General questions
Who are the dependants I can enroll?
You can enroll your spouse (even those above 65 years old) and adopted and biological children below 21 years old. You can also enroll your domestic partner and/or children outside of marriage upon submission of required documents. You may contact Cigna plan administrators (cignaplanadmin@irri.org) for details.
How much is my coverage?
US$25000 (approximately PHP1.1M) for every covered member per calendar year.
What is a care provider?
A care provider is a doctor, clinic, or hospital.
What happens if the maximum benefit limit (USD25,000) is exhausted before the contract year ends?
The member will have to shoulder the expenses that will be incurred beyond the maximum benefit limit (MBL). A new MBL will only take effect at the start of each contract year (1st of January).
What type of room can I avail of if I get hospitalized?
Room and board for all members is semi-private room. (For LBDH and HealthServ, please see topic Accredited Hospitals)
What if I get sick/have an accident abroad?
We suggest travelers to please know accredited care providers within the area of the country you are travelling to. This is so you may go to one of these care providers for medical treatment if needed.
Will I shoulder the difference in room cost if no semi-private room is available in an accredited hospital and a more expensive room is assigned to me?
No, Cigna will cover the difference in room cost if a more expensive room is assigned to you.
What if the Guarantee of Payment (GOP) has not yet been received by the hospital and I am about to be discharged?
Inform HRS that the GOP has not yet been received so that Cigna can be notified at once. Upon admission, it is important to remind the hospital to accomplish the cost estimate form and send it immediately to Cigna. Please see the video Hospitalization in an accredited care provider.
What if the treatment I need is not available in the Philippines but available in another country?
If you need to undergo a treatment that is not available in the Philippines, you may go to another country (except US and Singapore) where this treatment is available subject to the approval of a Cigna medical consultant. The medical expenses that will be incurred will be covered based on the Reasonable and Customary (R&C) charges applicable to the country where the treatment is available. Reasonable and Customary charges refer to the prevailing pattern of charges for professional and other health services at the country where the staff is stationed. Costs/expenses above the R&C will not be reimbursed.
Will Cigna cover my travel expenses if I go to another country for treatment?
No, Cigna will only cover the treatment but not the transportation expenses of the member.
Are maintenance medications covered?
They are covered, but the members are required to submit a medical prescription from their treating doctor clearly indicating the diagnosis.
How do I log-in to the Cigna web site?
A password to access the web site will be provided by Cigna to each principal member. Please refer to these steps on how to login, or you may download the NRS Medical Plan Brochure for detailed instructions.
My doctor is affiliated with a hospital that does not belong to Cigna's network. Can I still arrange for a cashless transaction for a planned inpatient treatment (e.g. childbirth)?
No, this will be on a pay and claim basis. However, if the doctor and hospital are willing to have an arrangement with Cigna, this can be cashless on the part of the member.
Who are the care providers in Cigna's network in the Philippines?
You may find the list of care providers in Cigna's network in the Philippines in the Resources page or in the NRS Medical Plan brochure.
Is there a forum I can go to get more information?
You may visit http://myhr.irri.org/forum to leave questions and get more information. IRRI.ORG account is required for access.
Accredited hospitals
What are the accredited hospitals in Los Baños area and what types of treatment are cashless on my part as member?
Los Baños Doctors Hospital and Medical Center (LBDH) and HealthServ Los Baños Medical Center.
Inpatient treatment is 100% covered and will be billed directly to Cigna.
The followingtreatments/procedures are cashless on oyur part as member:
- Outpatient treatment through emergency room;
- Medications prescribed, lab tests and diagnostic imaging ordered in item #1;
- Consultations with doctors/specialists, except Neurologists;
- Medications prescribed, lab tests and diagnostic imaging ordered in item #3;
Dental treatment is always on a "pay and claim" basis. Wart removal through cauterization should always be approved by Cigna medical consultant in order to be reimbursed.
What other hospitals agreed for some outpatient treatment to be cashless?
Asian Hospital, however, they are cashless only for the following:
- Outpatient treatment through emergency room;
- Medications prescribed, lab tests and diagnostic imaging ordered in item #1;
What will be required of me if the outpatient treatment is cashless on my part:
- Always carry several photocopies of your insurance card and any valid ID card with you. The hospitals will use this in lieu of letter of authority (LOA). The cards should be photocopied in the upper portion of the bond paper to leave space for the doctor to write on. For example -
- The IRRI ID card should be replaced by a new one, bearing the RESNO, as soon as it is available.
- The ID cards for dependant spouse and children could be SSS, student ID, etc. For newborn babies, please include in the photocopy the IRRI ID of principal members.
- At the hospital, proceed to the Admitting or HMO section (for LBDH and HealthServ) and International Health Services Office (for Asian Hospital, located at the ground floor, across the information desk) and present the cards to verify membership.
- Inquire with the admitting/HMO section if consultation/treatment could be cashless. If it is, the doctor will ask 2 photocopies of the cards as in above. If there are lab tests and diagnostic imaging, 1 photocopy will be asked for each test/procedure.
Note:
If there is available semi-private room in LBDH or HealthServ, but, I prefer a private room, what will be billed to me upon my discharge?
You will only be billed for the difference between semi-private and private room rates and the other charges not covered by the plan. The increment in cost of treatment for choosing private room will be covered by Cigna.
What else will I need to do before I am, or any of my dependant covered by the plan, is discharged from the hospital after treatment?
You should ask for the copy of the billing and review if all of the charges are indeed used/done during the treatment. You should clear with the care provider for anything that you may think should not be included in the billing.
Alternative medicine
Is acupuncture covered?
Acupuncture is covered only if it was rendered to treat a medical condition. Hence, plan members need to submit a prescription from the treating doctor clearly indicating the diagnosis.
Dermatological
Is wart removal/cauterization covered?
Wart removal/cauterization is subject to medical necessity. Members are required to submit a medical prescription indicating the diagnosis and type of treatment for approval of Cigna’s medical consultant.
Is treatment for hair loss covered?
Hair loss treatments are not covered.
Dental
Are teeth braces covered?
Teeth braces are covered if they are deemed necessary by the dentist. Only 80% of the cost will be reimbursed up to the maximum ceiling of US$500 per member per calendar year. A mouth x-ray is required to be submitted when filing a claim.
What procedures require mouth x-ray or OPG (Orthopantomogram)?
Almost all procedures except cleaning or prophylaxis, viz: root canal treatment, dental crowns / bridges, implant and dentures. It is also required to detect tooth decay, diagnostic purpose for abscess and cysts, and orthodontics treatment.
For regular fillings, a mouth x-ray is not usually necessary, but, still, it is subject to the dentist’s discretion and the patient’s condition.
Is treatment for Temporomandibular Joint (TMJ) disorder covered?
Yes, treatment for TMJ is covered. If the cause is considered dental, it will be reimbursed at 80% and up to the ceiling amount of USD500.00. If the cause is considered medical, it will be reimbursed at 100% with no ceiling amount.
Complete documentation and information on the treatment must be submitted to Cigna for them to evaluate and determine whether a particular TMJ case is dental or medical in nature.
Optical
Is Lasik treatment covered?
No.
For optical treatment, can a member have the lenses of corrective eyeglasses changed without recommendation from the optometrist/ophthalmologist?
All claims related to lenses must be submitted with the diopter (a unit of measurement of the optical power of a lens or curved mirror). If diopter from previous check up (even before July 1, 2015) is available, it can be submitted to Cigna, thus, there is no need to visit an optometrist or ophthalmologist.
Psychiatric
Will Cigna cover the cost of psychiatric counseling?
Yes, treatment of psychological problems is covered at 50% with a ceiling amount of USD600 per member per year. A prescription from psychiatrist stating the diagnosis is required.
Reimbursement
If Cigna requires additional medical report from me, but the doctor says I have to pay for it, will Cigna reimburse the cost of the medical report?
Yes, Cigna will reimburse it as long as you have a receipt from your doctor as proof of payment and send it to Cigna for reimbursement.
Can I reimburse the cost of nebulizer?
No.
How do I reimburse my medical expenses if no receipt was issued to me?
You will not be reimbursed without proof of payment/expenses, thus, it is necessary to secure official receipt and keep it for reimbursement purposes.
In the online filing of claim, do I have to fill out the portion for bank details? Will it be my bank details?
The bank details are not required fields for this group plan members so you need not fill them out. Cigna has the bank details of all participating centers, including IRRI. All reimbursements pertaining to its member will be sent to its bank account.
How long does it take before Cigna reimburses my claim?
It usually takes Cigna five to ten working days upon receipt of documents to process the reimbursement claim which shall be included in the payroll following receipt of money by Finance. Processing may take more than ten days if additional documents are required.
What is the timeline between submission of claim, settlement date and actual reimbursement through payroll? For example, when is the latest filing date for reimbursement to be included in Aug. 31, 2015 payroll?
It takes approximately 13 working days (if there are no issues) for a filed reimbursement claim to be included to IRRI’s account. Aside from the crediting of the reimbursements to IRRI’s bank account, the Payroll Submission Deadline should also be considered to determine whether such reimbursement will be included to the staff’s payroll for the coming period. In our example, to be included in the Aug. 31, 2015 payroll, all claims should have been filed by July 28, 2015. Below is an illustration for your reference.
What is this Payroll Deadline mentioned in the previous item?
This is the schedule/deadline observed by Finance for including payroll credit transactions (e.g. overtime, reimbursements, etc.) in a payroll run. Cigna reimbursements must already be received through IRRI’s bank account on or before the cut-off date in order to be credited to the nearest payroll period. The schedule for the rest of the year is as follows:
| MONTH | MID-MONTH PAY | Submission Deadline of ETS* (yyyy/mmm/dd) | PAY RUN (yyy/mmm/dd) | END-MONTH PAY | Submission Deadline of ETS** (yyyy/mmm/dd) | PAY RUN (yyyy/mmm/dd) |
| August | 14 | 2015-Aug-03 | 2015-Aug-04 | 28 | 2015-Aug-17 | 2015-Aug-18 |
| September | 15 | 2015-Sep-02 | 2015-Sep-03 | 30 | 2015-Sep-16 | 2015-Sep-18 |
| October | 15 | 2015-Oct-02 | 2015-Oct-05 | 30 | 2015-Oct-16 | 2015-Oct-19 |
| November | 13 | 2015-Nov-02 | 2015-Nov-03 | 27 | 2015-Nov-16 | 2015-Nov-17 |
| December | 15 | 2015-Dec-01 | 2015-Dec-02 | 18 | 2015-Dec-10 | 2015-Dec-11 |
| * Employee Time Sheet (For regular & non-regular employees) ** Employee Time Sheet (For non-regular employees only/Student Assistants) | ||||||
What is a note settlement and what should I do when I receive an email notification that a new note settlement is already available?
A note settlement contains details of claim/s filed with Cigna, but, is/are either:
- processed and will be reimbursed;
- pending submission of additional requirements /documents/justifications;
- processed, but, will not be reimbursed because they are not covered or exceeded the limit of coverage.
You should access Cigna’s website and review the note settlement. For claim/s under #2, re: pending, Cigna puts a comment, which can be viewed by clicking the red icon beside the amount (see below).
Once the additional requirement is fulfilled, Cigna then processes and reimburses the claim.
If I am prescribed by my treating doctor with food supplement or vitamins, can I claim them for reimbursement?
Generally, food supplement and vitamins are not covered by the plan even if prescribed by the doctor. However, they will be covered if there is proof of deficiency, e.g., lab test result, which will be submitted, together with the other documents (official receipt, diagnosis. etc.).
Vaccinations
Is vaccination for Hepatitis A covered?
Yes, Hepatitis A vaccination for babies and young children below 19 years old is now covered.
Are anti-rabies and anti-tetanus shots covered?
Yes, but only if bitten or after the accident/injury happened. It is not covered for preventive purposes.
Can I reimburse flu vaccinations?
Flu vaccination is not covered by the plan.
Are vaccinations / shots recommended by doctor for pregnant women, e.g. Rubella, chicken pox, Hepa B, covered?
Preventive vaccinations for adults are not covered. However, Hepatitis A & B, tetanus & Rubella shots for pregnant women will be covered if there is medical necessity. Thus, tests and doctor’s diagnosis should be submitted in order to be reimbursed.
Are boosters for children covered?
Yes, but only the following are covered: DPT (diphtheria, perlussis and tetatunus), polio, MMR (measles, mumps and rubella), varicella (chicken pox), hepatitis B, hemophilus, tetanus, diphteria, pneumoccal, meningococcal and tetramune and administered to dependant children below 19 years old.
Others
Is stem cell therapy covered?
Yes, however, it is only covered if approved by Cigna’s medical board prior to the start of the therapy. The member should send to Cigna a request for approval by attaching a complete medical report of the disease or condition. The medical board will then assess the report and will decide whether to approve or not.
Are crutches covered?
Yes. Recommendation/prescription and diagnosis of the doctor should be provided in order to be reimbursed.
Is the cost of ambulance used and the accompanying nurse covered for transfer of member from one hospital to another where treatment is available?
The ambulatory coverage of the plan is between the place where a member, in a life- threatening situation, is injured by accident or stricken by a disease to the nearest hospital where treatment can be given. However, if further treatment is not available in the first hospital, subsequent transfer should be communicated to and approved by Cigna. Ambulance charges will be an all inclusive bill.
Is core needle biopsy covered?
Yes.
Are the following covered?
Dental sealant
Yes, at 80 up to $500 per member per calendar year.
Frenoplasty to treat Ankyloglossia
Coverage is based on the diagnosis. A medical report from the treating doctor with justification for the procedure or a speech therapist report is required for evaluation of Cigna’s medical consultant.
Keloid scar removal
Coverage is based on the diagnosis. A medical report on details of the site and size of the scar, justification for removal and the method to be applied is required for evaluation of Cigna’s medical consultant.
Perimetry and optic nerve imaging
Coverage is based on medical necessity. A medical report and recommendation are required for evaluation of Cigna’s medical consultant.
Platelet rich plasma
Not covered by the plan as there is no sufficient scientific proof about the effectiveness in the peer reviewed published medical literature. Hence, it is only considered as an experimental treatment.
