Employee Benefits Guide - 2021/2022 TOGETHER WE ARE STRONGER AND MORE RESILIENT
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TOGETHER WE ARE STRONGER
AND MORE RESILIENT
2021/2022
Employee
Benefits Guide
Understanding your benefits
Fellow Scottsdale employees,
Welcome to your 2021/22 benefits guide. It is my pleasure to provide
you with this important resource regarding your benefits with the
city of Scottsdale. This comprehensive guide has everything you will
need for open enrollment and throughout the year to make educated
and cost-effective decisions that are right for you and your family.
I know how important good health benefits are to you and the
organization, which is why I am excited to share that we have several
new incentive programs and coverage additions to our benefit plans
this fiscal year. I am even more pleased to share that these additions
come with no increase to your benefit premiums. The ability to make
adjustments that provide you with innovative high-quality benefits
and wellness programs remains among my highest priorities.
Jim Thompson
Acting as smart consumers of health care services and thinking City Manager
carefully and proactively about yours and your family’s health will help
this positive trend continue. Please take advantage of this myriad of
benefit opportunities – your participation helps us maintain a healthy
workforce and allows us to perform our best for each other and the
community. Remember, together we are stronger and more resilient.
If you have questions regarding your benefits or this guide,
the HR Benefits Team is ready to assist you at
480-312-7600 or hrbenefitsemail@ScottsdaleAZ.gov.
Stay strong,
Jim
Table of Contents
What Is Open Enrollment?............................2 Vision Service Plan Highlights..................24-25
What’s New in 2021/22.................................3 Benefit Services & Programs....................26-28
2021/22 Wellness Incentives................... 4-6 – Short Term Disability
Cigna Resources............................................7 – Life Insurance
Virtual Care.....................................................8 – Flexible Spending Accounts
Employee Assistance Program...............9-10 – Health Savings Accounts
– Home Life Referrals Retirement........................................................ 29
– Financial and Legal Assistance – Arizona State Retirement System
– Emotional Health Services – Public Safety Personnel Retirement System
Other Resources.......................................... 11 – 457 Plan Deferred Compensation
Choose a Plan with Confidence ����������������12 Legal Notices............................................. 30-32
Monthly Benefit Premium and Privacy Policy..............................................33-36
Contribution Rates..................................13-15
Other Notices................................................... 37
Medical Plans Comparison Chart.........16-18
Benefit Providers Contact List ���������������������� 38
Prescription Plan Highlights................ 19-20
Key Terms to Know.......................................... 39
Dental Plan Highlights.......................... 21-22
Dental Plans Comparison Chart.......... 22-23
Maria Messenger, Mirna Smith, and Rosa Pinedo from Human Services
serving the community during COVID-19.
What Is Open Enrollment?
This booklet is a summary of your benefits Open Enrollment is May 3-21
package for 2021/22. Take the time to review This year’s open enrollment period takes
the information, so that you can make the best place online from May 3 through May 21. All
selections for you and your family. All information, employees are required to complete their
including the amount of any benefit and employee enrollment on the Employee Self Service intranet
eligibility for benefits, is subject to and governed site: scottsdaleaz.munisselfservice.com.
by the terms and conditions of the applicable
policy or plan documents, including Cigna’s clinical Benefit elections made during this open
policy bulletins. If any information provided in this enrollment period will become effective July 1.
guide differs from information provided by the
policy or plan, the terms of the plan will control. Tips
Employee Benefit Eligibility – If needed, update your address on the
Employee Self Service site. Don’t forget
Full-time employees or grandfathered part-time
that you can also visit this site to access
employees with benefits are eligible for coverage
your current benefit elections.
under the benefit plans. If both you and your spouse
work for the city, you may select coverage as an – Be sure to include your Social Security
employee or dependent. However, dependents number for you and all your dependents.
can only be enrolled under one parent. This is a federal requirement and
is necessary to properly administer
Dependent Eligibility Medicare Program benefits.
– Legal spouse/domestic partner – Open enrollment is the only time to make
– Children up to age 26, including natural-born, changes to your benefit selection for the
foster, stepchildren, legally adopted, placed coming year – unless you experience
for adoption or children whom you are a qualified life status change such
a legal guardian as marriage, birth of child or divorce.
You must notify HR Benefits within
– Unmarried children beyond 26 who are
30 days of a qualifying life change.
incapable of self-sustaining employment
because of a mental or physical Computers are available to employees for
disability incurred before age 19. online enrollment at the Human Resources
office at 9191 E. San Salvador Dr.
Domestic Partner Coverage
Health insurance coverage may be extended to an Benefit Status Changes
employee’s domestic partner and child(ren) with
completion of a notarized Domestic Partnership Federal Law allows you to qualify under a
Affidavit and supporting documentation on file. special enrollment period. See page 30 for more
Contact HR Benefits to select or change information under Special Enrollment Periods. If
domestic partner coverage and to discuss one of these situations applies, you may enroll
important tax considerations. before the next annual enrollment period.
2 | 2021/2022 EMPLOYEE BENEFITS GUIDE CONTACT HR BENEFITS: 480-312-7600 | hrbenefitsemail@ScottsdaleAZ.gov
What’s New for 2021/22
City Council approved recommended changes Employees have many ways they can minimize
to employee health care benefits at its regular the financial impact of their health care.
meeting on April 20. There will be no increase to – Be well and stay safe. Cigna and the city’s Live
benefit premiums for 2021/22. Changes include: Life Well program offer numerous classes
– Adding hearing aid benefit of one and free resources to help you stay healthy.
device per ear every three years. – Save money by using a Cigna Medical Group
facility or virtual care provider for treatment.
– Diabetic supplies will now be
covered at 100% on all plans. – Take advantage of the city’s wellness
incentives to offset any premium
– Healthy Pregnancy Healthy Babies program increases or save even more.
added to all plans for expecting mothers. – One of the most important things you can
– New MotivateMe wellness incentive program. do to stay healthy is see your physician
annually so that any serious medical
issues can be caught early and treated
before they become more serious.
Need Help?
Contact HR Benefits at 480-312-7600 or email hrbenefitsemail@ScottsdaleAZ.gov
Como podemos ayudar?
Por favor llamenle al 480-312-7600 si tiene alguna pregunta sobre su seleccion de beneficios
Matthew Bolton , Equipment Parts Technician on the job.
CONTACT HR BENEFITS: 480-312-7600 | hrbenefitsemail@ScottsdaleAZ.gov 2021/2022 EMPLOYEE BENEFITS GUIDE | 3
NEW! 2021-2022 Wellness Incentives
Take Care. Get Rewarded. I’m ready. How do I start?
Each of Scottsdale’s medical plans offer robust Visit mycigna.com, under “Incentives,”
wellness incentives through Cigna’s MotivateMe go to “Start Earning.”
Program. This program helps you change unhealthy STEP ONE: Complete the Start-Up Goal
behaviors and rewards you for it. That’s important,
because taking healthy actions will help reduce In order to earn any incentive rewards, employees
your risk of illness, disease and costly medical and spouse must complete the Health Risk
treatment. With MotivateMe, you’ll work towards Assessment on mycigna.com. A new Health
achieving real results that mean a real, healthy Assessment can be completed from May 1,
change for you. Get rewarded for the healthy actions 2021 to April 30, 2022. Biometric data is not
you take – the more you do, the more you earn. required to complete the Assessment.
Of course, the best reward is your good health. STEP TWO: Tackle other goals
After completing the Start-Up Goal,
jump right into any other goals that are
available to begin earning awards.
STEP THREE: Earn Awards
Goals are action-orientated opportunities
to make healthier daily choices. The more
you complete, the more you earn.
Employee Spousal
Goal Type Description Award Type Deadline Notes
Award Award
Start-Up Goal A confidential questionnaire N/A N/A N/A 06/30/2022 Visit mycigna.com to
Complete a personalized that asks you about your complete your Health
health assessment on health and well-being and Assessment.
mycigna.com. provides a personalized
Biometric data is not assessment of your current
required to complete the health.
assessment.
Complete an annual An annual physical is a Payroll $120 $120 06/30/2022 Visit your Primary Care
preventive physical preventive exam that’s used Deposit Physician, appropriate
OR to reinforce good health, physician or a Cigna
Complete an annual address potential and Medical Group facility
preventive OB/GYN exam chronic problems. for your free annual
preventive/wellness:
Don’t forget to take the An annual OB/GYN exam from July 1,
Wellness Screening Form. preventive exam can 2020 to June 30, 2022.
identify early ovarian and
cervical cancers, HPV
(human papillomavirus),
breast cancer and more.
Achieve a blood pressure of Get a blood pressure test. Payroll $10 per pay $10 per pay 06/30/2022 Download the
less than or equal to 139/89 Aim for systolic (pressure Deposit period period Wellness Screening
or improve to a healthy when heart beats) of 139 or Form and take it to
level. less and diastolic (pressure your appointment.
when heart is resting) of Upload the completed
Wellness Screening Form 89 or less. If you cannot Wellness Screening
is required to receive this achieve the blood pressure Form to mycigna.com
incentive. target, aim to improve to a or fax to Cigna.
healthier level.
4 | 2021/2022 EMPLOYEE BENEFITS GUIDE CONTACT HR BENEFITS: 480-312-7600 | hrbenefitsemail@ScottsdaleAZ.gov
NEW! 2021-2022 Wellness Incentives
Employee Spousal
Goal Type Description Award Type Deadline Notes
Award Award
Complete an annual A preventative dental Gift Card $100* $100* 06/30/2022 Schedule a preventive
preventive dental exam (two exam is used to reinforce ($50 per ($50 per exam with your Cigna
per year) good health and address dental exam) dental exam) dentist. Your incentive
potential and chronic will be credited
problems. when your claim is
processed.
Plan for your future Meet with the City of Gift Card $75* N/A 06/30/2022
Scottsdale’s Nationwide
Representative to discuss
your 457 account AND
complete/edit My
Interactive Retirement
Planner
(MIRP).
Expand your Financial Attend three of the City Gift Card $75* N/A 06/30/2022
Wellness of Scottsdale’s Financial
Education Classes
sponsored by Nationwide.
Talk to a coach and achieve Achieve a fitness, diet or Gift Card $50* $50* 06/30/2022 Visit mycigna.com or
a health goal health goal with the help of call 800.244.6224.
a trained health coach.
Get help improving my Quitting tobacco is one of Gift Card $50* $50* 06/30/2022 Visit mycigna.com.
lifestyle habits — Tobacco the most important things
you can do for better health.
A health coach can help you
take that critical first step
today.
Complete 9 lessons of the More than 1 out of 3 people Gift Card $50* $50* 06/30/2022 See if you’re eligible for
26-week Cigna Diabetes are at risk for diabetes. Are this program now at
Prevention Program you? This online program, omadahealth.com/
available through Cigna, in scottsdaleaz
collaboration with Omada,
helps you make lifestyle
changes that can reduce
risks.
Reduce your weight by 5% This online program offers Gift Card $50* $50* 06/30/2022 See if you’re eligible for
with the Cigna Diabetes support for healthy weight this program now at
Prevention Program based loss and better nutrition, omadahealth.com/
on 3 separate daily weigh which helps reduce the risk scottsdaleaz
ins compared to your initial for developing diabetes.
weight at the beginning of Available through Cigna in
the program collaboration with Omada.
Note: Maximum gift card earning per qualified individual is $275. Redeeming your incentive gift cards is easy. Learn how.
CONTACT HR BENEFITS: 480-312-7600 | hrbenefitsemail@ScottsdaleAZ.gov 2021/2022 EMPLOYEE BENEFITS GUIDE | 5
NEW! 2021-2022 Wellness Incentives
Employee Spousal
Goal Type Description Award Type Deadline Notes
Award Award
Enroll in the first trimester Speak with a maternity Gift Card $150 $150 See page 6 for more
and complete the nurse to receive support information about this
postpartum consultation and guidance starting in new program.
with my Healthy your first trimester and
Pregnancies Healthy Baby after your baby is born.
nurse. (Limit 1 maternity award per
pregnancy)
Enroll in the second Speak with a maternity Gift Card $75 $75 See page 6 for more
trimester and complete the nurse to receive support information about this
postpartum consultation and guidance starting in new program.
with my Healthy your second trimester and
Pregnancies, Healthy Baby after your baby is born.
nurse. (Limit 1 maternity award per
pregnancy).
Get your surgery performed Cigna’s Center’s of Gift Card $250 $250 06/30/2022 See page 7 for more
at a Center of Excellence Excellence program information on Cigna’s
Facility identifies hospitals that Centers of Excellence.
have received high ratings
for certain procedures
or conditions based on
patient outcomes and cost-
efficiency.
Note: Maximum gift card earning per qualified individual is $275. Redeeming your incentive gift cards is easy. Learn how.
NEW! Healthy Pregnancies, Healthy Babies Program
The city’s medical plans now offer even greater maternity support. Enroll in this program designed to help you
and your baby stay healthy during your pregnancy and in the days and weeks following your baby’s birth.
Find support early and often.
– Tell them about you and your pregnancy so they can meet your needs.
– Ask them anything - your health coach, who has nursing experience, is there to support you
during your whole pregnancy.
– Get a pregnancy journal with information, charts and tools to help you have a happy nine months.
Learn as much as you want. Get live support 24 hours a day, seven days a week. Just call the number
on your Cigna ID card to:
– Talk to a health coach who can help you with everything from tips on how to handle your discomfort
during pregnancy to what foods to avoid, birthing classes and maternity benefits.
– Access an audio library of maternity and general health topics.
– Or visit mycigna.com for tools to help you track your pregnancy week by week, prepare for delivery,
and care for your baby.
Get rewarded for making smart choices. When you participate and complete the program,
you may be eligible to receive:
– A $75 incentive if you enroll by the end of your second trimester; or
– A $150 incentive if you enroll by the end of your first trimester.
Call 800.615.2906 to enroll as soon as you know you are pregnant.
6 | 2021/2022 EMPLOYEE BENEFITS GUIDE CONTACT HR BENEFITS: 480-312-7600 | hrbenefitsemail@ScottsdaleAZ.gov
Cigna Resources
Cigna Medical Group By combining Cigna’s cost-efficiency and quality
Cigna Medical Group (CMG) is available to you and ratings with patient experience overall hospital
your family when you enroll in a Cigna medical plan. ratings, Cigna can help you make more informed
decisions. The Center’s for Excellence program
Cigna Medical Group is one of the Valley’s largest identifies hospitals that have received high rating for
multi-specialty group practices. At many of the certain procedures or conditions based on patient
centers you can see a doctor, fill your prescription, outcomes and cost-efficiency. During the 21/22
and get lab work and imaging. The use of electronic fiscal year, the city is offering a $250 incentive
health records and digital imaging allows CMG to use one of these centers for an outpatient
doctors at all locations to access accurate, real-time surgery for one of the following procedures:
information when considering your treatment and
digital imaging is faster and safer than traditional – orthopedic back surgery
X-rays. For more information on Cigna Medical – joint surgery (knee or hip replacement)
Group services and locations, – cardiac surgery
go to cigna.com/cmgaz.
– childbirth
– Multi-specialty and urgent care centers – bariatric surgery (OAP plan coverage only)
– CareToday convenience care clinics – transplant surgery
– On-site pharmacies and refill centers
This incentive is available to both the employee
– Vision services and spouse. You will be credited via payroll after
– Hearing services your claim has been processed. The online health
– Pediatric services risk assessment must be completed in order to
earn this additional incentive.
– Accredited Ambulatory Surgery Center
RecoveryOne for Cigna
Cigna Centers for Excellence
Are nagging injuries, muscle or joint pain
Cigna is committed to making it easy for you to keeping you down? It’s time to rejoin the fun!
make the best choice for a hospital by giving you
the information you need to make the right choice The city’s medical plans include an online
for you and your family. This includes Cigna’s physical therapy program called RecoveryOne
Centers for Excellence designation program, for Cigna and there’s no added cost to you or
and quality and cost-efficient ratings. Cigna also your eligible dependents. RecoveryOne is a
provides patient experience ratings for hospitals digital physical therapy program that provides
received from Consumer Union in the health a complete PT solution conveniently delivered
care professional directory on mycigna.com. via smartphone, tablet, or computer. The
RecoveryOne digital PT program lets members
do their PT from the comfort of home, with
expert support throughout their recovery.
Includes over 180 clinical pathways addressing
all areas of the body (from the neck down).
Learn more and enroll on mycigna.com.
CONTACT HR BENEFITS: 480-312-7600 | hrbenefitsemail@ScottsdaleAZ.gov 2021/2022 EMPLOYEE BENEFITS GUIDE | 7
Virtual Care
Your medical plan includes access to medical Behavioral/Mental Health Virtual Care
and behavioral/mental health Virtual Care. Cigna
Licensed counselors and psychiatrists
partners with MDLIVE. MDLIVE allows you to
can diagnose, treat and prescribe most
connect with a board-certified doctor via secure
medications for nonemergency behavioral/
video chat or phone, without leaving your home
mental health conditions, such as:
or office. Get the care you need when, where it – Addictions – Panic disorders
works best for you — including most prescriptions
— for a wide range of minor conditions. – Bipolar disorders – Parenting issues
– Child/adolescent – Postpartum
With virtual care, you can: issues depression
– Get medical virtual care 24/7/365 – via video – Depression – Relationship and
or call from your phone, tablet or computer. – Eating disorders marriage issues
– Schedule a behavioral/mental health virtual – Grief/loss – Stress
care appointment online in minutes. – Trauma/PTSD
– Life changes
– Connect with quality board-certified – Women’s issues
doctors and pediatricians, as well as – Men’s issues
licensed counselors and psychiatrists. Virtual Care Providers
– Have a prescription sent directly to Signing up is easy! Set up and create an account
your local pharmacy, if appropriate. with MDLIVE by completing a medical history
– Save money. Medical virtual care for minor using an online “virtual clipboard.” You can also
conditions costs less than ER or urgent download the MDLIVE app to your smartphone
care center visits, and maybe even less than or mobile device for access on-the-go.
an in-office primary care provider visit.
MDLIVEforCigna.com .............. 888-726-3171
It’s important to remember that telehealth
(Virtual medical and behavioral care)
services are designed for minor, non-life-
threatening conditions. In an emergency, you
should dial 911 or go to the nearest hospital.
Board-certified doctors and pediatricians can
diagnose, treat and prescribe most medications
for minor medical conditions, such as:
– Acne – Joint aches
– Allergies – Nausea
– Asthma – Pink eye
– Bronchitis – Rashes
– Cold and flu – Respiratory
– Constipation infections
– Diarrhea – Shingles
– Earaches – Sinus infections
– Fever – Skin infections
– Headaches – Sore throats
– Infections – Urinary tract
infections
– Insect bites
8 | 2021/2022 EMPLOYEE BENEFITS GUIDE CONTACT HR BENEFITS: 480-312-7600 | hrbenefitsemail@ScottsdaleAZ.govEmployee Assistance Program
Your home and work life impacts your health. The Children & Families:
Employee Assistance Program (EAP) is a free,
voluntary and confidential service available to all – Parenting: Receive guidance on
city employees and anyone in their household. child development, sibling rivalry,
EAP provides access to work/life resources, and separation anxiety and much more.
licensed clinicians to help you cope with a wide – Prenatal care: Get the information you need
variety of concerns, from family and financial issues for a healthier pregnancy and delivery.
to substance use, emotional health, and stress. – Child care: Whether you need care
City employees and any member of their household all day or just after school, find a
can receive up to five face-to-face counseling place that’s right for your family.
sessions per issue per 12-month period. (Sworn – Children with special needs: Let EAP
fire and police employees receive up to 12 face- help you better understand care
to-face sessions per issue per 12-month period.) for your unique family needs
Video-based sessions are also available. – Summer care: Summer care services provide
The city has hired Dori Dipietro, LCSW as a parents with the resources to help find the right
dedicated EAP provider. Individual counseling summer camps and programs for your children.
sessions are available to all employees and Education: A full suite of education services
their household members, whether you are available for parents. From kindergarten to
receive health benefits from the city or not, public schools to special programs and college
from 10 a.m. – 2 p.m. every Thursday. preparation, let the Employee Assistance Program
help get you the information you need to make
To schedule your EAP session, email Dori directly at the best decisions throughout your child’s life.
doridipietro@gmail.com. If you would like
to schedule an EAP counseling appointment Pet Care: From vets to dog walkers, EAP
at any other time, 24/7, visit mycigna.com pet care services will help connect you
or call 1-800-554-6931. If using mycigna. with the right resources so that your
com, log into your account, click Coverage, furry friends are well taken care of.
then Employee Assistance Program (EAP).
Senior Care: When it comes to managing
In addition to professional consultations, important senior citizen care issues that arise
the Employee Assistance Program can also in your family, making the right decisions
direct you to a variety of helpful referrals can be difficult. That’s why EAP provides the
or community resources such as: information you need along with a support
system to help guide you through the process.
Home Life Referrals
Adoption: Adopting a child is one of the most
wonderful times in an adoptive parent’s life. But
it can also be stressful. Cigna’s EAP adoption
services provide all the support you need to help
find the right adoption specialist and support
groups to get you headed in the right direction.
CONTACT HR BENEFITS: 480-312-7600 | hrbenefitsemail@ScottsdaleAZ.gov 2021/2022 EMPLOYEE BENEFITS GUIDE | 9Employee Assistance Program
Financial and Legal Assistance Emotional Health Services
Financial Services: When it comes to finances, Managing Stress: There are ways to manage stress
most of us need a little help now and then. and build resilience that can help make life easier.
Get a free 30-minute talk with a qualified Check out Cigna’s online Managing Stress Toolkit for:
financial services specialist. In addition, you
can get 25 percent off on tax preparation – Self-assessment tools
when you take advantage of this service. – On-demand stress reduction seminars
Identity Theft: If you think you might be a victim of – Mindfulness exercises for free download
identity theft, talk to a fraud resolution specialist. – Helpful articles and information
To start, you’ll get a free 60-minute consultation EAP National Wellness Seminars: Take part in monthly
and resources to help you protect your identity. seminars year-round on topics that apply to real-life
Legal: Some of life’s events call for expert advice. concerns. Watch life or on-demand from a computer,
When you need legal assistance, contact the smartphone or table at: cigna.com/EAPWebCasts.
Employee Assistance Program. You can be Behavioral Awareness Series: Cigna offers free monthly
connected to a lawyer in your area for a free behavioral health awareness seminars on autism,
30 minute consultation and up to a 25 percent eating disorders, substance use and children’s
discount on usual fees for most legal issues. behavioral health issues. For more information visit:
cigna.com/individuals-families/health-wellness
Jeff Chandler, Plans Examiner, assisting a citizen at One Civic Center.
10 | 2021/2022 EMPLOYEE BENEFITS GUIDE CONTACT HR BENEFITS: 480-312-7600 | hrbenefitsemail@ScottsdaleAZ.govOther Resources (for All Employees)
The following resources are available – There is a dedicated triage team that will help
to all employees regardless of plan veterans find the right resources and services
enrollment participation. including pain management , substance use
counseling and treatment, financial issues,
Scottsdale Walker Tracker food, clothing, housing, safety, transportation,
Take positive steps with the help of the Scottsdale parenting and child care, aging services,
Walker Tracker Program. Registration and health insurance, legal assistance and more.
participation is free for those enrolled on the city’s – If someone who is in a crisis calls, they will be
medical plan. Visit scottsdale.walkertracker.com immediately routed to a member of their crisis
to create a profile and compete against colleagues team trained to handle those specific situations.
and friends. All activities can be logged and you can
watch your progress on virtual maps throughout Mindfulness for Vets
our yearly competitions. Features include: This program is specifically designed for all
– Ability to create and compete in veterans, whether they are Cigna customers or not,
multiple competitions. to provide training in mindful stress management,
acceptance and compassion. The telephonic
– A map that includes a pacer to see if you program is available every Tuesday at 5 p.m.
are ahead or behind to achieve the distance ET at 866-205-5379 (passcode 113 29 178).
in the specified time frame.
– The ability to track daily fruit, vegetable – Many veterans suffer from chronic pain due
and water consumption. to injuries, post-traumatic stress disorder,
opioid dependency and other causes of stress
– A point & level system. at a higher rate than the general population.
– Ability to privately track other metrics (blood Mindfulness is an evidence-based therapy
pressure, body mass index, calories, etc.). proven to have a positive impact on depression,
– Ability to track and sync your devices, stress, anxiety, performance, sleep, addiction,
such as Fitbit or Garmin. and post-traumatic stress disorder.
– The option to download the iPhone or – Weekly trainings typically last for 45-60 minutes
Android Walker Tracker App. with time at the end for veteran participants
to ask questions and share experiences.
Veterans Support Line – Additional mindfulness sessions are available
The Veteran Support Line provides a wide for veterans, their caregivers and families
range of assistance for veterans, as well as every Monday and Thursday at 6 p.m. ET
their caregivers and families, whether they are and every Wednesday at 8:30 p.m. ET at
Cigna customers or not. The Support Line is 866-205-5379 (passcode 113 01 992).
free and available 24/7/365 at 855-244-6211.
– It is completely anonymous. Cigna does not ask
for verification of military status or relationship
to a veteran or for any personal identification.
– It’s staffed by licensed Cigna behavioral
health specialists, some of whom are
veterans themselves and understand the
unique and often difficult experiences both
veterans and their caregivers often face.
CONTACT HR BENEFITS: 480-312-7600 | hrbenefitsemail@ScottsdaleAZ.gov 2021/2022 EMPLOYEE BENEFITS GUIDE | 11Choose a Plan with Confidence
Reviewing health plan options can be confusing After enrollment, the support continues
and overwhelming at times. That’s why Cigna for Cigna’s city customers.
One Guide is available to city employees now
– whether you’re a current Cigna customer When you enroll with Cigna, your One Guide
or considering Cigna for the first time. representative will be there to guide you
through the complexities and unclear jargon
Call a Cigna One Guide representative during of the health care system, and help you avoid
pre-enrollment to get personalized, useful costly missteps. The goal is a simpler health
guidance. Your personal guide will help you: care journey for you and your family.
– Easily understand the basics of health coverage Cigna’s One Guide service provides
personalized assistance to help you:
– Identify the available health plans that best
meet the needs of you and your family – Resolve health care issues
– Check if your doctors are in-network to – Save time and money
help you avoid unnecessary costs – Get the most out of your plan
– Get answers on any other questions – Find the right hospitals, dentists and other
you may have about the plans or health care providers in your plan’s network
provider networks available to you – Get cost estimates
The best part is, during the enrollment period, – Understand your bills
your personal guide is just a call away. Should you – Navigate the health care system
forget to ask something and need to call back, Get it all in the way that’s most convenient
simply ask for your guide by name and you will be for you. Call 800-244-6224. Once enrolled,
reconnected, so you can pick up where you left off. access Cigna One Guide support by
downloading the myCigna app.
Healthy Scottsdale messaging at Scottsdale Quarter.
12 | 2021/2022 EMPLOYEE BENEFITS GUIDE CONTACT HR BENEFITS: 480-312-7600 | hrbenefitsemail@ScottsdaleAZ.govMonthly Benefit Premium and Contribution Rates
These are the monthly benefit premiums and contribution rates
taking effect July 1, 2021 through June 30, 2022.
Monthly City Employee
July 1, 2021 through June 30, 2022
Premium Contribution Contribution
City of Scottsdale Cigna OAP In-Network
Full-Time Employee Only $705 $564 $141
Part-Time Employee* Only $705 $423 $282
Full-Time Employee & Child(ren) $1,279 $959 $320
Part-Time Employee* & Child(ren) $1,279 $719 $560
Full-Time Employee & Spouse/Partner $1,526 $1,145 $381
Part-Time Employee* & Spouse/Partner $1,526 $859 $667
Full-Time Employee & Family $2,190 $1,643 $547
Part-Time Employee* & Family $2,190 $1,232 $958
City of Scottsdale Cigna LocalPlus Network
Full-Time Employee Only $638 $510 $128
Part-Time Employee* Only $638 $383 $255
Full-Time Employee & Child(ren) $1,157 $868 $289
Part-Time Employee* & Child(ren) $1,157 $651 $506
Full-Time Employee & Spouse/Partner $1,381 $1,036 $345
Part-Time Employee* & Spouse/Partner $1,381 $777 $604
Full-Time Employee & Family $1,983 $1,488 $495
Part-Time Employee* & Family $1,983 $1,116 $867
City of Scottsdale Cigna OAP
Full-Time Employee Only $618 $519 $99
Part-Time Employee* Only $618 $389 $229
Full-Time Employee & Child(ren) $1,123 $887 $236
Part-Time Employee* & Child(ren) $1,123 $665 $458
Full-Time Employee & Spouse/Partner $1,339 $1,058 $281
Part-Time Employee* & Spouse/Partner $1,339 $794 $545
Full-Time Employee & Family $1,922 $1,519 $403
Part-Time Employee* & Family $1,922 $1,139 $783
* Grandfathered only
CONTACT HR BENEFITS: 480-312-7600 | hrbenefitsemail@ScottsdaleAZ.gov 2021/2022 EMPLOYEE BENEFITS GUIDE | 13Monthly Benefit Premium and Contribution Rates
These are the monthly benefit premiums and contribution rates
taking effect July 1, 2021, through June 30, 2022.
Monthly City Employee
July 1, 2021 through June 30, 2022
Premium Contribution Contribution
City of Scottsdale Cigna OAP + HSA
Full-Time Employee Only $588 $529 $59
Part-Time Employee* Only $588 $397 $191
Full-Time Employee & Child(ren) $1,067 $885 $182
Part-Time Employee* & Child(ren) $1,067 $664 $403
Full-Time Employee & Spouse/Partner $1,273 $1,044 $229
Part-Time Employee* & Spouse/Partner $1,273 $783 $490
Full-Time Employee & Family $1,827 $1,462 $365
Part-Time Employee* & Family $1,827 $1,097 $730
City of Scottsdale HMO Dental
Full-Time Employee Only $9.60 $9.60 $0.00
Part-Time Employee* Only $9.60 $7.20 $2.40
Full-Time Employee & Child(ren) $21.52 $10.76 $10.76
Part-Time Employee* & Child(ren) $21.52 $8.08 $13.44
Full-Time Employee & Spouse/Partner $15.76 $9.60 $6.16
Part-Time Employee* & Spouse/Partner $15.76 $7.20 $8.56
Full-Time Employee & Family $25.28 $12.64 $12.64
Part-Time Employee* & Family $25.28 $9.48 $15.80
City of Scottsdale PPO Dental
Full-Time Employee Only $41.58 $36.40 $5.18
Part-Time Employee* Only $41.58 $27.30 $14.28
Full-Time Employee & Child(ren) $74.82 $40.54 $34.28
Part-Time Employee* & Child(ren) $74.82 $30.42 $44.40
Full-Time Employee & Spouse/Partner $91.44 $42.62 $48.82
Part-Time Employee* & Spouse/Partner $91.44 $31.98 $59.46
Full-Time Employee & Family $123.70 $45.74 $77.96
Part-Time Employee* & Family $123.70 $34.32 $89.38
* Grandfathered only
14 | 2021/2022 EMPLOYEE BENEFITS GUIDE CONTACT HR BENEFITS: 480-312-7600 | hrbenefitsemail@ScottsdaleAZ.govMonthly Benefit Premium and Contribution Rates
These are the monthly benefit premiums and contribution rates
taking effect July 1, 2021, through June 30, 2022.
July 1, 2021, through June 30, 2022 Monthly Premium Buy Up Premium
Vision Service Plan (VSP)
Full-Time Employee Only $4.00 $6.22
Part-Time Employee* Only $4.00 $6.22
Full-Time Employee & Child(ren) $8.54 $13.26
Part-Time Employee* & Child(ren) $8.54 $13.26
Full-Time Employee & Spouse/Partner $7.00 $12.42
Part-Time Employee* & Spouse/Partner $7.00 $12.42
Full-Time Employee & Family $13.66 $21.20
Part-Time Employee* & Family $13.66 $21.20
* Grandfathered only
One Eyed Jack in Old Town Scottsdale sporting a face covering during the city’s COVID-19 response.
CONTACT HR BENEFITS: 480-312-7600 | hrbenefitsemail@ScottsdaleAZ.gov 2021/2022 EMPLOYEE BENEFITS GUIDE | 15Medical Plans Comparison Chart
Which Plan Is Right For Me?
The city’s benefits package continues to provide quality and competitive plan choices and comprehensive
coverage. Four medical plans are offered. Use this guide and the comparison chart to make the best choice.
If you have questions, contact HR Benefits at 480-312-7600 or hrbenefitsemail@ScottsdaleAZ.gov.
Cigna OAP In-Network or
July 1, 2021 - June 30, 2022 Cigna OAP Cigna OAP+ HSA
Cigna LocalPlus
Medical Service In-Network In-Network Out-of-Network In-Network Out-of-Network
Choice of in-network physician(s)
Choice of in-network physician(s) or Choice of in-network physician(s) or
Choice of Physician only, no pre-selection of a primary
out-of-network physician(s) out-of-network physician(s)
care physician necessary
$2,000 $1,400 $3,500
$750 Individual,
Deductible per Plan Year None Individual, Individual, Individual,
$1,500 Family
$4,000 Family $2,800 Family* $7,000 Family*
$4,500 $4,500 $4,000 $7,000
$3,000 Individual,
Annual Out-of-Pocket Maximum Individual, Individual, Individual, Individual,
$6,000 Family
$9,000 Family $9,000 Family $8,000 Family* $12,000 Family*
Basic Care
Primary Physician Office Visits
$25 co-pay per 30% after 10% after 30% after
(Family & General Practice, Internal $25 co-pay per visit
visit deductible deductible deductible
Medicine, OB/GYN & Pediatrician)
Cigna Medical Group $10 co-pay per 10% after
$10 co-pay per visit No Benefit No Benefit
(25 locations valley wide) visit deductible
MDLIVE $5 co-pay per 10% after
$5 co-pay per call No Benefit No Benefit
(virtual care service) call deductible
$40 co-pay per 30% after 10% after 30% after
Specialist Office Visit $40 co-pay per visit
visit deductible deductible deductible
Acupuncture & Naturopathic
$40 co-pay per 30% after 10% after 30% after
Office Visit (maximum 12 visits per $40 co-pay per visit
visit deductible deductible deductible
plan year)
No co-pay/$100 co-pay for complex 10% after 30% after 10% after 30% after
Outpatient X-ray & Laboratory
imaging deductible deductible deductible deductible
Occupational, Speech Therapy 10% after 30% after 10% after 30% after
$40 co-pay per visit
(maximum 60 visits per plan year) deductible deductible deductible deductible
Physical Therapy (maximum 60 10% after 30% after 10% after 30% after
$30 co-pay per visit
visits per plan year) deductible deductible deductible deductible
Hearing & Vision
No deductible; No deductible;
No deductible; 1 visit every 12
Hearing Examinations 1 visit every 12 No Benefit 1 visit every 12 No Benefit
months
months months
Hearing Aids (1 device per ear every 10% after 0% after
10%, no deductible No Benefit No Benefit
3 years) deductible deductible
No deductible; No deductible;
No deductible; 1 visit every 12
Vision Basic Examinations 1 visit every 12 No Benefit 1 visit every 12 No Benefit
months
months months
Vision Materials (frames, lenses, Discounts available through Discounts available through Discounts available through
contact lens exam/fitting, etc.) Cigna Vision Network Cigna Vision Network Cigna Vision Network
*When on family coverage, the entire $2,800 (or $7,000 out-of-network) deductible must be met before any benefit is paid.
**Does not include supplies.
16 | 2021/2022 EMPLOYEE BENEFITS GUIDE CONTACT HR BENEFITS: 480-312-7600 | hrbenefitsemail@ScottsdaleAZ.govMedical Plans Comparison Chart
Cigna OAP In-Network or
July 1, 2021 - June 30, 2022 Cigna OAP Cigna OAP+ HSA
Cigna LocalPlus
Medical Service In-Network In-Network Out-of-Network In-Network Out-of-Network
Wellness
Routine Physicals, Exams,
30% after 30% after
Immunizations/ Pap Smears and No co-pay No co-pay No deductible
deductible deductible
Mammograms
30% after 30% after
Well Baby Care No co-pay No co-pay No deductible
deductible deductible
Chiropractor (maximum 20 visits 10% after 30% after 10% after 30% after
$30 co-pay per visit
per plan year) deductible deductible deductible deductible
30% after 10% after 30% after
Allergy Injections No charge No charge
deductible deductible deductible
Maternity Care
$25 co-pay first 30% after 10% after 30% after
Office Visits $25 co-pay first visit
visit deductible deductible deductible
$500 co-pay ($500 additional co- 10% after 30% after 10% after 30% after
Delivery
pay for newborns) deductible deductible deductible deductible
Hospital Services
10% after 30% after 10% after 30% after
Inpatient Hospital $500 co-pay per admission
deductible deductible deductible deductible
10% after 30% after 10% after 30% after
Outpatient Surgery $250 co-pay
deductible deductible deductible deductible
Emergency & Urgent Care
$150 co-pay, $150 co-pay,
10% after 10% after
Emergency Room $150 co-pay plus 10% after plus 10% after
deductible deductible
deductible deductible
10% after 10% after
Urgent Care Facility $50 co-pay $50 co-pay $50 co-pay
deductible deductible
Ambulance
10% after 10% after 10% after 10% after
Ground No co-pay*
deductible deductible deductible deductible
10% after 10% after 10% after 10% after
Air No co-pay*
deductible deductible deductible deductible
Extended Care
Home Health Care (maximum 40 10% after 30% after 10% after 30% after
No co-pay
visits per plan year) deductible deductible deductible deductible
10% after 30% after 10% after 30% after
Skilled Nursing (maximum 60 days) No co-pay
deductible deductible deductible deductible
10% after 30% after 10% after 30% after
Hospice Care No co-pay
deductible deductible deductible deductible
Mental Health
Employee Assistance Program 5 free face-to-face sessions per issue per 12 month period
30% after 10% after 30% after
Behavioral Health Outpatient Care $10 co-pay $10 co-pay
deductible deductible deductible
10% after 30% after 10% after 30% after
Behavioral Health Inpatient Care $500 co-pay
deductible deductible deductible deductible
*Does not include supplies.
CONTACT HR BENEFITS: 480-312-7600 | hrbenefitsemail@ScottsdaleAZ.gov 2021/2022 EMPLOYEE BENEFITS GUIDE | 17Medical Plans Comparison Chart
Cigna OAP In-Network or
July 1, 2021 - June 30, 2022 Cigna OAP Cigna OAP+ HSA
Cigna LocalPlus
Medical Service In-Network In-Network Out-of-Network In-Network Out-of-Network
Prescriptions - Retail (up to a 30-day supply)
50% co- 50% after
Preventive Generic $10 co-pay $10 co-pay $10 co-pay
insurance deductible
20% co- 20% co-
20% co-insurance insurance 50% co- insurance 50% after
Preventive Brand Name
($30 min-$50 max) ($30 min-$50 insurance ($30 min-$50 deductible
max) max)
40% co- 40% co-
40% co-insurance insurance 50% co- insurance 50% after
Preventive Non-Formulary
($50 min-$100 max) ($50 min-$100 insurance ($50 min-$100 deductible
max) max)
Covered at
50% co- 100% after plan 50% after
Non-Preventive Generic $10 co-pay $10 co-pay
insurance deductible and deductible
$10 co-pay
Covered at
100% after
20% co-
plan deductible
20% co-insurance insurance 50% co- 50% after
Non-Preventive Brand Name and 20%
($30 min-$50 max) ($30 min-$50 insurance deductible
co-insurance
max)
($30 min-$50
max)
Covered at
100% after
40% co-
plan deductible
40% co-insurance insurance 50% co- 50% after
Non-Preventive Non-Formulary and 40%
($50 min-$100 max) ($50 min-$100 insurance deductible
co-insurance
max)
($50min-$100
max)
Prescriptions - Mail Order (up to a 90-day supply) or Cigna 90 Day Now
Preventive Mail Order Generic $20 co-pay $20 co-pay No Benefit $20 co-pay No Benefit
Preventive Mail Order Brand Name $60 co-pay $60 co-pay No Benefit $60 co-pay No Benefit
Preventive Mail Order
$110 co-pay $110 co-pay No Benefit $110 co-pay No Benefit
Non-Formulary
Covered at
Non-Preventive Mail Order 100% after plan
$20 co-pay $20 co-pay No Benefit No Benefit
Generic deductible and
$20
Covered at
Non-Preventive Mail Order 100% after plan
$60 co-pay $60 co-pay No Benefit No Benefit
Brand Name deductible and
$60
Covered at
Non-Preventive Mail Order 100% after plan
$110 co-pay $110 co-pay No Benefit No Benefit
Non-Formulary deductible and
$110
18 | 2021/2022 EMPLOYEE BENEFITS GUIDE CONTACT HR BENEFITS: 480-312-7600 | hrbenefitsemail@ScottsdaleAZ.govPrescription Plan Highlights
All four medical plans provide a prescription benefit Employees calling for information on their
and include a three-tier prescription plan, with home delivery medications will have expanded
different co-payments in each tier. Prescriptions options in the automated system, including the
are assigned to a tier according to the Cigna ability to check their benefits and copayments,
formulary, which can change periodically: refills, order status and payments, and to obtain
an Explanation of Benefits. Call 800-835-3784
Tier 1 . . . . . . . Generic and a Cigna representative will manage your
Tier 2 . . . . . . . Brand home delivery orders and answer any questions.
Tier 3 . . . . . . . Non-Formulary Additionally, employees will have the ability to be
Refer to the medical plan comparison chart contacted by Express Scripts Pharmacy by text.
for specific information on plans costs for You can manage your home delivery medications
prescriptions. Please remember that non- on the Express Scripts website, which you can
preventive prescriptions on the Cigna OAP + access via the myCigna app or website. Additional
HSA will be subject to the deductible first. payment plan options will be available, such
If you choose a brand name drug over an available as online bill pay. Payment plan options will
generic drug, you will pay the generic copay plus the include additional communication features and
difference in cost between the generic drug and the preferences. Employees will also have access
brand name drug. However, if your doctor indicates to home delivery information for dependents
that you must take the brand name drug over the in the household who are considered minors.
generic, then you will only pay the applicable Adult family members will be able to grant
brand drug copay. access to other adult family members.
Home Delivery Pharmacy
Have the medications you take daily delivered
right to your door at no additional cost.
Because you can get up to a 90-day supply
at one time, you may even be able to save
money. You’ll get a reminder when it’s time to
reorder and have access to the CoachRx team
for help with drug interactions, side effects
and ways to lower your medication costs.
To participate in the program:
– Obtain a prescription for mail order drugs
from your physician. A mail order prescription
can be written for up to a 90-day supply
with three refills.
– Obtain a mail order drug form from
Human Resources or at cigna.com.
Kelly Walters working at Scottsdale Fire.
CONTACT HR BENEFITS: 480-312-7600 | hrbenefitsemail@ScottsdaleAZ.gov 2021/2022 EMPLOYEE BENEFITS GUIDE | 19Prescription Plan Highlights
Cigna 90 Now Five ways to get the most out of
The prescription benefit also includes a your pharmacy benefit plan.
maintenance medication program called
Cigna 90 Now. Cigna 90 Now offers you 1. Learn what medications are covered
more choice in how and where you can fill Save money by checking out the list of medications
your maintenance prescriptions. covered under your plan on mycigna.com.
The amount you pay depends on whether your
Cigna 90 Now offers a retail pharmacy network to medication is listed as a generic, preferred brand,
fill your 90-day prescriptions. As long as you use a non-preferred brand or specialty medication.
Cigna 90 Now Network pharmacist, you will save
money by paying the mail order co-pay for 2. Use the Prescription Drug Price Quote tool
a 90-day supply. View medication cost based on your pharmacy
plan, see if there are lower cost alternatives
30-day co-pay* 90-day co-pay* and compare prices between Express
Generic $10 $20 Scripts Pharmacy and retail pharmacies.
Brand 20%coinsurance, $60
$30 min - $50 max 3. Use Home Delivery Pharmacy or
Non-Formulary 40% coinsurance, $110 Cigna 90 Now for maintenance medications
$50 min - $100 max
4. Get help with specialty medications
The Network includes CVS, Walmart, and Fry’s. A Managing a complex condition isn’t easy. Take
complete listing of all participating 90-day supply advantage of Cigna’s Therapeutic Resource
pharmacies can be found at Centers provided by Accredo. This specialty-trained
cigna.com/pharmacy-networks/90-day-network. teams of pharmacist and nurses will provide you
*For those enrolled in the HSA plan, most with the personalized care and support you need
prescriptions will apply to the deductible first. to better understand your specific condition.
5. Use myCigna.com
The website gives you 24/7/365 access to:
– See your pharmacy claim history
– Read your benefit details
– See mediation prices based on your plan
– Manage your Home Delivery orders
– Ask a pharmacist a question
For questions, contact Cigna Customer Service
at 800-244-6224 or mycigna.com.
Lauran Beebe gets the COVID-19 vaccine.
20 | 2021/2022 EMPLOYEE BENEFITS GUIDE CONTACT HR BENEFITS: 480-312-7600 | hrbenefitsemail@ScottsdaleAZ.govDental Plan Highlights
The City of Scottsdale offers you a choice • Find out the cost for a service and how
between two types of dental plans. You can much the plan will cover. This will help you
find participating dental professionals and determine whether you will be billed later.
services using Cigna’s online directory at • If you will have to pay out-of-pocket for a service,
cigna.com or by calling 800-244-6224. consider searching for a participating provider
so you can receive the maximum benefit.
Cigna DHMO Plan
Cigna Dental Oral Health Integration Program
The Cigna DHMO Plan provides streamlined dental
care and makes most preventive and diagnostic A visit to the dentist is about more than just
services available at a reasonable cost or no avoiding cavities – it could save your life or your
additional cost to you, including yearly fluoride unborn child’s. Research has linked complications
treatments for covered children. There is a co- of heart disease, stroke, diabetes, preterm birth, pre-
pay for covered services, but no deductibles or eclampsia and other health issues to gum disease.
annual dollar maximums, no coverage waiting Several studies link oral health to our overall
periods and no claim forms to complete. health. For example, treating gum disease in
You choose a network general dentist to help individuals with diabetes can result in improved
manage your overall dental care. You don’t need a blood sugar levels, which may lead to a reduction
referral to see a network orthodontist. There is no of the effects of diabetes and its complications.
out-of-network coverage on the Cigna DHMO Plan. Oral health connections include:
Cigna DPPO Plan – Heart disease – The exact link has not yet
The Cigna DPPO Plan is a self-insured dental been pinpointed, but researchers are finding
program with a preferred provider network. Under an association between gum disease and an
this plan, you have the freedom to select the dentist increased risk for heart disease and stroke.
of your choice, but if you utilize a preferred provider – Pregnancy – A study showed that women
dentist, you will receive a higher level of coverage. with gum disease during the second
You have access to most preventive services at trimester were up to eight times more
a reasonable cost or at no additional cost to you likely to give birth prematurely.
and never need a referral to see a specialist.
– Head and neck radiation – Head and neck
Tips: radiation can cause the mouth to be dry,
which may cause increased risk for tooth
– Be sure to get any service over $200
decay and gum disease.
predetermined by Cigna Dental before you
proceed. You may risk the chance of – Organ transplants – Transplant patients
not being covered. can have an increased risk for systemic
and oral infections, including tooth
– Don’t get stuck paying more than you should.
decay and gum disease.
You may be billed for the balance of what the
plan does not cover. This is called “balance – Chronic kidney disease – Researchers found
billing.” Consider the following before that people with gum disease and those with
obtaining a service: missing teeth were nearly twice as likely to
have chronic kidney disease compared
• Make sure the provider and facility are
with those without these risk factors.
a part of the network. If you’re not sure,
call the provider or Cigna directly.
CONTACT HR BENEFITS: 480-312-7600 | hrbenefitsemail@ScottsdaleAZ.gov 2021/2022 EMPLOYEE BENEFITS GUIDE | 21Dental Plan Highlights & Comparison Chart
Cigna created the Cigna Dental Oral Health Integration Program, which provides enhanced dental coverage
for specific dental procedures, prescription and non-prescription discounts and samples, as well as
behavioral health information to all of its dental members who may have conditions impacting oral health.
Participants’ out-of-pocket costs are reimbursed at 100 percent for certain dental services if they have any
of the specified medical conditions.
For more information, visit cigna.com.
Cigna Dental HMO Plan Cigna Dental PPO Plan
Choice of Dentist Must choose participating primary dentist Choice of PPO or non-PPO dentist
Annual Deductible None $50 individual/$150 family
Annual Maximum Benefit None $1,500 per individual*
Routine Cleanings Two per plan year, $10 co-pay Two per plan year - In-network covered at 100%;
out-of-network covered at 90% after deductible
Basic Services Per schedule of co-payments In-network covered at 80% after deductible; out-
of-network covered at 70% after deductible
Major Services Per schedule of co-payments or 15-25% off In-network covered at 60% after deductible; out-
participating specialist fees of-network covered at 50% after deductible
Orthodontia For adults and children, 25% discount off For children under 19, 50% coverage: $1,500
participating orthodontist retail price lifetime max. per child.
*Members who receive a preventive cleaning will have their annual maximum benefit increase by $200 the following plan year.
Kate DeLaPointe. Librarian at Civic Center Library.
22 | 2021/2022 EMPLOYEE BENEFITS GUIDE CONTACT HR BENEFITS: 480-312-7600 | hrbenefitsemail@ScottsdaleAZ.govDental Plans Comparison Chart
PPO Dental Plan Choices
In Network
Out of Network
Cigna DPPO Advantage Cigna DPPO
MAXIMUM
REIMBURSEMENT LEVELS FEE SCHEDULE DISCOUNT ON FEES
REIMBURSABLE CHARGE
Progressive Maximum Benefit
Progressive Benefit Year 2: Increase contingent upon receiving Preventive Services in Plan Year 1.
Progressive Benefit Year 3: Increase contingent upon receiving Preventive Services in Plan Years 1 and 2.
Progressive Benefit Year 4: Increase contingent upon receiving Preventive Services in Plan Years 1, 2 and 3.
Policy Year Benefits Maximum Year 1: $1,500 Year 1: $1,500 Year 1: $1,500
Applies to: Class 1, 2 and 3 expenses Year 2: $1,700 Year 2: $1,700 Year 2: $1,700
Year 3: $1,900 Year 3: $1,900 Year 3: $1,900
Year 4: $2,100 Year 4: $2,100 Year 4: $2,100
Policy Year Deductible
Individual $50 $50 $50
Family $150 $150 $150
Service Levels Percent Plan Pays
Class 1 - Preventive & Diagnostic Care 100% 90% 90%
Oral Evaluations No Deductible No Deductible No Deductible
Prophylaxis: routine cleanings
X-rays: routine
X-rays: non-routine
Fluoride Application
Sealants: per tooth
Emergency Care to Relieve Pain
Class 2 - Basic Restorative Care 80% 70% 70%
Restorative: fillings After Deductible After Deductible After Deductible
Oral Surgery: minor and major
Anesthesia: general and IV sedation
Space Maintainers: non-orthodontic
Crowns: prefabricated stainless steel / resin
(for primary baby teeth only)
Class 3 - Major Restorative 60% 50% 50%
Inlays and Onlays After Deductible After Deductible After Deductible
Prosthesis Over Implant
Crowns: permanent cast and porcelain
Bridges and Dentures
Periodontics: minor and major
Endodontics: minor and major
Repairs: Bridges, Crowns and Inlays
Repairs: Dentures
Denture Relines, Rebases and Adjustments
Class 4 - Orthodontia 50% 50% 50%
Coverage for Dependent Children to age 19 No Deductible No Deductible No Deductible
Lifetime Benefits Maximum: $1,500
Class 6 - Implants 60% 50% 50%
Lifetime Benefits Maximum: $1,000 After Deductible After Deductible After Deductible
Reimbursements paid to the dentist by Cigna Contracted Rates - NO Balance Billing of outstanding charges 80% of Reasonable and
Customary Charges + any
balance not paid by Cigna
CONTACT HR BENEFITS: 480-312-7600 | hrbenefitsemail@ScottsdaleAZ.gov 2021/2022 EMPLOYEE BENEFITS GUIDE | 23You can also read
