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.

Medical Plan Options
Medical Plan Information

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: $8,550 (individual) / $17,100 (family)
    • - Out of network: $16,300 (individual) / $32,000 (family)

Need more information?
Summary of Benefits (CDHP)
CDHP Full Plan Documents
CDHP Pharmacy Full Plan
Cigna Choice Fund HRA Information Flyer

up icon

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
    • - Village Family Practice
    • - 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
    • - $8,550 (individual) / $17,100 (family)

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

up icon

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 for a Tier 1 specialist/$85 for a non-tier specialist
  • Deductible
    • - $850 (individual) / $1,700 (family)
  • Out-of-pocket maximum
    • - $8,550 (individual) / $17,100 (family)

Need more information?

Summary of Benefits (OAP)
OAP Full Plan Documents
OAP Pharmacy Full Plan Documents
up icon

Find a Doctor, Dentist or Facility

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

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

up icon

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

Look at the current lists for more urgent care and convenience care options.

up icon

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

Need more information?
Prescription Plan Features
2019 Plan Document for Limited Pharmacy
Cigna Value Four Tier Prescription Drug List

up icon

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.
up icon

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.

up icon

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 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.



I need an MRI. What will I pay for that and other 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 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.


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?

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.



Do I have to choose a primary care doctor?

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.

up icon

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-Village Family Practice 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.



What if my personal doctor isn’t in the Cigna Network?

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.



What is the difference between in-network and out-of-network coverage?

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.



How do I find in-network doctors and providers?

Start with the Cigna Provider Directory for your plan, 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.

up icon



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.



NEW CIGNA Dental Care (DHMO) & (DPPO) Plan


Who is our new dental provider?

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

up icon



What is the contact number for the dental 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.

  • 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.)


What is “Orthodontics in progress” (DHMO)?

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.



What about non-orthodontic treatments (DHMO)?

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
up icon



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

You now have the ability to print a Benefits Confirmation Statement once you complete your enrollment in ESS. If you are unable to print this confirmation, you can confirm your benefit elections by clicking on the current benefits tab in ESS.



I need to correct my dependent’s information (name, date of birth, etc.), how do I do that?

You can make corrections to your dependent’s information in ESS, but you must submit proof of any supporting documentation to the Benefits Division. Please contact the Benefits Division for more details.



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.

up icon



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
  • Maximum in-network out-of-pocket costs set to $8,150 individual / $16,300 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


What are some additional services that the City of Houston offers?

  • Bariatric surgery
  • Gender dysphoria services
  • Reduction mammoplasty
  • Varicose vein surgery
  • Hearing aids
  • Chiropractic services – this is a big one and should be added
up icon



What drugs are covered for free by mail order?

  • 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


What is the Patient Assurance Program?

The Patient Assurance Program is a new prescription program with Cigna. It allows for certain preferred brand insulin drugs to be capped at $25 for a 30-day supply and $75 for a 90-day supply at participating pharmacies.



Who is our life insurance carrier?

Dearborn National is City of Houston’s Life Insurance.



Will I receive a new insurance card?

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. All members will receive a new dental card. ID cards can also be printed by logging into mycigna.com. (More to come on this)



Why are grandchildren not covered under the life insurance policy?

Dearborn National have chosen to not offer that coverage effective 4/30/2020.



Why does the City of Houston need supporting documents for my dependents?

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.

up icon