Cigna TotalCare Plus (HMO DSNP) 2022 Annual Notice of Changes

Overview

The 2022 Annual Notice of Changes (ANOC) outlines the modifications to Cigna TotalCare Plus, the HMO Dual Eligible Special Needs Plan (DSNP) for Medicareeligible members who also qualify for Medicaid. This notice highlights plan benefits, costsharing adjustments, formulary updates, network changes, and new member services effective January1,2022.

Important Dates

• Effective date: January1,2022
• Distribution period: November1 December31,2021
• Member enrollment deadline: December15,2021 (if switching plans)
• Provider notification deadline: December31,2021

Key Benefit Changes

Medical Benefits

• Primary Care Visits: No costshare for the first 4 visits per calendar year; subsequently a $15 copayment.
• Specialist Visits: $20 copayment for the first 6 visits annually; $30 thereafter.
• Hospital Inpatient: 0% coinsurance for stays up to 7 days; 20% coinsurance for each additional day.
• Emergency Services: $100 copayment for nontransported emergencies; $250 for transported emergencies.
• Telehealth: Expanded coverage all virtual primary and specialist visits are $0 costshare.

Prescription Drug (PartD) Benefits

• Tier1 generics: $0
• Tier2 preferred brand: $10
• Tier3 nonpreferred brand: $35
• Tier4 specialty: 30% coinsurance (maximum $150 per prescription)
• Formulary expansion: 45 new FDAapproved drugs added, including several oncology and hepatitis C treatments.

Additional Benefits

• Annual wellness visit $0 costshare.
• Nutrition counseling up to 4 visits per year, $0 costshare.
• Enhanced care coordination services for chronic conditions (diabetes, heart failure, COPD).
• New member portal MyCigna TotalCare with secure messaging and prescription refill requests.

Provider Network Updates

Cigna has added 78 primary care physicians and 112 specialist physicians to the TotalCare Plus network in the following states:

• California, Florida, Texas, New York, Illinois, Pennsylvania, Ohio, Michigan, Georgia, North Carolina.

Members who currently see a provider that is leaving the network will receive a personalized notice with alternative innetwork options. The transition period allows continued care for up to 30 days after the providers departure.

CostSharing Summary

All costsharing amounts are subject to Medicaid supplemental coverage. When Medicaid covers a cost, members will not owe the amount.

Member Resources & How to Get Help

• Member Services Phone: 18005551234 (24hours).
• Online Portal: MyCigna TotalCare view benefits, request authorizations, and track claims.
• Paper Copy Request: Call the member services number and ask for a mailed copy of the 2022 ANOC.
• Local Assistance: Visit any Cignapartnered Medicaid office for inperson help.

Information for Providers

Providers should review the following updates:

• New priorauthorization criteria for specialty pharmaceuticals.
• Revised billing codes for telehealth services (use modifier 95).
• Updated claim submission deadlines claims must be submitted within 120 days of service.

Provider training webinars will be held on November15 and December5, 2021. Register via the Cigna Provider Portal.

Appeals & Grievances

Members may appeal any coverage decision within 60 days of the notice of denial. Appeals can be submitted online through the member portal, by fax (18005556789), or by mail to:

For urgent grievances, call 18005551234 and select option3.

Contact Information

If you have questions about the 2022 Annual Notice of Changes, please use one of the following methods:

• Phone (Member Services): 18005551234
• Phone (Provider Services): 18005559876
• Email: totalcareplus@cigna.com
• Website: www.cigna.com/totalcareplus