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Medical Plans

The City of Scottsdale offers you a choice between three types of medical plans. Please click on one of the plan links below for more information.

        Monthly Benefit Premiums       
 
        Hearing Flier

        Vision Care Flier - Discount Plan through Aetna (for information on the VSP Plan, 
        click here)
     
        Aetna Select Summary Plan Description
 
        CHIP Ammendment
    
        Aetna Choice POSII Summary Plan Description
 
        CHIP Ammendment
        
        Aetna Choice POSII HSA Summary Plan Description
 
        CHIP Ammendment

 

Why does the City of Scottsdale need to know the Social Security Number of all of my dependents?

We ask for this information to comply with Medicare reporting requirements (Section 111 of Public Law 100-173, also known as the "Medicare, Medicaid and SCHIP Extension Act of 2007"). When you make a claim, the law requires self-insurers like the City of Scottsdale to report specific information to the Department of Health and Human Services so it can coordinate Medicare payments with other insurance. The Centers for Medicare & Medicaid Services (CMS), part of the federal Department of Health and Human Services, uses this information to identify Medicare beneficiaries and coordinate Medicare payments. Note that the Privacy Act of 1974 and the Health Insurance Portability and Accountability Act Privacy Rule require Medicare to protect individual privacy and confidentiality while performing these duties. Aetna, our health plan, is considered a "Responsible Reporting Entity" under the Mandatory Insurer Reporting Law, and they have to check with the federal government on the Medicare eligibility of each party making an injury claim. Therefore, all dependent Social Security Numbers need to be sent to Medicare.
For details, see the "Why do I need to know about this legislation?" section of "Introduction to Section 111 Mandatory Medicare Secondary Payer Reporting" 


Do you want to compare Prescriptions costs?

 
Here are 2 prescription drug lists.  We encourage you to compare with other pharmacy's to ensure you receiving the best deal.  Some generic drugs are cheaper than others, depending on which pharmacy you go to.
 
 

Aetna Choice CPOSII + HSA Plan

Aetna Select Plan

Aetna Choice CPOS II

In-Network Benefits

Out-of-Network Benefits

In-Network Benefits

Out-of-Network Benefits

Choice of Physician

Choice of in-network physician(s) or out-of-network physician(s)

Choice of in-network physician(s) only, no pre-selection of a primary care physician necessary

Choice of in-network physician(s)
or out-of-network physician(s)

Deductible per
Plan Year

$1,250 Individual $2,500 Family

$3,500 Individual

$7,000 Family

None

$500 Individual

$1,000 Family

$2,000 Individual

$4,000 Family

Annual Out-of-Pocket Maximum

$4,000 Individual

$8,000 Family

$6,000 Individual

$12,000 Family

$1,500 Individual

$3,000 Family

$3,000 Individual

$6,000 Family

$4,000 Individual

$8,000 Family

Basic Care

Primary Physician Office Visits (Family & Gen. Practice, Int. Medicine, & Pediatrician)

90% after deductible

70% after deductible

$20 co-pay
per visit

$20 co-pay per visit

70% after deductible

Specialist Physician Office Visit

90% after deductible

70% after deductible

$40 co-pay
per visit

$40 co-pay per visit

70% after deductible

Outpatient X-ray & Laboratory

90% after deductible

70% after deductible

No co-pay/$40 for complex imaging

90% after deductible

70% after deductible

Physical, Occupational, Speech Therapy (max 60 visits per plan year)

90% after deductible

70% after deductible

$20 co-pay
per visit

90% after deductible

70% after deductible

Hearing & Vision

Hearing Examinations

100%, no deductible

No benefit

100%, no     co-pay

100%, no co-pay

No benefit

Vision Examinations

100%, no deductible

 

No benefit

100%, no     co-pay

100%, no co-pay

No benefit

Vision Materials (frames, lenses, contacts, etc.)

Discounts available through EyeMed Vision Program

Discounts available through EyeMed Vision Program

Discounts available through EyeMed Vision Program

Wellness

Routine Physicals, Exams, Pap Smears, Mammograms, Immunizations

100% no deductible

70% after deductible

No co-pay

No co-pay

70% after deductible

Well Baby Care

100% no deductible

70% after deductible

No co-pay

No co-pay

70% after deductible

Chiropractor (maximum 20 visits per plan year)

90% after deductible

70% after deductible

$20 co-pay
per visit

90% after deductible

70% after deductible

Maternity Care

Office Visits

90% after deductible

70% after deductible

$20 co-pay
first visit only

$20 co-pay first visit only

70% after deductible

Delivery

90% after deductible

70% after deductible

$300 co-pay (per mother and child)

90% after deductible

70% after deductible

Inpatient Hospital Care & Outpatient Surgery

Inpatient Hospital

90% after deductible

70% after deductible

$300 co-pay
per admission

90% after deductible

70% after deductible

Outpatient Surgery

90% after deductible

70% after deductible

$150 co-pay

90% after deductible

70% after deductible

Emergency Care & Urgent Care

Emergency Room (waived if admitted)

90% after deductible

 

$100 co-pay, plus 10% co-insurance after in-network deductible

$150 co-pay

$150 co-pay, plus 10% co-insurance after deductible

$150 co-pay, plus 10% co-insurance after in-network deductible

Urgent Care Facility

90% after deductible

 

$50 co-pay, plus 10% co-insurance after in-network deductible

$50 co-pay
per visit

$50 co-pay, plus 10% co-insurance after deductible

$50 co-pay, plus 10% co-insurance after in-network deductible

Ambulance

Ground

90% after deductible

70% after deductible

No co-pay

90% after deductible

90% after deductible

Air

90% after deductible

70% after deductible

No co-pay

90% after deductible

90% after deductible

Extended Care

Home Health Care (maximum 40 visits per plan   year)

90% after deductible

70% after deductible

$20 co-pay
per visit

90% after deductible

70% after deductible

Skilled Nursing (maximum 60 days)

90% after deductible

70% after deductible

$150 co-pay
per admission

90% after deductible

70% after deductible

Hospice Care

90% after deductible

70% after deductible

No co-pay

90% after deductible

70% after deductible

Prescriptions

If you choose a brand name drug over an available generic drug, you will pay the generic co-pay plus the difference in cost between the generic drug and the brand name drug.  If your doctor indicates that you must take the brand name drug, then you will pay only the applicable brand drug co-pay.

Preventive Generic

$10 co-pay

50% after deductible

$10 co-pay

$10 co-pay

50% co-insurance

Preventive Brand Name

20% co-insurance
($30 min-$50 max)

50% after deductible

 

20% co-insurance
($30 min-$50 max)

20% co-insurance
($30 min-$50 max)

50% co-insurance

Preventive Non-Formulary

40% co-insurance
($50 min-$100 max)

50% after deductible

 

40% co-insurance

($50 min-$100 max)

40% co-insurance
($50 min-$100 max)

50% co-insurance

 

Non-Preventive Generic

 Covered at 100% after plan deductible and $10 co-pay  

50% after deductible

 

$10 co-pay

 

$10 co-pay

 

50% co-insurance

 

Non-Preventive Brand Name

 Covered at 100% after plan deductible and 20% co-insurance
($30 min-$50 max)
 

50% after deductible

 

20% co-insurance
($30 min-$50 max)

 

20% co-insurance
($30 min-$50 max)

 

50% co-insurance

 

Non-Preventive Non-Formulary

 Covered at 100% after plan deductible and 40% co-insurance
($50 min-$100 max)
 

50% after deductible

 

40% co-insurance

($50 min-$100 max)

 

40% co-insurance
($50 min-$100 max)

 

50% co-insurance

Preventive Mail Order Generic

$20 (90-day supply)

No benefit

$20
(90-day supply)

$20 (90-day supply)

No benefit

Preventive Mail Order Brand Name

$60 (90-day supply)

No benefit

$60
(90-day supply)

$60 (90-day supply)

No benefit

Preventive Mail Order Non-Formulary

$110 (90-day supply)

No benefit

$110
(90-day supply)

$110 (90-day supply)

No benefit

 

Non-Preventive Mail Order Generic

Covered at 100% after plan deductible and $20 co-pay  

No benefit

 

$20
(90-day supply)

 

$20 (90-day supply)

 

No benefit

 

Non-Preventive Mail Order Brand Name

 Covered at 100% after plan deductible and $60 co-pay  

No benefit

 

$60
(90-day supply)

 

$60 (90-day supply)

 

No benefit

 

Non-Preventive Mail Order Non-Formulary

 Covered at 100% after plan deductible and $1100 co-pay  

No benefit

 

$110
(90-day supply)

 

$110 (90-day supply)

 

No benefit

EMPLOYEE ASSISTANCE PROGRAM 

This program provides ancillary work-life benefits at no cost to employees and family members for a wide array of non-medical issues, such as stress management, marriage and family issues, et.  The EAP also includes referral services for child and elder care, adoption assistance, legal assistance and other services. 
 
You receive five (5) free visits per issue, per 12 month period.
 
Call 800-554-6931 or visit their website at www.cignabehavioral.com

Mental Health

 Behavioral Health Outpatient Psychological Consultations

90% after deductible, through Aetna

$20 co-pay, through CIGNA

$20 co-pay, through CIGNA

Non-CIGNA Behavioral Health Outpatient Psychological Consultations

Aetna In-network 90% after deductible, out-of-network 70% after deductible

No benefit

CIGNA in-network 90% after deductible; 70% out-of-network after deductible

Behavioral Health Inpatient Care

Aetna In-network 90% after deductible

$150 co-pay
covered at 100% through CIGNA

90% after deductible - CIGNA in-network

Behavioral Health Inpatient Care

Aetna Out-of-network 70% after deductible

 

No benefit

70% after deductible - non-CIGNA in-network

 

Maximum Lifetime Benefit

Lifetime Maximum

 Unlimited

 Unlimited


This guide represents a summary of benefits provided by the City of Scottsdale to benefited employees. Every effort has been made to report information accurately. All information, including the amount of any benefit and employee eligibility of benefits, is subject to and governed by the terms and conditions of the applicable policy or plan documents. In all cases where any of the information provided in this guide differs from the amount of benefit actually provided by the policy or plan, the terms of the legal documents will control.