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MENTAL HEALTH EXCEPTION BENEFIT

Dartmouth College recognizes that there are a limited number of mental health providers in the Upper Valley who participate with health plans. To improve access to mental health care for Dartmouth employees and their families, we have worked closely with Cigna to increase the number of Cigna participating providers and to develop a mental health benefit program, as defined below.

MENTAL HEALTH COVERAGE EXCEPTION BENEFIT

Dartmouth College has worked with Cigna to develop an Exception Benefit. This Exception benefit allows for out-of-network claims to be paid at 90% for a lifetime maximum of twelve (12) mental health visits. This benefit is available to employees and covered dependents.  Regardless of who submits the claim (individual or provider), Cigna will pay 90% of the provider's charged fee and the individual will be responsible for 10% of the provider's charged fee.

REQUIRED DOCUMENTATION

To access the Exception benefit, a Cigna claim form needs to be submitted to Cigna. An itemized bill is also required. It's important to note that neither a credit card receipt nor a canceled check qualifies as an itemized bill. An itemized bill must contain the following information: name, address and tax identification number of the provider, patient's name, date of service, place of service, procedure code of service provided, diagnosis code and charge for the service. If the outlined process is not followed or if all necessary information is not submitted, there may be a delay in payment. Upon receipt of accurate and complete information, Cigna will make a payment directly to the individual or their provider depending on the instructions on the claim form (e.g. a signature under "payment instructions" indicates payment should be made directly to the provider). 

The Cigna claim form is available here.

If you have any questions, please call the Cigna customer service department at the phone number listed on the back of your Cigna member identification card (1-800-244-6224) or contact the Dartmouth College Benefits Office at 603-646-3588 or human.resources.benefits@dartmouth.edu

FREQUENTLY ASKED QUESTIONS

 

What will I pay out of my pocket for services under this exception process?

Cigna will process the claim to pay 90% of the provider billed charges. Under all three medical plans (Open Access Option 1, Open Access Option 2 or HDHP) members will be responsible for the other 10%.  Individuals may be responsible for paying the providers directly.  Please refer to examples below:

 

EXAMPLE

(actual billed amount depends on provider)

Open Access   

Options 1, 2

or HDHP

Members

Amount Billed for Visit = $150

Allowed Amount (90% of Billed) = $135

Member Responsibility (10% of Billed Charges) = $15

Check Issued from Cigna to Member or Provider = $135

 

Will the 10% paid by me be applied to my coinsurance?

Yes, the 10% that you pay will be applied to annual coinsurance and out of pocket maximum. You will not be required to meet your out-of-network deductible when accessing the 12 visits.

 

What happens if I exhaust the exception benefit but want to continue to treat with the same provider?

At the end of the 12 visit period, the out-of-network benefit will begin and any ongoing visits will be subject to the out-of-network deductible and coinsurance. Cigna will reimburse the usual and customary reimbursement to the provider. Since the provider is out-of-network, the provider may bill the member the remaining amount that is not paid by Cigna.

 

Will my in-network deductible and coinsurance apply towards my out-of-network deductible and coinsurance?

No, the in-network deductible and coinsurance are separate from your out-of-network deductible and coinsurance.  You will be responsible for meeting your out-of-network deductible and coinsurance payments after your 12 visits have been exhausted.

 

Who should I contact if I have any questions regarding the Mental Health Exception benefit?

Please contact the Dartmouth College

Benefits Office at 603-646-3588 or

human.resources.benefits@dartmouth.edu

Last Updated: 8/19/14