As it currently stands, the network agreement between Cigna and UW Medicine/UW Physicians will expire at the end of July. Negotiations between the two parties are ongoing, but if a new agreement is not approved by the end of July, UW Medicine and UW Physicians will become Out-of-Network providers for the University’s medical plan as of August 1, 2020. These providers would still be accessible to plan members, but would be subject to Out-of-Network coverage provisions.
As of the start of July, the University received clarification that Cigna has separate contracts to consider. The contract that is in peril includes UW Medical Center, (Montlake and Northwest Hospital campuses) and UW Physicians. However, Cigna holds a separate contract with Harborview Medical Center and Seattle Cancer Care Alliance. These two systems would remain In-Network on our Cigna Open Access Plus PPO network, no matter what happens with the contract in question.
About one-quarter of the University’s medical plan members have used UW Medicine or UW Physicians for services this year and it remains committed to providing access to this excellent system. Through its insurance brokers, the University has strongly communicated to Cigna that not including UW Medicine as an In-Network provider for the medical plan is unacceptable. As this situation evolves, please remember that this is a fee-based negotiation between two private entities. This situation is, unfortunately, rather common in the healthcare industry. Even so, this is a very inopportune season for it. Cigna is motivated to keep medical costs affordable for plan members, including SPU employees. At the same time, UW Medicine has seen major revenue shortfalls due to the impact from the pandemic, resulting in furloughs and layoffs.
What Can You Do to Prepare for this Pending Network Issue?
The University has been working with Cigna to provide several ways to assist affected members in preparing to manage this change.
The following actions are available to you:
- Review the FAQ with resources and links to pursue (see attached)
- Schedule an appointment for a phone conversation with Cigna’s SPU-dedicated team to review your individual circumstances: https://www.signupgenius.com/go/10C054FA9A72FAAFB6-cigna
- Complete an application for Continuity of Care treatment with Cigna (see info in attached FAQ)
In addition, Cigna will be proactively reaching out to those plan members that have ongoing, critical care currently scheduled at affected providers/systems. This will be in the form of a direct phone call. But if you are concerned about your situation, please be sure to use the above methods rather than waiting to be contacted
What Kind of Financial Impact Could This Network Change Cause?
As the negotiations between Cigna and UW Medicine continue, it is important remember that the SPU medical plans include a feature that combines In- and Out-of-Network costs together when calculating both your deductibles and annual out-of-pocket maximum. For example, if you have Employee Only coverage under the plan and have major expenses upcoming (like surgery or a hospital stay), you would expect to owe, once all the bills are collected, a maximum of $3,425 based on the annual out-of-pocket maximum. This amount would be further reduced by any other medical expenses you paid previously during the year for medical expenses claimed under SPU’s program. Whether you use In-Network or Out-of-Network providers, or some combination, the same annual out-of-pocket limit would be applied to your combined expenses. Those covering dependents have a higher combined limit of $6,850 per year.
While SPU’s medical plan does provide some financial relief for using Out-of-Network providers in the design of the deductibles and annual maximums as noted above, there could be a negative financial impact for plan members with low or moderate annual medical expenses that use of Out-of-Network providers versus In-Network providers. The plan design only covers 60% of the cost of covered services provided by Out-of-Network providers once the annual deductible is met versus 90% of the cost for In-Network providers, up to the annual out-of-pocket maximum. As a result, members’ additional out-of-pocket expenses after reaching the annual deductible will be higher when using Out-of-Network providers.
What's Next
The University remains hopeful that Cigna and UW Medicine will reach an agreement prior to the July 31st expiration date of the current agreement. In the meantime, please be on the lookout for further communication from the University as it continues to explore options available to you should an agreement not be reached.
Questions?
If you have questions about how this change might specifically impact your family that are not addressed above, please reach out to Human Resources for help. Human Resources is generally available from 8am to 5pm M-F at (206) 281-2908 or by email at hr@spu.edu.