How Your Medical Benefits Work

If You Receive Care in the United States

When you need healthcare services in the United States, you can choose to receive your care from an in-network or out-of-network medical provider. (See "If You Receive Care Outside the United States" if you will be receiving care outside the U.S.)

You will generally pay less when you receive your care from an in-network provider because network providers have agreed to charge pre-negotiated discounted rates. In addition, the deductible is lower for in-network care, so you incur less expense before the Plan begins to pay benefits, and your coinsurance rate is lower.

In-Network Care in the United States

The Plan generally pays 100% of the cost for preventive care without a deductible and 80% of the cost of most other covered services, such as hospitalization, after you meet the annual deductible.

See "Coinsurance Paid by the Expatriate Medical Plan" for tables that show the coinsurance percentage paid by the Expatriate Medical Plan on an in-network and out-of-network basis in the U.S.

In-Network Hospital Admissions

When you visit an in-network facility for a scheduled surgery, the Expatriate Medical Plan will cover care provided by radiologists, anesthesiologists, and/or pathologists (RAPs) at the in-network percentage of the reasonable and customary (R&C) charge, even if the provider is considered an out-of-network provider.

For example, assume you visit an in-network facility for surgery and are treated by an out-of-network anesthesiologist whose charge is $500. If the R&C charge for the anesthesiologist's services is $400, the Plan will reimburse you 80% of $400 ($320) after you have met the annual deductible; you will be responsible for payment of the remaining $180. Fees for services provided by any other out-of-network specialists who attend to you while you are confined in an in-network facility will be paid at the out-of-network level of benefits. Services performed in an out-of-network facility will be paid at the out-of-network level of benefits.

Out-of-Network Care in the United States

Out-of-Network Expenses

All out-of-network expenses are subject to reasonable and customary (R&C) limits; you are responsible for 100% of all charges above the R&C amounts. Since in-network charges for covered services have been negotiated with the providers, those charges would always be within the R&C limits.

You may use any licensed provider. Note: Charges from out-of-network providers are typically higher than the pre-negotiated fees charged by in-network providers.

Covered services will be reimbursed at the out-of-network level of benefits, subject to reasonable and customary (R&C) charges. These charges are based on average claims data in your area and are determined by Cigna to be appropriate fees for medical services. Please Note: You will be responsible for paying all charges above the R&C amount. Charges in excess of reasonable and customary levels are not considered a covered expense, and they are therefore not applied towards your annual out-of-pocket maximum.

The Plan generally pays 60% of medically-necessary eligible expenses (subject to reasonable and customary charge limits) after you meet the annual deductible.

You may need to pay for services at the time you receive care and submit a claim for reimbursement to Cigna Healthcare International. Please see "Filing a Claim for Benefits" for more information. Certain providers may choose to accept a guarantee of payment directly from Cigna Healthcare International. You would then be responsible for the difference not paid by the Plan.

See "Out-of-Network Care in the United States" for tables that show the coinsurance percentage paid by the Expatriate Medical Plan on an in-network and out-of-network basis in the U.S.

Prescription Drug Purchases at Retail Pharmacies in the United States

Important Note About Prescription Drugs

Due to U.S. and/or foreign laws, some controlled medications are limited to a 3-month supply at one time or may have other distribution limits.

To learn if you can purchase a 90-day or one-year supply of your prescription medications and if there are any associated travel restrictions, please call Cigna Global Healthcare International Customer Service at the telephone number on the back of your Cigna ID card.

For prescription drug purchases in the United States, Puerto Rico, and the U.S. Virgin Islands, you can use the Cigna Pharmacy Management network of participating pharmacies to obtain discounted brand-name and generic prescription drugs through more than 62,000 pharmacies. Simply present your Cigna Healthcare International ID card at any participating network pharmacy to take advantage of the savings. You can use the Provider Directory on the Cigna Envoy website at www.cignaenvoy.com to locate in-network pharmacies in the U.S., Puerto Rico, or the U.S. Virgin Islands.

When you have prescriptions filled at an in-network pharmacy, you pay only your coinsurance, and the pharmacy will bill Cigna Healthcare International directly for the balance.

Please Note: If you do not show your Cigna Healthcare International ID card at a network pharmacy, you will have to pay for the prescription drug and submit a claim form to Cigna Healthcare International to be reimbursed for the amount covered by the Expatriate Medical Plan (see "Filing a Claim for Benefits".)

If you plan to be outside of the U.S. for an extended period of time, you may be able to obtain a 12-month supply of prescription medications prior to leaving. If you have questions about the Cigna Pharmacy Management network or concerns about travel restrictions, please call Cigna Healthcare International Customer Service.

To determine whether your medication is subject to Cigna Healthcare International's utilization management program, please contact Cigna Healthcare International.

Mail-Order Prescription Drug Purchases in the United States

Express Scripts Home Delivery Pharmacy (through Cigna Healthcare International) is a convenient and economical alternative to obtaining your prescriptions at a retail pharmacy in the United States. This service allows you to purchase a three-month supply of medication that is delivered directly to your home at no additional cost. You can have your prescription drugs shipped to any address (including a post office box) in the United States, Puerto Rico, or the U.S. Virgin Islands.

If you plan to be outside of the U.S. for an extended period of time, you may be able to obtain a 12-month supply of prescription medications prior to leaving.

For current prescriptions, you can move them to Express Scripts Pharmacy. Simply call (800) 835-3784 and have your doctor's contact information and prescription medication name(s) and dosage(s) ready.

Two ways to place a new order

1. Electronically: For fastest service, ask your doctor's office to send your prescription electronically to Express Scripts Home Delivery, NCPDP 2623735.

2. By fax: Have your doctor's office call 888.327.9791 to get a Fax Order Form.

For new orders, please allow 10 to 14 days after Express Scripts Home Delivery Pharmacy receives your request. Refills ship within two business days of receipt of your request.

To determine whether your medication is subject to Cigna Healthcare International's utilization management program, please contact Cigna Healthcare International.

Purchase or Transport of Prescription Drugs Outside the United States

If you have questions or concerns about travel restrictions or the availability of prescription medications in your assignment location, please call Cigna Healthcare International at the telephone number on the back of your Cigna ID card.

Important Note: You cannot use the JPMorganChase New York City post office box address to receive your mail-order prescriptions in the U.S., as JPMorganChase cannot legally forward medications to your overseas location.

Out-of-Network Pharmacy Benefits in the United States Filing a Claim If You Use an Out-of-Network Pharmacy

If you purchase your prescription drugs through an out-of-network pharmacy in the United States, you will have to pay for the prescription drug and submit a claim form to Cigna Healthcare International to be reimbursed for the amount covered by the Expatriate Medical Plan (see "Filing a Claim for Benefits".) Home delivery pharmacy is only available In-Network in the United States.

To determine whether your medication is subject to Cigna Healthcare International's utilization management program, please contact Cigna Healthcare International.