Citi Benefits Handbook
Preventive Care
Preventive care services are available in all plans. Both exams and immunizations are covered by network providers at 100% with no deductible to meet.
Preventive care services include but are not limited to:
  • Routine physical exams and diagnostic tests, for example, CBC (complete blood count), cholesterol blood test, and urinalysis and immunizations;
  • Well-child services and routine pediatric care and immunizations for children, excluding travel immunizations; and
  • Routine well-woman exams.
In addition to well-woman exams, the following women's preventive services are covered by network providers at 100% with no deductible to meet:
  • Well-woman office visit to obtain recommended preventive services that are age and developmentally appropriate, including preconception and prenatal care;
  • Certain Food and Drug Administration (FDA)-approved contraceptive devices, including diaphragms and implantable devices, sterilization procedures, and patient education and counseling for women with reproductive capacity. See the Prescription Drugs section of the Plan/SPD for information about covered contraceptive drugs. Contact your plan for details;
  • Comprehensive lactation support and counseling by a trained provider during pregnancy and/or in the postpartum period (including costs for renting breast pumps and nursing-related supplies);
  • Human papillomavirus (HPV) DNA testing as part of cervical cancer screenings for women (at least every three years);
  • Human immune-deficiency virus (HIV) counseling and screening for all sexually active women;
  • Interpersonal and domestic violence screening and counseling;
  • Counseling on sexually transmitted infections for all sexually active women; and
  • Screening for gestational diabetes.
Additional preventive care services covered in full by Citi medical plans, as part of recent health care reform regulations include:
  • Preventive services related to pregnancy for dependent children;
  • Anesthesia performed in connection with a preventive colonoscopy;
  • Genetic counseling and BRCA genetic testing for women who have had non BRCA-related breast or ovarian cancer;
  • Gender-based preventive services for transgender individuals;
  • Tobacco-use cessation(for nonpregnant adults): counseling, behavioral interventions, and US Food and Drug Administration (FDA)-approved pharmacotherapy;
  • Tobacco-use cessation (for pregnant women): counseling and behavioral interventions;
  • Diabetes screening (at-risk adults): screening for abnormal blood glucose as part of cardiovascular risk assessment for overweight or obese adults ages 40–70 years; and intensive behavioral counseling about diet and exercise for patients with abnormal blood glucose; and
  • High blood pressure screening (adults): hypertension screening for adults ages 18 and older.
Contact your plan for details.
Patient Protection and Affordable Care Act (PPACA) Guidelines
The Patient Protection and Affordable Care Act (PPACA) requires that group health plans follow certain guidelines regarding how often certain preventive screenings should be covered. These guidelines are recommended by the U.S. Preventive Services Task Force, the Centers for Disease Control (CDC) and the Health Resources & Services Administration. (See the current guidelines at www.uspreventiveservicestaskforce.org.)
All of the Citi medical options follow these guidelines — or provide more generous benefits than what is required — however each of the plans may be administered differently. Contact your medical plan to confirm how these screenings are covered.
Screening recommendations include:
  • Colorectal Cancer— covered for adults 50-75, using fecal occult blood testing, flexible sigmoidoscopy, or colonoscopy
  • High Blood Pressure— covered every two years if below 120 systolic/80 diastolic, or every year if between 120-139 systolic/80-90 diastolic
  • Lipid Disorders— covered for men 20-35, women 20-45 if at high risk, or men over 35, women over 45 if normal risk
  • Type 2 Diabetes— covered for asymptomatic adults with blood pressure higher than135 80
  • HIV— covered for adolescents and adults at increased risk and all pregnant women
  • Syphilis— covered for adults at increased risk and all pregnant women
  • Abdominal Aorta Aneurysm— covered one time for men 65-75 who have ever smoked
  • Breast Cancer— covered every 1 to 2 years starting at 40
  • Genetic Testing Breast and Ovarian Cancer (BRCA)— covered for women with family history BRCA1 or BRCA2
  • Cervical Cancer— covered for sexually active women, 21-65
  • Osteoporosis— covered for post-menopausal women 60-85
  • Chlamydia— covered for sexually active women who are under age24 or are pregnant
  • Gonorrhea— covered for sexually active women who are under age 24 or are pregnant; includes prophylactic ocular topical medical for all newborns
  • Asymptomatic Bacteriuria— covered during 12-16 weeks gestation
  • Hepatitis B— covered during first prenatal visit
  • Iron Deficiency Anemia— covered for asymptomatic women during first prenatal visit
  • Rh (D) Incompatibility— covered during prenatal visit
  • Congenital Hypothyroidism— covered for newborns
  • Phenylketonuria (PKU)— covered for newborns
  • Sickle Cell Anemia (SSA)— covered for newborns
  • Hearing Loss — covered for newborns
  • Visual Impairment under age 5— covered to detect amblyopia, strabismus, and visual acuity defects
  • Depression covered for adults when staff-assisted depression care supports are in place to assure accurate diagnosis, effective treatment and follow-up; covered for adolescents age 12-18 for major depressive disorder (MDD) when systems are in place to ensure accurate diagnosis, psychotherapy (cognitive behavior or interpersonal) and follow-up
  • Alcohol misuse covered for adults, including pregnant women, in primary care setting
  • Obesity covered for adults and children age 6 and older, including intensive counseling and behavioral interventions.
Specific preventive care guidelines may apply depending on your plan administrator. For details, log onto the carrier's web site (Aetna: www.aetna.com, Anthem BlueCross BlueShield: www.anthem.com or Oxford: www.oxhp.com), or call the number on the back of your ID card.
Important Note:
For details on the frequency and age limits that apply to Routine Cancer Screenings, contact your physician, log onto the carrier's web site (Aetna: www.aetna.com, Anthem BlueCross BlueShield: www.anthem.com or Oxford: www.oxhp.com), or call the number on the back of your ID card.
Screening and Counseling Services
Covered expenses include charges made by your physician in an individual or group setting for the following:
Obesity
Screening and counseling services to aid in weight reduction due to obesity. Coverage includes:
  • Preventive counseling visits and/or risk factor reduction intervention;
  • Medical nutrition therapy;
  • Nutrition counseling; and
  • Healthy diet counseling visits provided in connection with Hyperlipidemia (high cholesterol) and other known risk factors for cardiovascular and diet-related chronic disease.
Benefits for the screening and counseling services above are subject to the visit maximums shown in your Schedule of Benefits, available from Aetna or Anthem BCBS. In figuring the visit maximums, each session of up to 60 minutes is equal to one visit.
Misuse of Alcohol and/or Drugs
Screening and counseling services to aid in the prevention or reduction of the use of an alcohol agent or controlled substance. Coverage includes preventive counseling visits, risk factor reduction intervention and a structured assessment.
Benefits for the screening and counseling services above are subject to the visit maximums shown in your Schedule of Benefits. In figuring the visit maximums, each session of up to 60 minutes is equal to one visit.
Use of Tobacco Products
Screening and counseling services to aid in the cessation of the use of tobacco products. Tobacco product means a substance containing tobacco or nicotine including: cigarettes, cigars; smoking tobacco; snuff; smokeless tobacco and candy-like products that contain tobacco. Coverage includes the following to aid in the cessation of the use of tobacco products:
  • Preventive counseling visits;
  • Treatment visits; and
  • Class visits.
Benefits for the screening and counseling services above are subject to the visit maximums shown in your Schedule of Benefits. In figuring the visit maximums, each session of up to 60 minutes is equal to one visit.
Limitations
Unless specified above, not covered under this benefit are charges for:
  • Services which are covered to any extent under any other part of this plan;
  • Services which are for diagnosis or treatment of a suspected or identified illness or injury;
  • Exams given during your inpatient stay for medical care;
  • Services not given by a physician or under his or her direction;
  • Psychiatric, psychological, personality or emotional testing or exams.
Family Planning Services
Covered expenses include charges for certain contraceptive and family planning services, even though not provided to treat an illness or injury.
Contraception Services
Covered expenses include charges for certain contraceptive services and supplies provided on an outpatient basis, including:
  • Contraceptive devices, including diaphragms and implantable devices, prescribed by a physician provided they have been approved by the Federal Drug Administration;
  • Related outpatient services such as:
    • Consultations;
    • Exams;
    • Procedures; and
    • Other medical services and supplies.
Other Family Planning
  • Covered expenses include charges for family planning services, including:
    • Voluntary sterilization; and
    • Voluntary termination of pregnancy.
The plan does not cover the reversal of voluntary sterilization procedures, including related follow-up care.
Contraception Services Not Covered
  • Charges for services which are covered to any extent under any other part of the plan or any other group plans sponsored by your employer; and
  • Charges incurred for contraceptive services while confined as an inpatient.
Vision Care Services
Covered expenses include charges made by a legally qualified ophthalmologist or optometrist for the following services:
  • Routine eye exam: The plan covers expenses for a complete routine eye exam that includes refraction and glaucoma testing. A routine eye exam does not include a contact lens exam. The plan covers charges for one routine eye exam per calendar year.
Limitations
Coverage is subject to any applicable Calendar Year deductibles, copays and payment percentages.
Hearing Exam
Covered expenses include charges for an audiometric hearing exam if the exam is performed by:
  • A physician certified as an otolaryngologist or otologist; or
  • An audiologist who:
  • Is legally qualified in audiology; or
  • Holds a certificate of Clinical Competence in Audiology from the American Speech and Hearing Association (in the absence of any applicable licensing requirements); and
  • Performs the exam at the written direction of a legally qualified otolaryngologist or otologist.
The plan will not cover expenses for charges for more than one hearing exam per calendar year.
All covered expenses for the hearing exam are subject to any applicable deductible, copay and payment percentage.