Citi Benefits Handbook
Fully Insured Health Maintenance Organizations (HMOs)
Citi has entered into fully insured arrangements with numerous HMOs to provide health benefits to eligible employees. Although HMOs generally deliver benefits in the same way, the coverage that each HMO provides differs from the others.
This section provides a description of the medical benefit information available to HMO participants and should be read together with the Eligibility and participation section, the Administrative information section, and the HMO Certificate of Insurance listed under "2017 Insured HMOs." There is a separate HMO Certificate of Insurance for each fully insured HMO.
- Eligibility and participation and Administrative information provide information about eligibility and enrollment for you and your dependents, coordination of benefits, your legal rights, your contributions, and other administrative details.
- HMO Certificates of Insurance provide detailed information about the benefits and coverage available through each HMO. For example, the Certificate of Insurance will generally provide you with information concerning:
- The nature of services provided to members, including all benefits and limitations;
- Conditions pertaining to eligibility to receive such services (other than general conditions pertaining to eligibility to participate in the HMO) and circumstances under which services may be denied; and
- The procedures to be followed when obtaining services and the procedures available for the review of claims for services that are denied in whole or in part.
The HMO will send a Certificate of Insurance and a provider directory to you at your home upon enrollment in the HMO. If you do not receive your Certificate of Insurance, call your HMO at the telephone number listed under "2017 Insured HMOs" or on your ID card.
For a list of the HMOs offered by Citi and the Certificate of Insurance for each HMO, see "2017 Insured HMOs." The HMOs available to you will depend on your home zip code.
Note: Citi offers the opportunity to join an insured HMO. The actual coverage provided by the HMO is the HMO's responsibility. Citi does not guarantee or have any responsibility for the quality of health care or service provided or arranged by the HMO. Citi is not responsible for medical expenses that are not covered services under the HMO. HMO participants have the right to choose their own health care professionals and the services they receive under the HMO.
Be sure to check directly with the HMO prior to enrolling to ensure that you fully understand the provisions of the HMO.
If you have questions about coverage, providers, or using an HMO, call the HMO directly at the telephone number listed under "2017 Insured HMOs." This number can also be found on your HMO ID card, if you are a member of that HMO.
All the materials described above make up the Plan Document for Citi's fully insured HMOs. The Plan Document is intended to comply with the requirements of ERISA and other applicable laws and regulations. This HMO Plan Document does not create a contract or guarantee of employment between Citi and any individual.