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(QCIP) FAQs

Quality and Cost Incentive Plan (QCIP) Frequently Asked Questions

Listed below are FAQs for the Equity-League Funds’ (ELF) Quality and Cost Incentive Plan (QCIP) for Health Plan participants. For additional information, refer to the main Quality and Cost Incentive Plan (QCIP) page and a page describing how QCIP credits may be used.

What is the QCIP?

The Quality and Cost Incentive Plan (QCIP) is a pilot program, and participation is voluntary. The QCIP uses financial incentives to encourage participants to choose higher quality and lower cost health care options for eligible procedures.

Why did ELF decide to offer the QCIP?

With this pilot program, we seek to learn if participants will consider changing some ways in which they use their medical benefits. The QCIP offers financial incentives and provides information to help you make these decisions with your doctor.

Who is eligible to participate in the QCIP?

The QCIP is available to all ELF Health Plan participants enrolled in the Cigna Plan.

What procedures are eligible for the QCIP incentives?

QCIP incentives are available for colonoscopies and certain orthopedic procedures. For a complete list of currently eligible procedures, visit our QCIP main page.

How do I find an orthopedic surgeon who meet QCIP standards?

You can search for CCD-designated orthopedic surgeons through the following simple steps:

1. Visit www.cigna.com and click “Find a Doctor” near the middle of the home page. Then, on the following page, click the image labeled “If Your Insurance Plan Is Offered Through Work or School.”

2. Select “Doctors.”

3. Enter your “Search Location” by ZIP or city / state. For “Select a Plan, choose the first Cigna OAP Open Access Plus option. In the “Looking For,” type ”orthopedic surgeons” and click “Search.”

4. On the list that appears below the search field, click “Surgery, Orthopedic” under “Specialties.”

5. View the provider listings you are presented. CCD surgeons are noted by the graphic below. If you do not see any search results, adjust the slider to increase the “Distance” and repeat your search.

How do I find facilities that meet QCIP standards for orthopedic procedures?

You can search for COE-designated orthopedic facilities through the following simple steps:

  1. Visit www.cigna.com and click “Find a Doctor” near the middle of the home page. Then, on the following page, click the image labeled “If Your Insurance Plan Is Offered Through Work or School.”
  2. Select “Hospital, Pharmacy, or Facility.”
  3. Enter your “Search Location” by ZIP or city / state. For “Select a Plan, choose the first Cigna OAP Open Access Plus option. In the “Looking For,” type ”COE” and click “Search.”
  4. On the list that appears below the search field, click “Center of Excellence Hospital” under “Specialties.”
  5. View the provider listings you are presented. COE facilities are noted by the graphic below. If you do not see any search results, adjust the slider to increase the “Distance” and repeat your search.

How does a hospital or surgeon receive the Cigna designations?

Cigna’s COE (facilities) and CCD (physicians) designations are given to providers with better than average outcomes and lower than average costs, based upon Cigna’s data and metrics.

What are the incentives for orthopedic procedures performed by providers with the Cigna designations?

If you have one of the eligible orthopedic procedures performed in a COE facility by a CCD surgeon, you will earn a $400 credit through the QCIP. Your procedure must also be medically necessary.

What are the incentives for colonoscopies performed in a physician's office and/or under light sedation?

If you have a colonoscopy in your physician’s office instead of an inpatient or outpatient hospital facility, you will receive a $300 credit through the QCIP. Additionally, if you have a colonoscopy under light instead of deep sedation, you’ll earn a $200 credit. After discussing these options with your doctor, you may choose to meet one or both requirements to earn $200, $300, or $500 in QCIP credits. Your colonoscopy must also be medically necessary.

How do I choose where to have my colonoscopy and the kind of sedation that will be used?

Many colonoscopies can be done in an office setting under light sedation. However, you should talk to your doctor to determine if this is appropriate for you. Your doctor will help you make this decision based on your health status and his or her medical judgment. If you are willing to have your colonoscopy in the doctor’s office, or under light sedation, tell your doctor. Many physicians actually prefer to do colonoscopies in this setting.

What is light sedation? Is it better than deep sedation?

When you undergo deep sedation, you are completely unconscious. With light sedation, you typically feel drowsy, but you are not unconscious. Both methods of sedation are generally equally pain-free.

Is light sedation new?

No. Light sedation was the standard for colonoscopies for many years. However, in recent years, many such procedures are performed under deep sedation, which must be administered by an anesthesiologist.

What is the difference in cost between light sedation and deep sedation?

Significant. Often, the anesthesiologist’s charges to administer deep sedation are greater than the charges of the physician who performs the colonoscopy.

Is light sedation equally effective and safe?

There is no evidence that colonoscopies performed under deep sedation are more comfortable than those done with lighter sedation. In contrast, at least one study suggests that the risk of complications, while very low with either form of sedation, is higher under deep sedation.

Are any other procedures eligible for the QCIP incentives?

At present, we only offer the QCIP for colonoscopies and the designated orthopedic surgeries. If other procedures are added to the QCIP, we will notify participants, though there are currently no plans to expand the program.

What are the incentives for colonoscopies performed in a physician's office and/or under light sedation?

If you have a colonoscopy in your physician’s office instead of an inpatient or outpatient hospital facility, you will receive a $300 credit through the QCIP. Additionally, if you have a colonoscopy under light instead of deep sedation, you’ll earn a $200 credit. After discussing these options with your doctor, you may choose to meet one or both requirements to earn $200, $300, or $500 in QCIP credits. Your colonoscopy must also be medically necessary.

What kind of expenses are eligible for the QCIP?

Funds credited to your HRA under the QCIP may be used for:

• paying your Health Plan premiums

• meeting the Health Plan’s deductible and coinsurance requirements, or

• paying for certain health care and ancillary care services not covered by the Health Plan.

To learn more, visit this page, which lists common expenses that are eligible and are not eligible for QCIP reimbursement.