The only City of Houston medical plan that does not offer nationwide coverage is the Cigna Limited Network plan.

However, members of this plan can “guest” with another Cigna service area 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 with all the benefits of a regular Cigna healthcare plan participant.

The Guest Privileges program is optional and is available at no additional charge. Contact a Cigna On-Site Representative for more information.

In most cases, you’ll pay an additional fee for high-cost X-rays, such as MRI, MRA, CAT scan and PET scan, on top of your doctor’s visit copay or coinsurance.

What you’ll pay varies by plan:
CDHP: At the physician’s office, in-patient hospital facility, out-patient facility, ER or urgent care facility, you pay 20% of the bill, after your annual deductible is met.

Limited Network: At in-patient facilities, high-cost X-rays and imaging are covered under in-patient hospital-facility services. At out-patient facilities, your doctor’s office and in the emergency room, you pay a $100 copay per type of scan per day.

Open Access: During a physician’s office visit, at an in-patient or out-patient facility, or at an emergency room or urgent care center, you pay 30% of the bill, after your annual deductible is met.

Cigna Tiered Benefits formerly known as Cigna Care Network (CCN) is a tiered plan design. Every year Cigna evaluates provider performance in certain primary care and medical specialties.

Providers with top results in delivering quality, cost-efficient care become Tier 1. Under your plan, every time you use a Tier 1 in-network provider, you will have a lower copay.

You’ll pay a $65 copay instead of $80, which is the copay for specialists outside of Tier 1. This specialist discount is ONLY available in the Cigna Open Access plan.

You are not required to choose a primary care doctor, but it is encouraged so that your primary care doctor can direct your care. However, a primary care doctor is required for the Cigna Limited Network Plan.

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 the Cigna Limited Network-Renaissance plan and the Cigna Limited Network-Village Medical group.

Note that if you choose to see an out-of-network specialist, the health care services you receive will not be covered and you will be responsible for all out-of-pocket expenses. The CDHP plan is the only plan that offers out-of-network benefits at a higher cost share than in-network benefits.

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 listed on cigna.com (New Hire or new to the plan).

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 not be covered unless you select the CDHP plan and use the out-of-network benefit option.

In-Network - Most health plan have a group, or network of doctors, hospitals, labs, and other health care providers that they contract with to provide services at a discounted rate. You typically pay less when you see in-network providers.

Out-of-Network – Out-of-Network refers to a health care provider who does not have a contract with your health insurance plan.

If you use an out-of-network provider, health care services could cost more sine the provider doesn’t have a pre-negotiated rate with your health plan.

Open Access and Consumer Driven Health Plans - Visit myCigna.com and search under Find Care & Cost tab on the top menu.

Limited Network – Visit myCigna.com and under the Find Care & Cost tab on the top menu, click on “Important Messages Regarding Your Plan” to view the Limited Network Provider Directory. You may also call one of the on-site Cigna representatives. Please refer to the provider contact list for details.

Cigna will cover authorized medical services provided by a participating hospital at your in-network coverage level, whether you were sent there by in- or out-of-network doctor.

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.

The phone number for Superior Vision is 866.265.0517, or visit their website: www.superiorvision.com.

Cigna is our dental provider and you now have the option to choose between the Cigna Dental Care Access (DHMO) plan and Dental PPO (DPPO) Plan.

The Pre- Enrollment phone number for Cigna Dental Care Access plan is 800.401.4041. You can find a network dentist or specialist online at www.Cigna.com before you sign up, or go to your personalized website at myCIGNA.com or contact Cigna Customer Service at 800.997.1406 after April 30th.

The Pre- Enrollment phone number for Cigna Dental Care Access plan is 800.401.4041. You can find a network dentist or specialist online at www.Cigna.com before you sign up, or go to your personalized website at myCIGNA.com or contact Cigna Customer Service at 800.997.1406 after April 30th.

Cigna Dental Care Access (DHMO) Plan Facts

• No dollar maximums
• No deductibles
• Benefits start right away with no waiting periods
• No claim forms to file when using network dentists
• You will select a Cigna Dental Care network general dentist to manage all of your dental health care needs who will refer you to any network specialist. (Referrals are not required for pediatric dentists for children under age 7 and orthodontists.)

It’s when you start orthodontic treatment with one carrier. Then you switch to a Cigna Dental Care plan before your orthodontic care is done. Your treatment is still “in progress.” And your Cigna plan may cover it.

Your Cigna Dental Care plan doesn’t usually cover non-orthodontic treatment in-progress. This includes:

• Root canal treatment
• Crown and bridge work
• Dentures

TOTAL CIGNA DPPO PLAN FACTS

• Freedom to visit any licensed dentist or specialist
• No specialty referrals required
• The plan will cover eligible dental expenses after you satisfy any applicable waiting periods and meet any deductibles
• The plan is based on coinsurance levels that determine the percentage of costs covered by the plan for different types of services

Since 2010, the City of Houston has implemented the following services based upon PPACA guidelines:

• Coverage for dependents up to age 26 (City of Houston 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 of Houston 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:
  • - Diaphragms and sponges;
  • - Birth control pills;
  • - IUDs;
  • - Emergency contraception (Plan B and Ella);
  • - Sterilization procedures; and
  • - 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
• Maximum in-network out-of-pocket costs set to $8,700 individual and $17,400 family
• Gender dysphoria 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 and gum) covered at 100%
• Statins covered 100% at retail network pharmacies for members between the ages of 40-75 (statins have been covered at 100% through mail order by City of Houston plans since May 1, 2015)
• Telehealth benefits (this is a requirement by the Texas State Legislature as opposed to PPACA, and was incorporated into the City of Houston’s medical plan effective May 1, 2018)

The following PPACA requirements were included as part of the City of Houston’s medical plans prior to the enactment of PPACA and necessitated no plan design changes:

• Ability to self-select a Primary Care Physician (PCP)
• Ability to visit an OB/GYN without a referral from their PCP
• Coverage for all true 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

• Bariatric surgery
• Gender dysphoria services
• Reduction mammoplasty
• Varicose vein surgery
• Hearing aids
• Chiropractic services

• Generic and preferred brand diabetes related drugs and supplies;
• Generic and preferred brand asthma related drugs;
• Generic and preferred brand blood pressure related drugs;
• Generic and preferred brand osteoporosis related drugs;
• Generic and preferred brand prenatal vitamins;
• Generic and preferred brand cholesterol related drugs;
• Generic and preferred brand anxiety/depression/bipolar related drugs; and
• Generic and preferred brand blood thinner related drugs

Dearborn National is City of Houston’s Life Insurance.

Only enrollees who are new to the medical plan or those changing from one medical plan to another medical plan will receive a new ID card. ID cards can also be printed by logging into mycigna.com.

The City of Houston requires two types of documents when adding dependents: documents to confirm the relationship to the employee (marriage certificate, birth certificate, etc.) and documents to confirm the dependent’s identity (Social Security Card or TIN).

The Affordable Care Act (ACA) confirms medical coverage based on Social Security numbers and IRS filings – this is why we are unable to accept driver’s licenses or other identification.

No. If your spouse is covered as an employee, they cannot be covered as a dependent under your plan.

No. If you are both covered as employees, only one of you may enroll your eligible dependent children for voluntary life insurance.

Yes. If your spouse decides not to elect voluntary life insurance coverage as a retiree, you can add them to your voluntary life insurance coverage.

No. You cannot be covered as a dependent child of another City employee.