Top Asked Questions
What are Preventive Health Actions?
Preventive Health Actions are three easy steps members take to earn financial rewards - and help improve their quality of life. Employees and their spouses or domestic partners, if any, simply:
1. Visit MySeeChangeHealth.com and complete a short, online, private and secure health questionnaire;
2. Complete a biometric screening (i.e. blood test). Contact SeeChange Health to learn more about conducting a biometric screening at our worksite
3. Participate in an annual preventive examination appropriate for a member’s age and gender.
Does every member in a family need to complete Health Actions?
No. Only employees and their spouses need to complete Health Actions to earn financial rewards. Dependent children need not complete Health Actions.
What are Chronic Health Actions?
When members complete their Preventive Health Actions they may learn they have a chronic condition such as asthma, diabetes, and heart disease. We will recommend additional Health Actions designed to help them better deal with their conditions. Some of our plans offer additional financial incentives to members who complete these Chronic Health Actions.
Are preventive Health Actions covered benefits?
Yes. The preventive examination is covered at 100% as long as the member visits a contracted GWH-Cigna provider. The biometric screening is also covered at 100%.
How often does a member need to complete Health Actions?
Once per deductible period. A member's deductible period is determined by their employer at the time the group enrolls with SeeChange Health:
Calendar Year Deductible Period: Members must complete their Health Actions once per calendar year.
Plan Year Deductible Period: Members must complete their Health Actions within 12 months of their effective date and then within 12 months after each anniversary date.
What kind of financial incentives can members receive?
Some plans offer Enhanced Benefits, which reduces the member’s coinsurance and out-of-pocket expenses. Others offer contributions to a Health Incentive Account. HIAs are just like Health Reimbursement Accounts (HRAs) except the contributions come from the carrier instead of the employer. Other plans offer both Enhanced Benefits and contributions to an HIA. The Select HRA Plans offer a credit to the deductible. For more details, please see the Benefit Summary for each plan.
When a member earns financial incentives, does an employer's premium go up?
No. An employer pay for the Standard Benefits. Whether we make a deposit in a member’s Health Incentive Account or enhance their benefits, employers' premiums remain the same.
What are Enhanced Benefits?
With our Classic and HSA plans, members are rewarded with Enhanced Benefits - a reduction in co-insurance and out-of-pocket expenses - when the employee and spouse (if any) completes their Health Actions.
Will Enhanced Benefits be applied retroactively?
Yes. On plans offering Enhanced Benefits, when an employee and spouse, if any, both complete their Preventive Health Actions, SeeChange Health will readjudicate claims as if the family enjoyed Enhanced Benefits from the beginning of the deductible year. We then send them a check for the difference between the Standard Benefits they previously received and the Enhanced Benefits they earned.
For example: a member incurs an injury in May that results in claims exhausting their out-of-pocket obligation. In July this member completes her Health Actions. Her out-of-pocket obligation is now lower (let’s say by $1,000). We’ll send her a check for the $1,000 difference even though the claims were incurred prior to her completing the Health Actions.
Can children receive Enhanced Benefits?
Yes. Dependent children will automatically be moved to Enhanced Benefits when the employee and spouse, if covered by us, completes their Health Actions.
What are Health Incentive Accounts?
In certain plans, when employees and their spouses (if any) complete their Health Actions, SeeChange Health Insurance will deposit a cash award into Health Incentive Accounts (HIAs) we establish for them. HIAs are much like Health Reimbursement Accounts (HRAs), except the contributions are made by the insurance carrier, not the employer. Only SeeChange Health can contribute to the account and account dollars will automatically be used to reduce a member’s out-of-pocket expenses as claims are processed. Or members may use these dollars for other eligible expenses such as dental, vision or medical expenses not covered by our policies. Our Classic and Deluxe Co-Pay Plans offer HIAs. (Please note, the Classic Plan also offers Enhanced Benefits).
Can members earn HIA deposits for completing Chronic Health Actions?
Yes. On certain SeeChange Health plans, if Chronic Health Actions are warranted, we will deposit additional cash rewards in their HIA.
Can members carry over their HIA dollars to subsequent years?
Yes. The account dollars do not expire at the end of the benefit year. Members may use HIA dollars to pay for services defined by the IRS as “eligible medical expenses” such as dental and vision services.
What happens to HIA dollars if an employee leaves SeeChange Health? Or if an employer moves to another health plan?
When an employee leaves SeeChange Health they forfeit any remaining dollars in their HIA. If an employer moves the company to another carrier all employees forfeit any unspent dollars in their SeeChange Health HIAs.
Can dependent children earn HIA payments?
No. However, while deposits into an HIA are not made on behalf of dependent children, funds in an HIA may be used on their behalf.
Are my HIA deposts automatically applied toward my deductible?
No. HIA dollars may be used for reimbursement of eligible expenses such as deductibles, co-insurance, co-pays, etc. or dental, vision or medical expenses not covered by SeeChange Health. HIA dollars used for non-covered expenses will not apply toward your deductible. Reimbursement requires the submission of a HIA reimbursement form which can be found and downloaded in the My Claims section.
What dependents may be covered under SeeChange Health plans?
Eligible dependents include spouses, same-sex domestic partners, children under age 26 and disabled children of any age.
Do SeeChange Health’s plans cover preventive care?
Yes. SeeChange Health covers preventive care, as defined by state and federal law, at 100%, as long as the member visits in-network providers. Preventive care received from a provider not in the SeeChange Health Network is not covered under this plan. Please refer to the Preventive Services Flier for more details.
Do your pharmacy benefits cover brand name drugs?
All of our plans cover both brand and generic drugs. However, the type of prescription determines the copayment and out-of-pocket amounts (for example, generic drugs have a lower co-pay than brand name drugs), Drugs not on the SeeChange Health formulary (a list of approved drugs that includes prescriptions offered at preferred pricing) will result in higher member out-of-pocket costs.
Does SeeChange Health Insurance offer only PPO plans?
Yes. We recognize employers have different needs, so we offer a wide range of PPO plans, from HSA-eligible plans to co-pay plans.
Can an employer offer its employees more than one SeeChange Health plan?
Yes. Under our Employee Option program employers may select one of our benefit suites (e.g., Classic or No-Deductible plan suites) and allow each employee to choose any plan available in that suite. Or the employer may choose the HSA and one other suite (e.g., the HSA and the Deluxe Co-Pay plans) and employees may choose from any of the plans in those suites.
Can an employer offer another carrier’s HMO alongside a SeeChange Health plan?
Yes. Under our HMO Combo program, employers may offer our plans alongside an HMO so long as at least 75% of the eligible employees enroll in one of the plans offered by the employer and, of those, the greater of five, or 50% of the eligible employees enroll with SeeChange Health. The HMO Combo Program may be paired with the Employee Option Program which allows an employer to select any two benefit suites (ie. Classic & Select HRA) and its employees to select any plan with those plan suites (ie. Classic 2500, 3500, 5000 and/or Select HRA 3000, 5000, 8000).
Does SeeChange Health offer a calendar year deductible or a plan year deductible?
Employers choose their deductible year at the time they enroll with Seechange Health. This is an important decision as the deadline for completing Health Actions is tied to the group's deductible period. Once made, this selection cannot be changed.
Calendar Year Deductible Period: Members must complete their Health Actions once per calendar year.
Plan Year Deductible Period: members must complete their Health Actions within 12 months of the group's effective date and then within 12 months after each anniversary date.
Do I need to fill my maintanence medication prescriptions through mail-order?
No. You can select either the retail pharmacy or mail-order home delivery option.
However, by getting your prescriptions through the mail you’ll receive 3 months of medication for the price of 2.5 co-pays. In other words, you’ll save one-half of a co-pay. To make it even easier to take advantage of this savings program, Cigna Pharmacy will contact your doctor to get a 90-day prescription for you.
Even 90-day supplies of non-formulary, specialty or injectable medications are discounted, although they are still subject to the appropriate co-insurance rates.
You can sign-up for mail order program at any time by contacting Cigna Pharmacy at (800) 325-1404.
How do members track their Health Actions?
Members may track their progress toward completing their Health Actions through the Member Portal at www.MySeeChangeHealth.com. To earn Financial Rewards both the employee and their spouse or domestic partner, if any, need to complete their Preventive Health Actions.
How many doctors are in your network?
Through a strategic alliance with Cigna we can offer your employees one of the most comprehensive provider networks in the country with over 600,000 doctors, hospitals and specialists coast-to-coast. In California alone our network includes over 50,000 physicians, 90,000 specialists and nearly 500 hospitals. Provider directories are available at www.SeeChangeHealth.com in the member and employer portals.
How are out-of-network charges treated?
All of SeeChange Health’s plans are PPOs, meaning members can see any doctor they like. However, member’s share of costs is substantially higher when out-of-network doctors provide treatment or services. Out-of-network providers are subject to a separate deductible and the member is responsible for all charges in excess of 110% of Medicare’s reimbursement rates. This is far less than what we cover for in-network providers. In short, members pay substantially more out-of-pocket when using out-of-network doctors and facilities. (For more details please see the Benefit and Exclusions flier).
What happens if a member needs care while traveling or lives out-of-state?
Members have access to our nationwide network wherever they travel or live.
What about your pharmacy network?
SeeChange Health provides prescriptions and pharmacy-related services through a partnership with Cigna Pharmacy Management. It’s important to note that coverage under the pharmacy portion of benefits is separate from the medical deductible and out-of-pocket maximums (except with our HSA plans).
Why does GWH-Cigna appear on my card?
SeeChange Health Insurance provides your insurance coverage. We have contracted with Cigna for your provider network. Cigna is a national network of over 700,000 health care professionals and 5,600 facilities coast-to-coast with over 75,000 health care professionals and nearly 500 hospitals in California alone. By working with Cigna in this way, we maximize your ability to obtain the more favorable, in-network benefits we offer.
My hospital bill lists Cigna as my insurer, but I thought I was insured by SeeChange Health. What’s going on?
SeeChange Health Insurance is your insurer. We have contracted with Cigna for your provider network. The billing systems used by some doctors, hospitals and other facilities are unable to separate the network from the insurer when preparing your bill or Explanation of Benefits. Since they are part of Cigna’s network, they display Cigna’s name. This doesn’t change your coverage, however. You are still insured in a value-based benefit policy from SeeChange Health Insurance.
Are members covered for emergency coverage outside the country?
SeeChange Health plans do not cover non-emergency care received outside the United States. However, in an emergency, care will be paid at the in-network benefit level. Some tips on receiving Emergency Care while outside the country:
- Go to the nearest medical facility
- Call your physician as soon as possible
- Once your care is completed, you are responsible for paying the bill. Keep all of your receipts.
- When you return, download a claim form from MySeeChangeHealth.com and submit it with your receipts.
- You will be reimbursed based on your plan's benefits.
THE MEMBER PORTAL
How do members sign up for an online member portal account?
Registering on the member portal is easy. Members simply visit
www.MySeeChangeHealth.com with their SeeChange Health ID card ready. They’ll enter information from their ID card, select a user name and a password, just like any other web site. In order to register they will need to provide their email address.
What information is available through the member portal?
The member portal is the primary source for all information about a member's health plan. Members can view coverage information, check deductible and out-of-pocket balances, track progress toward completing Health Actions and much more. We’ll even send reminder messages to our member’s online account to help ensure they’re receiving the right care and getting the most from their benefits.
Is the SeeChange Health member portal private?
SeeChange Health uses the latest in security protections to make sure our members' information is secure and HIPAA compliant to protect your privacy. We know that privacy within a family can also be important, therefore we only communicate health information to the patient – we don’t share private information with anyone else.
Who is SeeChange Health Insurance?
SeeChange Health Insurance is a new type of health plan. Our value-based benefit plans provide financial rewards to help employees discover and deal with health conditions earlier. The result: healthier employees, a more productive workforce, lower medical costs and more stable premiums. While we're a new carrier, we have a long history. Our sister company, SeeChange Health Solutions, provides value-based plan services to approximately one million individuals. And they’ve been administering medical benefits for more than a decade. This gives us both the expertise and service infrastructure to now bring these benefits to small and mid-sized businesses.
Is SeeChange Health Insurance available in my area?
SeeChange Health Insurance is currently available for employer groups throughout the state of California and Colorado. Our Administrative Service Only offerings to self-insured groups is available nationwide.
How do members request a replacement or additional SeeChange Health ID cards?
Additional and/or replacement ID cards can either be ordered online at www.MySeeChangeHealth.com, or by calling us at (866) 218-6009.
Where do members submit claims, appeals, or the like?
Claims, appeals, and other applicable documentation should be mailed to:
SeeChange Health Insurance
P.O. Box 14326
Reading, PA 19612
What is SeeChange Health’s rating with A.M. Best?
In 2010 SeeChange Health LLC purchased Central Benefits Insurance Company and renamed it SeeChange Health Insurance Company. A.M. Best does not give ratings to companies whose ownership has changed until several years have passed.
How can I have confidence in SeeChange Health’s financial strength?
There are several reasons SeeChange Health can be trusted to fulfill its financial obligations:
• SeeChange Health passed all financial requirements of the California Department of Insurance when we were approved to offer coverage. We have also passed all periodic reviews conducted by the DOI since we launched in the state.
• We maintain a capital reserve pool at 300% of risk-based capital—50% higher than the level recommended by the National Association of Insurance Commissioners.
• We reinsure claims at $200,000 (meaning if a claimant incurs more than $200,000 in claims these expenses are paid by our reinsurer, Lloyds of London, Best Rated “A”. This $200,000 threshold is significantly lower than industry standards.
• SeeChange Health is covered by the California State Guaranty Fund which protects individuals, s of April 1, 2011 up to $470,125.
• In May 2011 one of the nation’s largest private investment funds invested several million dollars in SeeChange Health after a thorough review of our financial strength.