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Medical Plans

The City of Scottsdale offers you a choice between three types of medical plans.

       Monthly Benefit Premium Comparison


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.
 
Target Drug List;         Walmart Drug List
 

Printable Version

Aetna Basic PPO

Aetna EPO Elect Choice

Aetna High Level PPO - 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

$1,750 Individual $3,500 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

90% after deductible

70% after deductible

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

90% after deductible

70% after deductible

$15 co-pay
per visit

90% after deductible

70% after deductible

Hearing & Vision

Hearing Examinations

$10 co-pay per visit

No benefit

$10 co-pay
per visit

$10 co-pay per visit

No benefit

Vision Examinations

$10 co-pay per visit

No benefit

$10 co-pay
per visit

$10 co-pay per visit

No benefit

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

Discounts available through Vision One program at Sears, JC Penney & Target

Discounts available through Vision One program at Sears,
JC Penney &
Target

Discounts available through (VSP) Vision Service Plan

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

$15 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

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)

$100 co-pay, plus 10% co-insurance 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

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

$15 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.

Generic

$10 co-pay

50% co-insurance

$10 co-pay

$10 co-pay

50% co-insurance

Brand Name

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

50% co-insurance

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

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

50% co-insurance

Non-Formulary

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

50% co-insurance

40% co-insurance

($50 min-$100 max)

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

50% co-insurance

Mail Order Generic

$20 (90-day supply)

No benefit

$20
(90-day supply)

$20 (90-day supply)

No benefit

Mail Order Brand Name

$60 (90-day supply)

No benefit

$60
(90-day supply)

$60 (90-day supply)

No benefit

Mail Order Non-Formulary

$110 (90-day supply)

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

CIGNA Behavioral Health Outpatient Psychological Consultations

$20 co-pay for first 30 visits, $40 per visit thereafter

$20 co-pay for first 30 visits, $40 per visit thereafter

$20 co-pay for first 30 visits, $40 per visit thereafter

Non-CIGNA Behavioral Health Outpatient Psychological Consultations

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

No benefit

90% after out-of-network deductible

CIGNA Behavioral Health Inpatient Care

No benefit

$300 co-pay
per admission;
covered at 80%

No benefit

Non-CIGNA Behavioral Health Inpatient Care

$150 co-pay per admission, covered at 80%

No benefit

$150 co-pay per admission, covered at 80%

Maximum Lifetime Benefit

Lifetime Maximum

 $2,000,000 maximum per person combined all plans.

 $2,000,000 maximum per person combined all plans.


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.