Cigna Healthcare® is expanding personalized care management

Through new capabilities with AI and predictive analytics we expect to support 20% more customers with emerging, complex or chronic health needs – including cancer, heart disease, kidney disease, high-risk pregnancy, and behavioral health conditions. Clinicians will help customers address health needs earlier and manage conditions more effectively. For engaged customers, this has reduced medical costs by $2,000 per year on average resulting in an estimated $200 million in total savings over the next three years. The new expanded programs will apply to Customers with HMCM Basic Standard, Preferred and Complete. These new capabilities will begin in Q4 2026 and continue to expand in 2027.

January 2027 Qualified High Deductible Health Plan Minimums:

The federally mandated minimum HSA individual deductible amount is $1750. The minimum family deductible is moving to $3500. All renewals and proposals with effective dates of January 2027 or later will reflect the new minimums if the current plan is less than the new compliant amount.

New Network Offering for OAP in Utah:

We are pleased to announce that OA Flex is available now on our Facets Platform. OA Flex retains the national OAP network while adding a Utah-specific network anchored by Intermountain Health, expanding provider access without changing the core plan design. The offering addresses a key market need by increasing competitiveness, meeting employer expectations, and balancing cost with choice. Employers can offer OAP, OA Flex, or both, giving employees greater flexibility through network choice backed by strong national coverage and expanded access to local providers statewide. Please note that this is a Facets only capability at this time, Proclaim capability will follow at a later date.

Evicore Fee Changes. Effective January 2027

Beginning January 1, 2027, the following medical management programs managed by EviCore by Evernorth with have fee changes:

integrated oncology management – $1,170 to $1,287 per EOC
musculoskeletal – $0.43 to $0.44 PMPM
gastroenterology – $0.13 to $0.14 PMPM
oncology clinical consult – $4,250 to $4,400 per consult
radiation therapy – $987 to $1,017 per EOC
diagnostic cardiology – $0.19 to $0.13 PMPM
These programs serve to increase affordability through utilization review, site of care, and network management.

Federal Government Increase to PCORI Fees:

The PCORI fee is based on the average covered lives for the applicable 12-month policy or plan year. It is paid using IRS Form 720 by July 31 each year for the plan year that ended in the preceding calendar year. As a reminder, employers must use their ERISA plan year if it is different from the renewal date. The fees for 2025, due July 31, 2026, are below:

For policy / plan years ending on or after 10/1/2025 and before 10/1/2026 – Fee per average covered life: $3.84. This is an increase from the prior year of $3.47.

For insured plans (including guaranteed cost, shared returns and minimum premium), fees are built into the Cigna Healthcare premiums. However, clients must pay the fee for their health reimbursement accounts (HRAs) and certain flexible spending accounts (FSAs) if they have either. This is because HRAs and certain FSAs are considered self-funded group health plans.

For self-funded medical clients with or without an HRA or FSA (including level funding and graded preferred plans), clients will be responsible for all of the related fees calculated by using the average number of lives covered under the policy or plan multiplied by the applicable dollar amount for that policy or plan year.

Cigna Healthcare provides self-service reports at no cost to help self-funded employers determine their average covered lives. Employers can access reports through CignaForEmployers.com.