The following is important information which
every person covered under the Basic Plan
should keep in mind when accessing medical
services, behavioral health services or prescription
drugs. This information will help you to
obtain the highest level of benefit from
the Basic Plan while ensuring that you obtain
the care you require.
In-Network Service
Each Claim Administrator has In-Network providers for
the use of Plan Participants.
- The CIGNA network is a broad based preferred
provider network from which MILA Members may
select any participating physician, hospital or other
provider if that provider has been contracted for the
service. For example, one might select a cardiologist
to treat heart ailments.
- The CIGNA network includes in-store health clinics
in select locations under the brand names of:
- Little Clinic in Kroger and Publix Stores,
- Minute Clinic Health Care Centers in CVS/Caremark® Pharmacies and elsewhere,
- RediClinic in Wal-Mart and elsewhere,
- Sutter Express Care in California, and
- TakeCare Health Clinics in Walgreens and Eckerd Stores.
These clinics generally offer extended hours of operation
(often 24 hours), they do not require appointments, they
generally see patients within one-half hour or less, they
offer a limited menu of services in the treatment of minor
illness or injury, and the services are performed by nurse
practitioners under the direction of a staff physician – all
for a primary care copay of $25.
-
The ComPsych network of behavioral health
providers include psychiatrists, psychologists,
certified psychological counselors and so forth.
As in the CIGNA network, MILA Members may
select any In-Network provider with the appropriate
credentials for treatment.
-
The Caremark® network of pharmacies includes all
the retail pharmacies with which Caremark® has a
contract. If the Caremark® logo is displayed, the retail
pharmacy is available to MILA Members. MILA has
been assigned to one mail service pharmacy and, at
this time, that pharmacy location is the exclusive
provider of mail service to MILA Members.
-
Although you are responsible for complying with the
Plan’s medical management procedures, In-Network
providers generally are familiar with these procedures
and will assist you in this process.
The In-Network providers have been selected based upon
those providers’ credentials and the quality of service
which those providers have delivered in the past. A
provider must agree, as a condition of participation, to
give the network a discount on the cost of service.
However, quality service is the most important contributor
to lower Plan cost. If the service is appropriate to the
Member’s medical needs, the Member will recover faster
and require less medical service. Not only will this result in
lower total Plan cost, but it will create a more satisfactory
experience for the Member.
