Ic Healthcare Plan Guide Eng 0420 PDF

THE SCHLUMBERGER
INTERNATIONAL
HEALTH CARE PLAN
PARTICIPANT GUIDE
FOR INTERNATIONAL
COMMUTER EMPLOYEES
Version Date: January 2020

TABLE OF CONTENTS
1. QUICK VIEW: PLAN CONTACTS AND SERVICES 6. SCOPE OF COVERAGE
a. Your Cigna Customer Service Team a. Geographical Scope
b. Online Services b. Plan Limit and Scope of Reimbursement
c. Pre-certification and UCR c. Employee Cost Sharing
d. Find a Doctor/Hospital
e. Emergency Repatriation
f. Where to find further information related to the plan 7. BENEFITS COVERED BY THE PLAN
(AND THOSE WHICH ARE NOT)
a. Preventive Care
2. PLAN OVERVIEW b. Maternity Treatment
c. Inpatient Treatment and Day Care Surgery
3. IMPORTANT CONCEPTS d. Outpatient Treatment and Day Care Surgery
e. Dental Treatment
YOU SHOULD UNDERSTAND f. Vision Treatment
a. Cigna’s Global Network g. General Exclusions
b. Usual, Customary and Reasonable (UCR) Criteria
c. Pre-certification Procedure
d. Second Medical Opinion 8. PLAN ADMINISTRATION
e. Report unprofessional or unethical behaviour a. How do I know that I am enrolled in the plan?
of providers to Cigna b. How to contact Cigna
c. How to get fast reimbursement
d. What documentation do I need to provide to pre-certify/
4. HEALTH AND WELLBEING SERVICES make a claim?
a. Pre-Assignment Assistance Assessment (PAAA) e. Claims Processing
b. Health and Wellbeing Translation Tools f. Online Services available from Cigna’s web portal
c. Employee Responsibility g. How to make a complaint
5. ELIGIBILITY FOR COVERAGE 9. SERVICES PROVIDED BY INTERNATIONAL SOS

a. Eligible Schlumberger Employees
b. Eligible Family Members
c. Commencement and Termination of Coverage 10. INTERNATIONAL EMERGENCY MEDICAL
d. Levels of Coverage
e. Plan Cost and Optional Coverage Levels
EVACUATIONS
a. Definition
b. Procedure
11. FUTURE OF THE PLAN
SCHLUMBERGER INTERNATIONAL HEALTH CARE PLAN PARTICIPANT GUIDE FOR INTERNATIONAL COMMUTER EMPLOYEES
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FULLY INTEGRATED SERVICE PLATFORM
Communication
Claims Submission Members contact Cigna via global
Online, scanned, email, hardcopy contact number, email, online
One Dedicated Schlumberger Customer Services Team

4 core languages supported 24/7 (English, French, Spanish, Arabic)
31 languages supported in-house. 140+ languages supported through language line
Global Contact Numbers

+44-345-601-2239
Reverse charges or request a call back are available
+1-800-841-7764
Toll free when calling from within the US
(please see section 1a for further information)
Primary Schlumberger Operational Locations -

Spain and UK
Supported by US (California) and Malaysia (Kuala Lumpur)
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1. QUICK VIEW: PLAN CONTACTS AND SERVICES
Welcome to your Schlumberger International Health Care Plan which is managed in partnership with Cigna Global Health Benefits.
1a. Your Cigna Customer Service Team 1c. Pre-certification and UCR 1f. Where to find further information related to the plan
As a plan member, you can enjoy a wide range of services, such as: These are important concepts for you to understand, and are explained fully The master copy of this Participant Guide, where all future updates will be
n You can contact your dedicated Schlumberger Customer Service team by in sections 3b and 3c. made, is posted on the IS Portal under ‘Documentation’ at:
calling +44-345-601-2239 or +1-800-841-7764 (toll free when calling from https://mycompandben.slb.com/Portal/IsPortalHome.aspx.
within the U.S.). Cigna will be happy to accept a reversed charge call to Pre-certification means prior approval of treatment. To arrange prior
either number. You can also reach us at [email protected] approval of inpatient treatment and any other treatment above US$1,200, You will find answers to many common questions asked by plan participants in
n When calling on either of the above telephone numbers you will be you should notify Cigna ideally ten days in advance to enable them to section 8 (Plan Administration). In addition, a detailed FAQ is available at the
prompted to select from a list of languages. A complete list of these arrange direct payment, where possible, and for you to be notified of any above link. If you cannot find the answer to your question in the FAQ, contact
options can be found in section 8b expenses which are above Usual, Customary and Reasonable (UCR). Make your Cigna Customer Service team for any medical issues or questions related
n Multilingual 24/7 customer support with instant access to your policy, your pre-certification request by logging into www.CignaEnvoy.com, and to plan benefits or services. If your question is not related to medical services
providing details of your benefit coverage, advice on where you can seek select the ’Pre-certification Form’ from the ‘My Account’ dropdown box. forward it to ‘Ask HR’ or your local HR Representative.
treatment, and updates on the status of your claim Alternatively you can contact your dedicated Schlumberger Customer
n Access to health care providers worldwide Service team by calling +44-345-601-2239 or +1-800-841-7764 (toll free Your personal Cigna web pages, Cigna Envoy, also provide invaluable
n Access to health and wellbeing services. when calling from within the U.S.). Cigna will be happy to accept a reversed information related to your plan. After the initial registration, you
charge call to either number. You can also reach us at will be able to access Cigna Envoy via single sign on if within the
1b. Online Services [email protected]. Schlumberger firewall (SINet). This removes the need for you to
You can access information regarding your policy anytime through your remember the Cigna Envoy login details. Note the Cigna login details
personal Cigna web pages, Cigna Envoy (www.CignaEnvoy.com). 1d. Find a Doctor/Hospital are required each time you access the Mobile App from your phone or
Cigna recognises that you may be unfamiliar with local medical providers in a tablet.
Cigna Envoy is also available while you’re ‘on the go’ via our Mobile App.
your country of assignment. To assist you in making a selection, Cigna has
From Cigna Envoy you can find: created a provider directory of pre-screened full service hospitals, clinics and To complete registration, click here (or access www.CignaEnvoy.com). Enter your
n Pre-certification request outpatient centres worldwide, which is available at www.CignaEnvoy.com Cigna ID number as it appears on your Cigna welcome email and answer a few
n Certificate of coverage and on the Cigna Mobile App, which provides GPS functionality to locate the security questions. Click ‘Register’ and a temporary PIN will be displayed on the
n Printable ID card (Electronic ID cards are available on the Mobile App) provider nearest to you. The network listing will also confirm whether the screen. Change the temporary PIN to a password of your choice. Registration is
n Policy documentation provider you select can offer direct settlement and/or preferential rates as well now complete.
n Claims submission features* as details of languages spoken. If you require any assistance, want to visit an
n Health and wellbeing resources out of network provider, or do not find your preferred provider in the directory, When accessing Cigna Envoy outside the Schlumberger firewall, use the same
n Country guides your Cigna Customer Service team will happily assist you. link www.CignaEnvoy.com, then select ‘I have an existing login’ and use the
n Contact your Cigna Customer Service team* password you have created at registration.
n Claims tracking* 1e. Emergency Repatriation
n Global provider search.* In the event of a life threatening medical emergency which cannot be
handled by the local emergency services on the ground, you must request
Details of how to download the Mobile App can be found in section 8f. authorisation to use the specialist emergency medical services provided
by International SOS, a provider specialising in evacuation and repatriation
services. Further details can be found in section 9.
* Also available on the Mobile App
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2. PLAN OVERVIEW
This Participant Guide provides you, and your eligible family members who are covered under the plan, with an understanding of the important concepts, key features and details of treatment
covered. Additionally, by reading through the content you will understand what conditions are excluded from cover, you will know how to make a claim for reimbursement, which types of
treatment require pre-certification, how you can benefit from the health and wellbeing resources, and what services are provided by Cigna.
Eligible employees are responsible for ensuring they understand how IHCP has been designed to:
the plan works and for sharing this Participant Guide with eligible family n Act as Complementary Coverage when other Private or Government
members. This will avoid you making claims for items which are not covered Medical, Dental or Vision schemes are available. You are expected to first
by the plan or finding out after treatment is taken that reimbursement will be make a claim from your primary plan and claim only the supplemental part
reduced as the necessary procedures were not followed. from IHCP. The plan is not intended to be a source of profit
n Act as Main Coverage when no other coverage is available to an
The Schlumberger International Health Care Plan, from hereon will be employee or their dependents
referred to as IHCP. n Provide coverage only for Medical, Dental, Vision treatment, therefore
expenses, such as travel, transportation and accommodation, that are not
n IHCP is insured and administered by Cigna directly or indirectly related to your receipt of medical treatment, are not
n IHCP provides comprehensive inpatient, outpatient, dental, vision and covered under IHCP
emergency evacuation coverage to International Commuter employees. n Cover treatments or diagnoses that fall under conventional or mainstream
Eligible dependents can be covered under the plan at employee discretion. medicine classifications. Therefore, experimental treatment and many
alternative or complementary treatments are not covered under the plan
In addition to being a highly competitive plan in the industry, IHCP unless detailed in the Table of Benefits
provides the following important features:
n No waiting periods For more details on IHCP exclusions please refer to the exclusions under each
n No exclusions for pre-existing conditions of the tables in section 7: Benefits Covered by the Plan and General Exclusions
n No restrictions in the choice of doctors, laboratories, clinics/hospitals section 7g.
as long as they are appropriately licensed and registered doctors/
hospitals and the related cost is considered Usual, Customary and You can obtain further information related to the plan by calling your Cigna
Reasonable (UCR) Customer Service team, details of which you will find in section 8: Plan
n No restrictions on which country you can take your treatment, Administration.
with the exception of maternity, dental and vision treatment. Only
employees and their eligible spouse who are US nationals or Green Card
holders will be covered for maternity, dental and vision treatment
in the US. Non US nationals/green card holders are covered for
maternity, dental and vision on a worldwide basis excluding US.
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3. IMPORTANT CONCEPTS YOU SHOULD UNDERSTAND
Continuing to be able to offer a comprehensive level of medical care to its International Commuter employees and their families is a high priority for Schlumberger. However,
with the increasing cost of medical treatment it is essential to ensure that all participants in the plan are responsible consumers and make good decisions about the necessity of
treatment, the location in which they take the treatment, the frequency with which they use the plan, and the type of facility they use.
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plan to help in this respect and you are encouraged to understand them to are UCR or not?
avoid disappointment if your claim is affected by one of them. Inpatient treatment: All costs under this category should be approved It is strongly recommended that you do not disclose
in advance via the pre-certification procedure, therefore costs are known in the level of your benefits to any providers (doctors,
3a. Cigna’s Global Network advance by Cigna. One of the advantages of pre-certification for participants dentists, ophthalmologists), as they may be tempted
Cigna has established a substantial global network of hospitals and clinics. in the plan is that if the costs for treatment are not UCR then you will be to apply an unreasonable surcharge to the estimate of
Each provider relationship is independently contracted and negotiated by notified upfront what charges will be covered by the plan and what charges their fees or even use your benefit limit as a ‘budget’.
Cigna’s in-house provider partnership team. You have a free choice regarding you will have to pay from your own pocket. In most cases you should have
which provider you use for treatment and this is not restricted. the option to change to a UCR facility before the treatment is taken.
However, the advantage of using a medical facility from Cigna’s network Outpatient treatment: As this category of treatment is reimbursed
listing is that this, in most cases, provides you access to direct settlement for after treatment is taken, you will only know about UCR at the time of
inpatient treatment and for outpatient treatment above $1,200. In addition, reimbursement. Cigna would recommend that you check with them before
due to the preferential rates that Cigna has negotiated with many of their taking extensive outpatient treatment, particularly if the facility appears
network providers, you should experience lower out of pocket costs. more expensive than other facilities in your location.
3b. Usual, Customary and Reasonable (UCR) Criteria What happens if the costs of doctors, laboratories, clinics/hospitals
What is UCR? are above UCR?
Usual, Customary and Reasonable (UCR) limit refers to maximum amount IHCP allows you complete freedom in choosing your medical providers.
eligible for reimbursement under the IHCP, for the benefits covered under the However, if the provider you have chosen charges above UCR for that
IHCP. location, and you have validated that with Cigna, you can either:
n Decide to remain with your initial choice of provider, and accept to pay
How is UCR determined? the difference in charges between the UCR and the actual costs for that
These UCR reimbursement limits have been determined based on a review procedure with the chosen provider, or
of the current charges made by peer doctors for the same type of medical n Ask Cigna to help you find an alternative provider whose pricing is within
service within a specific country or geographical area. Some healthcare the UCR criteria.
providers charge above the UCR limits, however the plan will reimburse only
up to the UCR considered for that specific treatment. When the participant What could the cost be to me if I choose a facility above UCR?
guide states 80% of UCR charges, this means a contribution of 20% will be As an example, if the UCR cost of a standard hospital room in France is €229
required from you as member. and the cost at The American Hospital in Paris is €1,018, the plan will pay
€229 and the patient will pay €789 per night.
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3. IMPORTANT CONCEPTS YOU SHOULD UNDERSTAND
3c. Pre-certification Procedure n Outpatient treatment: when a series of treatment is taken i.e. several If you have concerns regarding the treatment being recommended by your
What is the Pre-certification Procedure? physiotherapy sessions, or expensive dental work, then Cigna, when doctor, you are entitled to request a second medical opinion. The plan will
Pre-certification, also referred to as pre-authorisation, is the process of notified, can assess whether the costs charged by the medical facility or reimburse this second opinion as it may affect the treatment being taken
informing Cigna, in advance of your medical or dental treatment when it doctor are UCR. If they are above UCR you are notified in advance and and the charges to the plan. A second opinion will assist you in making an
meets certain criteria (see below ’When is it necessary to pre-certify for can make a decision whether to remain with that provider or change to informed choice on the nature of treatment to be carried out and to help you
treatment?). another who charges within UCR. Additionally, Cigna can organise direct to weigh up the benefits and any potential risks of surgical procedures. For
payment of your treatment whenever possible. some conditions there are medically sound alternatives which may be more
When is treatment considered medically necessary? suitable to your circumstances.
Medically necessary covered services and supplies are those determined by When is it necessary to pre-certify for treatment?
the Medical Team to be: n Inpatient treatment: In all cases, including maternity Second Medical Opinion via Cleveland Clinic
nrequired to diagnose or treat an illness, injury, disease or its symptoms; n Outpatient/Dental treatment: In all cases over US$1,200 Doctors can provide a second opinion face to face.
northodox, and in accordance with generally accepted standards of medical n Emergency treatment: The Pre-certification Procedure cannot
practice; be followed as emergency treatment cannot be planned, however, Alternatively, Cigna provides an online second opinion service offering a
nclinically appropriate in terms of type, frequency, extent, site and duration; you are required to inform Cigna within 72 hours of admission as truly independent, objective and evidence based second analysis.
nnot primarily for the convenience of the patient, physician or other health they may be able to negotiate the treatment charges and arrange
care provider and; direct billing on your behalf. Through www.CignaEnvoy.com you can access the confidential My Consult
nrendered in the least intensive setting that is appropriate for the delivery Online Second Medical Opinion. You will be prompted to answer a secure
of the services and supplies. What happens if you do not follow the Pre-certification Procedure? online condition-specific questionnaire and asked to submit relevant medical
In the event the Pre-certification Procedure is not followed, the direct records electronically to Cleveland Clinic’s My Consult service. A medical
Where applicable, the Medical Team may compare the cost-effectiveness of
payment or reimbursement will be systematically reduced to the Usual, specialist from the renowned Cleveland Clinic will review your medical
alternative services, settings or supplies when determining least intensive
setting. Customary and Reasonable charge for that country or geographical area, records and diagnostic tests, and provide an online medical second opinion
where applicable. that includes treatment options or alternatives, and recommendations about
future therapeutic considerations (usually within 10-14 days).
Why should I follow the Pre-certification Procedure? You should note that it is not uncommon for some medical facilities to
By following this process you ensure that: require the patient to guarantee part of the treatment on a credit card, even Third opinions need to be authorised by Cigna in advance and are only
n Inpatient treatment: Cigna can organise direct payment to your medical though Cigna have already arranged pre-certification. Whilst Cigna try to covered by IHCP in exceptional circumstances. Please contact your dedicated
service provider avoiding you having to first make payment, which in some minimise this occurrence, it is normal practice in some private hospitals and Schlumberger Customer Service team by calling +44-345-601-2239 or
cases can be very significant, and then make a claim for reimbursement. clinics and cannot be avoided. +1-800-841-7764 (toll free when calling from within the U.S.). Cigna will be
Also Cigna can notify you of any UCR that may apply, giving you the happy to accept a reversed charge call to either number. You can also reach
opportunity to change provider if their charges are unreasonable. If 3d. Second Medical Opinion us at [email protected].
planned treatment is known in advance, then Cigna can negotiate a In some countries health care is a ‘business’ and doctors may recommend
pricing reduction through their Preferred Provider Network. Additionally, invasive procedures even if the patient does not necessarily require them or 3e. Report unprofessional or unethical behaviour of providers
if surgery is recommended, Cigna doctors may request a second opinion if the medical condition can be treated by a non-invasive medical procedure. to Cigna
to determine whether there is an alternative treatment which is non- In some cases the reason for a diagnosis could be simply due to the fact If you are uncomfortable with the conduct of a provider, the way they are
invasive. that the patient has a comprehensive medical insurance which covers such charging or the advice they are providing, you have a responsibility to report
treatment. that situation to Cigna. Do not continue using services of an unprofessional
provider, Cigna can help you find an alternative.
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4. HEALTH AND WELLBEING SERVICES
With Cigna’s Health and Wellbeing services, you can learn about the areas of health that interest you.
4a. Pre-Assignment Assistance Assessment 4c. Employee Responsibility

(PAAA) It is the individual responsibility of every adult participant (or parent of a
Preparing and beginning a new assignment can dependent child) covered by the IHCP to make careful decisions about their
be stressful, particularly if you are travelling to an health. In many cases, the treatment being provided under the health care
unfamiliar location or if you or your family members plan is a direct result of lifestyle choices, some of which could be prevented
have existing medical conditions. Cigna’s confidential by following a healthy lifestyle, reducing your chances of developing chronic
pre-assignment assistance assessment can assist members by identifying risk diseases such as diabetes, cancer and heart disease.
factors that could impact your assignment, and provide you and your family
members with the tools to effectively prepare for and manage any medical issues. It`s important to take care of yourself and you are encouraged to:
n Eat healthy foods. Avoid junk food. Reduce the amount of sodium in your
The PAAA is a simple survey which can be accessed through the health and diet. Choose water to drink and eat healthy snacks
wellbeing page on www.CignaEnvoy.com. Once you have completed a few basic n Get plenty of exercise. Reduce screen time
questions regarding your assignment location and existing medical conditions n Stop Smoking (Smoking Prevention is covered under section 7a)
for you or your family members, the assessment will identify whether you would n If you drink alcohol, consume in moderation
benefit from discussing your situation with a dedicated health care advisor. Your n Drive safely; practise DriveSMARRT
advisor can help you to prepare for your medical needs whilst on assignment, n Get sufficient sleep
including sourcing prescription drugs, locating a suitable provider in your new n Keep vaccinations up to date
location, and offering medical advice. n Take regular preventive anti-malaria medication when going to high
malaria risk countries
n Go for periodic health check-ups (particularly important for persons over 40
4b. Health and Wellbeing Translation Tools years of age)
There is a wide variety of information available to you at n Have a blood pressure test at least every two years (above age 40) or three
www.CignaEnvoy.com, including translation tools relating to: years (below age 40)
nD rug translations: the same drug can have different names in different n Practise safe sex avoiding STDs.
parts of the world. Use Cigna’s helpful drug translation tool to identify
more than 295 drugs in 24 countries For more information visit the Schlumberger ‘Health Hub’ at:
nM edical terms translations: more than 850 terms in 10 languages to https://slb001.sharepoint.com/sites/hse/health/SitePages/Home.aspx
help you use and understand the correct medical terms for the country
you’re in
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need in a different country can be a challenge. Learn how to ask “Can I see
a doctor please” and 100 more phrases in 10 languages. You can access all health and wellbeing resources
The previous tools are available within the ‘‘What to Know When Travelling available through Cigna at www.CignaEnvoy.com.
& Relocating’’ section at www.CignaEnvoy.com.
08/28
5. ELIGIBILITY FOR COVERAGE
This section details those employees who are eligible to be covered under the IHCP and their eligible family members.
5a. Eligible Schlumberger Employees 5b. Eligible Family Members

International Commuter (IC) employees paid by International payroll are The following family members are eligible for coverage under IHCP:
covered by the IHCP. n Legal spouse
n Common law spouse
In the event of a dual career couple Cigna will create a joint/family n Dependent child until they reach their 19th birthday
membership for both employees so you are not disadvantaged by having to n Dependent children who are physically or mentally incapacitated following
pay two separate and individual Out of Pocket (OoP) expenses. the child’s 19th birthday provided:
n The child remains unmarried
As a recognised dual career policy, Cigna offers you the option to select the n The child cannot live independently
primary policy holder of this account by emailing [email protected]. n The child is 100% financially dependent on the employee
Alternatively, should you and your spouse/partner wish to remain covered n Proof of the disability is submitted to Cigna prior to the child’s 19th
under two separate policies (e.g. because you are not residing in the same birthday and regularly thereafter at Cigna’s request
location) please inform us accordingly via the same email address. n Dependent children aged above 18 years and under 25 years provided
he/she:
The primary policy holder will be our first point of contact, and will receive n Remains unmarried
login instructions for Cigna Envoy which can also be used for our Mobile App. n Is a full-time student
n Is 100% financially dependent on the employee.
*
OoP = Out of Pocket: see section 6c.
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In order to prove that a child is a full-time student, a ‘Certificate of Attendance’ issued by the relevant school/university must
be presented to Cigna on an annual basis. You can upload your certificate directly to Cigna Envoy by selecting ‘My Account’
then ‘Evidence of Eligibility’. Coverage under IHCP will be provided only for the period stated in the ‘Certificate of Attendance’
but may be further extended to cover vacation periods in the case of known extended periods of study, after which a new
certificate will have to be submitted for the new educational year. For further information please refer to the FAQ document
held under ‘My Plans’ then ‘My Documents and Forms’ on Cigna Envoy.
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5. ELIGIBILITY FOR COVERAGE
5c. Commencement and Termination of Coverage n The Out of Pocket maximum i.e. the amount of cost sharing paid by the of coverage you require within 60 days of the date of your hire or transfer
Commencement of Coverage: participant before the plan reimburses at 100%. (as per SAP) for the coverage to be secured. If you do not make a choice
Coverage under IHCP commences the date the employee is transferred as during that timeframe, you will remain on ‘Essential – Employee Only’
International Commuter paid by International payroll and is effective from See section 6 for more details related to Cost Sharing. cover until the next Open Enrolment window. No exceptions will be made.
the date of transfer or hire recorded in the Schlumberger employee database If you choose to cover your family and/or to upgrade your cover you will pay
(SAP). 5e. Plan Cost and Optional Coverage Levels the contribution towards this cover via your monthly pay slip.
The Company pays 100% of the cost of participation in the ‘Essential – n I n the event of a change of your personal circumstances
Termination of Coverage: Employee Only’ cover for all IC employees. In case of a life event such as a marriage, birth or divorce, you can extend
Coverage under IHCP is terminated when: (and/or upgrade, for ICE Green or ICE White employees) your coverage to
n An employee is terminated from eligible status, and is effective from the The table below details the cost of employee participation for each of the include additional eligible family members (you do not have to wait until
date of termination recorded in the SLB employee database (SAP) other options: the annual Open Enrolment period). Following the event, you will first need
n An employee is transferred to a non-eligible employment status to request the update of SAP (Schlumberger HR database) by sending
i.e. not IC status the supporting documentation (such as a marriage or birth certificate) to
n An employee goes on Personal Project Leave or Educational Leave AskHR ([email protected]). Upon confirmation from AskHR, you will need to
provided the employee expressly requests to be removed from coverage. Essential Plan Extensive Plan log on to My Comp & Ben Employee web portal at https://mycompandben.
See ‘Useful Tip’ below. slb.com within 60 days of the date of the event. If you do not make any new
All ICs automatically $62 choice during that timeframe, then you will remain on your current choice of
5d. Levels of Coverage Employee Only enrolled. Company Company pays balance coverage until the next Open Enrolment window.
By default, all IC employees are covered under the ‘Essential – Employee pays 100% of premium of funding n During Annual ‘Open Enrolment’
*$31
Only’ cover. There is an option to remove your option coverage during the annual ‘Open
Married Enrolment’ period which runs every year during November and December:
$41 $103
ICE Blue employees can decide to extend IHCP to cover their eligible Company pays balance Company pays balance 1) Select a new option of coverage between ‘Employee only’, ‘Married’,
Employee &
dependents under one of three options: of funding of funding ‘Employee & Child(ren)’, ‘Family’.
Child(ren) *$20 *$51
n Married cover - extend Essential coverage to your spouse 2) For ICE Green or ICE White employees, move from ‘Essential’ coverage
n Employee & Child(ren) cover – extend Essential coverage to your eligible to ‘Extensive’ coverage, or from ‘Extensive’ coverage to ‘Essential’
child(ren) where there is no spouse covered
$51 $123 coverage.
Family Company pays balance Company pays balance
n Family cover – extend Essential coverage to all eligible dependents
of funding of funding
*$25 *$61 All IC employees are notified by email when the ‘window’ is open. Choices
ICE Green or ICE White employees can decide to extend IHCP to cover their should be made via the My Comp & Ben Employee web portal at
eligible dependents as described above, but they can also choose to upgrade *If employee’s annual base salary < $35k, their monthly premiums are https://mycompandben.slb.com.
from Essential cover to Extensive cover. reduced by 50%.
Once you change options, you cannot make any change within the next 24
There is no difference between those two levels in the overall plan limit or There are three opportunities for an IC employee to change coverage. months, unless this directly follows a life event.
the coverage for Preventive or Inpatient treatment. The differences between These are:
the cover options lie in the following: n During Initial Enrolment
n Reimbursable limits for Outpatient, Psychiatric, Dental and Vision When first joining IC status, please log on to My Comp & Ben Employee
categories web portal at https://mycompandben.slb.com. You should indicate the level
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6. SCOPE OF COVERAGE
IHCP provides medical cover for our International Commuter employees who are required to work in very diverse environments. It is vital that the plan permits fast access to high
quality treatment, therefore there are very few restrictions on where treatment can be taken.
6a. Geographical Scope Routine treatment, however, like many other health care plans, is reimbursed We have used the Out of Pocket limit for the Extensive Plan in the
Individuals or families where the employee and/or the spouse is a US with an element of employee cost sharing which is designed to encourage two examples below to demonstrate how the cost sharing and Out of
citizen or US Green Card holder are covered on a worldwide basis responsible use of medical treatment in terms of the nature, the frequency Pocket mechanism works for outpatient, dental and vision treatment:
(including the US). and the quantity of consumption. It is in these categories where you will a) A single employee pays US$400 for dental treatment; the plan will
see the difference between the Essential and Extensive plans. reimburse 80% of that cost of treatment i.e. US$320 and the employee
Individuals or families where the employee and/or the spouse is not will pay US$80 out of his pocket. All subsequent treatments in the
a US citizen or US Green Card holder are covered on a worldwide Cost sharing is represented as a % of reimbursement cost which is capped outpatient, dental and vision categories during that plan year will be
basis except for maternity, dental and vision treatment which will not be at an Out of Pocket (OoP) maximum detailed in the table below: reimbursed on the same basis until the OoP, the accumulation of the
covered in the US (unless in an emergency situation that requires immediate employee’s 20%, has reached US$650 which is when total individual
attention to prevent loss of life, sight or limb. Evidence will be needed claims reach US$3,250. The plan will then reimburse 100% of the cost of
ESSENTIAL COVER EXTENSIVE COVER
to substantiate such a claim and to demonstrate that treatment was not eligible treatment.
intentionally being sought in the US). Employee Only Cover US$800 US$650 b) A family of multiple claimants will share the OoP of US$800, paying 20%
Family Cover US$1,000 US$800 of the cost of treatment until the joint family spend is US$4,000, at which
6b. Currency of the Plan Married Cover US$1,000 US$800 point the plan will reimburse 100% of the cost of eligible treatment. If
The currency of the plan is US$. any individual family member reaches an OoP of US$650, the plan will
Employee & Child(ren) Cover US$1,000 US$800
reimburse at 100% for that individual, and the additional family members
6c. Employee Cost Sharing The OoP maximum applies to each plan year, running 1st January to 31st will continue to pay 20% of treatment cost until the family has reached its
The table below shows that the major, often unexpected and expensive December. The OoP limits apply across all eligible expenses within the plan combined OoP of US$800.
treatment is covered 100% by the Company in both the Essential and where cost sharing applies (see table bottom left) i.e. there is not a separate
Extensive plans. OoP for dental, vision and outpatient. The ‘Out of Pocket’ cap applies across all outpatient, dental and vision
categories so the maximum an individual will pay under the Extensive Plan,
assuming that UCR charges are applied, is US$650, and the maximum a
SCOPE OF REIMBURSEMENT
family would pay under the plan is US$800.
Employee Cost Sharing Company Funded
For the Essential Plan you can read the above examples applying the Out of
Prevention Nil 100% of UCR charges Pocket maximum of US$800 for Employee Only cover and US$1,000 for
Inpatient Treatment and Day Care Surgery Nil 100% of UCR charges Family cover.
T IP
Emergency Room Nil 100% of UCR charges UL
If an employee goes on Personal Project Leave or
U SE F
Emergency Repatriation Nil 100% of UCR charges
Educational Leave without amending an ‘IHCP Election
Treatment as a result of a work related accident/injury** Nil 100% of UCR charges Form’ to confirm coverage is no longer required, then
coverage under IHCP remains active at the employee’s
Outpatient Treatment, Dental Treatment, Vision Treatment 20% of UCR charges up to an OoP* 80% of UCR charges up to an OoP*
cost until the employee returns from Leave, or leaves
*
OoP = Out of Pocket: see section 6c. employment at which time the contributions are
**
Work related accidents, occupational or assignment related diseases must be supported by a Schlumberger Accident Report. deducted from the final payment.
11/28
7. BENEFITS COVERED BY THE PLAN (AND THOSE WHICH ARE NOT):
In all the following benefit tables the sub category limits are applied on a calendar year basis, 1st January to 31st December each year. Note that under each sub category there
are some exclusions, however, you must also read the General Exclusions in section 7g.
7a. PREVENTIVE CARE EXCLUSIONS FOR PREVENTIVE CARE
Please refer to General Exclusions (section 7g)
The benefits provided by the Essential Plan are identical to those provided by the Extensive Plan under this category
for additional guidance regarding coverage
Type of Service Plan Reimbursement Notes
Pre-employment check-ups
Covers MedTrack exam (below age 40) and MedTrack Plus exam (above age 40) every three
Anti aging treatment
years for employee and eligible dependents
100% of UCR charges for maximum of one
Health check-up*
check-up per year
To qualify all tests must be completed within 30 days of initial consultation. Blood Pressure T IP
test recommended every 2–3 years for adults
UL
U SE F
he Med
Please consult the MedTrack FAQs available on
100% of UCR charges with a limit of
Smoking prevention Treatment must be prescribed by a doctor the Schlumberger HealthHub
US$300 per calendar year per insured
For any condition that requires multiple sessions
Treatment should be prescribed by a doctor. See the main list of covered vaccinations as of treatment, the eligible number of sessions is
Vaccinations 100% of UCR charges to be agreed by the Cigna Medical Team
approved by Schlumberger HSE by clicking here
Malaria preventive and

100% of UCR charges Excludes curative malaria kit distributed by HSE
curative treatment
7b. MATERNITY TREATMENT

n Cigna should be notified of pregnancy as soon as it is known. See section 8c for detail of documentation required in order to pre-certify. Upon notifying Cigna, the Cigna Customer Services team can provide you with the
Maternity flyer, this document contains very important information regarding pregnancy and delivery
n Pre-certification for delivery is required at least 60 days before due date in order to allow Cigna to arrange direct payment to hospital/clinic/doctor
n In some clinics delivery costs are not Usual, Customary and Reasonable. Therefore, you are encouraged to notify Cigna as soon as you are aware of your pregnancy so you are clear about which charges the plan will accept
Type of Service Plan Reimbursement Geographical Scope Notes
Prenatal consultations Individuals or families where the employee and/or the spouse is a US Please make sure to notify Cigna in order to be reimbursed at 100% for costs in relation
100% of UCR charges citizen or US Green Card holder are covered for maternity treatment on to maternity. Until notification, you may have to contribute 20% to your maternity costs.
Childbirth (normal delivery or C-section) a worldwide basis (including the US)
Expenses relating to any form of contraception are excluded.
Individuals or families where the employee and/or the spouse is not a US

Post Natal consultations including 80% of UCR charges up to the citizen or US Green Card holder are covered on a worldwide basis
prescribed medication OoP** maximum except for maternity, dental and vision treatment which will not be
covered in the US
*A full list of the available Health check-ups can be found on https://slb001.sharepoint.com/sites/hse/health/Shared%20Documents/Contents%20of%20the%20Medical%20Examinations%20(Pre-employment,%20Standard%20Med-Track,%20Med-
Track%20Plus,%20Annual%20Health%20Check-up).pdf
**OoP = Out of Pocket: see section 6c.
12/28
7c. INPATIENT TREATMENT AND DAY CARE SURGERY EXCLUSIONS FOR INPATIENT
TREATMENT AND DAY
n Inpatient treatment is defined as treatment received in hospital which includes an overnight stay
CARE SURGERY
n Pre-certification is required for all Inpatient treatment and Day Care Surgery and should ideally be made 10 days before treatment commences Please refer to General Exclusions
n See section 8c for detail of documentation required in order to pre-certify (section 7g) for additional guidance regarding
coverage
Type of Service Plan Reimbursement
Ancillary inpatient services e.g. TV, phone,
Room and board for standard private or semi-private accommodation internet, extra bed, VIP rooms, newspapers etc
Parent accommodation, insured parent with an insured child under 12 years of age in hospital Any service or item provided in a medical
facility during inpatient stay, when it is part
Intensive Care and Coronary Care Facilities
of outpatient exclusions. e.g. nutritionist
Operating, delivery, recovery rooms and equipment consultation incurred during a hospital stay
Nursing fees, medical expenses and ancillary charges Stays in a cure centre, SPA centre, health
resort and recovery centre
Surgeons’, consultants’, anaesthetists’, doctors’ fees
Cosmetic surgery
Inpatient x-rays, pathology, diagnostic tests and procedures
Expenses for the acquisition of an organ
Prescribed medicines, drugs and dressings 100% of UCR charges including, but not limited to, donor search,
Day Care Surgery (requiring general anaesthetic and admission to the facility for investigation/operation/recovery) typing, harvesting, transport and administration
costs
Reconstructive surgery following an accident or following surgery for an eligible medical condition
Domestic services following surgery, such as
Prostheses, artificial body parts surgically implanted to form permanent parts of an insured person’s body home help
Chronic Medical Conditions, organ transplant surgery (see exclusions in the table to the right)
Cancer detection (screening when required for treatment) and treatment, including Chemotherapy & Radiotherapy
Accidents and Emergencies, Emergency Room
Ground ambulance transportation (locally)
Post-hospitalisation rehabilitation stay in a convalescent facility received within 30 days of being discharged from hospital (includes
100% of UCR charges up to 60 days per condition
registered nursing/home health services)
100% of UCR charges up to 30 days lifetime limit per

Psychiatric inpatient treatment
insured
13/28
7d. OUTPATIENT TREATMENT AND DAY CARE SURGERY EXCLUSIONS FOR
OUTPATIENT TREATMENT
nP re-certification is required for all treatment in excess of US$1,200 and should ideally be made 10 days before treatment commences
Please refer to General Exclusions
n See section 8c for detail of documentation required in order to pre-certify
(section 7g) for additional guidance regarding
Type of Service ESSENTIAL PLAN EXTENSIVE PLAN Notes coverage
Primary consultations including doctors’ fees
Over the counter medicines, purchased
Specialists’ and consultants’ fees for consultations without prescription, to treat minor short term
Medicines, including vitamins and minerals, must be conditions lasting less than 5 days; such as
Prescribed medicines, drugs and dressings medication for headaches, fever and pain, sore
prescribed
Diagnostic testing x-rays, pathology, diagnostic tests and procedures 80% of UCR charges up to 80% of UCR charges up to the throat lozenges, mouthwash, ear, nose drops
the OoP* maximum OoP* maximum and tear replacements are not reimbursed
MRI, PET and CT Scans (when it is not part of cancer detection or treatment)
Nutritional or dietary consultations and
Physical Therapy Requirements treatment that is established as being Cigna Medical team to advise on number of sessions,
supplements, including but not limited to special
medically necessary to treat an illness, injury, disease or its symptoms which is subject to condition
infant formula and cosmetic products, even
Medical appliances including hearing aids, artificial limbs, rental of
if medically recommended or prescribed or
wheelchair or crutches, wigs following chemotherapy, orthopaedic soles
acknowledged as having therapeutic effects
80% of UCR charges up to OoP*
maximum for Occupational, Parapharmaceutical items such as
Occupational therapy, Vision therapy, Speech therapy where linked to a Speech therapy & ABA therapy is covered up to the
Nil Vision & Speech therapies thermometers, sunblock creams, disinfectants,
medical problem and not a learning difficulty age of six
50% of UCR charges up to OoP*
soap, moisturising cream, shampoo, mosquito or
maximum for ABA therapy
insect repellent, nappies, feminine care products,
Day Care Surgery for non-surgical/minor-surgical procedures requiring local
anaesthetic and short recovery time (<3 hours)/no admission required
shaving cream, after shave
Fees charged by registered nurses, home health aide
Massage therapy
services or home health care agencies in accordance
Registered nursing with a home health care plan after eligible inpatient
80% of UCR charges up to 80% of UCR charges up to the treatment are covered by the plan, when provided by a Home nursing services: home help such as
the OoP* maximum OoP* maximum qualified nurse washing, dressing, feeding when not provided
Prosthetic appliances by a registered nurse
Ground ambulance transportation (locally) If prescribed
Limited to a total of 12 sessions per insured per year *
Acupuncture, osteopathy, chiropractic, psychology
across the whole category
50% of UCR charges with
80% of UCR charges with a
a cap of US$1,000 per Annual maximum includes prescribed
Psychiatric treatment and psychotherapy cap of US$3,200 per insured
insured up to the OoP* medicines and drugs
up to the OoP* maximum
maximum
Chemotherapy and radiotherapy 100% of UCR charges 100% of UCR charges
Please refer to the Dental section (7e) of this booklet for This benefit will be payable for treatment received
Emergency Dental Treatment information on the benefits that apply should you require during the emergency visit immediately after
emergency dental treatment accidental damage to natural teeth
14/28
7e. DENTAL TREATMENT EXCLUSIONS FOR
DENTAL TREATMENT
n Pre-certification is required for all treatment in excess of US$1,200 and should ideally be made 10 days before treatment commences
n See section 8c for details of documentation required in order to pre-certify
(section 7g) for additional guidance regarding
Type of Service Essential Plan Extensive Plan coverage
Geographical Scope
Total cap across all dental treatment: US$2,500 US$5,000 Aesthetic treatment including bleaching,
veneers, gum lift, bite reclamation,
Basic Dental Care: Individuals or families where the and other cosmetic services
Regular oral examinations, teeth cleaning, treatment for the employee and/or the spouse is a
immediate relief of dental pain, accidental damage to natural teeth US citizen or US Green Card Orthodontic treatment for employees and/or
and restoration of natural teeth including x-rays, fillings, extractions, 80% of UCR charges up to the OoP* 80% of UCR charges up to the OoP* holder are covered for dental spouses/partners
root-canal treatment, gum treatment, basic dental surgery, wisdom maximum maximum treatment on a worldwide
teeth extraction, Tempo Mandibular Joint, periodontology basis (including the US)
For children under age 16 only:
Fluoride applications, sealant and space maintainers Individuals or families where the
employee and/or the spouse is
Major Dental Care: 50% of UCR charges up to the OoP* 80% of UCR charges up to the OoP*
Dental crowns, bridges, dentures, implants and implant related maximum with cap of US$650 per tooth maximum with cap of US$1,100 per not a US citizen or US Green
surgery and US$1,500 per year per insured tooth and US$3,000 per year per insured Card holder are covered on a
worldwide basis except for
For children under age 19 only: 50% of UCR charges up to the OoP* 80% of UCR charges up to the OoP* maternity, dental and vision
Orthodontic treatment maximum with a lifetime maximum of maximum with a lifetime maximum of treatment which will not be
US$1,000 per child US$2,000 per child covered in the US
7f. VISION TREATMENT EXCLUSIONS FOR

VISION TREATMENT
Type of Service Essential Plan Extensive Plan Geographical Scope
80% of UCR charges up to the OoP* 80% of UCR charges up to the OoP* Individuals or families where the employee and/ (section 7g) for additional guidance regarding
Eye Tests/Ophthalmologists’ fees
maximum maximum or the spouse is a US citizen or US Green Card coverage
holder are covered for vision treatment on a
80% of UCR charges up to the OoP* 80% of UCR charges up to the OoP* worldwide basis (including the US) Sunglasses without prescription lenses
Eyeglasses (lenses and frame) or Contact maximum with cap of US$200 per year per maximum with cap of US$400 per year per
Lenses person. One pair of eyeglasses. Includes person. One pair of eyeglasses. Includes Insurance for glasses (frames and lenses)
Individuals or families where the employee and/or
safety glasses safety glasses the spouse is not a US citizen or US Green Card
holder are covered on a worldwide basis except
80% of UCR charges up to a lifetime for maternity, dental and vision treatment
Laser Surgery for vision correction Excluded from cover
maximum of US$1,000 per eye which will not be covered in the US
*
15/28
7g. GENERAL EXCLUSIONS
Type of Service Notes
All items already detailed throughout section 7 Refer to ’Exclusions’ tables under each sub category
Charges for services dated before or after eligibility for coverage under the plan See section 5: Eligibility for Coverage
Expenses covered by a government programme such as a Social Security, a local primary insurance,
or any other insurance plan
Treatment carried out by a Plastic Surgeon whether or not for medical/psychological purposes and any cosmetic Except reconstructive surgery necessary to restore function or appearance after a disfiguring accident, or as a result of surgery for
or aesthetic treatment to enhance appearance, even when medically prescribed cancer, if the accident or surgery occurs during your membership of the scheme. Treatment must be pre-approved
Care or treatment for intentionally caused diseases or self inflicted injuries
Treatment for obesity (except when the Body Mass Index is over 35) or treatment for weight loss
Infertility and Fertility Procedures, including but not limited to, contraception products and devices, tubal
ligation, vasectomy, sterilisation, IVF, sexual dysfunction. Expenses relating to any form of contraception are
excluded.
Termination of pregnancy, except where it is a therapeutic abortion due to underlying conditions related to
maternal health or fetal disease, whether based on medical advice, or in an emergency situation. 100% of UCR
charges will be reimbursed under these circumstances.
Circumcision Unless for medical reasons. Medical report will be requested and treatment needs to be pre-approved
Sex change operations and reversals, or any treatment needed to prepare for or recover from these operations
e.g. psychological counselling (including complications arising out of such treatment)
Treatment related to the delayed development of children such as speech therapy, or treatments such as
Speech therapy is only eligible for reimbursement in the context of a diagnosed physical impairment such as nasal obstruction,
conduct disorder, oppositional defiant disorder, antisocial behaviour, attachment disorders, adjustment disorder,
neurogenic impairment or articulation disorders involving the oral structure e.g. cleft palate; or if a medical report shows there is a
and treatments that encourage positive social-emotional relationships such as communication therapies, floor
medical condition, it can be covered up to the age of 6
time and family therapy
16/28
7g. GENERAL EXCLUSIONS

Treatment for any illnesses, diseases or injuries resulting from active participation in war, riots, civil disturbances, terrorism, criminal acts or acts against any
foreign hostility
Travel and accommodation costs other than for approved emergency or urgent evacuations
Custodial care means services and supplies including room and board which are
Care in a nursing home, custodial care or home for the elderly provided to an individual, whether disabled or not, primarily to assist in the activities
of daily living
Any form of treatment or products which are considered experimental or unproven, based on generally accepted medical practice
Alternative or Complementary treatment, with the exception of those listed in the benefit table Chinese medicine and Ayurvedic medicine are excluded from cover
Anything not ordered by a doctor or not medically necessary, as well as medical or dental services that are considered not meeting professional standards n anything which is not ordered by a doctor or is not medically necessary; such as
treatment not provided by an appropriate qualified and licensed practitioner
n any medical or dental services which are not considered orthodox
Charges for missed appointments or interest on late fees
Any treatment or amount which is not a Usual Customary and Reasonable expense
Genetic testing is excluded, these are tests for identification of hereditary diseases for members. Sequencing-Based Non-Invasive Prenatal Testing (NIPT) is included where
recommended by a treating physician i.e. in the event of a high-risk pregnancy or
for women aged 35 or over.
Cigna will not offer cover or pay benefit when it is illegal to do so under applicable laws. Examples include but are not limited to, exchange controls, local licensing,
regulations, trade embargo and anti-corruption
Costs or fees for filling in a claim form or other administration charges
International services expenses related to repatriation and evacuation for:

n non-emergency, routine or minor medical problems, tests and exams where there is no clear or significant risk of death or imminent serious injury or sickness
nm edical care or services scheduled for the patient’s or provider’s convenience which are not considered an emergency
Treatment directly related to surrogacy. Cigna will not pay maternity benefits to:
n an eligible female who acts as a surrogate
n a nyone else acting as a surrogate for an eligible female
The IHCP plan is not intended to be a source of profit. The combined reimbursement should not exceed the actual costs of the medical, dental and vision care received by you or your covered dependents.
17/28
8. PLAN ADMINISTRATION
The Schlumberger International Health Care Plan is insured and administered by Cigna.
Multilingual customer service advisors are available to assist you and your 8a. How do I know that I am enrolled in the plan? When calling your Cigna Customer Services team you will be given the
family members to better understand the benefits provided under the IHCP, to Cigna will contact you to confirm your enrolment in the plan, normally within following options:
handle pre-certification requests, to issue insurance certificates (e.g. required the first week of your SAP action/transfer. You will be sent a welcome pack n For ISOS, press 1
for visa purposes), to help you find medical providers, to manage the claims detailing your Cigna ID number and explaining how to connect to n For English, press 2
reimbursement process, and to answer any related questions you may have. www.CignaEnvoy.com. You will be required to log onto www.CignaEnvoy.com n For Arabic, press 3
and complete personal details, e.g. residence address, contact telephone n For Spanish, press 4
Cigna is committed to protecting your privacy and complies with the highest number, language preference and bank details for reimbursement of medical n For French, press 5
standards of data confidentiality and security. Cigna only shares your medical claims. These changes can be made by selecting the ‘My Account’ dropdown.
or personal information as set out in the Privacy Notice, available on Cigna will be happy to accept a reversed charge call or arrange a call back
www.CignaEnvoy.com. Electronic ID cards are available to download from the Cigna Envoy Mobile if required.
App (see section 8e). You can download a printable version of your ID cards
In the event of emergency repatriation or sensitive diagnosis, your medical from www.CignaEnvoy.com by selecting ‘My Account’ then ‘Access ID Cards’. Cigna’s office addresses are as follows:
or personal information may be shared between the Cigna Medical Team You can also request to receive a plastic ID card by clicking on the blue n Cigna Global Health Benefits Europe, Parque Empresarial La Finca, Paseo
and the Schlumberger Medical Advisers. Also, at Schlumberger’s instruction, ‘Access ID Cards’ box on the home page. del Club Deportivo 1, Edificio 14 Planta 1, 28223 Pozuelo de Alarcón,
Cigna may disclose your medical or personal information to the Schlumberger Madrid, Spain
Medical Advisors from time to time, for example, for purposes of case If you have not received a welcome pack within two weeks of the n Cigna Global Health Benefits Europe, 1 Knowe Road,
management, employee safety issues, or similar. commencement of your assignment (as per your SAP transfer date), please Greenock PA15 4RJ, Scotland
feel free to contact your Cigna Customer Service team. n Cigna Global Health Benefits, PO Box 15050, Wilmington,
DE 19850-5050 USA
8b. How to contact Cigna n Cigna, Suite 3B-15-3A Level 15 Block B, Plaza Sentral,
You can contact your Cigna Customer Service team by telephone, email or Jalan Stesen Sentral 5, 50470 Kuala Lumpur, Malaysia
through Cigna Envoy.
Please note, it is strongly recommended to use the Cigna secure website

(www.CignaEnvoy.com) when submitting queries containing confidential
medical information. Emails sent from your slb.com address to a cigna.com
address are secure.
+44-345-601-2239 or +1-800-841-7764 (toll free when calling from

within the U.S.). Cigna will be happy to accept a reversed charge call to
either number
[email protected]
www.CignaEnvoy.com
18/28
8c. HOW TO GET FAST REIMBURSEMENT
The table below shows some Tips & Tricks to help you to be reimbursed as quickly as possible and with no inconveniences along the way. By using these you can avoid us having to contact you for clarification before
Cigna can process your claims, and as a result reimburse you faster. The aim is to process claims within 5 business days of receipt, having the data mentioned below will ensure no additional delays occur.
Tips & Tricks
Input the reason for the medical claim in the Diagnosis/symptoms field so that your claim can be assessed. Examples of the information to be provided by you should be detailed such as
‘blood tests due to fatigue’, ‘severe and ongoing headache’, ‘routine dental checkup’ instead of a generic comment such as ‘doctors visit’ or ‘dentist appointment’
Ensure you have confirmed your preferred payment currency, payment method and complete bank account details
Please include readable official invoices. These should clearly state: the name of the patient, the treatment date, the breakdown of costs per type of treatment.
Always keep copies of invoices for your own records. Also include any other documents you may have justifying the medical expense (e.g. medical report, or prescription, breakdown of
treatment (i.e. x-rays, scan, laboratory test, physiotherapy) discharge summary for inpatient cases (hospital stays) as this may speed up the reimbursement process.
In the event of having paid upfront (pay and claim reimbursement) please provide proof of payments/ payment receipts.
The table on the next page provides a detailed overview of further supporting documentation that is required in function of the type of claim you submit.
Claims for different family members should be submitted under the name of each individual family member
Claims for each type of treatment (medical, dental, vision) should be submitted separately
When submitting claims online, only select Medtrack (Plus) if the claim is for a Medtrack (Plus) exam
Claims for major dental treatment should include the tooth number(s)
When you send your claims via email, the total attachment size should not exceed 3MB
19/28
8d. WHAT DOCUMENTATION DO I NEED TO PROVIDE TO PRE-CERTIFY/MAKE A CLAIM?

In order for Cigna to quickly and efficiently administer your claim you should ensure that you provide the necessary documentation. The table below details the supporting documentation or information required for the
different types of treatment, as well as indicating whether pre-certification is required:
Nature of treatment Pre-certification required Supporting documentation/information required for claim
n Medical documentation indicating the diagnosis and explanation of type of surgery or treatment recommended
Inpatient treatment n Name and contact details of treating doctor and facility in which treatment will take place
Yes
or Day Surgery n Date of service and type of room (if overnight stay included)
n Cost estimate for the treatment or surgery
n Name and contact details of treating doctor and facility in which delivery will take place
n E xpected due date and type of room
Maternity Yes n Cost estimate for the delivery including breakdown of services (where possible: In the case of a ‘maternity package’ you should note that charges must be itemised and they will be
paid at the end of the services, or at intervals. Cigna will not reimburse services before they are incurred)
n For delivery in the US, evidence of US nationality or a copy of a valid Green Card will be required, if the claimant is not a Schlumberger employee (for whom nationality is known)
n Invoice to include name of patient, date of service, name of treating doctor and medical facility
Consultations No
n For specialist consultations the specialisation of the doctor should be shown on the invoice/letterhead, Note: there is no requirement for a doctor’s referral
Diagnostic testing and n Invoice to include name of patient, date of service, name of treating doctor and medical facility, and type of test
Only if over US$1,200
medical imaging n For MRI, CAT scans etc over US$1,200, medical documentation from the doctor explaining why required
n Invoice to include name of patient, date of issue, name of prescribing doctor and name of medication
Prescriptions No
n Copy of the original prescription from a registered doctor must be provided
n Invoice to include name of patient, date of service, name of therapist and medical facility, type of therapist, number of sessions
Physical therapies Yes
n Medical referral is required. For ongoing/registered pre-existing medical cases and Alternative and Complementary Medicine, Cigna may require an up to date referral/prescription
n Detailed plan of treatment including how many teeth are being treated
n Cost estimate (itemised for each service)
Dental Only if over US$1,200 n Name of dentist, practice name and contact details
n In the case of major dental or treatment to single teeth, the tooth number is to be provided. Cigna may request an OPG (panoramic dental view of the mouth)
n For treatment in the US, evidence of US nationality or a copy of a valid Green Card will be required, if the claimant is not a Schlumberger employee (for whom nationality is known)
Eyeglasses and/or lenses:

Invoice to include name of patient, split of cost between frame/lenses and vision defect (alternatively prescription to be submitted)
Only if over US$1,200 for
Vision Laser Surgery:
Laser Treatment
Invoice to include name of patient and technique used
n For treatment in the US, evidence of US nationality or a copy of a valid Green Card will be required, if the claimant is not a Schlumberger employee (for whom nationality is known)
20/28
8e. Claims Processing How do I get reimbursed?
1 2 3 Tips to speed up the claims process

n Ensure all documentation as described in section 8c is provided
n State how and where you want the reimbursement issued
n For electronic bank transfer, full details must be provided, including bank
name and address, account name, account/IBAN number and sort/routing/
Online claims submission Fast Track - Submit via Mobile Receive your BIC/SWIFT code. For cheque reimbursement please provide address
App or Website reimbursement details.
Collect the required documents, please refer to Scan or take a photo of all required documents You can view claims that have been Schlumberger employees, as the main insured under the policy, will have
section 8d for all of the documents needed for as per 8d and submit via www.cignaenvoy.com submitted online (in the ‘Manage My Claims’ administrative access to personal data held on all family members covered
the claim submission. or onto the Envoy mobille app. section at www.CignaEnvoy.com or via the under the plan. In the event of a claim, this will include some limited sensitive
When you are a registered user of Mobile App) and track progress. Payment is personal data.
www.CignaEnvoy.com you can submit claims Or send by email: usually made within five days. Once payment
T IP
through the secure web portal in an easy to 1. Complete a claims reimbursement form for has been made a copy of your settlement UL
U SE F
follow process. Just click the ‘Manage My each patient (available to download on www. letter will be added to the ‘Manage My
Claims’ section. cignaenvoy.com) Claims’ section of Cigna Envoy.
2. Scan the claims reimbursement form and the One of the common reasons participants have a
required documents reduced reimbursement is due to the application
3. Email the scanned documents to of the cost sharing. This is often confused with an
[email protected] exchange rate conversion. It is also important to
note that the Out of Pocket does not include the
If you are an international employee on assignment in a sanctioned country, Cigna is able to support your customer service needs including access to following items: reduced reimbursement due to sub
their online services through Cigna Envoy or via the Envoy App. Eligible treatment taken in an OFAC sanctioned country should be paid in advance by you and will category limits i.e. dental cap per tooth, charges
be reimbursed by Cigna to your bank account outside the country of treatment. in excess of UCR and expenses not covered by the
Sanctioned country nationals ordinarily resident in another sanctioned country or residing in another country which is not sanctioned can only be covered plan. Therefore, it is important you understand
for emergency or urgent care incurred in their country of origin, if they returned for a short visit for business or personal reasons (Cigna Customer Services will the items where cost sharing is applied i.e. on
request details regarding the length and purpose of the visit to the home country; additional documentation covering the treatment may also be requested to outpatient, dental and vision care, the sub category
determine whether it was urgent or emergent). Claims cannot be reimbursed into a bank account in the sanctioned country or directly to a provider in the said limits and why UCR is important before you contact
country, nor in the currency of the sanctioned country. Elective medical treatment (treatment arranged in advance and which is not critical in nature), cannot be Cigna to query your reimbursement.
reimbursed.
Trailing dependents (i.e. dependents of a sanctioned country national remaining permanent residents of the sanctioned country) are not eligible for cover. If you
or your family members return to the sanctioned country for an extended stay (i.e. several months) other than for a holiday or business trip you will be considered
ordinarily resident in the sanctioned country and no longer eligible for coverage under the plan.
Cigna will communicate with their partners, including Schlumberger, in situations where there may be inpatient or expensive treatment required.
21/28
Below are some common questions you may have about the claims process: If I send a claim based on a currency that is not the same as The general rule is that one plan pays first and the second plan pays the
the currency of my bank account, what exchange rate is used? remaining eligible expenses up to the limits in the second plan. Make your
What is the deadline for sending my expenses? The exchange rate used to determine your reimbursement is the Cigna agreed claim to the primary plan, then provide Cigna with supporting documents for
Please ensure you submit your claim as soon as reasonably practicable exchange rate (based on the daily rate provided by Citibank to Cigna). The the remaining eligible expenses.
following the start of treatment, and no later than 12 months from the start exchange rate used will be shown on your settlement letter.
of treatment. Prompt filing results in faster payment of your claims. Claims If you have the possibility of using the benefits provided by your country’s
received more than 12 months after the start of treatment will not be paid. I do not understand the reimbursement that I received/I disagree with social security plan, you are encouraged to use this as your first source of
the reimbursement. Who should I contact? cover (whenever possible and where treatment is of acceptable quality).
What currency will my claim be reimbursed in? Go to www.CignaEnvoy.com and select option ‘Contact Us’. Alternatively you This will help preserve the future of the IHCP.
Payment will be made to you in the currency of your choice. However, you can contact your dedicated Schlumberger Customer Service team by calling
will automatically be reimbursed in US dollars, unless you specifically instruct +44-345-601-2239 or +1-800-841-7764 (toll free when calling from within the What do I do if I have expenses for which a third party may be liable?
Cigna that reimbursements should be made in another currency. If you wish to U.S.). Cigna will be happy to accept a reversed charge call to either number. You and your dependents must tell Cigna in writing as soon as possible
change your currency of payment you can do so by logging on to You can also reach us at [email protected]. about any claim or right of legal action against any other insurance, person
www.CignaEnvoy.com. or source, that arises from a claim under this plan. You must keep Cigna fully
My dependents benefit from coverage of another plan. informed of any developments.
Who pays the bank charges as a result of the claim reimbursement? What should I do?
Cigna bears the cost of bank to bank transfers but cannot be held responsible If you, or your eligible dependents, are covered by a Government program or Providing your claim is eligible for cover within the terms and conditions and
for bank fees applicable in your country or related to your type of account. local social security plan or another group health care plan (e.g.your partner’s benefit limits of this policy, the recovery by Cigna of claims costs from a third
employer’s health care plan, divorced parent plan covering your dependent party will not delay or prevent the payment of your claim by Cigna. Cigna will
For security of payment and quicker reimbursements purposes it is children, educational institution, professional association, etc.), the benefits not pay for the proportion of any treatment which is over the benefit limits in
recommended that you provide your bank details to Cigna and avoid of both plans will be coordinated so that the combined payments do not the list of benefits.
requesting reimbursement by cheque. exceed the actual covered expenses.
22/28
8f. Online services available from Cigna’s web portal Mobile App 8g. How to make a complaint
After the initial registration, you will be able to access Cigna Envoy via Cigna Envoy is available while you’re ‘on the go’ via our Mobile App which If you have any cause for complaint, or wish to highlight any concerns, please
single sign on if within the Schlumberger firewall (SINet). Accessing Envoy can be downloaded from the Apple App store, Google Play Store (not within contact Cigna in the first instance:
directly from the Hub after the initial registration removes the need for you to mainland China), Amazon App Store or BlackBerry World (not within France).
remember your Cigna Envoy login details. Just search for “Cigna Envoy”. You will need to use your Cigna user name and In writing: Cigna Global Health Benefits Europe, 1 Knowe Road,
password when using our Mobile App. Greenock PA15 4RJ, Scotland
See section 1 for login procedure. By phone: +44-345-601-2239 or +1-800-841-7764 (toll free when calling from
From the Mobile App you are able to: within the U.S.). Cigna will be happy to accept a reversed charge
There is a wide range of information available to you on these web pages, n Download your electronic Cigna member (ID) card call to either number
including: n Contact your Cigna Customer Service team By email: [email protected]
n Pre-certification request n Submit a claim (available on iOS and Android) or check the status of
n Certificate of coverage a claim The dedicated complaints handling staff at Cigna will acknowledge receipt
n Printable ID card (Electronic ID cards are available on the Mobile App) n Search for a medical facility within the Cigna network, using GPS of complaints within 24 hours of their being received and aim to resolve all
n Policy documentation: your benefits and exclusions, what you and your functionality. complaints fairly and consistently, within 5 working days. You can request to
family members are covered for speak to a supervisor at any time if you are not satisfied with the service or
n Claims submission features* answer you receive from your Cigna Customer Services Team.
n Country guides allowing you to access practical travel information, such as
cultural, health and safety, travel tips, visitor and currency information for
over 190 countries
n Tap into health care resources including medical phrase translation,
medical terms translation, managing a condition (e.g. asthma, diabetes
and heart problems) and a health library with articles on various health
conditions, medical tests, medications and more
n Contact your Cigna Customer Service team*
n Claims tracking: you and your dependents’ full claims history*
n Global provider search: allowing you to find an appropriate medical
provider in your location*.
* Available on the Mobile App Complaint resolution dispute

If you are unhappy with the final decision reached, or the investigation has not been completed
within 8 weeks you may refer the matter to the Ombudsman des Assurances either email:
[email protected] or telephone: + 32 2547 5871.
Their decision is binding on Cigna but you may reject it without affecting your legal rights.
23/28
9. SERVICES PROVIDED BY INTERNATIONAL SOS
Schlumberger has partnered with International SOS to provide the following services
to all international employees and their eligible dependents:
n International Medical Evacuation: Full details in section 10
(approval required).
Additionally the services listed below are directly accessible by IHCP participants:
n Malaria Hotline
(https://slb001.sharepoint.com/sites/hse/health/SitePages/Malaria%20Prevention.aspx)
n Medical advice in critical or emergency situations (where you consider
that immediate medical advice is necessary) - assistance available in 90
different languages, with direct access to a doctor
n Dispatch of medication and medical supplies (if not available in your country
of assignment/visit)
n Medical online information (subscription to medical alerts, access to
International SOS Medical Country Guides and access to International SOS
“Membership App” on Smartphones)
n Access to International SOS clinics (however, these are subject to local Terms
and Conditions for each clinic - check with GeoMarket HSE Manager).
The International SOS contact details and Schlumberger Contract number are
detailed in section 10.
International SOS web:

https://www.internationalsos.com/MasterPortal/default.aspx?membnum=15ACMA000032
24/28
10. INTERNATIONAL EMERGENCY MEDICAL EVACUATIONS
All participants of the International Health Care Plan have 24 hour, 7 day a week coverage in the event that an emergency evacuation is required.
International SOS will work in conjunction with and share information with Cigna, where required.
10a. Definition
An international emergency medical evacuation is the transfer of an individual SERVICES COVERED EXCLUSIONS FOR EMERGENCY REPATRIATION
suffering from a life threatening medical case, generally by airplane from one Please refer to General Exclusions (section 7g) for additional
geographical location to another, in order to obtain adapted and/or better guidance regarding coverage
quality medical or surgical care and save the patient’s life. Medical evacuation and repatriation
Any condition or situation which can be treated safely and
Dispatch of specialised doctor effectively in the location it occurs
International medical evacuations require the assistance of a specialised The following services
Supervision of local treatment require prior approval by a Rescue expenses for certain activities which occur during vacation:
medical evacuation company. Schlumberger has contracted with International
Schlumberger Manager and for instance, mountain climbing, ski-ing accident emergencies,
SOS to provide worldwide coverage. Guarantee of Payment for emergency treatment
Schlumberger Medical Doctor dangerous sports. You are advised to take out personal insurance
Transportation costs to return minor children home for these activities
The cost of international medical evacuations that have been approved
by the Schlumberger International Health Coordinator or his deputy will be Repatriation of mortal remains Evacuation in the event of transport or carrier failure, or an
covered by the IHCP with payment made by Cigna. automobile breakdown. You should take out specific local insurance
Dispatch of essential medicine not available locally to cover these risks
No prior approval is required
Referral to medical correspondents abroad Repatriation will not be provided to a pregnant lady after six
for these services
Note: Transportation for non-urgent, non-life threatening emergencies will months of pregnancy (local treatment will need to be found)
Long distance medical advice
not be covered by the IHCP and the cost of travel and other non-health related
expenses (hotels, meals, taxis, etc.) shall be the responsibility of the employee.
Evacuation required
SLB Medical Doctor contacts

International SOS to initiate
evacuation
Member requires assistance Member contacts authorised Member or SLB Manager

with emergency situation manager as listed on the Hub calls SLB Medical Doctor for Evacuation not required
assistance and case review
SLB Medical Doctor provides
member or SLB Manager with
assistance and guidance
25/28
10. INTERNATIONAL EMERGENCY MEDICAL EVACUATIONS
10b. Procedure
Schlumberger international emergency medical evacuations must be International SOS will be responsible for gathering the information contained in
initiated and authorised by one of the Authorised Managers, as listed on the Medical Emergency Response Plan (MERP) Evacuation Form filled out by the
the Hub: https://slb001.sharepoint.com/sites/hse/health/SitePages/SLB%20 examining doctor, available on the Hub: https://slb001.sharepoint.com/sites/hse/
International%20Emergency%20Medical%20Evacuations.aspx and approved by health/SitePages/Home.aspx. Having this information ready before contacting
either the Schlumberger International Health Coordinator or his Deputy. International SOS or the Schlumberger International Health Coordinator will
accelerate the process.
Only in the event that you are not able to contact one of the Authorised
Managers for your location should you contact International SOS directly, via
one of their 24/7 dedicated Schlumberger hotlines.
International SOS contract number for Schlumberger employees is: 15ACMA000032
IF YOU ARE CALLING FROM: YOU SHOULD CALL:

EUROPE, AFRICA or MIDDLE EAST
International SOS Paris: +33 1 5563 3397
(Except for India and Pakistan)
CENTRAL or SOUTH AMERICA International SOS Philadelphia: +1 215 942 5458
MEXICO or ANY LOCATION IN THE CARIBBEAN International SOS Philadelphia: +1 215 942 5458
Call local emergency telephone number: 911 or if you need assistance call:
NORTH AMERICA
International SOS Philadelphia: +1 215 942 5458
CIS
International SOS, Moscow: +7 495 937 6491
(Sakhalin included)
ASIA
International SOS Singapore: +65 6336 9517
(India, Pakistan and Australia included)
T IP
UL
U SE F
Medical emergencies should be managed locally. Local ambulance, hospital, fire or police departments should be used to
assess and treat injured and sick people on a Schlumberger worksite.
26/28
11. FUTURE OF THE PLAN
It is Schlumberger’s aim to continue to provide a highly competitive health care plan and the company recognises that the peace of mind this brings for our expatriate employees
is very well appreciated. Being able to have very quick access to treatment, with the freedom of choice of facilities as well as no cost sharing for the inpatient, prevention,
emergency repatriation and ambulance services is of significant value.
The nature and scope of benefits provided under the plan in the future will be
highly dependent on the responsible usage of the plan by all participants. The
benefits provided will evolve in line with market positioning and affordability
with changes to benefit limits, treatment covered and employee cost
participation being reviewed on an annual basis.
27/28
Cigna Global Health Benefits Europe Cigna Global Health Benefits Europe Cigna Global Health Benefits Cigna
Parque Empresarial La Finca 1 Knowe Road PO Box 15050 Suite 3B-15-3A Level 15 Block B
Paseo del Club Deportivo 1 Greenock PA15 4RJ Wilmington Plaza Sentral
Edificio 14 Planta 1 Scotland DE 19850-5050 USA Jalan Stesen Sentral 5
28223 Pozuelo de Alarcón 50470 Kuala Lumpur
Madrid Malaysia
Spain
www.CignaEnvoy.com
Telephone number +44-345-601-2239 or +1-800-841-7764 (toll free when calling from within the U.S.)
Cigna will be happy to accept a reversed charge call to either number
“Cigna” is a registered service mark, the “Tree of Life” logo, “GO YOU” and “Cigna Global Health Benefits” are service marks of Cigna Intellectual Property, Inc., licensed for use by Cigna Corporation and its operating subsidiaries. All products and
services are provided by or through such operating subsidiaries including Cigna Life Insurance Company of Europe S.A.-N.V. registered in Belgium, with registered address at Avenue de Cortenbergh 52, 1000 Brussels, Belgium. Details about the
extent of our regulation are available from us on request. Privileged confidential property of Cigna. © Copyright 2019 Cigna.
28/28

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THE SCHLUMBERGER

Version Date: January 2020

5. ELIGIBILITY FOR COVERAGE 9. SERVICES PROVIDED BY INTERNATIONAL SOS

11. FUTURE OF THE PLAN

One Dedicated Schlumberger Customer Services Team

Global Contact Numbers

Primary Schlumberger Operational Locations -

* Also available on the Mobile App

4a. Pre-Assignment Assistance Assessment 4c. Employee Responsibility

5a. Eligible Schlumberger Employees 5b. Eligible Family Members

Malaria preventive and

7b. MATERNITY TREATMENT

Individuals or families where the employee and/or the spouse is not a US

Accidents and Emergencies, Emergency Room

Ground ambulance transportation (locally)

100% of UCR charges up to 30 days lifetime limit per

7f. VISION TREATMENT EXCLUSIONS FOR

Care or treatment for intentionally caused diseases or self inflicted injuries

7g. GENERAL EXCLUSIONS

Charges for missed appointments or interest on late fees

Costs or fees for filling in a claim form or other administration charges

International services expenses related to repatriation and evacuation for:

Please note, it is strongly recommended to use the Cigna secure website

+44-345-601-2239 or +1-800-841-7764 (toll free when calling from

8d. WHAT DOCUMENTATION DO I NEED TO PROVIDE TO PRE-CERTIFY/MAKE A CLAIM?

Eyeglasses and/or lenses:

1 2 3 Tips to speed up the claims process

* Available on the Mobile App Complaint resolution dispute

International SOS web:

SLB Medical Doctor contacts

Member requires assistance Member contacts authorised Member or SLB Manager

International SOS contract number for Schlumberger employees is: 15ACMA000032

IF YOU ARE CALLING FROM: YOU SHOULD CALL:

CENTRAL or SOUTH AMERICA International SOS Philadelphia: +1 215 942 5458

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