Know your health plan
This page contains resource you need to know more about your health plan. Below you will find links to the latest information for each appointment category. You will also find instructional videos on how to do tasks. There is also a compilation of answers to frequently asked questions.
Globally Recruited Staff
For Globally Recruited Staff please visit http://aiarc.org/Medical for the most up-to-date information about the GRS medical plan.
Nationally Recruited Staff - Headquarters
For Nationally Recruited Staff - Headquarters, please download this brochure for the most up-to-date information about your medical plan.
Nationally Recruited Staff - Country Office
For Nationally Recruited Staff - Country Offices, please download this brochure for the most up-to-date information about your medical plan.
How-to videos for NRS
Frequently asked questions
General Questions
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 (hrs-personnel@irri.org) for details.
You may contact Cigna plan administrators (hrs-personnel@irri.org) for details.
A care provider is a doctor, clinic, or hospital.
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).
Room and board for all members is semi-private room.
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.
No, Cigna will cover the difference in room cost if a more expensive room is assigned to you.
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.
If you need to undergo a treatment that is not available in the country of your duty station, 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.
No, Cigna will only cover the treatment but not the transportation expenses of the member.
They are covered, but the members are required to submit a medical prescription from their treating doctor clearly indicating the diagnosis. Food supplements and vitamins are not covered even if prescribed.
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.
You may find the list of care providers in Cigna's network by logging in to your personal Cigna account and clicking "Provider search" tab.
You may visit http://myhr.irri.org/forum to leave questions and get more information. An IRRI.ORG account is required for access.
Accredited hopsitals in the headquarters area
Los Baños Doctors Hospital and Medical Center (LBDH) and HealthServ Los Baños Medical Center are accredited hospitals in the headquarters area.
Inpatient treatment and outpatient treatment through emergency room are 100% covered and will be billed directly to Cigna.
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.
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.
All incremental charges due to the patient's preference of a private room over a semi-private room will be charged directly to the patient.
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
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
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.
Hair loss treatments are not covered.
Dental
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.
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.
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.
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..
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..
Yes, at 80% up to $500 per member per calendar year.
Optical
No, Lasik treatment is not covered.
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
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
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.
No, nebulizer cost cannot be reimbursed.
You will not be reimbursed without proof of payment/expenses, thus, it is necessary to secure official receipt and keep it for reimbursement purposes.
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.
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 August 31, 2017 payroll, all claims should have been filed by July 31, 2017. Below is an illustration for your reference.
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.
A note settlement contains details of claim/s filed with Cigna, but, is/are either:
Once the additional requirement is fulfilled, Cigna then processes and reimburses the claim.
- 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.
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
Yes, Hepatitis A vaccination for babies and young children below 19 years old is now covered.
Yes, but only if bitten or after the accident/injury happened. It is not covered for preventive purposes.
Flu vaccination is not covered by the plan.
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.
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
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.
Yes. Recommendation/prescription and diagnosis of the doctor should be provided in order to be reimbursed.
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.
Yes, core needle biopsy covered.
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.
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.
Coverage is based on medical necessity. A medical report and recommendation are required for evaluation of Cigna’s medical consultant.
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.
