The City of Plano’s medical plan is administered by WebTPA. This plan is an EPO Plan, which means it provides in-network only benefits. It is very important to make sure you are seeing in-network providers, so check your provider’s status at webtpa.com.
The City of Plano prides itself in providing an excellent benefit plan to its employees/retirees. Maintaining good health and receiving quality care in time of illness is of utmost importance. Below is a summary of the health benefits available to you.
Plan Summary
NEW! Healthcare Highways (HCH) HCH is a specialized (high performance) healthcare network that operates in conjunction with the Aetna network. If you choose to receive medical services from a healthcare provided that is part of the network your claims will be processed as a Tier 1 claim. This means you will receive enhanced benefits such as a lower annual deductible, coverage at a higher percent (coinsurance), and an overall lower out of pocket. Great news; if your provider is not part of the HCH network, your benefits remain the same through the Aetna network.
Direct Your Provider to the Right Place Please advise your provider to contact WebTPA at 844-380-4552 to validate member eligibility, benefit coverage and to ensure they are in the Aetna Signature Administrators’ network. Providers should not call Aetna for this information as Aetna is not your insurance company. Providers can access the Interactive Voice Response (IVR) system 24/7 for eligibility and benefit information. They may also visit WebTPA.com to create a free provider portal account – a faster way to verify eligibility.
How to Contact WebTPA Members can call WebTPA Customer Service at 844-380-4552 or email at [email protected], or visit your member portal at webtpa.com. DO NOT CALL AETNA.
Log in to WebTPA Member Portal Members can access information about their plan benefits and claim information at webtpa.com. This secure site keeps member information safe and ensures strict HIPAA-compliant confidentiality. The member portal provides self-service tools designed to save time by giving you the ability to view eligibility information, print a temporary ID card, order a new ID card, view claim status and history, download important forms and documents, and communicate with Customer Service.
Logging on to WebTPA.com
My WebTPA Mobile App Available to iPhone and Android users, the WebTPA Mobile App is FREE and provides on-the-go functionality enabling members to view coverage, claims information, ID cards & balances, as well as contact Customer Service. Downloading the app is quick and easy – visit the Apple App Store or Google Play for Android. *Please note – members must create an online account at webtpa.com before logging in to the mobile app
How to Find a Healthcare Highways Provider (Tier 1)
How to Find an Aetna Provider (Tier 2)
Find a Cost Estimate What is ‘’Your Cost”? Your cost is the expected out-of-pocket cost to you based on your benefit plan and healthcare spending since the start of the plan year. This is
Catalyst Health Network - Primary Care Physicians City of Plano partners with the Catalyst Health Network, an independent group of primary care providers with locations in the North and Central Texas regions. Providers in this network strive to improve health outcomes by supplying patients with a local team of care coordinators, nurses, pharmacists and referral coordinators all to support the individual through their healthcare journey.
NEW! Carrum Health About Carrum Health How it works After contacting Carrum Health, each participant is assigned a Care Specialist to determine if the participant is eligible for Carrum Health and provide non-medical coordination throughout the entire episode of care. Care Specialist services can include assistance with hospital and physician selection, medical records collection, appointment scheduling, travel reservations, and logistics management. Participants must agree to provide their medical records and any other relevant information to their selected hospital and physicians in order to facilitate a consultative evaluation to determine if the procedure is appropriate and medically necessary. Medical records and images are collected on behalf of participants by their assigned Care Specialists. Receiving this evaluation does not commit a participant to proceed with the procedure or to use Carrum Health. Participants may use Carrum Health for the following procedures:
NEW! Green Imaging Diagnostic Medical Imaging Services Include: Here’s how it works: Step 1: If you don’t have an order, ask your doctor to fax Green Imaging the order at 866-653-0882, or text your order to 713-524-9190 and include: Prefer not to text? Step 2: Step 3:
Description Tier 1
WebTPA/
Healthcare Highways Network (HCH)Tier 2
WebTPA/Aetna Network
Annual Deductible $625 Individual
$1,250 Family$1,250 Individual
$2,500 Family
Coinsurance Level Plan Pays 90% / You Pay 10% Plan Pays 80% / You Pay 20%
Out-of-Pocket Maximum (Includes medical deductible, medical coinsurance, medical copays, Rx deductible, and Rx copays) $5,000 Individual
$10,000 Family$7,000 Individual
$14,000 Family
Lifetime Maximum Unlimited Unlimited
Preventive Care Plan Pays 100% Plan Pays 100%
Physician Services Primary Care - $25 copay
Specialist - $40 copay
Catalyst Health Network / Village Health Partners - $5 copay Primary Care - $25 copay
Specialist - $40 copay
Catalyst Health Network / Village Health Partners - $5 copay
Telemedicine - Teladoc $5 copay $5 copay
CVS MinuteClinic $5 copay $5 copay
Urgent Care Services $40 copay $50 copay
Emergency Room Deductible + $200 copay per event
(copay waived if admitted)Deductible + $200 copay per event
(copay waived if admitted)
Chiropractic Care (24 visits per calendar year) $25 copay $25 copay
Physical, occupational, speech therapy (20 visits per calendar year) $25 copay $25 copay
Airrosti (injuries/pain) $15 copay $15 copay
Inpatient Hospital Services Deductible + 10% Deductible + 20%
Outpatient Services Deductible + 10% Deductible + 20%
Mental Health / Substance Abuse Outpatient Individual Therapy = $25 copay
Outpatient Group Therapy = $20 copay
Inpatient Hospitalization = Deductible + 10%Outpatient Individual Therapy = $25 copay
Outpatient Group Therapy = $20 copay
Inpatient Hospitalization = Deductible + 20%
Home Health Care (60 days per calendar year) Deductible + 10% Deductible + 20%
Skilled Nursing (60 days per calendar year) Deductible + 10% Deductible + 20%
Hospice (limited to 360 days per lifetime) Deductible + 10% Deductible + 20%
*Tier 1 deductible and out-of-pocket maximum amounts accumulate with Tier 2 amounts.
Employees that are over the age of 18 and are enrolled in the medical plan have access to Carrum Health which provides enhanced coverage for certain planned procedures at participating Centers of Excellence. Through Carrum Health, participants have access to specialized providers and facilities selected for their expertise in certain high-risk or high-cost procedures.
Plan participants can contact Carrum Health at 1-888-855-7806, Monday-Friday 8 a.m. – 7 p.m. CST, online at carrum.me/CityofPlano or by downloading the ‘Carrum Health’ app on iPhone and Android devices to search for and compare participating hospitals and physicians.
Carrum Health City of Plano Plan
Hip and knee replacement No out-of-pocket costs (i.e., 100% covered; no deductible) Regular health plan
benefit level
Spinal fusion surgery No out-of-pocket costs (i.e., 100% covered; no deductible) Regular health plan
benefit level
Other orthopedic procedures
(e.g, hand, wrist, elbow, shoulder, ankle, foot)No out-of-pocket costs (i.e., 100% covered; no deductible) Regular health plan
benefit level
Cardiac (heart) surgery No out-of-pocket costs (i.e., 100% covered; no deductible) Regular health plan
benefit level
Oncology
Carrum's cancer program includes:
- Virtual guidance and ongoing support for all cancer diagnoses
- Comprehensive treatment for breast and thyroid cancers
- CAR (chimeric antigen receptor) - T-cell therapy*No out-of-pocket costs (i.e., 100% covered; no deductible) Regular health plan
benefit level
*Restrictions may apply
Introducing Green Imaging! Your health is important to us and we have contracted with Green Imaging to provide medical imaging services at NO COST to you. The process couldn’t be easier – you’ll be connected to a Green Imaging Medical Concierge who will personally walk you through the entire process when you need imaging services.
Your doctor has given you an order for a diagnostic imaging exam. Have this order ready.
At your appointment, show your Green Imaging voucher
If your referring physician has not received your exam report, call Green Imaging at 713-524-9190.