits, plan members are notified at least 60 days before the change takes place. Click HERE or browse the menu to the left to learn more about your 2016 benefits.
Q: Will I need a new ID card?
A: Yes. A new ID card will be sent to you in the mail before January 1, 2016. Be sure to take this card to your providers. It will have different group and member identification numbers from the current information your provider may have on file. It is your responsibility to make sure your provider has the correct insurance information.
Q: When will the new cards come out?
A: The goal is to have new cards to each enrolled member by the end of December.
Q: Will they come in the mail, from whom?
A: They will come in the mail from Allegiance.
Q: What if I don’t get a card?
A: If you do not have your card with you but you are covered under the plan, let your provider know you are with Allegiance and provide the information they request. You may also contact customer service at 1-855-999-1057 to request a card.
Q: Will everyone in my family have separate cards?
A: Dependents are listed on the enrollee’s card. For dependents over the age of 18, a separate card is generated.
Q: Will Cigna prior authorizations be honored?
A: Any prior authorizations currently on file from Cigna will be honored one year from when they were made.
Q: Do I need prior authorization for outpatient services now that we’re with Allegiance?
A: Yes. Members should call Allegiance to get prior authorization on outpatient procedures like CT’s, MRI’s, Speech Therapy, Cardiac Tests, and Chemotherapy. Allegiance relies on medical experts as well as national standards of care to make good decisions when it comes to prior authorizations.
Q: When does Allegiance start processing my medical claims?
A: Allegiance will start processing State of Montana claims beginning January 1, 2016. Any claims incurred before that time will be processed by Cigna.
Q: How do I see my Explanations of Benefits (EOB) from Allegiance?
A: A member may access their EOB information online at www.askallegiance.com/som.
Q: Who do I call if I have benefit or claims questions?
A: Call Allegiance Customer Service Department at 1-855-999-1057.
Vision and Vision Hardware
Q: Have our vision benefits changed?
A: No. The vision benefits are the same as 2015 and are administered through Cigna VSP. All members of the State Plan get one eye exam for a $10 copay at an in network provider each year. If you have Vision Hardware coverage, the benefit is the same. Click HERE to see that benefit.
Q: Will the vision network change?
A: No. The vision network is still Cigna VSP.
Q: Will I get a new vision hardware coverage ID card?
A: Your vision coverage information is on the back of your Allegiance medical ID card.
Q: I’m working with a Cigna Case Manager. How will the transition work?
A: Allegiance/StarPoint will receive information regarding your care management case and will contact you to coordinate the transition and to answer any questions you may have. In the meantime, you can call StarPoint at 1-877-792-7827 and ask to talk to one of our Nurse Case Managers.
Q: What kinds of Case Management services are available?
A: Services are available to manage chronic issues through Disease Management or high cost impacts such as cancer. CM nurses will work to coordinate and assist you through the process.
Q: How will my global billing be processed if I’m pregnant now, but have the baby after Jan. 1?
A: Global billing means all charges are billed at the time of the baby’s delivery. If that delivery happens Jan. 1, 2016 or later, your bill will be processed by Allegiance.
Q: Will I be eligible for the Healthy Mothers Healthy Babies benefit that I’m currently signed up for?
A: Yes. We will transition the Healthy Mothers Healthy Babies participants to Allegiance’s program, Allegiance Maternity Management. The two programs are very similar and will continue to offer the benefits to current enrollees including whatever financial incentive you would have qualified for under Healthy Mothers Healthy Babies ($250 if you signed up in your first trimester/$125 if you signed up in your second trimester.)
Q: Does Allegiance have a pregnancy program?
A: Yes. Allegiance Maternity Management is the Allegiance program. It is similar to the Cigna Health Mothers Health Babies program. Click HERE for more information.
Q: How does Allegiance handle getting breast pumps for new moms? What about lactation counseling?
A: Allegiance allows breast pumps to be purchased at any retail store or through a provider’s office and the member will be reimbursed up to $450. Receipts can be submitted by fax to 406-523-3111, mailed to address on card or submitted online through claims submission options.