Human Resources Department

Medical Benefits


Medical benefits imageWhether you want more choices or more monthly savings, the City offers three unique medical plan options to meet your individual needs. All plans include free preventive care services and a four-tier prescription drug plan.



Consumer-Driven Health Plan (CDHP)

The Consumer-Driven Health Plan (CDHP) uses the same Cigna network of providers as the City of Houston’s Open Access Plan (OAP).

What you want to know:

  • Includes a Health Reimbursement Account (HRA)
    • - City of Houston pays the first $500 (for individual) or $1,000 (for family) towards deductible
    • - Unused amounts rollover from previous plan year
  • No copays = more out-of-pocket costs at the time of service
    • - 20% coinsurance (in network) / 40% coinsurance (out of network)
  • Deductibles
    • - In network: $1,750 (individual) / $3,500 (family)
    • - Out of network: $3,500 (individual) / $7,000 (family)
  • Out-of-pocket maximums
    • - In network: $7,900 (individual) / $15,000 (family)
    • - Out of network: $15,000 (individual) / $30,000 (family)

Need more information?
Summary of Benefits (CDHP)
CDHP Full Plan Documents

Cigna Choice Fund HRA Information Flyer

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Limited Network Plan

The Limited Network Plan allows you to choose from three provider groups, with an easy to understand co-pay and deductible system.

What you want to know:

  • Provider groups:
    • - Kelsey Seybold
    • - Memorial Hermann
    • - Renaissance
  • Copays for doctor visits
    • - $35 copay for primary care visit
    • - $65 copay for specialist visit
  • Deductibles
    • - For medical services: $200 (individual) / $600 (family)
    • - For prescriptions: $150 (individual) / $450 (family)
  • Out of pocket maximums
    • - $7,900 (individual) / $15,800 (family)

Need more information?
Summary of Benefits (Limited Network) Limited Network Full Plan Documents

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Limited Physicians Directory


Open Access Plan

The Open Access Plan (OAP) is the most expensive plan, but has access to Cigna’s national network of providers.

What you want to know:

  • Access to over 572,000 providers all over the United States, without having to list a primary care physician or request referrals to specialists
  • Copays for doctor visits
    • - $40 copay for primary care visit
    • - $65-$80 for specialist (depending on network)
  • Deductible
    • - $850 (individual) / $1,700 (family)
  • Out-of-pocket maximum
    • - $7,900 (individual) / $15,800 (family)

Need more information?
Summary of Benefits (OAP)
OAP Full Plan Documents

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True Cost of Medical Services

Who’s sharing the cost of medical services? See the examples below of some common costs for the City of Houston’s medical plans.



Find a Provider

Download the myCigna app, or log into your myCigna.com portal for quick and easy access to providers in your area.

You may alos call one of the on-site Cigna representatives. Please refer to the provider contact list for details.

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Urgent Care Facilities

If you need medical attention, your first thought may be to go to the emergency room. But if your condition isn’t serious or life threatening, you have a less expensive option.

An urgent care center provides quality care like an emergency room, but can save you time and money. Visit an urgent care for things like minor cuts, burns and sprains, fever and flu symptoms, joint or lower back pain, and urinary tract infections.

24/7 Urgent Care Facilities (Accepted by all City of Houston medical plans)

Community Emergency Center – San Felipe
6363 San Felipe St., Houston, TX 77057
713.972.8300

St. Luke’s Community Emergency Center
2727 Holcombe Blvd., Houston, TX 77025
832.355.7525

Community Emergency Center – Pearland
11713 Shadow Creek Pkwy., Pearland, TX 77584
713.793.4600

Click here for more urgent care and convenience care options.

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Prescription Plan

Prescription Plan imageChoosing the medication that’s right for you should be a decision made by you and your doctor. Cigna’s prescription plan offers an extensive list of name brand and generic medications to help you choose the right one based on how well it works, and how much it costs.

Prescription drugs fall into one of four tiers, with different copay amounts for each tier and each medical plan:

  • Generics, which have the same active ingredients, safety, dosage, quality and strength as their brand name counterparts.
  • Preferred brands, which often don’t have a generic equivalent available.
  • Non-preferred brands, which generally have generic alternatives or one or more preferred-brand options within the same drug class.
  • Specialty drugs, a coverage tier that includes injectable medications that are often used to treat arthritis, multiple sclerosis, hepatitis C, asthma, and other chronic ailments.

When it comes to filling your prescriptions, choice, convenience and cost are important to you. Your Cigna plan has over 68,000 retail pharmacies, and you have the choice of filling your medications in either a 30-day or 90-day supply. Retail pharmacies include local pharmacies, grocery stores, retail chains and wholesale warehouse stores – all places you may already shop.

All pharmacies in your Cigna network can fill 30-day prescriptions, but only a select number of pharmacies can fill 90-day prescriptions. 30-day prescription pharmacies include:

  • CVS/Target
  • Kroger
  • HEB Pharmacy
  • Kelsey-Seybold
  • Walgreens
  • Walmart
  • Participating independent pharmacies

90-day prescription pharmacies include:

  • CVS/Target
  • Kroger
  • Walmart
  • Express scripts (formerly Cigna Home Delivery)*

2019 Plan Document for Limited Pharmacy

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Free Medications

If you use Cigna Home Delivery, you can now fill the following prescriptions at no cost to you:

  • Generic, and some brand name, asthma medications;
  • Generic diabetic supplies;
  • Brand name insulin;
  • Generic cardiovascular and high blood pressure medications;
  • Generic cholesterol medications.
    *Not all prescriptions are available with Express scripts (formerly Cigna Home Delivery) services.

COBRA

COBRA Notification Obligations

Under federal law, Consolidated Omnibus Budget Reconciliation Act (COBRA), the City of Houston is required to offer covered employees and/or covered family members the opportunity to remain covered with continued health coverage at group rates when coverage under the health plan would otherwise end due to certain qualifying events. Continuation of coverage under COBRA is the same as that provided to active employees and subject to the same requirements. Evidence of good health is not required to continue coverage. Failure to notify the plan administrator within 60 days of a qualifying event or from the loss of coverage date will result in a loss of any potential COBRA rights you may have had.

For more information about COBRA, please contact WageWorks by calling 888.678.4881 or visiting www.mybenefits.wageworks.com.

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FAQ's

My son goes to college in Ohio. Will he still be able to get coverage at college?

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 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 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.



I need an MRI. What will I pay for that and another advanced radiological imaging?

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 40% of the bill, after your annual deductible is met.
  • 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 the emergency room, you pay a per scan copay of $100.
  • 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 20% of the bill, after your annual deductible is met.


I noticed that for the Cigna 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 copay instead of $80, which is the copay for specialists outside the CCN. This specialist discount is ONLY available in the Cigna 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 for the Cigna Limited Network – Renaissance plan.



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 the Cigna Limited Network-Renaissance plan and the Cigna Limited Network-Memorial Hermann group. 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 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 Cigna’s 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 with the Consumer Driven Health Plan (CDHP), 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 and providers?

Start with the Cigna Provider Directory, or visit www.myCigna.com. You may also call one of the on-site Cigna representatives. Please refer to the provider contact list for details.



What if I go to an out-of-network doctor who sends me to an in-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 in- or out-of-network doctor.



If I am in the Cigna Limited Network plan and I need to see a doctor 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, or visit their website: www.superiorvision.com.



What is the contact number for the dental plan?

The phone number for Delta Dental DHMO plan is 844.282.7637 and for DPPO plan is 855.242.1549. You can also visit their website: www.deltadentalins.com.



I completed the online enrollment form, but did not receive a confirmation. What should I do?

As long as you saved the change, your benefit elections are in the system, even if you were unable to print a confirmation. You can confirm your changes by going to the current benefits tab in your ESS.



I need to correct my dependent’s name spelling. How do I do that?

You can make corrections to your dependent’s name in ESS, but you will need to submit proof of their correct name to the Benefits Division. Please contact Benefits for more information.



I cannot access my Employee Self-Service. What is my password?

For password resets and other issues with logging into your Employee Self-Service, contact the HITS Client Services Help Desk at 832.394.HITS.



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 832.394.HITS or the Benefits Division 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 in 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 832.394.HITS or the Benefits Division at 832.393.6000.



What services have been added to the City of Houston’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 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
  • Automatic employee health plan enrollment required (eligible employees must opt out of the City of Houston’s plan)
  • Maximum in-network out-of-pocket costs 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 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:

  • Enrollee has the ability to self-select a Primary Care Physician (PCP)
  • Enrollee has the 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
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What are some additional services that the City of Houston offers?

  • Bariatric surgery
  • Transgender services
  • Reduction mammaplasty
  • Varicose vein surgery
  • 100% coverage of preventive care services, well exams (man, woman and child), and immunizations
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