Frequently Asked Questions

Self-insurance means that payments for claims are being made by the city of Scottsdale rather than by an insurance company. In the three medical plans, Cigna processes claims and provides customer service on behalf of the city but the money for actual claim payments comes from the city. However, the city is protected by stop loss insurance if claim costs are greater than expected. Cigna also provides plan participants with various services such as use of their networks, case management, and other services such as the nurse line and disease management programs.

From the consumer's perspective, there is really no difference between the two. HMO stands for health maintenance organization while EPO stands for exclusive provider organization. The general premise of HMO's and EPO's is the same in that members must use the providers in the plan's network to receive benefits under the plan. The technical difference is that generally an HMO is an insured product (the insurance company pays the claim costs) whereas an EPO is generally a self-insured product (the employer pays the claim costs). Since the City of Scottsdale's plan is self-insured, it is technically called an EPO.

A PPO is a preferred provider network. This means that the plan offers two levels of benefits coverage: in-network benefits and out-of-network benefits. If a member uses providers within the plan's network (in-network benefits) they receive a higher level of coverage than if they use providers who are not within the plan's network (out-of-network) benefits. This differs from an HMO or an EPO in that in an HMO or EPO out-of-network coverage is not available.

No it will not. You will be given another unique identifier.

Yes. Even if you do not have authorization for general Internet access, the Information Systems Department is providing limited access for all city employees for the provider web sites listed under BeneFacts. Employees can also access those web sites from a home computer. To obtain information on Cigna go to www.cigna.com

The prescription drug plans will be handled through each of the health plans. You will pay a specific percentage of the cost (with a minimum and maximum) for each tier (generic, brand and non-formulary) under the drug plan. In addition, all health plans provide a mail order drug program, which is a cost effective way to fill your prescription for maintenance medicines.

Each insurance plan has a preferred listing of drugs for the plan. That listing is called a formulary. If a drug is not on the health plan's preferred listing it is considered a non-formulary drug. If you are prescribed a drug which is not on the plan's formulary, you can still get that drug; however, you will pay more than what you would pay for a drug which is on the formulary. If you are taking a drug that is not on the formulary, you may want to consult with your doctor to find out if there is a formulary drug that you could take instead.

The city provides benefited employees a basic life insurance benefit as well as short-term disability insurance and supplemental life insurance. Fee schedules are included under the Disability Benefits link.

Voluntary and Basic Life insurance does reduce upon attaining a certain age. Please see your certificate for details on those reductions.

The HR staff is ready to help. Employees can send e-mails to [email protected], call 480-312-7600 or stop by the HR office at 9191 E. San Salvador Drive .

The Benefits web site is available to anyone with an internet connection at home. Family members who need specific information also are invited to contact HR through email, by phone, or by dropping in at the HR office location.

All plans are paid on a fiscal year basis so you will need to meet/satisfy your deductibles and out-of-pocket maximums from July 1 through June 30 each fiscal year.

Cigna OAP In-Network Plan - no deductible.

Cigna OAP Plan - You must meet a deductible before the plan begins paying for many procedures. However, you do not need to satisfy a deductible before the plan will pay for in-network office visits or prescription drug benefits. For in-network office visits, you only pay the co-pay and the plan pays the rest. Thus, if you visit a network primary care physician and the visit costs $100, you pay $25 and the plan pays the remaining $75. The deductibles are $750 for an individual/$1,500 for the entire family for in-network benefits and $2,000 for an individual/$4,000 for the entire family for out-of-network benefits.

Cigna OAP + HSA - You must meet a deductible before the plan begins paying for any service. For example, if you visit a network primary care physician and the visit costs $100, you pay $100. The deductibles are $1,400 for an individual/$2,800 for the entire family for in-network benefits and $4,000 for an individual/$8,000 for the entire family for out-of-network benefits.

Under all plans, the deductible, co-payments and co-insurance for medical services count towards your out-of-pocket maximum.

Prescription drug co-payments and any co-payments and co-insurance under CIGNA Behavioral Health do count towards your out-of- pocket maximum.

Any expenses for medical services or supplies that are not covered by the plan, and all charges in excess of Usual and Customary do not count towards your out-of- pocket maximum.

Yes, there are separate deductibles and out-of-pocket limits for in-network and out-of-network benefits. The expenses you incur for in-network benefits only accumulate towards your in-network deductible and out-of-pocket maximum. The expenses you incur for out-of-network benefits only accumulate towards your out-of-network deductible and out-of-pocket maximum.

For example, if you have already met your in-network deductible, and then decide to go out-of-network for surgery, you would have to start accumulating out-of-network expenses towards your out-of-network deductible and out-of-pocket maximum.

The individual deductible is the amount of expenses that one individual must accumulate before their deductible is met. The family deductible is the amount that all covered family together must accumulate before the deductible is met for all family members. Once the family deductible is met, no individual family member needs to accumulate additional expenses towards their deductible.

For example, if under the Cigna OAP plan, one member of your family accumulates $750 of in-network expenses, their in-network deductible has been met. Then, if a second covered family member accumulates $750 of in-network expenses, their in-network deductible is met as is the in-network deductible for any other family member since the family has met the $1,500 in-network deductible. The family in-network deductible could also be met, for example, if one covered family member had $750 in in-network expenses, another had $450, and a third had $300. Since the $1,500 family in-network deductible is met, all covered family members have met their in-network deductible.

There are several ways that you can find out if your doctor participates in one of the plan's networks. Because all networks experience some change in provider participation, the most reliable way to find out if a doctor is currently participating in a network is to contact the plan directly, either through their web site or member services. This will provide you with the most up-to-date information. Printed provider information can become outdated very quickly; it is always a good idea to check with the plan or with your doctor prior to each visit to confirm that they are participating in the network.