2021 2022 EMPLOYEE BENEFITS SUMMARY - Inside you will find information about our: Suwanee, GA
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2021 - 2022 EMPLOYEE BENEFITS SUMMARY
Inside you will find information about our:
Benefits Eligibility • Benefits Enrollment • Wellness Program
• Medical Benefits • Dental Benefits • Disability Benefits • Life Benefits
For the plan year: July 1, 2021 through June 30, 2022
This booklet provides a summary of plan highlights. Please consult the carrier’s contract for complete information on
covered charges, limitations, and exclusions. This is not a binding contract. The carrier’s contract will prevail. If you have
further questions please contact the carrier or Relation Insurance Services.
WELCOME
Dear City of Suwanee Employees,
Our success is only possible with the dedication and skills of a winning team. At the city of Suwanee, we
value the contribution of our employees to our ongoing success. We are also committed to attracting
and retaining high-quality employees that understand and support our vision and goals. In a continuing
effort to provide high-quality and cost-effective benefit programs, we annually review all of our benefit
plans.
It is important that you have access to a choice in medical plan selection so you can balance your own
financial goals with your healthcare needs. We are pleased to inform you that although healthcare costs
continue to rise annually, we were able to work with Cigna to agree to hold the rates for medical and
dental for another year!
As such, we intend to renew our medical and dental insurance with our current provider, Cigna. We will
again be offering two plan options: HMO and HDHP with a Health Savings Account (HSA). As in the past,
the city of Suwanee will continue to fund most of the cost of the health insurance premium. You will not
see an increase to your paycheck for the new plan year starting July 1st 2021.
In addition to a traditional HMO plan, the city will again offer the HDHP/HSA option. This plan works a
little differently than traditional plans and is designed to give employees greater control over their costs
while still providing access to large networks and free preventive care. Additionally, the plan’s
associated HSA serves as a savings vehicle allowing you to accumulate funds to be used for health needs
in the future.
Your ancillary benefits, disability and life insurance, will remain with Mutual of Omaha with the same
benefit package. Vision insurance will remain with VSP.
At city of Suwanee, we believe that by leading healthier lifestyles our employees can live longer,
happier, and more productive lives. The city is committed along with our carriers to provide you the
tools you need to get the most “mileage” out of your plans. You should closely review this booklet to
determine the options that are right for you.
Thank you for all of your hard work and dedication.
________________
Marvin Allen
City Manager
Contents
Benefit Focus������������������������������������������������������������������������������������������������1 Basic Life������������������������������������������������������������������������������������������������������20
Benefit Enrollment ��������������������������������������������������������������������������������������2 Disability Insurance & EAP ������������������������������������������������������������������������21
Benefit Changes��������������������������������������������������������������������������������������������3 Definitions & Rates ������������������������������������������������������������������������������������22
Medical���������������������������������������������������������������������������������������������������� 4-16 Notices�������������������������������������������������������������������������������������������������� 23-25
Dental���������������������������������������������������������������������������������������������������� 17-18 Important Contacts����������������������������������������������������������������������Back cover
Vision ����������������������������������������������������������������������������������������������������������19
BENEFIT FOCUS
Our Benefit Goals
We evaluate our benefits programs each year
to make sure that we accomplish several goals.
Your Benefits are Paid for
We strive to: with Pre-Tax Dollars
• Provide employees with affordable access to health benefits
• Provide competitive benefits programs Every penny in your paycheck counts.
• Promote health and wellness among City of Suwanee To help you stretch your income, we established a
employees and their dependents Cafeteria Plan or Flexible Benefit Plan that allows you
• Provide resources to support employees and their to pay for your benefits using pre-tax money.
dependents as they make important decisions about their What Does a Cafeteria Plan Mean to Me?
health and health care
• • • • •
You save at least 15% in Federal Tax
Important Benefit • • • • •
You save 7.65% in FICA Tax
Plan Reminders • • • • •
You save 6% in Georgia State Tax
• • • • •
As you enroll in your benefits, remember: More flexibility— you have a menu of benefit
alternatives and levels and can choose
• Lifetime limits have been eliminated on all medical plans the right options for you
• Dependents can remain on the medical plan up to age 26
without maintaining student status, even if they are married
— 1 —
BENEFIT ENROLLMENT
Benefit Eligibility
Full-time employees are eligible for benefits on the first day of the month following 30 days of service.
Spouses and dependent children of the employee are also eligible to participate in the City of Suwanee’s benefit plans. Dependent
children include natural children, legally adopted children, stepchildren, and children for whom the employee has been appointed
guardian.
You can also enroll the following dependents in our group benefits plan:
• Your legal spouse, either same sex or opposite sex
• Children under age 26
• Unmarried children of any age if totally disabled and claimed as a dependent on your federal income tax return
(documentation of disability status must be provided)
Many employees have other dependents living with them who are not eligible for our benefit plan.
Dependents not eligible to be added to your benefit plans:
• Grandchildren, nieces, nephews or other children that do not meet specifications listed above
• Common law spouses or domestic partners (same or opposite sex)
• Ex-spouses, unless required via court order (documentation required)
• Parents, step-parents, grandparents, aunts, uncles, or other relatives that are not qualified legal dependents
(even if they live in your house)
How to use Employee Navigator
We will once again offer online enrollment during Open Enrollment through
Employee Navigator, a web-based tool that allows you to make your benefit
elections online. It is available 24 hours a day, 7 days a week, throughout the year.
1. Go to https://www.employeenavigator.com/benefits/Login/Registration.aspx
2. Register as a new user or go to step 5 if you are a current user.
3. Fill out your personal information and click ‘Next’
(Company Identifier: COSU)
4. Create a User Name and Password. Then check the
‘I agree to terms and conditions’ before you click ‘Finish’
5. Click ‘Login’ and then enter your User Name and Password.
6. Start your enrollment by clicking the orange ‘Start’ button on the home page.
7. Hit the submit button to complete the enrollment and then close the window.
— 2 —
BENEFIT CHANGES
Making Changes to Your Benefits
Most benefit deductions are withheld from your paycheck on a pre-tax basis (medical, dental, and vision) and
therefore your ability to make changes to these benefits is restricted by the IRS.
Open Enrollment elections are effective July 1, 2021 and stay in effect until June 30, 2022 unless you experience a Life Status Change.
To be eligible to make benefit changes because of a Life Status Change, you must notify Human Resources within 30 days of the date of
the qualifying event. Proof of your life event may also be required. Changes outside of the 30-day period are not allowed until the next
annual Open Enrollment period, unless you experience another qualified Life Status Change.
The Most Common Life Status Changes
• Marriage, divorce, legal separation
• Birth or adoption
• Receipt of a Qualified Medical Child Support Order or other court order
• Change in eligibility for you or a dependent for Medicaid or Medicare
• Change in your or your spouse’s work status that affects your benefits or an eligible dependent’s benefits
• Change in health coverage due to your spouse’s annual Open Enrollment period
To make benefit changes as a result of a Life Status Change, as allowed under Section 125 of the IRS Code
• Notify Human Resources within 30 days of the date of the qualifying event
• Provide proof of your life status event
— 3 —
MEDICAL
CIGNA
Open Access HMO (In-Network Benefits Only)
Network Name: Cigna Open Access HMO In Network
Calendar Year Deductible
$1,500 individual
Carryover Deductible provision included but does not credit the out-of-pocket amount. Benefits for an
$4,500 family
individual within a family are paid once the individual deductible has been met.
Out of Pocket Maximum (Includes deductible, coinsurance, medical and Rx copays) $3,500 individual
$7,000 family
Most Commonly Used Benefits In Network Member Costs
Office Visits: Preventive Care
Well Child and Immunizations Plan pays 100% no copay, no deductible
Periodic Health Examination (mammogram, routine prostate, annual gynecology exam) Plan pays 100% no copay, no deductible
Office Visits: Illness or Injury
Primary Care Physician (includes lab, x-rays, and diagnostics) $40 copay
Specialist $60 copay
Virtual Care Visit $40 copay
Urgent Care (All services including Lab & X-ray) $75 copay
Emergency Room Care All services rendered apply to ER benefit including Lab & X-ray $250 copay
Ambulance Plan pays 90% after deductible
Office Surgery (Office visit copay applies even if no office visit charges are incurred) Plan pays 100% after office visit copay
Lab and X-ray Plan pays 90% after deductible
Independent Lab and X-ray paid based on status of the facility
Advanced radiology imaging services includes MRI, MRA, PET, CT-Scan, and Nuclear medicine
Durable Medical Equipment (Included external prosthetic appliances) Plan pays 90% after deductible
Inpatient Services (Requires precertification) Plan pays 90% after deductible
Including anesthesia
Inpatient Lab & X-ray services are subject to the professional service reimbursement
Outpatient Services (Requires precertification) Plan pays 90% after deductible
Outpatient surgery
Including anesthesia
Ambulatory Surgery
Lab & X-ray paid based on facility network status
Therapy Services
Outpatient physical therapy (20 visits) $60 copay
Outpatient speech, hearing and occupational therapy (20 visits) $60 copay
Chiropractic services (20 visits) $60 copay
Other Services
Skilled Nursing Facility (requires precertification) (60 visits) Plan pays 90% after deductible
Home Health Care (60 visits) Plan pays 90% after deductible
Hospice Care (requires precertification) Plan pays 90% after deductible
Behavioral Health/Substance Abuse
Inpatient (requires precertification) Plan pays 90% after deductible
Professional Outpatient Services $60 copay
Hearing Aids 2 (one per ear) devices & $3,000 maximum per 6 months through the age of 18
Prescription Drug (deductible and out-of-pocket maximums are integrated with medical)
Tier 1: Retail 30-day and 90-day prescription $15 copay / $45 copay
Tier 2: Retail 30-day and 90-day prescription $30 copay / $90 copay
Tier 3: Retail 30-day and 90-day prescription $60 copay / $180 copay
Mail Order/Home Delivery (up to 90-day prescription) 25% to a maximum of $300
If a Brand name drug is requested when there is a Generic equivalent, member must purchase the Generic drug, or pay 100% of the difference between the Brand name price and the Generic
price, plus the appropriate brand-name copay (unless the physician indicates “Dispense As Written” DAW), Includes contraceptives, Cigna National Pharmacy Network. You can choose to
fill your medications in a 30 or 90 day supply at any network pharmacy, Specialty medications are limited to a 30 day supply, Specialty Drugs provided at Home Delivery at the Retail cost
share. CVS, Kroger and Walmart have the best discounts.
This summary should not be considered a full explanation of benefits, see certificate for exact coverage and exclusions.
— 4 —
MEDICAL
CIGNA
High Deductible Health Plan (HDHP) w/ HSA
Employer Annual Contribution
Annual Employer HSA Contribution Employee: $750 Employee + Child(ren): $1,250
Deposited directly into employees established Employee + Spouse: $1,250 Family: $1,750
HSA account to assist with health care expenses
Network Name: Cigna Open Access Plus In Network Out of Network
Calendar Year Deductible $2,800 individual $5,200 individual
In-network and out-of-network expenses do not cross accumulate. Benefits for an individual $5,200 family $10,400 family
within a family are paid once the individual deductible has been met.
Out of Pocket Maximum $3,500 individual $10,500 individual
(includes deductible, coinsurance, medical and Rx copays) $7,000 family $21,000 family
Most Commonly Used Benefits In Network Member Costs Out of Network Member Costs
Office Visits: Preventive Care Plan pays 100% no copays, no deductible Plan pays 70% after deductible
Office Visits: Illness or Injury
Primary Care Physician / Specialist Plan pays 90% after deductible Plan pays 70% after deductible
Virtual Care Visit $59 copay N/A
Urgent Care (All services including Lab & X-ray) Plan pays 90% after deductible Plan pays 90% after deductible
Emergency Room Care All services rendered apply to ER benefit including Lab & X-ray Plan pays 90% after deductible Plan pays 90% after deductible
Ambulance Plan pays 90% after deductible Plan pays 90% after deductible
Office Surgery (Office visit copay applies even if no office visit charges are incurred) Plan pays 90% after deductible Plan pays 70% after deductible
Lab and X-ray Plan pays 90% after deductible Plan pays 70% after deductible
Independent Lab and X-ray paid based on status of the facility
Advanced radiology imaging services includes MRI, MRA, PET, CT-Scan, and Nuclear
medicine
Durable Medical Equipment (Included external prosthetic appliances) Plan pays 90% after deductible Plan pays 70% after deductible
Inpatient Services (Requires precertification) Plan pays 90% after deductible Plan pays 70% after deductible
Outpatient Services (Requires precertification) Plan pays 90% after deductible Plan pays 70% after deductible
Therapy Services
Outpatient physical therapy (20 visits) Plan pays 90% after deductible Plan pays 70% after deductible
Outpatient speech, hearing and occupational therapy (20 visits) Plan pays 90% after deductible Plan pays 70% after deductible
Chiropractic services (20 visits) Plan pays 90% after deductible Plan pays 70% after deductible
Other Services
Skilled Nursing Facility (requires precertification) (30 visits) Plan pays 90% after deductible Plan pays 70% after deductible
Home Health Care (120 visits) Plan pays 90% after deductible Plan pays 70% after deductible
Hospice Care (requires precertification) Plan pays 90% after deductible Plan pays 70% after deductible
Behavioral Health/Substance Abuse
Inpatient (requires precertification) Plan pays 90% after deductible Plan pays 70% after deductible
Professional Outpatient Services Plan pays 90% after deductible Plan pays 70% after deductible
Hearing Aids 2 (one per ear) devices & $3,000 maximum for 36 months through the age of 18
Prescription Drug (deductible and out-of-pocket maximums are integrated with medical)
Tier 1: Retail 30-day and 90-day prescription $15 copay / $45 copay $15 copay / $45 copay
Tier 2: Retail 30-day and 90-day prescription $35 copay / $90 copay $35 copay / $90 copay
Tier 3: Retail 30-day and 90-day prescription $60 copay / $180 copay $60 copay / $180 copay
Mail Order/Home Delivery (up to 90-day prescription) 2.5x copay ($38/$75/$150) 2.5x copay ($38/$75/$150)
Once the medical deductible is met, then the member is responsible for the copay.
If a Brand name drug is requested when there is a Generic equivalent, member must purchase the Generic drug, or pay 100% of the difference between the Brand name price and the Generic
price, plus the appropriate brand-name copay (unless the physician indicates “Dispense As Written” DAW), Includes contraceptives, Cigna National Pharmacy Network. You can choose to
fill your medications in a 30 or 90 day supply at any network pharmacy, Specialty medications are limited to a 30 day supply, Speciatly Drugs provided at Home Delivery at the Retail cost
share. CVS, Kroger and Walmart have the best discounts.
This summary should not be considered a full explanation of benefits, see certificate for exact coverage and exclusions.
— 5 —
MEDICAL
CIGNA
How does an HSA work?
A Health Savings Account (HSA) paired with a High-deductible medical
plan, helps employees save and pay for health care. Employees can
access funds in their HSA using a convenient debit card at the point-of-
purchase. For more information about HSA plans, consult a tax advisor
and visit any of the following websites:
• www.ustreas.gov
• www.irs.gov
If you enroll in the HDHP you must visit www.optumbank.com to setup a Health Savings Account.
Note: You will need the Cigna group number (607884) to set up your account.
City Contribution to Your HSA
Employee Only $750
Employee + Spouse or Child(ren) $1,250
Family $1,750
What will I receive once I have made my election? Do doctors require payment at the time of service?
If you are new to the HSA, OptumHealth Bank will send a Most network physicians will bill CIGNA first and then bill you for
welcome kit to your home 7-10 business days after notification your adjusted costs.
of your enrollment. Only those employees who make changes or
enroll for the first time will receive new ID cards from Cigna or What happens to my HSA if I never withdraw funds, change
HSA debit cards. Your debit card and your CIGNA ID card will each jobs, or retire?
be mailed to your home separately. In addition, you will receive Funds in your HSA are yours, even if you change employers or
a Certificate of Coverage detailing your plan benefits. retire. The less you spend on current medical expenses, the more
money stays in your account accumulating interest. Under IRS
How do I make deposits to my account? guidelines, HSAs are treated like IRAs. HSA funds are never taxed
City deposits to your HSA are made through pre-tax payroll or penalized if they are used for qualified medical expenses.
deductions. Employer prorated HSA deposits are made monthly. Funds can be withdrawn for any reason, without penalty once
Employee contributions are made bi-weekly. Employees are you reach age 65.
encouraged to contribute to the HSA in addition to what the
City contributes. Effective January 1st 2021 combined Employer/ What expenses are counted towards my deductible?
Employee contributions cannot exceed $3,600 for individuals and Only medical expenses covered by your medical plan apply
$7,200 for families. Anyone over age 55 can add an additional towards your deductible. However, HSA funds used for qualified
$1,000 for catch-up contributions. medical expenses not covered under your medical plan (for
example, orthodontia), will not count towards your health plan
Who verifies that my HSA was used for qualified expenses? deductible.
Save your receipts — in the event of an IRS audit, you are
responsible for providing documentation to the IRS. Can I pay for services that cost more than my HSA balance?
No, your HSA balance must be sufficient to cover the expense
before funds are withdrawn, or you must wait until you have
enough money in the account and then submit the expense for
reimbursement.
— 6 —
MEDICAL
CIGNA
HSA: A Health-wise Investment for Your Future.
Remember with an HSA, you can:
Designating a beneficiary
When you set up an HSA, it is important that
you also select a beneficiary. This will ensure
that your HSA money is immediately available
to your beneficiary upon your death. You may
select more than one beneficiary and assign the
portion of your account that would go to each.
What if you don’t select a beneficiary?
If you do not specify a beneficiary and you are
married, your HSA becomes your spouse’s HSA
account. If you are not married at the time of
your death, the funds will go to your estate and
Using your HSA the funds may be subject to taxation.
You can use your HSA funds to pay for “qualified medical expenses,” How do you designate your beneficiary?
even if an expense is not covered by your health plan. For example, Log in to your HSA and select “Manage your
few health plans cover the cost of acupuncture, but you can use profile” from the “Self Service” links. You’ll find a
your HSA to pay for it. link to “Beneficiary Designation” on the “Profile”
page.
Your HSA dollars are available not only to you, but also to your spouse and
dependents, even if they are not covered by your high-deductible health plan.
The list of “qualified medical expenses” is defined by the IRS, and it includes a wide range of dental, vision and medical expenses. You
should become generally familiar with the list and consult it as needed to determine if an expense can be paid for with your HSA.
Qualified medical expenses
Expenses that qualify for payment or reimbursement from your HSA tax free are defined by federal regulation. The following is a short
list of some products and services in this category:
• Chiropractic services • Vision care, including contact lenses, • Doctor office visits
• Acupuncture prescription sunglasses, even LASIK • Dental care, including extractions and
• Hearing aids (and the batteries, too) surgery braces
• Prescription medications
For more information about qualified medical expenses, visit the IRS website at www.IRS.gov or optumbank.com.
Other HSA-qualified expenses
Generally you cannot use your HSA to pay for health insurance premiums, but there are exceptions. You may use your HSA to pay for:
• Any health plan coverage while receiving federal or state unemployment benefits
• COBRA continuation coverage after leaving employment with a company that offers health insurance coverage
• Eligible long-term care insurance
• Medicare premiums and out-of-pocket expenses, including deductibles, copays and coinsurance for:
• Part A (hospital and inpatient services) • Part C (Medicare HMO and PPO plans)
• Part B (physician and outpatient services) • Part D (prescription drugs)
Note: this does not include premiums for a Medicare supplemental policy, such as Medigap.
— 7 —
MEDICAL
CIGNA
Member Website / Mobile App
myCigna helps consumers manage health care benefits and provides access to WebMD’s suite of health information
and decision support tools. The myCigna app gives you an easy way to personalize, organize and access your
important health information on the go.
Register today:
Health care provider search Membership cards 1. Go to myCigna.com and select “Register Now”.
• Search for a doctor, • Download or 2. Enter your personal details like name, address
hospital or facility send electronic and date of birth.
• Easy to locate using membership cards 3. Confirm your identity with secure information
Google maps like your Cigna ID, social security number or a
• Download and save security question. This will make sure only you
search results can access your information.
4. Create a user ID and password.
5. Review and submit.
Claims
Now you’re ready to log in to your
• File a claim by taking a
picture of your invoice personal, secure myCigna.com site. See
Contact details
• View past claims • Contact us with
how the site has been redesigned with
• Review and check the the tap of a finger you in mind, making it easy to navigate
status of claims instantly and find what you need.
Cigna Virtual Care
Connect with a board-certified doctor via video chat or phone, from your home, office or on-the-go 24/7/365,
including weekends and holidays. You can get the care you need – including most prescriptions (when appropriate)
– for many minor conditions. Your out-of-pocket costs are typically the same or less than a visit with your primary
care provider. Register today!
Board certified doctors can diagnose, treat and prescribe most medications for minor medical conditions, such as:
• Acne • Earaches • Pink eye
• Allergies • Fever • Rashes
• Asthma • Headaches • Shingles
YoUR HEALTH pLAn In YoUR poCkET.
• Cold and flu • Infections • Sinus infections
• Constipation • Joint aches • Sore throats
• Diarrhea • Nausea • Urinary tract infections
noW WITH pHoTo CLAIMInG!
Connect with virtual care your way:
• Contact your in-network provider
nt our customers to have
• Talk to an MDLIVE quick
medical and
provider oneasy access
demand to our
or schedule services,onanywhere
an appointment myCigna.comand anytime. With
e Cigna•Health Benefits
Call MDLIVE mobile app they can manage their health plan from their smartphone.
24/7 at 888-726-3171
— 8 —
logo are trademarks of Apple Inc., registered in the U.S. and other countries. App Store is a service mark of Apple Inc. Google Play is a trademark of Google Inc.
d use of the App is subject to the terms and conditions of the App and the online stores from which it is downloaded. Standard mobile phone carrier and data usage charges apply. Actual Mobile App features available may vary depending onMEDICAL
CIGNA
Healthy Rewards
Cigna’s Healthy Rewards® program provides discounts of up to 60% on various wellness programs and services,
ranging from Weight Management and Nutrition, to Vision and Hearing Care, and Nicotine Cessation.
To learn more about these and other Healthy Rewards® programs, visit Cigna.com/rewards (password: savings) or call 1-800-258-3312.
Omada Active&Fit Direct Program
Omada is a digital lifestyle program that inspires healthy As a Cigna Customer, you have access to discounts on
habits through technology and support programs. health programs through Cigna Healthy Rewards program.
The goal is to help you accomplish the changes that matter most Cigna members and any dependents over the age of 18 are
in the areas of eating, activity, stress, and sleep. The program eligible to join the Active & Fit gym membership network.
is available at no additional cost if you or your covered adult Start by logging in to myCigna.com> Wellness> Healthy
dependents are enrolled in the company medical plan offered Rewards- Discount Programs> Fitness & Mind/ Body> Fitness
through Cigna, are at risk for diabetes or heart disease, and are Discounts> Low-cost Fitness Center Memberships> Learn More.
accepted into the program. Memberships are $25 per month (plus a $25 enrollment fee)
Omada features: which allows you access to multiple local gyms in the Active &
• Interactive program to guide your journey Fit network.
• Wireless smart scale to monitor your progress
• Weekly online lessons to empower you
• Professional Omada health coach for added support
• Small online peer group to keep you engaged
— 9 —MEDICAL
CIGNA
How to Save Money with Cigna!
With healthcare costs continuing to rise, it’s more important than ever to be conscious of how much you are paying
for the care you receive. Becoming an educated healthcare consumer is a great way to help you manage your out-
of-pocket healthcare expenses. You don’t have to go it alone. Cigna is on your side. Cigna has the tools and support
you need to help you find a quality in-network doctor near you, including 24/7 live customer service, plus a host of
valuable resources to help you manage and track claims, and compare cost and quality information. Cigna tools are
accessible online or on the go, through myCigna.com or with the free myCigna mobile App.
Top Seven Tips to Save Money with Cigna
1. Schedule your annual checkup.
Preventive care is key to good health and is covered at 100%. Getting your annual checkup can help keep you in shape. Covered services
include:
• Routine physical examinations
• Well baby and child care
• Screening mammography
• Screening colonoscopy or sigmoidoscopy
• Cervical cancer screenings
• Prostate cancer screening
• Diabetes screenings
• Bone and mineral density tests
The best way to treat a serious illness is by catching it early or stopping it from happening. During your checkup, your doctor can often
detect the early signs of more serious issues. Remember, in order to receive the 100% preventive care benefit, services must be received
in accordance with USPTF guidelines under Health Care Reform and your physician must code the claims as preventive.
Call Cigna 24/7/365 at 1-866-494-2111 to help find a primary care provider within your area!
2. Find the best providers.
The Cigna Care Designation (CCD) is one decision-making tool you can use to choose a doctor. Cigna checks education and board certifications,
and they also check to see if the quality of care has earned recognition from within the medical industry. Providers who meet Cigna’s
specific quality and cost-efficiency criteria will have the Cigna Care Designation symbol next to their name in the online provider directory
tools. Quality recognition ratings are assigned to providers and provider groups indicating the quality criteria met, and stars are used to
communicate cost-efficiency performance as compared with their peers of the same specialty type and geographic market. Results in the
top category for cost-efficiency assessment will be displayed with three stars.
Sample: Online Health Care Professional Directory display (myCigna.com)
Quality, cost efficiency and Cigna Care Designation Symbol
Cigna Care Designation displays
Cost Efficiency Rating
— 10 —MEDICAL
CIGNA
3. Find the most cost effective Rx.
• Buy generic. When it comes to generic vs. brand name drugs, the main difference is name and appearance. Generic drugs are manu-
factured to be just as effective as brand name drugs and they are less expensive. Always check with your doctor or pharmacist to
understand your options.
• Ask your doctor about getting a three-month supply of your prescription. 90-day prescriptions may be filled using Cigna Home Deliv-
ery Pharmacy or your preferred retail pharmacy. You may be able to save money when you switch from a retail pharmacy to Cigna’s
Home Delivery Pharmacy. Call Cigna Home Delivery Pharmacy at 1-800-285-4812.
• Compare drug costs at different pharmacies. Login to myCigna.com> Select Prescriptions Tab> Select “Price a Medication”> Enter or
Select a Drug Name> Enter Form/Dosage, Quantity, Frequency and Duration> Get cost estimates.
4. Stay In-Network.
Costs will be lower if you choose to see doctors, hospitals and facilities in Cigna’s network. If you use an out-of-network provider, your
costs can add up quickly. You’re going to pay full price and not the discounted price an in-network doctor would charge. Out-of-Network
doctors / facilities may balance bill you for the amount that Cigna does not cover. When you are scheduled for surgery, ensure that the
surgeon, anesthetist, and facility are all In-Network.
How to search for an In-Network Provider:
• The provider directory on myCigna.com shows you results based on your health plan network and your location. Log in to myCigna.
com> Select Find Care & Costs Tab> Find care and cost estimates in your area by “Primary Care, Doctor by Type, Doctor by Name,
Reason for Visit or Locations”> Select “Doctor by Type” and Enter a specialty or type of doctor> For example, type “Primary Care Pro-
vider”> Results for In-Network primary care providers near your area will be displayed.
• Know before you go. Before you visit any provider or facility, we recommend you call ahead to be sure they are in your plan’s network,
as well as confirm their address, office hours, and that they are accepting new patients. Cigna is available 24/7/365! Call anytime day
or night for live customer service at 1-866-494-2111.
5. Shop with Cigna for the best outpatient facilities for diagnostic tests.
Costs can vary significantly depending on where you receive care. MRIs, CTs and PET scans can cost much less at some facilities. You can
save by making a more informed choice about where you get your services. You could save money without giving up quality care. Local
facilities offer the same services at a lower cost.
• The provider directory on myCigna.com shows you cost of service within your location. Login to myCigna.com> Select Find Care &
Costs Tab> Find care and cost estimates in your area by “Primary Care, Doctor by Type, Doctor by Name, Reason for Visit or Loca-
tions”> For example, Select “Reason for Visit” and Enter procedure “Shoulder MRI Scan with Dye”> Select Facilities> Results for facility
costs near your area will be displayed.
• Connect directly with the Cigna Customer Service team. Cigna’s team can find the most cost-effective facility for a service. Cigna will
help you compare costs for hundreds of procedures. Call anytime day or night for live customer service at 1-866-494-2111
Freestanding Facility vs Outpatient Hospital
Radiology Center Cost Outpatient Hospital Cost
MRI: $706 MRI: $1,676
CT Scan: $457 CT Scan: $1,376
Potential Savings: Over $900
National averages of participating facilities; actual costs will vary. The information
provided here is intended to be general information on how you can get the most out of
your plan and your health care dollars. It is not intended as medical advice. You should
consider all relevant factors and consult with your treating doctor when selecting a
provider for care.
— 11 —MEDICAL
CIGNA
6. The value of In-Network labs.
One of the biggest contributors to your health care costs may be laboratory expenses. You can save money if you use an In-Network lab
instead of an Out-of-Network lab. Cigna’s network includes national labs like LabCorp or Quest as well as regional and local labs. It’s easy
to find In-Network labs in your area by using the Cigna directory. These In-Network labs can provide general and specialty laboratory and
pathology testing in locations that are convenient and cost-effective. You have a choice when it’s time for lab tests, like blood work. Labs
in Cigna’s network give you quality service at a lower cost. When your doctor says you need lab tests, tell your doctor you want to stay In-
Network. Even if samples are taken in the doctor’s office, you can ask for them to be sent to an In-Network lab.
7. Access care in the right settings.
Deciding whether to see a doctor, go to urgent care, or use another option can be difficult. When you need treatment for common
ailments and injuries, you have more choices. Now you can get high-quality, affordable services for a wide variety of routine medical
conditions through different types of settings.
Cigna Health Information Line: A telephone service staffed by nurses that helps you understand and make informed decisions about
health issues you are experiencing, at no extra cost. It can help you choose the right care in the right setting at the right time, whether
it’s reviewing home treatment options, following up on a doctor’s appointment, or finding the nearest urgent care center. Just call Cigna
at 1-866-494-2111.
Lower Cost and Time Greater
Your Guide For Where To Go When You Need Medical Care
Cigna Virtual Care Convenience Care Clinic Doctor’s Office Urgent Care Center Emergency Room
Treat minor medical Treat minor medical The best place to go for For conditions that For immediate
conditions. Connect concerns. Staffed by nurse routine or preventive aren't life threatening. treatment of critical
with board-certified practitioners and physician care, to keep track of Staffed by nurses and injuries or illness. Open
doctor via video or assistants. Located in retail medications. doctors and usually 24/7. If a situation
phone. stores and pharmacies. have extended hours. seems life-threatening,
call 911 or go to
nearest ER.
Colds and flu Colds and flu General health issues Fever and flu symptoms Sudden numbness,
Rashes Rashes or skin conditions Preventative care Minor cuts, sprains, weakness
Sore throats Sore throats, earaches, Routine checkups burns, rashes Uncontrolled bleeding
Headaches and sinus pain Immunizations and Headaches Seizure or loss of
Stomachaches Minor cuts or burns screenings Lower back pain consciousness
Fever Pregnancy testing Joint pain Shortness of breath
Allergies Vaccines Minor respiratory Chest pain
Acne symptoms Head injury/ major
UTIs and more Urinary tract infections trauma
Blurry or loss of vision
Costs same or less than Costs same or lower May charge copay/ Costs lower than ER. No Costs highest. No
a visit with primary care than doctor's office. No coinsurance and/or appointment needed. appointments needed.
provider. Appointments appointment needed. deductible. Usually Wait times will vary. Wait times may be
typically in an hour or need appointment. long.
less.
The information provided here is intended to be general information on how you can get the most out of your plan and your health care dollars. It is not intended as
medical advice. You should consider all relevant factors and consult with your treating doctor when selecting a provider for care.
— 12 —MEDICAL
CIGNA
ER Utilization Guide
When your life or health is in serious danger, there’s only one option — the emergency room. But for those times
when the situation isn’t life-threatening but still needs immediate care, there are lots of options that can be more
convenient, less expensive and more appropriate.
An Urgent Care Center is a walk-in clinic staffed by doctors who treat conditions that should be looked at
right away, but aren’t as severe as emergencies. Doctors in an urgent care often do X-rays, lab tests and
stitches.
A Walk-In Doctor’s office is convenient option to an ER visit because employees don’t have to be an existing
patient or have an appointment to receive care. These offices handle most routine care and common
illnesses.
A Retail Health Clinic is a clinic where medical professionals provide basic medical care. These clinics are
almost always located in retail stores, supermarkets and pharmacies.
Cigna’s Virtual Care program can help you get the care you need for a wide range of minor acute
conditions. Televisits with MDLIVE usually cost less than going to a convenience care or urgent care clinic,
and significantly less than going to an emergency room.
Convenience Care Clinics
When you need treatment for common ailments and injuries, you can get high-quality, affordable services for a
wide variety of routine medical conditions through Convenience Care Clinics located throughout the country.
Because we believe that your doctor has primary responsibility for your care and treatment, the results of your diagnosis and treatment
are sent to your doctor with your permission. If you have a more severe condition, or require treatment in a different setting, the
Convenience Care clinician will refer you to your doctor or an Emergency Room.
Consider Convenience Care for help with the following conditions:*
• Allergies • Ear infections • Minor sunburn • Sinus infections Participating
• Athlete’s foot
• Bladder infections
• Influenza
• Laryngitis
•
•
Mononucleosis
Pink eye and styes
•
•
Strep throat
Swimmer’s ear
Clinics
• Bronchitis • Minor burns, • Poison ivy • Swimmer’s itch • Cigna Medical Group
CareToday
• Cold sores rashes, or skin • Pregnancy testing • Wart removal
• Deer tick bites • MinuteClinic
infections • Ringworm
• RediClinic
We also provide vaccinations* for: • Take Care Health
• DTaP (Diphtheria, • Hepatitis A & B • MMR (Measles, Mumps, • Td (Tetanus,
• Target Clinic
• • The Little Clinic
Tetanus, Pertussis) Polio Rubella) Diphtheria)
• Influenza • Meningitis • Pneumonia
Refer to the provider directory for a complete list of Convenience Care Clinics in the CIGNA network.
— 13 —MEDICAL
CIGNA
What is a preventive care service?
Preventive care services are provided when you don’t have any symptoms and haven’t been diagnosed with the
health issue connected with the preventive service. For example, a flu vaccination is given to prevent the flu
before you get it. Other preventive care services like mammograms can help detect an illness when there aren’t
any symptoms. Even if you’re in the best shape of your life, a serious condition with no signs or symptoms may put
your health at risk. During a wellness exam, you and your doctor will determine what tests and health screenings
are right for you based on your age, gender, personal health history and current health.
Service Gender, Age, Frequency
Birth, 1, 2, 4, 6, 9, 12, 15, 18, 24 and 30 months
Well-baby/well-child/well-person exams, including annual well-
Additional visit at 2-4 days for infants discharged less than 48
woman exam (includes height, weight, head circumference,
hours after delivery
BMI, blood pressure, history, anticipatory guidance, education
Ages 3 to 21 once a year
regarding risk reduction, psychosocial/behavioral assessment)
Ages 22 and older periodic visits, as doctor advises
Breast Cancer Screening (mammogram) Women ages 40 and older, every 1 - 2 years
Cervical Cancer Screening (pap test) Women ages 21 - 65, every 3 years
HPV DNA Test with pap test Women ages 30 - 65, every 5 years
Screening of children and adolescents (after age 2, but by age
10) at risk due to known family history; when family history
is unknown; or with personal risk factors (obesity, high blood
Cholesterol/Lipid Disorders Screening
pressure, diabetes)
All men ages 35 and older, or ages 20-35 if risk factors
All women ages 45 and older, or ages 20-45 if risk factors
The following tests will be covered for colorectal cancer
screening, ages 50 and older:
• Fecal occult blood test (FOBT) or fecal immunochemical test
(FIT) annually
Colon Cancer Screening • Flexible sigmoidoscopy every 5 years
• Double-contrast barium enema (DCBE) every 5 years
• Colonoscopy every 10 years
• Computed tomographic colonography (CTC)/virtual
colonoscopy every 5 years - Requires precertification
Diabetes Screening Adults with sustained blood pressure greater than 135/80
Age 65 or older ( or under 65 for women at risk). Computed
Osteoporosis Screening
tomographic bone density study requires precertification
Prostate Cancer Screening (PSA) Men ages 50 and older or age 40 with risk factors
Sexually Transmitted Infections (STI) Screening All sexually active adolescents. All adults at risk
Skin Cancer Prevention - counseling to minimize exposure to
All genders ages 10 - 24
ultraviolet radiation
Tobacco Use/Cessation Interventions All Adults; Pregnant Women
— 14 —MEDICAL
CIGNA
How much physical activity do you need?
Here are the American Heart Association recommendations for adults.
Fit in 150+
Get at least 150 minutes per week of moderate-
intensity aerobic activity or 75 minutes per week of
vigorous aerobic activity (or a combination of both),
preferably spread throughout the week.
Move More, Sit Less
Get up and move throughout the day. Any activity
is better than none. Even light-intensity activity can
offset the serious health risks of being sedentary.
Add Intensity
Moderate to vigorous aerobic exercise is
best. Your heart will beat faster, and you’ll
breathe harder than normal. As you get
used to being more active, increase your
time and/or intensity to get more benefits.
Add Muscle
Include moderate-to high-intensity muscle-
strengthening activity (like resistance or
weight training) at least twice a week.
Feel Better
Physical activity is linked with better sleep,
memory, balance and cognitive ability. And
less risk of weight gain, chronic disease, de-
mentia and depression. It’s one of the most
important things you can do for your health
and well-being.
Move more, with more intensity, and sit less.
Find out how at heart.org/movemore.
— 15 —Health care provider search
› Search for a doctor, hospital or facility
MEDICAL › Easy to locate using Google maps
CIGNA › Download and save search results
Claims
!› File a new claim by taking
W
nE a picture of your invoice
› View past claims
› Review and check the
status of claims instantly
Pharmacy Benefits
Cigna’s Prescription Drug List Search Tool lets members view YoUR HEAL
medications commonly covered.
noW WITH
To use the tool, choose the drug list name ‘Performance 3 Tier’. Then, enter
a medication name or look for your medication name in the alphabetical list. Prescription Drug List
We want our customers to have q
Cigna Home Delivery: the free Cigna Health Benefits m
Members can log in to
• 24/7 access to licensed pharmacists. the myCigna℠ website or app
• Convenient delivery. We provide free standard delivery right to your home or and use the Drug Cost Tool to
work address. Your medication is shipped in packaging that protects your privacy see the medications your plan
and is designed to stand up to harsh weather. covers and specific coverage
• Easy refills. Fill up to a 90-day supply of your medication at one time, so you fill requirements.
Apple and the Apple logo are trademarks of Apple Inc., registered in the U.S. and other
less often. The downloading and use of the App is subject to the terms and conditions of the App
your plan. The listing of a health care professional or facility in the mobile directories av
• Refill reminders. Sign up to get free refill reminders by email or text. your official plan documents, or call the number listed on your ID card, for information
Corporation and its operating subsidiaries. All products and services are provided by or
• Order online. You can refill your medication and track your orders on the myCigna © 2017 Cigna. Some content provided under license. 5.90.568_EN (0117)
website or through the mobile app.
To learn more about Cigna's Pharmacy Benefits, visit the myCigna website / app or call 800-285-4812.
Prescription Tips
Free Prescriptions: Some grocery stores offer a list of antibiotics, high blood pressure and diabetes medications at
no cost (dosage restrictions and quantity limits may apply).
GoodRx: GoodRx is a website that helps you find the least expensive prescriptions by giving you pricing information
and more cost-effective alternatives. Go to www.goodrx.com or download the app!
— 16 —DENTAL
CIGNA
Dental Plan
Good oral hygiene is part of a healthy lifestyle.
Routine dental care does more than just brighten your smile.
Research shows that receiving regular dental care can help
detect minor problems before they become major and
expensive to treat. Also, routine dental exams can help catch
serious health problems, such as diabetes, leukemia, heart
disease and kidney disease. In fact, some diseases produce oral
signs and symptoms. So a healthier mouth may help you have
a healthier life.
The Total Cigna Dental PPO (DPPO) network makes it easy to
protect your health – and your smile – with the right dental
care at the right price. You can choose a dentist from one large
network directory. To find an in-network provider call 1-866-
494-2111.
Our plan covers preventive services at 100% in-network, with
no deductible for preventive services. You can visit any dentist;
however, STAY IN-NETWORK if you want the best value.
Cigna will pay all out-of-network claims based on the
90th UCR. This means that they will look at what 9
out 10 dentists in your area are charging, and pay
claims based on that amount.
Cigna - Dental
Network Name: Total Cigna Dental PPO In Network Out of Network
Maximum Annual Benefit (per individual per calendar year) $1,500 $1,500
Calendar Year Deductible $50 individual $50 individual
(Waived for Type I Services) $150 family $150 family
90th percentile of reasonable &
Reimbursement Levels Based on reduced contract fees
customary allowances
Class I- Preventive Services
Oral exams, routine cleanings, full mouth x-rays, bitewing x-rays, Plan pays 100% no deductible Plan pays 100% no deductible
panoramic x-rays, fluoride application (to age 14)
Class II- Basic Restorative Services
White fillings on front & back teeth, root canal therapy/endodontics, Plan pays 80% after deductible Plan pays 80% after deductible
space maintainers, oral surgery- simple extractions, anesthetics
Class III- Major Restorative Services
Plan pays 50% after deductible Plan pays 50% after deductible
Crowns, dentures, bridges, inlays/onlays
Class IV- Orthodontia
Plan pays 50% after deductible Plan pays 50% after deductible
Dependents up to age 19
Class IX- Implants Plan pays 50% after deductible Plan pays 50% after deductible
See plan certificate for frequency of service limitations and exclusions.
— 17 —DENTAL
CIGNA
You use your
plan to receive
IN-NETWORK dental care OUT-OF-NETWORK
Select a dentist or specialist Select any dentist
in-network DPPO Advantage list or specialist
• By choosing a DPPO Advantage dentist, you may receive • Your out-of-pocket expenses will generally be higher
higher in-network benefit coverage which may result in because out-of-network dentists have not agreed to offer
lower out‑of‑pocket expenses. Cigna plan customers negotiated rates.
• Pay less for covered services because in-network dentists • Depending on your plan design, out-of-network dentists
have agreed to offer services at lower negotiated rates, may bill you for the difference between the payment they
approximately 35% off average area charges with DPPO receive from Cigna Dental and their usual fees.
Advantage. • You may also have to file your own claims
• You may save on out-of-pocket costs for many services not
covered under your plan. In-network dentists have agreed Save more with in-network care!
to offer our customers discounted fees for all procedures
on their fee schedules. (Not available in all states.)
• In-network dentists will submit claims for you.
• All in-network dentists have been screened through
a process modeled after the highest national quality
standards, and we repeat the process every three years.
Get connected to myCigna.com. It’s easy to get things done with myCigna, our secure customer website.
After your effective date, simply register at myCigna.com. Then, check your coverage and more:
• View your personalized dental plan information • Search for claims
• Print a personalized ID card • Use our interactive tools to learn more about your oral health
• Enjoy discounts on a variety of health/wellness products and services
Find a Network Provider
Just follow these easy steps:
1. Visit www.cigna.com and click ‘Find a Doctor’ at the top of
the screen.
2. Select ‘plan through employer’.
3. Enter the location you want to search, then click ‘Pick’.
4. Under Dental Plans select ‘Cigna Dental PPO’.
5. Click ‘Choose” to load the selected plan in the search.
6. You may enter a physician name.
7. Click ‘Search’.
For a dentist in the Total DPPO Network, call Cigna at 1-866-494-2111.
— 18 —VISION
VSP
Vision Care Plan
The Vision Plan, administered by VSP, offers a nationwide network composed of private practice optometrists and
ophthalmologists, many of which offer extended evening and weekend hours. Visit www.vsp.com or call 1-800-877-7195
for the most up-to-date list of in-network providers.
VSP only contracts with private practice optometrists and ophthalmologists who own their practices. It is our philosophy that our providers
have the ultimate stake in their practice and will provide the best level of patient care. They have a vested interest in building patient loyalty and
in maintaining lifelong relationships with their patients by providing the highest level of care.
VSP doctors:
• Average nineteen years in private practice
• Are specially trained and licensed to diagnose and treat many medical eye conditions
• Are credentialed to the highest standards
You do not need an ID card to use VSP providers. At the time of service, simply identify yourself as a VSP member. The provider will call VSP
member services to verify eligibility, receive authorization and provide the services. When using an out-of-network provider, you will need to get
an itemized invoice or receipt from your service provider and submit it to the VSP Claims Department for reimbursement.
VSP doctors can detect VSP doctors can help treat
symptoms of: and manage:
• Diabetes • Cataracts
• Hypertension • Corneal diseases
• High cholesterol • Diabetic retinopathy
• Tumors • Eye infections
• Thyroid disorders • Glaucoma
• Neurological disorders • Macular degeneration
VSP - Vision
In Network Out of Network
Eye Exams $10 copay Up to $45 allowance
Lenses (once every 12 months)
Single Vision Lenses $30 copay Up to $30 allowance
Lined Bifocal Lenses $30 copay Up to $50 allowance
Lined Trifocal Lenses $30 copay Up to $65 allowance
Lenticular Lenses $30 copay Up to $100 allowance
Lens Options $55-$175 copay or 20-25% off certain options Up to $70 allowance
Frames (once every 24 months) You pay 80% of any amount over $130 Up to $210 allowance
Contact Lenses (once every 12 months) Plan pays up to $130 for contacts and contact Up to $105 allowance
lens exam (fitting and evaluation), 15% off
contact lens exam (fitting and evaluation)
Laser Correction Surgery 15% off usual and customary rates No discount
Glasses and Sunglasses 20% off additional glasses and sunglasses, No discount
including lens options, from any VSP doctor
within 12 months of your last Well Vision Exam
See plan certificate for frequency of service limitations and exclusions.
— 19 —BASIC LIFE
MUTUAL OF OMAHA
Basic Term Life Insurance
Coverage
Eligibility Active, Full-time employees working a minimum of 40 hours per week
Benefit Amount 2 times annual salary , to a maximum of $200,000
Accidental Death & Dismemberment 2 times annual salary , to a maximum of $200,000
Spouse (must be enrolled in medical) $5,000
Coverage ends at age 70
Children (must be enrolled in medical, unmarried dependent child)
• 14 days to 6 months $500
• 6 months to 19 years $2,500
to age 26 (if a full time student)
Conversion Included
Cost 100% paid by City of Suwanee
Terminal Illness The lesser of 50% up to $100,000
Benefit Reduction Schedule 65% @ age 65, 45% @ age 70, 30% @ age 75, 20% @ age 80
Voluntary Term Life Insurance
Coverage
Eligibility Active, Full-time employees working a minimum of 40 hours per week
Benefit Amount
• Employee Up to 5 times annual salary, not to exceed $200,000 (Increments of $10,000)
• Spouse Up to $100,000, not to exceed 50% of employee amount (Increments of $5,000)
• Children (unmarried dependent child) $10,000 (14 days to age 19 or to age 26 if full time student)
Accidental Death & Dismemberment As Above
Open Enrollment Provisions
Late Entrants or Benefit Increases Evidence of Insurability required (EOI)
Guarantee Issue Amount (GI): This is the amount you can elect without completing medical questions
• Employee $100,000
• Spouse $10,000
• Children $10,000
Portability and Conversion Included for employee and spouse. Coverage ends at age 70
Cost Employee and spouse rates are based on employee age at time of enrollment
Terminal Illness The lesser of 50% up to $100,000
Benefit Reduction Schedule 65% @ age 65, 45% @ age 70, 30% @ age 75, 20% @ age 80
Why buy life insurance?
Life insurance provides a lump sum cash benefit to surviving dependents to cover immediate expenses such as funeral expenses or
ongoing living expenses. This benefit helps survivors adjust to the loss of income related to the death of a wage earner or to provide
funds for college or retirement for the survivors.
Waiver of premium
If it is determined that you are totally disabled, your life insurance benefit will continue without payment of premium, subject to certain
conditions.
What is Evidence of Insurability?
Our carrier guarantees that employees will be able to purchase • New Hires – You may apply for coverage up to $100,000 for
life insurance coverage for the Guarantee Issue amount during yourself, and $10,000 for your spouse, and $10,000 for your
New Hire enrollment. To purchase voluntary life coverage above child(ren) through the normal enrollment process. To purchase
those amounts, the carrier requires Evidence of Insurability. If coverage above that, you will be required to provide Evidence
you or your dependents have medical conditions that make it of Insurability.
difficult to purchase life insurance on your own, understanding • Marriage, Adoption or Birth – If you are already enrolled in
Evidence of Insurability and the Guaranteed Issue is important. employee life insurance you can enroll new dependents as long
Evidence of Insurability means you will need to complete a medical as you follow normal Life Status Change deadlines. If you wish to
questionnaire, obtain a physical (at the carrier’s request), and increase your employee life amount above $100,000 or spouse
receive carrier approval before your insurance takes effect. Life coverage above $10,000, you must complete the Evidence of
insurance enrollment time frames are limited as detailed: Insurability Form and submit it within the normal Life Status
Change deadlines.
— 20 —You can also read
