SAU 80

Health Insurance

CIGNA is our health insurance carrier, and SchoolCare administers our plan. Employees have three plans to choose from.

health maintenance organization (hmo)

In the HMO, or Health Maintenance Organization, each enrollee must select a Primary Care Physician (PCP) from within the CIGNA network.  Doctors in the CIGNA network are called participating providers and the PCP coordinates the delivery of care for their patients.  All covered services must be authorized by the PCP, with the following exceptions: enrollees may self-refer for routine OB/GYN care, pregnancy related services, chiropractic care, routine vision appointments, outpatient services for mental health/substance abuse and, of course, emergency services.  Except in cases of emergency, enrollees must use participating providers to be eligible for benefits.  An enrollee can verify whether a doctor or health care facility is in the CIGNA network by either calling member services (the phone number is on the back of their SchoolCare ID card), or using the CIGNA website and click on "Provider Directory".

open access point of service (POS)
The POS plan is an Open Access plan that does not require members to select a PCP or obtain referrals to see other providers or specialists in the CIGNA network. Enrollees receive the highest level of benefits if services are obtained using participating providers.  If an enrollee chooses to use a doctor or facility that is not part of the CIGNA network, coverage will be provided at a lower level, requiring the enrollee to pay a larger portion of the cost out-of-pocket.  POS enrollees can choose to use in or out-of-network providers each time they receive medical care.  
(Summary of Benefits - Effective 7/1/12)


open access + (OA)
The OA+ plan is similar to the HMO; however, as an Open Access plan, enrollees are not required to select a PCP or obtain referrals to see other providers or specialist in the CIGNA network.  The plan emphasizes wellness and prevention through $0 copays for preventive care (including mental health benefits) and generic maintenance medications.  Other benefits are subject to a deductible and coinsurance.  Except in cases of emergency, enrollees must use participating providers to be eligible for benefits. 
(Summary of Benefits - Effective 7/1/12)

65+ (NOT CIGNA)
This is a plan for retirees enrolled in Medicare Parts A and B. Medicare is the primary plan and School Care 65+ is secondary, filling in some of the gaps not covered by Medicare and providing additional benefits, such as prescription drug coverage. You can reside anywhere in the United States and use any provider. United American and Express Scripts (Rx) administers the benefits for SchoolCare 65+. To receive the highest level of benefits, you should use a provider that accepts Medicare assignment; otherwise you will be responsible for charges above the Medicare approved amount. For questions about Medicare, contact your nearest Social Security office or call 1-800-633-4227, or visit www.medicare.gov.
(Summary of Benefits - Effective January 1,  2012)



Good For You! is SchoolCare’s commitment to your good health. It is a collection of evidence-based, achievable and fun wellness programs. Most programs offer participants reward points as cash through reimbursement for exercise and taking care of your health. SchoolCare has partnered with Planned Action Toward Health (PATH) to offer more extensive and on line programs. 

Reward Points are awarded for completing or participating in programs. One (1) reward point equals $1. Individuals can earn up to $800 in reimbursements and reward points per plan year. Families can earn up to $1200 in reimbursements and reward points per plan year.

  • Keeping Fit by SchoolCare
  • Health Education Reimbursement
  • Health Risk Assessment (HRA)
  • Preventive Incentive
  • CIGNA WellAware
  • Employee Assistance Program
  • On Site Wellness Fairs
  • Flu Shot Clinic
  • MyCIGNA.COM Employee Portal
  • CIGNA Healthy Rewards® 1-800-870-3470
  • CIGNA 24-Hour Health/Nurse Information Line 1-800-564-8982
  • CIGNA Behavioral Advantage Programs