My son goes to college in Ohio. Will he still be able to get coverage at college?
The only plan that does not offer nationwide coverage is the Cigna Limited Network plan. Yes, members of this plan can guest with another Cigna HealthCare site if they temporarily relocate to another area of the country for at least 60 days but less than two years.
The Cigna HealthCare Guest Privileges program provides members with a primary-care physician at your guest site, along with full access to your temporary guest network and all the benefits of a regular Cigna HealthCare plan participant.
The Guest Privileges program is optional and is available at no extra charge. Contact a Cigna on-site representative at 832-393-6191, 832-393-6192 or 832-393-6193 for more information and for a form to get started.
I need an MRI. What will I pay for that and other advanced radiological imaging?
In most cases, you’ll pay an addition fee for high-cost X-rays, such as MRI, MRA, CAT scan and PET scan, on top of your doctor’s visit copayment or coinsurance. What you’ll pay varies by plan:
Cigna Limited Network:
- At in-patient facilities, high-cost X-rays are covered under in-patient hospital – facility services.
- At out-patient facilities, your doctor’s office and in ERs, you pay a per scan copayment of $100.
Cigna Open Access:
During a physician’s office visit, at an in-patient or out-patient facility, or at an ER or urgent-care center, you pay 20 percent after your annual deductible is met.
At the physician’s office, in-patient hospital facility, out-patient facility, ER or urgent-care facility, you pay 40 percent after your annual deductible is met.
I noticed that for the Open Access plan, specialists in the CCN network cost less. What is CCN, and why does it cost less to see them?
CCN stands for Cigna Care Network, a network of specialists in 19 categories who meet or exceed quality and cost efficiency. Because of that, they cost the plan and you less when you go to them: You’ll pay a $65 copayment instead of $80, which you’ll pay for specialists outside the CCN. Here’s a list of CCN specialists. This specialist discount is only available in the Open Access plan.
Do I have to choose a primary-care doctor?
You are not required to choose a primary-care doctor for most plans. However, a primary care doctor is required in the Cigna Limited Network Renaissance IPA.
Do I need a referral to see a specialist?
Though you may want your personal doctor's advice and assistance in arranging care with a specialist in the network, you do not need a referral to see a participating specialist, except for in the Cigna Limited Network Renaissance, Memorial Hermann provider groups. Note that if you choose to see an out-of-network specialist, the health care services you receive will be covered at the out-of-network level, meaning you will pay more than if you saw a participating doctor.
What if my personal doctor isn't in the Cigna Provider Directory?
That means your doctor does not participate in the Cigna network. To receive your maximum coverage, you should select a doctor from the Cigna list of participating doctors. Participating doctors must meet standards to become a part of our network. You can continue seeing your current doctor, even if he or she is not a participating doctor. However, in that case your care will be covered at the out-of-network level, meaning you will pay more than if you saw a participating doctor.
What is the difference between in-network coverage and out-of-network coverage?
When you visit a Cigna participating doctor, your costs will be lower than with a non-participating doctor. That's because our participating doctors have agreed to charge lower fees, and your plan covers a larger share of the charges. With out-of-network coverage, available only in the Consumer-Driven Health Plan, you can see any doctor you wish and still be covered for treatment of any illness or injury. Keep in mind, however, that your out-of-pocket costs will be higher if you choose a doctor who doesn't participate in our network.
How do I find in-network doctors?
Start with the Cigna Provider Directory, or visit our website at mycigna.com.
What if I go to an out-of-network doctor who sends me to a network hospital? Will I pay in-network or out-of-network charges for my hospitalization?
Cigna will cover authorized medical services provided by a participating hospital at your in-network coverage level – whether you were sent there by an in- or out-of-network doctor.
If I am in the Cigna Limited Network plan and I experience acute symptoms or a life-threatening emergency while out of town, where can I seek immediate care?
If you need urgent care, you can use an urgent care facility or emergency room. In the case of a life-threatening emergency, seek care from the nearest emergency room. As soon as the emergency situation is stabilized, Cigna will work to transition your care back to network providers. Routine care is not covered unless it is provided by a network provider.
What is the contact number for the vision plan?
The phone number for Superior Vision is 866-265-0517. The website is www.superiorvision.com.
What is the contact number for the dental plan?
Our dental carrier is Delta Dental. For DHMO please call 844-282-7637 or for DPPO please call 855-242-1549
I completed the online enrollment form, but did not receive a confirmation. What should I do?
As long as you save the change, it is good to go, even if you were not able to print the confirmation. You can confirm your changes by going to the current benefits tab in your open enrollment screen.
I need to correct my dependent's name spelling. How do I do that?
You can make corrections to your dependents name in ESS. If you are not able to make that correction, Contact Benefits at 832-393-6000, so that a member of our eligibility team can edit the name in the system.
I cannot access Employee Self Service. What is my password?
For password resets and other issues with Employee Self Service, contact the HITS Client Services Help Desk at 832-393-9800.
I have a "File not found error" when accessing the enrollment form, how do I fix this?
You may need to press F5 a few times to refresh the pop up window. If that fails to work, contact the HITS client services help desk at 832-393-HITS. Or call Benefits Customer Service at 832-393-6000.
What do I do when I get a "Person is already being processed error" when accessing the enrollment form?
Close all the pop up windows and log out of ESS, then log on again and try accessing the form. You may need to press F5 a few times to refresh the pop up window. If that fails to work, contact the HITS client services help desk at 832-393-HITS. Or call Benefits Customer Service at 832-393-6000.
What services have been added to the City’s Medical Plan per the Patient Protection and Affordable Care Act (PPACA) guidelines?
Since 2010, the City of Houston has implemented the following services based upon
- Coverage for Dependents to Age 26 – City plans covered dependents up to age 25 until May 1, 2011, when the age limit was increased to age 26
- No annual dollar limits on essential health benefits – City plans were compliant with this requirement prior to PPACA, except for the lifetime maximum on PPO benefits
- No lifetime benefit limits – the PPO plan (under BCBSTX) had a lifetime maximum of $1.5 million until May 1, 2011, when all limits were removed
- Contraception and domestic violence screening without cost sharing. Contraception includes: 1) diaphragms and sponges, 2) birth control pills, 3) IUDs, 4) emergency contraception (Plan B and ella), 5) sterilization procedures, 6) counseling
- Provision of support for breastfeeding equipment
- Provision of a standard Summary of Benefits and Coverage document to all individuals enrolled in the medical plan annually
- No plan eligibility period over 90 days
- Automatic employee health plan enrollment required (eligible employees must opt out of the city’s plan)
- Maximum in-network-out-of-pocket set to $6,350 individual/$12,700 family
- Transsexual surgery and related therapies (psychological counseling and hormone therapy)
- Smoking cessation counseling and free medications (such as Chantix) and over-the-counter nicotine replacement therapies (nicotine patches or gum) covered at 100%
- Statins covered 100% at retail network pharmacies for members between the ages of 40-75 – Statins have been covered 100% through mail order by City plans since May 1, 2015
- Telehealth benefits – This is a requirement of the Texas State Legislature as opposed to PPACA, and was incorporated into the city’s medical plan effective May 1, 2018
NOTE: Members and/or their providers should verify benefit coverage prior to receiving medical services.
The following PPACA requirements were included as part of the city’s medical plans prior to the enactment of PPACA and necessitated no plan design changes:
- Enrollee ability to self-select a Primary Care Physician (PCP)
- Enrollee ability to visit an OB/GYN without a referral from their PCP
- Coverage of all emergency services as in-network benefits
- No pre-existing conditions exclusion
- 100% coverage of preventive care services, well exams (man, woman and child) and immunizations