Get Health Care

Prepare for your visit to the doctor or pharmacy

Before visiting your doctor or receiving care at a facility, make sure they are part of the network. Note: You can’t assume that your doctor will refer you to an in-network provider!

Visit your carrier’s website to find quality, in-network providers, and compare costs based on your needs.

• Cigna – myCigna.com
• HIP (EmblemHealth) – emblemhealth.com
• Kaiser – kaiserpermanente.org

When visiting your doctor or pharmacy, it’s important to bring your insurance cards with you. Access yours easily by visiting your carrier’s website, as described above.

Finally, make the most of your visit, by doing some preparation before you go. Write down your questions, so you don’t forget to address all your concerns.

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Telemedicine

Skip the wait at an urgent care center, and use MDLIVE. You can see a board-certified doctor via secure video on your smartphone, tablet, or computer 24/7/365—for free! It’s ideal if you’re on the road, or if you just don’t want to get out of bed. MDLIVE is currently available only to participants covered by the Cigna medical plan. It is not available if you’re enrolled in the Medicare Supplemental program or the HMO options.

For nonemergency care, MDLIVE offers one-on-one live video consultations with a doctor, who will assess your symptoms and then prescribe medication or other treatment, or help you decide if you need further diagnosis. In addition to secure online videoconferencing, you can communicate via phone or email.

Help for common conditions

Consider using MDLIVE for common medical conditions, including:

• Allergies
• Cough
• Ear infection
• Fever
• Flu
• Headache
• Insect bites
• Nausea
• Pink eye
• Rash
• Sore throat
• Urinary problems or UTIs

Note: Many states restrict the use of telemedicine for some services, including prescription drugs. To learn more about what’s available in your state, call MDLIVE toll-free at (888) 726-3171.

How to get care

To set up your account, call MDLIVE toll-free at (888) 726-3171, or visit the MDLIVE website.

You’ll answer a few questions about your medical history and set up a payment mechanism (debit or credit card). Note: You will not be charged for any visits; the MDLIVE system just requires a card to be on file in order to register. Once that’s done, you can schedule an appointment anytime.

Telehealth option through myCigna app

Virtual care is also available through the myCigna app after you download it from the App Store or Google Play.

1. Tap Find Care & Costs icon on the home screen.
2. Select Cigna Telehealth Connection.
3. Search for a provider to get the care you need.

Note: Many states restrict the use of telemedicine for some services, including prescription drugs. To learn more about what’s available in your state, call MDLIVE toll-free at (888) 726-3171.

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Mental health

Whether you’re looking for someone to talk to or need more intensive mental health services, your health plan has you covered. The Mental Health Parity Act ensures that medical plans cover mental health services just as they provide other health care services.

Visit your carrier’s website to find an in-network provider.

• Cigna – myCigna.com
• HIP (EmblemHealth) – emblemhealth.com
• Kaiser – kaiserpermanente.org

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Urgent care

Whether you’re on the road or can’t wait for an appointment with your primary care doctor, both the Cigna and HMO medical plans offer coverage for urgent care.

Covered by Cigna

If you’re covered by the Cigna medical plan, how much you pay for urgent care visits to network and independent urgent care facilities depends on the Tier in which you are enrolled. Under Tier 1, urgent care is covered at 100%, and Tier 2 covers urgent care at 100% after you meet a $50 copayment.

Visit Cigna’s website to find an in-network provider.

• If you haven’t already, you’ll need to register by going to myCigna.com or launching the myCigna app and selecting Register Now.
• Enter your personal information.
• Confirm your identity.
• Create your security information, and provide your primary email address for enhanced security protection and notifications.
• Review, then select Submit.

For out-of-network urgent care, you’ll pay for the cost of the services you receive and then file a claim for reimbursement.

Submitting out-of-network claims to Cigna (Tiers 1 and 2)

To be reimbursed for covered out-of-network care, you must submit claims within 12 months of the date of service. Follow these steps for submitting a claim:

1. Download the claim form, and complete your portion of the form (including your name and Social Security number, the patient’s name, and the patient’s date of birth).
2. Have your doctor complete the Attending Physician’s Statement section of the claim. Alternatively, your doctor can submit a completed HCFA 1500 or UB 92 universal health insurance claim form, or submit a HIPAA-compliant electronic claim.
3. Attach any other itemized hospital bills or doctor’s statements that describe the services rendered.
4. Check to be certain that all applicable portions of the form are completed and that you have submitted all itemized bills. By doing so, you will speed the processing of your claim. Incomplete claim forms will be returned to you, resulting in delayed payment of eligible expenses.
5. Mail any additional bills or statements for services as soon as you receive them. Call the number on your medical ID card for the correct address.

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Covered by an HMO?

Review your plan information, or call the number on your ID card for local urgent care options.

Note: Out-of-network HMO urgent care coverage applies only when you are temporarily out of the HMO’s service area. For covered expenses, you can submit a claim for reimbursement. Call the number on your ID card for details.

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When you need to travel for care

There may be times when participants have a limited ability to access the full range of health care benefits in certain states. To offer support beyond what the Cigna plan covers, the Fund offers a Supplemental Travel Benefit.

Please note that the additional benefits provided by the Fund for lodging and food are taxable. You will receive a W-2.

What is covered

If you or a covered dependent must travel more than 60 miles to obtain in-network abortion, gender affirmation, or behavioral health services (inpatient or outpatient), the plan will cover certain travel expenses up to preset limits. These include:

• Transportation, including airfare, vehicle rental, tolls, fuel, parking, bus, and taxi or Uber (as appropriate to the distance and need)
• Lodging, covered at $50 per night for individuals or $100 per night for an individual and one authorized companion

Food and mileage are not covered under this benefit. However, the Fund will cover up to $100 per day for meal expenses for you and any approved companion (combined). This supplemental benefit covers only the nights immediately before and after the procedure.

There is a lifetime maximum benefit of $10,000 for Cigna’s travel benefit.*

The Fund will supplement the Cigna benefit to cover up to $350 per night. For example, if you travel without a companion and Cigna pays $50 per night, the Fund will pay up to an additional $300. If you and a companion need lodging and Cigna pays $100 per night, the Fund will pay up to an additional $250. This supplemental benefit covers only the nights immediately before and after the procedure.

The Fund will only reimburse expenses incurred on days for which you received reimbursement under Cigna’s travel benefit (including meals on the day you check in and the day you check out) and only expenses incurred on the day before treatment begins, any days of outpatient treatment, and the night following your last treatment.

How to receive coverage

When you need care:

• Contact Cigna at the customer service telephone number on the back of your ID card for travel authorization.
• Explain the need to travel for health care, and get connected to a care team member.
• Wait to receive a confirmation letter, reimbursement form, and travel benefit instructions.
• Travel for care.
• Submit your claim form and expenses.
• After Cigna has approved the claim, send the Supplemental Travel Benefit claim form by email or U.S. Post Office, as shown below.

Email:
Submit the Supplemental Travel Benefit claim form through MailGate, the Fund Office’s secure email application. See instructions for using MailGate.

U.S. Post Office:
Equity-League Health Trust Fund
P.O. Box 392062
Pittsburgh, PA 15251-9062

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