Yuzu partners with Cigna, one of the largest national provider networks, so employer groups and plan designers on Yuzu’s platform can access Cigna's contracted providers and negotiated rates. Yuzu administers the plan while Cigna provides the network and utilization management.
For an employer group to use the Cigna network, there are a few requirements to know upfront. We've broken them down below.
Group size
Cigna supports groups with 25 or more eligible subscribers (employees). Smaller groups may still qualify as part of a bundled arrangement. Reach out to Yuzu for more information.
Geography
We can quote and support Cigna network plans in every U.S. state except groups headquartered in Minnesota. If your group is headquartered in Minnesota, we can discuss a carve out alternative network option for them.
Plan design requirements
For an employer group that is using the Cigna network, there are two rules that every plan on has to meet when it comes to plan design and benefit structure:
Rule 1: The plan has to pay at least 70% of in-network bills.
After the deductible, when a member sees an in-network doctor, the plan must pay 70% or more of the cost of care.
Rule 2: The in-network tier has to be at least 10% better than the out-of-network tier
Cigna has built a robust provider network across the US. In exchange for letting members access it, they require that every plan incentivizes members to actually use it. The deal for staying in-network must be at least 10% better than going out of network.
The gap doesn't have to come from coinsurance alone. It can come from any combination of things that make out-of-network worse, like a higher out-of-network deductible, a higher out-of-network out-of-pocket max, or copays that only apply in-network. As long as the overall in-network benefit is at least 10% better in some capacity, the plan qualifies.
Structural requirements
Self-funded under ERISA. The plan must be offered on a self-funded basis and comply with ERISA.
A signed Network Service Agreement, per group. Each employer group has to be individually papered with its own Network Service Agreement before any of its members can access Cigna providers at Cigna rates. This means the group's agreement needs to be fully signed before the plan year starts. Yuzu builds this into every implementation timeline so it's never a surprise or issue!
Exclusivity. The Cigna network must be the exclusive provider network for that employer group and its members, across all service areas and all covered services. Members can't have access to another provider network, and there can't be an arrangement that routes members to a non-Cigna network first that ‘unlocks’ Cigna care.
Cigna utilization management. Groups on the Cigna network must use Cigna's utilization management program, which covers pre-certification, concurrent care review, and discharge planning.
Group contracts
If a group is not in a “bundle” then each group is required to sign a Network Agreement with Cigna. In order for members to appear eligible for the Cigna network, this document must be signed and returned to Cigna.
In order for claims to be repriced and deemed eligible by Cigna, they must be submitted with 180 days of the Date of Service (“timely filing”).
Exceptions Gateway
If you have group or plan design that does not align with these expectations, an exception can be submitted to Cigna by Yuzu directly. If an exception is needed, Yuzu will work with your team to build the requirements, expected financial upside, and the impact to the network. Due to the volume of these requests, we cannot guarantee we will be able to submit every exception, whether approval will occur, or on what timeline the decision will be made.
Basic information we need for every exception includes:
Company
Company legal name
Primary contact
Year founded
Ownership/backing
Brief company overview
Carrier on plans
Business
What products do you offer?
What employer sizes do you target?
How do you distribute your products (broker, GA, direct, etc.)?
Current covered lives and projected growth (12–24 months)
Partnership
Geographic footprint
Current network(s) used
Compliance
Any relevant certifications (SOC 2, HITRUST, NCQA, etc.)?
Any regulatory or legal issues we should know about?
Supporting Documents
Company overview/deck (or website)
What this means for you!
IIf your group has 25 or more subscribers, is self-funded, not in Minnesota, and wants a plan design that clears the two rules above, the Cigna network is an option for you. If you don't meet those requirements, we are happy to connect you with some of our other network partners. Most traditional PPO and HDHP designs should clear these requirements, but as part of plan design onboarding, we check each specific plan design to make sure it abides by Cigna’s rules, and nothing goes live until it does!