HBR Guide to Cigna, Optum, and SilverScript Resources
The NALC Health Benefit Plan High Option delivers world-class benefits through a network of trusted partners. Built on long-standing relationships with Cigna and Optum, and enhanced by our 2024 partnership with SilverScript, we provide comprehensive medical, behavioral, and pharmacy coverage to postal employees and retirees across the country.
As a Health Benefits Representative, your dedication makes a real difference in how members understand and use their coverage, since they rely on you not just for answers, but for clarity, reassurance, and guidance; especially when they face complex questions about medical care, mental health, or prescriptions.
To guarantee consistency in your daily conversations with members, we’ve created this guide to serve as a practical reference to help HBRs leverage partner resources efficiently, reduce member frustration, and ensure accurate support across all touchpoints.
Overview of each partner
Cigna, medical coverage and provider network
Cigna serves as the medical network partner for the NALC Health Benefit Plan. Through the Cigna PPO network, members have access to a broad nationwide selection of doctors, hospitals, specialists, and facilities.
Cigna’s role includes:
- Managing medical provider networks
- Maintaining provider directories
- Supporting claims processing for medical services
- Offering utilization and care coordination support
For High Option members, Cigna serves as the primary resource for locating in-network providers, verifying the status of precertified medical services, and coordinating with their Priority Health Coach.
Optum, mental and behavioral health services
Optum provides mental health and behavioral health services for NALC HBP members, including access to therapy, counseling, substance use treatment, and behavioral health support programs.
Optum’s scope includes:
- In-network behavioral health providers
- Virtual and in-person mental health care
- Care coordination for behavioral health needs
- Support for stress, anxiety, depression, and related conditions
This way, Optum ensures mental health care is accessible, confidential, and integrated with overall medical coverage.
SilverScript, prescription drug coverage
SilverScript administers the pharmacy benefits for NALC HBP, including prescription drug claims, formularies, mail-order services, and pharmacy network management.
SilverScript responsibilities include:
- Prescription drug coverage and pricing
- Pharmacy network access
- Mail-order and specialty pharmacy coordination
- Prior authorization and formulary management
For HBRs, SilverScript is essential when members ask about medication coverage, copays, drug tiers, or mail-order prescriptions.
Member benefits by partner
Knowing who handles what makes it easier for you to quickly direct questions and provide accurate answers about medical care, mental health services, or pharmacy benefits to help members get the support they need and avoid unnecessary back-and-forth.
Cigna
- In-network and out-of-network medical providers
- Preventive care visits and screenings
- Specialist referrals
- Hospital and outpatient services
- Medical claims status and explanations of benefits (EOBs)
“Is this provider in the network?”
“Why was my medical claim denied?”
“Do I need preauthorization for this procedure?”
Optum
- Therapy and counseling services
- Behavioral health provider networks
- Mental health virtual visits
- Substance use treatment resources
“How do I find a mental health provider?”
“Is virtual therapy covered?”
“What mental health services are included in my plan?”
SilverScript
- Prescription drug formularies
- Retail and mail-order pharmacy access
- Specialty medications
- Drug pricing, tiers, and prior authorizations
“Is my medication covered?”
“Why did my prescription cost change?”
“How do I use a mail-order pharmacy?”
“Why do I have to use CVS Caremark® for my long-term or maintenance medications?”
Partner resources for NALC HBRs
Fortunately, each partner offers tools and portals that provide easy access to training materials, provider information, and benefit details to answer questions accurately and assist members with confidence and efficiency.
Besides, each partner maintains dedicated service channels, allowing HBRs to escalate or redirect members when necessary.
NALC HBR Resource Hub
The NALC HBR portal is your central hub for everything you need to support members. It brings together training, reference materials, and plan updates in one place, helping you deliver accurate information across all member interactions about enrollment, coverage, or specific benefits.
Within the Hub, you can access the National Health Benefit Seminar information, Digital Courses, and the HBR Resources library to provide reliable support that aligns with NALC Health Benefit Plan standards. Besides, the portal is regularly updated to ensure you have the most current information at your fingertips.
Cigna provider directory
Cigna provider directory lets you quickly check which medical providers are in-network. It’s essential for helping members find the right doctors, specialists, or facilities covered by their plan, so you can confidently answer questions about provider options.
Optum behavioral health search tools
Optum directory helps you locate mental health providers and services within the plan’s network. They make it easier to guide members seeking counseling, therapy, or other behavioral health support.
In addition, the Optum Health portal provides access to claims support and resources for understanding coverage details. It also offers guidance on authorization requirements and how members can access virtual or in-person behavioral health care.
SilverScript formularies
SilverScript portal provides easy access to important forms that members may need to request services, update information, or address benefit questions. Having these forms readily available allows you to quickly guide members through administrative processes, ensuring they have the correct paperwork to manage their coverage smoothly.
Best practices to use these resources
Start with centralized sources
Always begin by consulting official NALC HBR resources before responding to member questions to ensure consistency, accuracy, and alignment with current benefits. Make it a habit to check for updates regularly, especially during Open Season and throughout the year, when coverage details or processes may change.
Use resources to confirm, not assume
Even familiar questions can have updated answers. Use available tools and reference materials to verify details rather than relying on memory or prior experience. This approach helps prevent misinformation, reduces follow-up issues, and builds member confidence in the guidance they receive.
Guide members step by step
When assisting members, use resources to walk them through processes in manageable steps so they can feel supported and less confused.
Focus on clarity and consistency
Use standardized language and explanations drawn from official materials to ensure members receive the same information regardless of whom they speak with, reinforcing trust in the Plan and in HBR support.
Keep key materials easy to access
Identify the documents, pages, or tools you use most often and keep them readily available to save time during member interactions and respond efficiently.
Encourage member self-service when appropriate
When possible, show members where and how to find information themselves using Plan resources, this can reduce repeat questions and helps them feel more confident managing their benefits.
Commit to ongoing learning
Regularly reviewing training materials, updates, and educational resources helps you stay informed and prepared to handle both common and complex questions.
FAQs about partner resources
Which partner should I contact first when a member reports a denied claim?
Medical claim denials are handled by Cigna, while prescription claim issues are managed by SilverScript. Behavioral health claims should be directed to Optum, depending on the service type.
Can HBRs access partner portals directly on behalf of members?
HBRs typically guide members to the appropriate portal or contact channel rather than accessing member-specific data directly, to maintain privacy and compliance standards.
What should an HBR do if a member is confused about mental health coverage versus medical coverage?
Clarify that mental and behavioral health services are administered through Optum, even though they are part of the overall medical benefit structure.
How can HBRs confirm whether a prescription requires prior authorization?
The SilverScript help desk provides the most accurate information on prior authorization, step therapy, and coverage restrictions.
Are provider networks the same nationwide for all members?
Cigna offers a nationwide PPO network; however, provider participation can change at any time and the online directory is subject to change. To ensure a provider is currently in-network, we recommend searching the official directory or calling Cigna at 1 (800) 997-1654 to confirm their status before your appointment.