Mental Health Exception Benefit

In-Network Providers

To find a list of in-network mental health providers or to see if your mental health provider is in the Cigna network, please use the link below:

Behavioral Health Providers

• Enter your zip code
• Click DOCTOR BY CHOICE and Select the specific type of mental health provider from the full drop down list to get a listing of in-network mental health providers.
• Click DOCTOR BY NAME and enter your existing mental health provider's name to see if they are in the Cigna network.

Mental Health Coverage Exception Benefit

Dartmouth has worked with Cigna to develop a short-term benefit that helps to pay for 90% of billed charges on your first twelve (12) lifetime, out-of-network, mental health visits. This benefit is available to employees and their covered dependents.  Regardless of whether you or your provider submit the claim(s), the plan will reimburse 90% of the entire provider's charged fee and you will be responsible for paying the remaining 10%.

Required Documentation

To access the Exception benefit, a Cigna mental health 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). 

Cigna Mental Health Benefit Claim Form

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 (1-855-869-8619) or contact the Dartmouth Benefits Office at 603-646-3588 or human.resources.benefits@dartmouth.edu.

Frequently Asked Questions

How Does the 12 visit per Lifetime Exception Benefit Work?

• OAP, CCF and HDHP with HRA Plan:
  When enrolled in the OAP, CCF and HDHP with HRA plans, your first twelve visits with an out-of-network mental health provider will be processed by Cigna to pay 90% of the provider's billed charges. You will be responsible for the remaining 10%.  Once the twelve life-time visits have been exhausted, Cigna will process all future claims at the out-of-network deductible and coinsurance levels.
  • Example: (The following billed and allowed amounts are for example purposes only) Amount billed per visit is $150.  Cigna’s allowed amount is $135.  Your first 12 lifetime visits, Cigna will pay $135 (90%) and you pay $15 (10%).  Visits 13+, Cigna will pay $0.00 until you meet the annual deductible, then Cigna will pay $94.50 (70% of $135) and you pay the balance of $55.50.
• HDHP with HSA Plan:
  When enrolled in the HDHP with HSA plan, the IRS requires that you first meet your annual out-of-network deductible before the benefit can pay at the coinsurance level.  Once your annual deductible has been met, the plan will cover your next 12 visits at 90% of the provider's billed charges. You will be responsible for the remaining 10%.  Once the twelve lifetime visits have been exhausted, Cigna will process all future out-of-network mental health claims based on the plans out-of-network deductible and coinsurance levels. If at any time during the 12 visit exception process, you cross into the next calendar year, you will again need to meet that year’s annual deductible, before the plan will pay at 90%.
  • Example: (The following billed and allowed amounts are for example purposes only) Amount billed per visit is $150.  Cigna’s allowed amount is $135. You begin 1X per week treatment on January 5th. You will first need to meet your annual out-of-network deductible before the benefit will pay.  Cigna will only recognize the $135 per visit allowed amount when counting toward your annual out-of-pocket maximum.  The remaining $15 per visit is balance billed (See NOTE below). If the out of network annual deductible is $5,000, then you will need to attend 37 weekly visits (at $135 each) before your annual out-of-network deductible is met on or around September 14th. The mental health exception benefit now begins.  Your next 12 visits are then covered at 90% of the full billed amount (90% of $150=$135) and you will pay the remaining 10% ($15).   Continuing treatment at 1X per week, you will exhaust the lifetime benefit on or around December 7th.  The remaining visits of the calendar year are paid by Cigna at 70% of the allowed amount (70% of $135 = $94.50) and you pay the balance of $55.50 per visit. 

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

Yes, the 10% that you pay during the exception period on the 12 lifetime visits is considered coinsurance and will be applied toward your out-of-pocket maximum.

What happens if I exhaust the 12 Mental Health Exception visits but want to continue to treat with an out-of-network provider?

On January 1, 2023 Dartmouth expanded the out of network behavioral benefit.  This change is in recogntion of the current difficulty of receiving in-network behavioral health services in our area. The additional coverage now allows all out-of-network mental health claims to be paid at the same copay and deductible/coinsurance amounts that you pay for in-network visits (balance billing may apply even after out-of-pocket maximum has been met). 

• OAP and CCF plans:  This means that you would pay a $25 or $35 in-network copay amount if enrolled in the OAP or CCF medical plans. (balance billing may apply even after out-of-pocket maximum has been met)
• HDHP plan:  You would pay 100% of the cost toward until you met the in-network annual deductible on the High Deductible Health Plan (HDHP).  Once the in-network deductible has been met on the HDHP plan, the in-network coinsurance of 10% will apply, where you pay 10% of the cost of each visit and the plan pays 90% until the in-network out-of-pocket maximum has been met.  After which time claims are paid at 100%.  (balance billing may apply even after out-of-pocket maximum has been met)
• Balance Billing: Cigna will only reimburse up to the "allowed" amount shown on your Explanation of Benefits (EOB). When a provider is out-of-network, and not contracted with Cigna, the provider is allowed to charge you for any remaining amount that is not paid by Cigna. These balance billed amounts display on your Explanation of Benefits as a "not covered" amount. Balance billed amounts are not applied toward the annual deductible or out-of-pocket maximum.

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

Benefits Office at 603-646-3588 or human.resources.benefits@dartmouth.edu