The General Secretariat (GS/OAS) offers health insurance coverage to its eligible retirees through Cigna and Kaiser Permanente.

Participation of former GS/OASstaff members and their eligible dependents in the health insurance programs offered by the GS/OAS is regulated by the GS/OAS Policy on Participation which establishes eligibility requirements.

Please refer to the  Policy on Participation for more details.

General Provisions

• Dependent children up to age 26 may maintain coverage.
• No additional dependents can be added or reinstated to the coverage after separation from service.
• Citizens or Residents of US at age 65 are required to enroll in Medicare A and/or B.
• Health insurance premiums are billed to former staff members and,as applicable, their dependents, by GS/OAS in advance,
• Every six months. Payment must be made in advance to GS/OAS in order to avoid interruption of coverage. Payment may be made monthly. In addition, the premium may be deducted from a pension or from a Credit Union account.
• Any health plan participant who has not paid his/her required GS/OAS health insurance premiums for a period of ninety (90) days will be cancelled from the GS/OAS insurance plan and may not be reinstated into the plan. Any amount owed in premiums will be collected.

Information for members living in the United States

Dedicated line for OAS clients in the U.S.

  1-855-488-0548

  E-mail: [email protected]

Information for members living outside the United States

  1-844-233-11-45 (U.S. free call) or if international, collect calls are accepted.

  E-mail: [email protected]

Coverage outside the USA

If you have an inpatient medical care you can call Cigna from outside the United States to the number on the back of your ID card 866-763-8442 o 302-797-3100 to arrange direct billing from the Hospital to Cigna. In most cases, you should not need to pay upfront for inpatient care when the direct billing was arranged, except for the out-of pocket costs (non-covered services, deductible co-payments and co-insurance) you normally pay and the hospital should submit your claim on your behalf.

  Cigna Overseas Medical Help   1-866-763-8442 or   1-302-797-3100

If the Hospital did not accept direct billing to Cigna, you will have to pay the total charges upfront and submit a claim to Cigna through the GS/OAS Insurance office.

Tools to administrate your Cigna account

Exclusive Customer Service Line for GS/OAS members 1-855-488-0548 and an e-mail dedicated to the OAS   [email protected]. With these toolsyou will have direct access to a Cigna representative at the premium service level.  Spanish-speaking representatives are also available.  This line also has Spanish translation available. You can find this number on the back of your medical ID card.

My Account: Access to all your account information, the status of reimbursements, management of your prescription drug mail orders, a search  for participating providers and more. Just sign up at: https://my.cigna.com.

My Cigna Cellphone App to access My Account from your smart phone. It allows you to see your account history, find PPO providers and have immediate access to your Medical ID card.  How to register in My Account.

Personal appointment with a Cigna representative: the last Wednesday of each month, a Cigna representative will be available at the GS/OAS (GSB Building) to address any matter related to your health insurance plan. To make an appointment please call or send an e-mail to the OAS Insurance Office. Telephone appointments are also available.

Medicare

Medicare is the United States government health insurance program that covers people age 65 or older. Upon reaching age 65, US Citizens or Residents are eligible for Medicare A and/or B coverage, and are required to enroll.

Medicare eligibility. In the case of OAS staff members with a G4 visa, when you become a Resident of the US and reach 65 years of age you are eligible for Medicare B and must apply for it.

The OAS highly recommends that you contact Social Securityand verify if you are elegible and when you can sign up for Medicare Part A and/or Part B.   1-800-772-1213

If a spouse contributed to Social Security, when the spouse reaches 65, both are eligible for Medicare A&B and you must inform GS/OAS of this enrollment by sending a copy of the Medicare card. The OAS premium will be reduced to help pay for the Medicare B cost.

Regarding Medicare D Prescription Drugs, OAS has decided to maintain Prescription Drug Benefits and recommends that retirees not apply because the OAS coverage offers comparable benefits.

Medicare A pays hospital charges, Medicare B pays physician charges. If a person contributed to Social Security during 10 working years – he/she is eligible for Medicare A at no cost, and for Medicare B by paying a monthly premium to Medicare.

Medicare Part A
Hospital Services

Medicare Part B
Outpatient Medical Services

The application is made with Social Security during the initial enrollment period (3 mos. before 65th b/day). For more information you can visit the website at www.socialsecurity.gov or call toll-free,   1-800-772-1213.

If you already have your Medicare ID card:

Medicare becomes primary coverage and OAS/Cigna coverage is secondary and pays the remaining charges and Medicare deductible. Please note that those services that are not covered by Medicare, i.e. dental services, acupuncture, and services received outside the United States, can be covered by the OAS/Cigna coverage upon review of medical necessity.

Both Medicare and Cigna ID cards must be presented to the provider who submits the claim to Medicare first, after Medicare pays, Medicare EOB is submitted to Cigna to pick up balances.

If a provider does not accept Medicare B or has opted out of Medicare, the claim must be filed to Medicare or Cigna as the case may be, and benefits will be considered as out-of-network.

If your doctor, provider, or supplier doesn't participate with Medicare:

Medicare has allowed providers to exclude themselves from the Medicare program. The provider chooses not to participate with Medicare. When this happens, a provider has no legal obligation to submit claims to Medicare. This provider will not submit a claim to Medicare, so there will be no Medicare Explanation of Medicare Benefits.

Before care is rendered, the provider asks patients to sign a contract acknowledging that the patient is liable and that the patient must not send a claim to Medicare for the provider. The provider must submit the contract (also known as the Medicare Opt Out Affidavit) with every claim for a member when Medicare should be primary.

Please be advised that in order for Cigna to process a claim for an opt out provider the letter must be attached with each claim's submission. This letter must be attached for each claim.