Answers to common questions about Medical with Smart Coverage, an industry-first approach that combines qualifying medical coverage with employer-paid supplemental health insurance benefits.
Medical with Smart Coverage is Cigna Healthcare’s industry-first benefit design that combines qualifying high-deductible medical plans with employer-paid supplemental health coverage to help employees better manage the financial impact of unexpected or costly health events.
Medical with Smart Coverage, at a glance
- Combines a qualifying high-deductible Cigna Healthcare® medical plan with employer-paid supplemental health coverage.
- Employees are automatically enrolled when they select a qualifying medical plan.
- No separate enrollment decision and no additional employee premium.
- Eligible employees and covered family members may receive up to $7,000 in cash benefits following covered health events.
- Cash benefits can be used for medical expenses or everyday costs such as transportation, childcare, groceries, rent, mortgage payments, and household bills.
- Features Simple File Sync Plus capability that identifies qualifying events and triggers claim submission invitations/reminders, and in some cases automatic cash payment.
- Designed to help employers offer affordable coverage options while providing employees with additional financial protection and easier access to available benefits when certain unexpected or costly health events occur.
What is Medical with Smart Coverage?
Medical with Smart Coverage is a benefits offering from Cigna Healthcare that combines a qualifying high-deductible medical plan with employer-paid supplemental health coverage. Employees who enroll in a qualifying medical plan automatically receive supplemental coverage that provides cash benefits following certain covered health events. There is no separate enrollment decision and no additional premium cost to employees
What problem is Medical with Smart Coverage designed to solve?
Medical with Smart Coverage is designed to help address the financial uncertainty many people experience after certain unexpected or costly health events. While health insurance helps cover the cost of care, employees may still face out-of-pocket expenses and other financial pressures during recovery. Research from Cigna Healthcare and Ipsos found that 60% of Americans say they are not financially prepared for a health event, and 44% spent $1,000 or more out of pocket following a diagnosis, injury, or hospitalization.
It also helps address a common challenge with supplemental benefits. Many people may already have access to supplemental coverage but do not realize they are eligible for benefits when a covered health event occurs. Because medical and supplemental benefits are administered separately, navigating available support can be complicated.
Medical with Smart Coverage connects these traditionally separate experiences, making it easier for people to understand, access, and use available financial support when they need it most.
How does Medical with Smart Coverage support people enrolled in higher-deductible health plans?
Unexpected injuries, illnesses, and hospital stays can create financial challenges for many families. Medical with Smart Coverage provides cash benefits following covered health events, helping people manage medical expenses and other recovery-related costs, even when they have health insurance.
Source: Cigna Healthcare and Ipsos survey
The cash benefits are paid directly to employees and covered family members and can be used however they choose.
What health events are covered by Medical with Smart Coverage?
Medical with Smart Coverage provides benefits for a range of unexpected or costly health events, including:
- Accident-related urgent care visits
- Accident-related emergency room visits
- Ground ambulance services
- Water ambulance services
- Air ambulance services
- First hospital inpatient admissions
- Invasive cancer
- Carcinoma in situ
- Heart attack
- Stroke
Benefit amounts are linked to the employee’s qualifying medical plan deductible.
Benefits are paid directly to the covered individual and can help offset medical expenses and recovery-related expenses.
Source: Cigna Healthcare and Ipsos survey
How much money can employees receive through Medical with Smart Coverage?
Eligible employees and covered family members may receive up to $7,000 in supplemental cash benefits, depending on the covered health event and the qualifying medical plan selected by their employer. Benefits are paid directly to the individual.
Can Medical with Smart Coverage cash benefits be used for everyday expenses?
Yes. Cash benefits may be used for medical expenses, deductibles, or co-pays, but they can also be used for everyday expenses such as:
- Transportation
- Childcare
- Groceries
- Rent and mortgage payments
- Household bills
- Other recovery-related expenses
The money is paid directly to the individual, who decides how to use it. This flexibility is important because fewer than one-third of people understand that supplemental benefits can be used for everyday expenses such as groceries, housing, and childcare.
Is Medical with Smart Coverage a buy-up benefit?
Not for employees. Medical with Smart Coverage includes employer-paid supplemental health coverage that is automatically paired with a qualifying medical plan. Employees do not need to make a separate purchase decision or pay an additional premium to receive the supplemental coverage.
Employers choose whether to offer Medical with Smart Coverage as part of their benefits strategy.
Do employees and covered family members need to file a claim to receive cash benefits?
Not always. Medical with Smart Coverage includes Simple File Sync Plus, which uses medical claims information to help identify covered health events and notify eligible individuals when a cash benefit may be available.
In some cases, cash benefits can be paid automatically, reducing paperwork and helping people access financial support more quickly. The goal is to help close the gap between having benefits and actually using them when a covered health event occurs.
How is Medical with Smart Coverage different from traditional supplemental health coverage?
Medical with Smart Coverage connects medical and supplemental health benefits in a single experience. Instead of requiring employees to elect supplemental coverage separately, qualifying employees automatically receive employer-paid supplemental coverage when they enroll in an eligible medical plan.
Many people may have supplemental benefits today but may not realize they are eligible for benefits when a covered health event occurs. By connecting medical and supplemental benefits and pairing them with Simple File Sync Plus, Medical with Smart Coverage helps close the gap between having benefits and actually using them.
This approach is designed to make financial support easier to access, understand, and use when covered health events occur.
Why would employers offer Medical with Smart Coverage?
Medical with Smart Coverage gives employers another way to support employees during unexpected or costly health events while maintaining a focus on affordability.
The solution connects medical and supplemental benefits that have traditionally been managed separately, helping create a simpler experience for both employers and employees. It also helps address the growing need for financial protection, financial certainty, and peace of mind when certain unexpected or costly health events occur.
Source: Cigna Healthcare and Ipsos survey
Which employers can offer Medical with Smart Coverage?
Medical with Smart Coverage is available to eligible Cigna Healthcare U.S. employer clients with 500 to 2,999 employees that offer qualifying medical plans with an individual deductible of $1,000 or more. Availability varies by state and plan type, with expansion planned over time.
Terms to know
Higher-deductible health plan (HDHP): A health plan with lower monthly premiums and higher out-of-pocket costs before insurance begins paying for certain services.
Supplemental health coverage: Coverage that provides cash benefits following certain covered health events.
