Citi Benefits Handbook
Using Your Medical Plan
This section provides important information about preventive care coverage, emergency room care, urgent care, mental health and substance abuse benefits, as well as other programs available to you through your medical plan. Understanding this information will help ensure you make the most of your medical plan coverage.
Preventive Care
Access Doctors on Demand
If you're a member of a Citi Aetna or Anthem BlueCross Blue Shield medical plan, you have access to a national network of U.S. board-certified doctors, pediatricians, psychologists or therapists who are available on-demand 24 hours a day, 7 days a week, 365 days a year to diagnose, treat and prescribe medication (when necessary) for many medical or mental health issues via phone or online video consultation. Learn more about Aetna's Teladoc service at www.teladoc.com or about Anthem's LiveHealth Online service at www.livehealthonline.com.
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 visits to obtain recommended preventive services that are age and developmentally appropriate, including preconception and prenatal care;
  • Certain U.S. 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); and
  • Screening for gestational diabetes.
Additional preventive care services covered in full by Citi medical plans as part of the Affordable Care Act (also referred to as PPACA) 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;
  • Human immune-deficiency virus (HIV) counseling and screening for all sexually active people;
  • Interpersonal and domestic violence screening and counseling;
  • Counseling on sexually transmitted infections for all sexually active people;
  • Tobacco-use cessation (for non-pregnant adults): counseling, behavioral interventions and U.S. 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 ages 45-75, 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 120-139 systolic/80-90 diastolic;
  • Lipid disorders — covered for men ages 20-35 and women ages 20-45 if at high risk, and for men over 35 and women over 45 if normal risk;
  • Type 2 diabetes — covered for asymptomatic adults with blood pressure higher than 135/80;
  • 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 ages 65-75 who have ever smoked;
  • Breast cancer — covered every one to two years starting at age 40;
  • Genetic testing for breast and ovarian cancer (BRCA) — covered for women with family history BRCA1 or BRCA2;
  • Cervical cancer — covered for sexually active women ages 21-65;
  • Osteoporosis — covered for post-menopausal women ages 60-85;
  • Chlamydia — covered for sexually active people who are under age 24 or pregnant;
  • Gonorrhea — covered for sexually active people who are under age 24 or 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 ages 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; and
  • 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 on to the carrier's website (Aetna: www.aetna.com. Anthem BlueCross BlueShield: www.anthem.com) or call the number on the back of your ID card.
Screening and Counseling Services
Covered expenses include charges made by your physician, psychologist or therapist 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 that are covered to any extent under any other part of this plan;
  • Services that 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; and
  • 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 U.S. Food and 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 that 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.
Routine hearing and vision tests are covered in network at 100%, not subject to deductible.
Routine Cancer Screenings
In the In-Network Only Plan, Choice Plan and High Deductible Plan with HSA, cancer-screening tests are covered 100% with no deductible when performed by network providers. For frequency limits, please contact your plan at the number on the back of your ID card.
Cancer screening tests are:
  • Pap smear;
  • Mammography;
  • Sigmoidoscopy;
  • Colonoscopy; and
  • PSA test.
Covered expenses include, but are not limited to, charges incurred for routine cancer screening as follows:
  • Mammograms;
  • Pap smears;
  • Gynecological exams;
  • Fecal occult blood tests;
  • Digital rectal exams;
  • Prostate specific antigen (PSA) tests;
  • Sigmoidoscopies;
  • Double contrast barium enemas (DCBE); and
  • Colonoscopies.
These benefits will be subject to any age, family history and frequency guidelines as set forth in the most current:
  • Evidence-based items that have in effect a rating of A or B in the current recommendations of the United States Preventive Services Task Force; and
  • The comprehensive guidelines supported by the Health Resources and Services Administration.
Unless specified above, not covered under this benefit are charges incurred for:
  • Services that are covered to any extent under any other part of this plan.
Important Note:
For details on the frequency and age limits that apply to routine cancer screenings, contact your physician, log on to the medical carrier's website (Aetna: www.aetna.com. Anthem BlueCross BlueShield: www.anthem.com) or call the number on the back of your ID card.
Using an Emergency Room
Know Where to Go for Care?
Do you know when to go the emergency room, urgent care center or your doctor? Test your knowledge with the Right Place to Get Care quiz.
If you have a true medical emergency, you should go to the nearest emergency facility. If you are admitted, you must notify your plan within 48 hours. If you are not able to do this, have a representative contact your plan.
The Plan does not cover non-emergency services provided in an emergency room.
Urgent Care
Urgent care centers consist of a network of physicians that may be used when immediate care is needed. Generally, urgent care centers have evening and weekend hours and do not require an appointment. The centers may be used when you or a covered dependent needs immediate care (for example, for a high fever, a severe rash or the flu) but does not need the services of a hospital emergency room (for example, for chest pains, poisonings or seizures).
MinuteClinic and HealthHUB Visits
We know that convenient access to medical care is important to you. MinuteClinic and HealthHUB centers (available in select CVS pharmacies) offer immediate treatment for minor conditions like ear infections, rashes, minor burns and cold or flu symptoms.
To make it easier on you and your covered family members to get this care when you need it, the In-network Only Plan and Choice Plan will cover many services provided by MinuteClinic or HealthHUB at no cost to you.* For High Deductible Plan with HSA members, you pay $0 after meeting the plan deductible.*
Of course, nothing can replace the value of having a trusted relationship with a primary care doctor who knows you and your health history. But MinuteClinic and HealthHUB offer convenient options when you need minor medical attention right away, saving you time and money. On www.cvs.com, you can search for MinuteClinic and HealthHUB locations near you.
*Any associated lab tests will be covered at standard cost.