Healthcare Providers

CDHP Healthcare Providers

Whether you regularly service NALC Health Benefit Plan members or you are seeing one for the first time, understanding our Plan policies and the benefits we offer is a top priority. Below you will find information pertaining to CDHP provider networks, Eligibility, Member Benefits, Claim Submissions, Claim Status, Electronic Payment Information and Provider Resources.”

Looking for a different NALC Health Benefit Plan?

If you need resources for a different member plan, you can visit our High Option Provider Page
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Provider Networks of the
Consumer Driven Health Plan (CDHP)

We strive to give our members the freedom to choose the providers they wish to see. We provide our CDHP members in-network medical providers through the Cigna OAP Network, and the Cigna Behavioral Health Network for mental health and substance use providers.

  • For providers rendering services to our CDHP members, we have partnered with Cigna who administers benefits on behalf of the NALC Health Benefit Plan. To learn more please visit, https://www.cigna.com/health-care-providers
  • If you do not participate in the Cigna networks, that is ok. We also offer out-of-network benefits, which are considered our standard benefits. To learn more please contact Cigna’s Customer Service Center for providers at 800-882-4462, or by downloading our official 2026 Plan Brochure.
  • If you are interested in becoming part of the Cigna network, please visit Cigna's Health Care Provider Credentialing website.

Note: If Medicare is the primary payor, we follow Medicare guidelines while our Cigna OAP provider network is waived.

CDHP Eligibility

Determining a member’s eligibility is an important step when it comes to giving them the care they need. Please see the information below to determine member eligibility

  • From 8 a.m. to 5 p.m. Eastern, to determine eligibility please contact Cigna’s Customer Service Center for providers by calling
    800-882-4462
  • From 5 p.m. to 8 a.m. Eastern, to determine eligibility please contact Cigna’s 24-hour health information line by calling
    855-511-1893.
  • If you would like to check eligibility information online, please visit cignaforhcp.com

CDHP Plan Benefits

Understanding a member’s plan benefits is an important step toward a satisfied patient. For benefit information,
please see the information below.

BENEFIT
MEMBERS PAY (IN-NETWORK)
MEMBERS PAY (NON PPO)
Annual Routine Physical Exam (age 3 or older)
Nothing
50% after deductible is met*
Adult Routine Immunizations & Tests
Nothing
50% after deductible is met*
Well Child Care (through age 2)
Nothing
50% after deductible is met*
Routine Immunizations (through age 21)
Nothing
50% after deductible is met*

*in addition, for out of network services you are responsible for the difference, if any, between the Plan allowance and the billed amount.

BENEFIT
MEMBERS PAY (IN-NETWORK)
MEMBERS PAY (NON PPO)
Maternity
20% after deductible is met
50% after deductible is met*
Maternity related hospital services
20% after deductible is met
50% after deductible is met*

*in addition, for out of network services you are responsible for the difference, if any, between the Plan allowance and the billed amount.

BENEFIT
MEMBERS PAY (IN-NETWORK)
MEMBERS PAY (NON PPO)
Medical/surgical
20% after deductible is met
50% after deductible is met*
Emergency Medical
20% after deductible is met
50% after deductible is met*

*in addition, for out of network services you are responsible for the difference, if any, between the Plan allowance and the billed amount.

BENEFIT
MEMBERS PAY PPO
MEMBERS PAY NON-PPO
Initial office visit and 12 office visits per calendar year when rendered on the same day as covered manipulations
20% after deductible is met
50% after deductible is met*
Manipulations (12 per calendar year)
20% after deductible is met
50% after deductible is met*

*in addition, for out of network services you are responsible for the difference, if any, between the Plan allowance and the billed amount.

BENEFIT
MEMBERS PAY (IN-NETWORK PPO)
MEMBERS PAY (NON PPO)
Office or virtual visits
20% after deductible is met
50% after deductible is met*
Telehealth professional services for minor acute conditions
10% after deductible is met
All charges
X-rays, other diagnostic services
20% after deductible is met
50% after deductible is met*

*in addition, for out of network services you are responsible for the difference, if any, between the Plan allowance and the billed amount.

BENEFIT DESCRIPTION
MEMBERS PAY (IN-NETWORK PPO)
MEMBERS PAY (NON-PPO)
Lab Services
20% after deductible is met
50% after deductible is met*

*in addition, for out of network services you are responsible for the difference, if any, between the Plan allowance and the billed amount.

BENEFIT DESCRIPTION
MEMBERS PAY (IN-NETWORK PPO)
MEMBERS PAY (NON-PPO)
Office visit
20% after deductible is met
50% after deductible is met*
Outpatient telemental or virtual visits
10% after deductible is met
50% after deductible is met*
Other diagnostic services
20% after deductible is met
50% after deductible is met*
Laboratory Services
20% after deductible is met
50% after deductible is met*

*in addition, for out of network services you are responsible for the difference, if any, between the Plan allowance and the billed amount.

PRESCRIPTION DRUGS
THIS IS A MANDATORY GENERIC PROGRAM
NETWORK
NON-NETWORK
Retail Pharmacy
1st and 2nd fill:


$10 for generic (after deductible is met)

$40 for Formulary brand (after deductible is met)

$60 for Non-Formulary brand (after deductible is met)
Note: You may purchase up to a 90-day supply (84-day minimum) of covered drugs and supplies at a CVS Caremark® Pharmacy through our Maintenance Choice Program. You will pay the applicable mail order copayment for each prescription purchased.
50% of the Plan allowance after deductible is met*
Mail Order Program
90-day supply:
$20 generic / $90 Formulary brand / $125 Non-Formulary brand (after deductible is met)
Specialty drugs (requires prior approval)
Caremark Specialty Mail Order:
30-day supply: $250 / 90-day supply: $450

*in addition, for out of network services you are responsible for the difference, if any, between the Plan allowance and the billed amount.

BENEFIT DESCRIPTION
NEWORK
NON NEWORK
CDHP
  • Self - $2,000

  • Self Plus One - $4,000
  • Self and Family - $4,000
  • Self - $4,000

  • Self Plus One - $8000
  • Self and Family - $8,000
Medical/Surgical/Mental health and substance abuse care
In-Network providers/facilities, preferred network pharmacies or mail order pharmacy out-of-pocket maximum:
  • Per person: $6,600

  • Per family: $12,000
Out-of-Network providers/facilities out-of-pocket maximum:
  • Per person: $12,000

  • Per family: $24,000
BENEFIT
MEMBERS PAY (IN-NETWORK)
MEMBERS PAY (NON PPO)
Annual Routine Physical Exam (age 3 or older)
Nothing
50% after deductible is met*
Adult Routine Immunizations & Tests
Nothing
50% after deductible is met*
Well Child Care (through age 2)
Nothing
50% after deductible is met*
Routine Immunizations (through age 21)
Nothing
50% after deductible is met*

*in addition, for out of network services you are responsible for the difference, if any, between the Plan allowance and the billed amount.

BENEFIT
MEMBERS PAY (IN-NETWORK)
MEMBERS PAY (NON PPO)
Maternity
20% after deductible is met
50% after deductible is met*
Maternity related hospital services
20% after deductible is met
50% after deductible is met*
  • in addition, for out of network services you are responsible for the difference, if any, between the Plan allowance and the billed amount.
BENEFIT
MEMBERS PAY (IN-NETWORK)
MEMBERS PAY (NON PPO)
Medical/surgical
20% after deductible is met
50% after deductible is met*
Emergency Medical
20% after deductible is met
50% after deductible is met*
  • in addition, for out of network services you are responsible for the difference, if any, between the Plan allowance and the billed amount.
BENEFIT
MEMBERS PAY PPO
MEMBERS PAY NON-PPO
Initial office visit and 12 office visits per calendar year when rendered on the same day as covered manipulations
20% after deductible is met
50% after deductible is met*
Manipulations (12 per calendar year)
20% after deductible is met
50% after deductible is met*

*in addition, for out of network services you are responsible for the difference, if any, between the Plan allowance and the billed amount.

BENEFIT
MEMBERS PAY (IN-NETWORK PPO)
MEMBERS PAY (NON PPO)
Office or virtual visits
20% after deductible is met
50% after deductible is met*
Telehealth professional services for minor acute conditions
10% after deductible is met
All charges
X-rays, other diagnostic services
20% after deductible is met
50% after deductible is met*
  • in addition, for out of network services you are responsible for the difference, if any, between the Plan allowance and the billed amount.
BENEFIT DESCRIPTION
MEMBERS PAY (IN-NETWORK PPO)
MEMBERS PAY (NON-PPO)
Lab Services
20% after deductible is met
50% after deductible is met*
  • in addition, for out of network services you are responsible for the difference, if any, between the Plan allowance and the billed amount.
BENEFIT DESCRIPTION
MEMBERS PAY (IN-NETWORK PPO)
MEMBERS PAY (NON-PPO)
Office visit
20% after deductible is met
50% after deductible is met*
Outpatient telemental or virtual visits
10% after deductible is met
50% after deductible is met*
Other diagnostic services
20% after deductible is met
50% after deductible is met*
Laboratory Services
20% after deductible is met
50% after deductible is met*
  • in addition, for out of network services you are responsible for the difference, if any, between the Plan allowance and the billed amount.
PRESCRIPTION DRUGS
THIS IS A MANDATORY GENERIC PROGRAM
NETWORK
NON-NETWORK
Retail Pharmacy
1st and 2nd fill:


Generic = 20% of Plan allowance (after deductible is met)
Formulary brand = 30% of Plan allowance (after deductible is met)
Non-Formulary brand = 50% of Plan allowance (after deductible is met)
Note: You may purchase up to a 90-day supply (84-day minimum) of covered drugs and supplies at a CVS Caremark® Pharmacy through our Maintenance Choice Program. You will pay the applicable mail order copayment for each prescription purchased.
50% of the Plan allowance after deductible is met and any difference between our allowance and the billed amount
Mail Order Program
90-day supply: (after deductible is met)
Generic = 20% of Plan allowance, maximum of $450 per prescription
Formulary brand = 30% of the Plan allowance, maximum of $450 per prescription
Non-Formulary brand = 50 % of Plan allowance
Specialty drugs (requires prior approval)
Caremark Specialty Mail Order:
30-day supply: $250 / 60-day supply: $450 / 90-day supply: $650
  • in addition, for out of network services you are responsible for the difference, if any, between the Plan allowance and the billed amount.
BENEFIT DESCRIPTION
NEWORK
NON NEWORK
CDHP
  • Self - $2,000

  • Self Plus One - $4,000
  • Self and Family - $4,000
  • Self - $4,000

  • Self Plus One - $8000
  • Self and Family - $8,000
Medical/Surgical/Mental health and substance abuse care
In-Network providers/facilities, preferred network pharmacies or mail order pharmacy out-of-pocket maximum:
  • Per person: $6,600

  • Per family: $12,000
Out-of-Network providers/facilities out-of-pocket maximum:
  • Per person: $12,000

  • Per family: $24,000

If you have questions, please contact Cigna’s Customer Service Center for providers by calling
800-882-4462

Download Plan Brochure

Where should You
Submit Your Claims?

If you have claims to submit for Consumer Driven Health Plan members, please see below for the submission process that best fits your scenario.

Medical / Mental Health & Substance Use Claim Submissions:

  • Please submit claims electronically to:
    Cigna/NALC HBP using electronic payor ID# 62308
  • If you are submitting claims by paper, please mail to:
  • NALC CDHP,
    PO Box 188050,
    Chattanooga, TN 37422-8050
  • If you have questions, please contact Cigna Customer Service Center for providers by calling 800-882-4462.

Do You Need To Check The status of a claim?

If you previously submitted a claim and have yet to receive an explanation of benefits or payment, please see the following options.

For Medical / Mental Health & Substance Use:

  • Please contact Cigna Customer Service Center for
    providers by calling 800-882-4462.
  • If you would like to check this information online,
    please visit cignaforhcp.com

Electronic Payment Information

Providers rendering services to CDHP members of the NALC Health Benefit Plan can obtain access to Cigna's website where they can view post service EOBs and payment information.

  • To access Cigna's website please visit cignaforhcp.com.
  • If you have questions, please contact Cigna's Customer Service Center for providers by calling 800-882-4462.

Provider Resources

As a provider, having the resources needed can make your job a little easier. 

The following information can be handled by visiting Cigna’s website at cignaforhcp.com.

01
Filing an appeal
02
Precertification
03
Reimbursement and payment policies
04
Requesting prior authorization
05
Submitting medical records
06
Submitting another companies EOB
Visit Cigna For HCP

If you have questions, please contact Cigna’s Customer Service Center for providers by calling 800-882-4462.

Download the official NALC BHP Plan Brochure

Everything in one place - the Official NALC Plan Brochure.

The brochure is the go-to guide for plan benefits, coverage details and enrollments codes.
Keep it handy for your self and share it with members.

Download 2026 Brochure
Download 2025 Brochure

FAQs – CDHP Providers

Need Help or
Have Questions?

We’re here to help you understand your health care options and make the most of your coverage.

Talk to an Expert

Please contact Cigna Customer Service Center for providers between the hours of 8 a.m. to 5 p.m. Eastern, Monday - Friday by calling 800-882-4462.

  • If you are an in-network medical provider in the Cigna Network, please contact Cigna Provider Relations.
  • If you are an in-network mental health/substance use provider in the Cigna Behavioral Health Network, please contact Cigna Provider Relations.
  • If you are a non-participating provider, please contact Cigna’s Customer Service Center for providers by calling 800-882-4462.
  • If you are an in-network medical provider in the Cigna Network, please contact Cigna Provider Relations.
  • If you are an in-network mental health/substance use provider in the Cigna Behavioral Health Network, please contact Cigna Provider Relations. 
  • If you are a non-participating provider, please contact Cigna’s Customer Service Center for providers by calling  800-882-4462.
View All FAQs