Health Plan Basics
Who is Crumdale Specialty?
Crumdale Specialty is the program manager behind your health plan, offering a tailored approach to cost savings. We streamline the fragmented healthcare system by delivering innovative solutions that not only reduce health benefit expenses but also drive better outcomes for both employers and employees.
Who is Cigna?
Cigna is the Provider Network for your health plan. Cigna is not the administrator of your plan. This allows you to see providers and hospitals all over the United States that are in network with your plan. Cigna has contracts and negotiated rates with the providers and hospitals.
Who is Personify?
Personify is a TPA, or Third Party Administrator, that administers your health plan, manages eligibility and benefits, and pays claims. Claims and benefit eligibility are handled by Personify, not your provider network.
Who is WellDyne?
WellDyne is a Pharmacy Benefit Manager (PBM). A PBM is a third party administrator who manages your prescription drug benefits. They create and maintain your plan's formulary (list of drugs that your plan covers) as well as process prescription claims.
Getting to Know Your ID Card
Your ID card provides information about your medical, prescription drug, and telemedicine coverage. On the front, you’ll find your name, member ID, and group number. Cigna gives you access to a network of providers. Cigna does NOT verify eligibility and benefits or pay claims. Your providers can check eligibity and benefits by calling Personify at the number on the front of your ID card. Providers should send to claims to Personify at the address on the front your ID card.
Coverage provided by
Subscriber: John Smith
Member ID: 123456789
Group #: CP1234
Group Name: Your Employer
Member Benefits:
PCP: $25
Specialist: $50
Urgent Care: $75
In-Network Deductible: $5,000
Out of Pocket: $10,000
Medical Network:
Administered by
Provider Information:
Eligibility & Benefits:
Phone: 833-870-2630
Payer ID#: 07205
Precertification:
985-284-3242
Claims Submission:
Electronic: Payer ID# 62308
Mail: Cigna
PO Box 188061
Chattanooga, TN 37422
For Members:
For All Member Questions:
Call/Text Crumdale Advocates:
855-255-7060
Email: advocates@crumdalepartners.com
Website: www.mycarehc.com
Provider Directory: hcpdirectory.cigna.com/
Telemedicine
855-6RECURO
www.RecuroHealth.com
Pharmacy Information
RxBIN: 08878
Rx PCN: WDRX
Rx GRP: RWXYZXYZ
Phone: 877-207-0872
Questions and Answers
Where do Providers send my claims?
Providers send claims to Personify to be processed and paid. The information your provider needs can be found on the front of your card under Claims Submission.
What is an EOB and how to understand it?
An EOB is an Explanation of Benefits. It is what is generated after your provider submits a claim to be processed and is paid to the provider. It is NOT a bill. It is an explanation as to what was submitted to your insurance company and what was paid to your provider.
If you owe your provider a copay, coinsurance or money towards your deductible, you will receive a bill in the mail from your provider.
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Total Charges – total amount the provider billed the insurance company
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Co-Pay Amount – The amount your provider either billed you at time of service or may bill you later.
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Co-Insurance Amount – The percentage of cost a patient pays after meeting their deductible.
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Deductible Amount – The amount you will have to pay toward the cost of your healthcare before the insurance company begins to cover a percentage of your costs.
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Payment Amount – Total the Insurance company paid.
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Claim Remarks – Note from the health plan that explains more about the costs, charges, paid amounts or denial reasons.