Cigna Care Network

Cigna Care Network

Cigna Care Network® is a coverage plan option available for Cigna plans in 74 service areas across the country. It was developed in response to our members' requests for more information about physician quality and cost efficiency. The Cigna Care designation helps distinguish physicians within Cigna's physician network based on their performance under specific quality and cost efficiency measures in 19 specialty care types and 3 Primary Care Physician types.

Plan Description

Under the Cigna Care Network benefit plan, a subset of participating physicians in specialties receive the Cigna Care Designation display icon based on specific selection criteria. Physicians with the designation have Cigna Care Designation displayed next to their name in the Cigna directory.

Cigna participating providers are considered in-network whether or not they receive the Cigna Care Network. However, a lower customer co-payment or coinsurance level may apply if the customer chooses a Cigna Care Designation physician. To learn more about Cigna Care Designation follow the attached link for Cigna Care Designations Whitepapers.

https://www.cigna.com/customer_care/healthcare_professional/index.html

Plan Availability

The Cigna Care Network is available in the following service areas:

  • Arkansas (Little Rock Metro)
  • Arizona
  • California (Los Angeles, Orange County, San Diego, Ventura, Bakersfield, Central California, Northern California, San Francisco and Sacramento)
  • Colorado (Denver and Colorado Springs)
  • Connecticut
  • Delaware
  • Florida (Orlando, Tampa, Ocala, South Florida and Jacksonville)
  • Georgia
  • Illinois (Chicago Metro, Champaign and Urbana)
  • Indiana (except Evansville Metro)
  • Kansas/Missouri (Kansas City)
  • Louisiana
  • Massachusetts
  • Maryland (Maryland and Washington, D.C.)
  • Maine
  • Michigan (HAP)
  • Mississippi
  • Nevada
  • New Hampshire
  • New York (Metro New York)
  • New Jersey (Northern and Southern New Jersey)
  • North Carolina
  • Ohio (Northern, Central and Southern Ohio)
  • Oregon (Portland)
  • Pennsylvania (Philadelphia, Pittsburgh, and Eastern and Western Pennsylvania)
  • Rhode Island
  • South Carolina (markets vary)
  • Tennessee (Memphis, Nashville, Knoxville and rural Tennessee)
  • Texas (Dallas, Ft. Worth and Houston)
  • Utah
  • Virginia
  • Wisconsin
  • West Virginia

Selection Criteria

Cigna participating physicians in the 21 specialties (including 3 Primary Care Physician Types) have been evaluated for Cigna Care designation. Other Cigna contracted health care professionals, including hospital-based physicians, hospitals, ancillary providers and physicians in specialties not listed, are not Cigna Care designated professionals but are still considered participating for this plan option.

  • Allergy/immunology
  • Cardiology
  • Cardio-thoracic surgery
  • Dermatology
  • Ear, nose and throat
  • Endocrinology
  • Gastroenterology
  • General surgery
  • Hematology/oncology
  • Nephrology
  • Neurology
  • Neurosurgery
  • Obstetrics/gynecology
  • Ophthalmology
  • Orthopedics and surgery
  • Pulmonology
  • Rheumatology
  • Urology
  • Family Practice
  • Internal Medicine
  • Pediatrics

Participating specialists in the specialties listed are evaluated at least every other year for Cigna Care Network. Participating specialists were evaluated based on these criteria:

Quality evaluation and displays

Our quality displays are based on the following, if the information is available for the physician:

  • National Committee for Quality Assurance (NCQA) recognition for diabetes care, cardiac and stroke care, back pain care, physician practice connections, or patient-centered medical home
  • Adherence to select evidence-based quality measures
  • Group board certification criteria

Cost-efficiency evaluation and displays

We determine how a physician’s cost efficiency compares to other physicians in the same specialty category in the same service area. The results are based on a comparison of fee schedules, utilization patterns, and referral patterns (i.e., use of hospitals and other facilities).

When compared to others of the same group specialty type and within the same geographic market:

  • Three stars represent the top 34% of physicians and physician groups for cost efficiency.
  • Two stars represent physicians and physician groups that are in the middle 33% for cost efficiency.
  • One star represents physicians or physician groups that are in the lower 33% for cost efficiency.

Physician Reimbursement

The Cigna Care benefit design, which is intended to encourage Cigna customers covered by these plans to consider using a Cigna Care Network designated physician, affords a lower co-payment or coinsurance for services provided by a designated physician than if the individual were to select a participating, non-designated physician. Overall physician reimbursement is unchanged.

Member Impact

Members enrolled in the Cigna Care Network coverage plan option must see Cigna Care Network designated specialists for those services to be covered at the enhanced coverage level. Members may still receive care from other Cigna participating practitioners at the standard in-network coverage level.