Health and Dental Insurance Open Enrollment is Monday ... · 26/10/2016 · Health and Dental Insurance Open Enrollment is Monday, October 31, 2016 to Monday, November 21, 2016

Richmond Retirement System730 East Broad Street * Suite 900 * Richmond, VA 23219

Phone: 804 -646-5958 * 1-888-288-2781 * Fax: 804-646-5299http://www.richmondgov.com/retirement

Richmond Retirement System

October 26, 2015

Contact: Kristina Friar Retirement Specialist

Email: [email protected] Phone: 804 – 646 – 5428

Health and Dental Insurance Open Enrollment is Monday, October 31, 2016 to Monday, November 21, 2016

The City of Richmond Department of Human Resources and CIGNA have partnered to mail information about open enrollment to covered RRS retirees. Open enrollment for both CIGNA health and CIGNA dental insurance will begin on October 31, 2016 and end on November 21, 2016. During this time, retirees may choose to add, drop, or modify their health and dental insurance coverage. Highlights: Retirees are encouraged to read the attached memo to determine if they want to submit forms to

add, drop, or modify coverage. However, no action is required by retirees. In general, retirees who participated in the Health Assessment Initiative will not see their CIGNA

health insurance premiums increase.

Conversely, retirees who did not participate in the Health Assessment Initiative will see their CIGNA health insurance premiums increase.

Because the new plan year will begin January 1, 2017, any changes will first affect payments made on January 31, 2017.

For retirees making changes, information must be received before 5:00 p.m. on November 21,

2016. Retirees should mail information to: Richmond Retirement System, 730 East Broad Street, Suite 900, Richmond, Virginia 23219.

The following pages provide more detailed information. If you have questions about open enrollment, you can attend an information session or call the Department of Human Resources at (804) 646-5660 or CIGNA at 1-800-564-7642.

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N E W S R E L E A S E

C i t y o f R i c h m o n d , V i r g i n i a

Summary of CIGNA Retiree Premium Rates, monthly* NO CHANGE TO DENTAL PREMIUM RATES:

CIGNA Dental DHMO All Retirees

OLD rate NEW rate Retiree Only $17.25 $17.25 Retiree + Child $28.23 $28.23 Retiree + Spouse $35.16 $35.16 Family $48.14 $48.14

CIGNA Dental PPO All Retirees

OLD rate NEW rate Retiree Only $24.40 $24.40 Retiree + Child $40.27 $40.27 Retiree + Spouse $50.27 $50.27 Family $79.45 $79.45

*New rates effective January 1, 2017.

Summary of CIGNA Retiree Premium Rates, monthly* HEALTH ASSESSMENT TAKEN:

PLAN A, PREMIER PLAN, HEALTH ASSESSMENT TAKEN 25 or more Years of Service 15 or more Years of Service 10 or more Years of Service Less than 10 Years of Service

OLD rate NEW rate OLD rate NEW rate OLD rate NEW rate OLD rate NEW rate Retiree Only $224.82 $224.82 $291.80 $291.80 $358.76 $358.76 $963.73 $999.08 Retiree + One $840.66 $840.66 $907.62 $907.62 $974.60 $974.60 $1,927.46 $1,998.16 Family $1,333.34 $1,333.34 $1,400.30 $1,400.30 $1,467.26 $1,467.26 $2,608.31 $2,703.99 Dependent Spouse $594.04 $594.04 $594.04 $594.04 $594.04 $594.04 $594.04 $594.04

PLAN B, CLASSIC PLAN, HEALTH ASSESSMENT TAKEN 25 or more Years of Service 15 or more Years of Service 10 or more Years of Service Less than 10 Years of Service

OLD rate NEW rate OLD rate NEW rate OLD rate NEW rate OLD rate NEW rate Retiree Only $210.54 $210.54 $277.50 $277.50 $344.46 $344.46 $909.51 $942.88 Retiree + One $808.56 $808.56 $875.98 $875.52 $942.48 $942.48 $1,819.03 $1,885.76 Family $1,286.98 $1,286.98 $1,353.92 $1,353.92 $1,420.90 $1,420.90 $2,461.58 $2,551.87 Dependent Spouse $560.68 $560.68 $560.68 $560.68 $560.68 $560.68 $560.68 $560.68

CHOICE FUND (HIGH DEDUCTIBLE PLAN WITH HSA), HEALTH ASSESSMENT TAKEN 25 or more Years of Service 15 or more Years of Service 10 or more Years of Service Less than 10 Years of Service

OLD rate NEW rate OLD rate NEW rate OLD rate NEW rate OLD rate NEW rate Retiree Only $173.38 $173.38 $228.52 $228.52 $283.66 $283.66 $748.99 $776.47 Retiree + One $665.85 $665.85 $721.00 $720.99 $776.54 $776.14 $1,497.99 $1,552.93 Family $1,044.44 $1,044.44 $1,098.78 $1,098.78 $1,153.13 $1,153.12 $1,997.69 $2,070.97 Dependent Spouse N/A $560.68 N/A $560.68 N/A $560.68 N/A $560.68

*New rates effective January 1, 2017. Use RAPIDS Retiree Self Service to confirm rate changes on January 31, 2017.

HEALTH ASSESSMENT NOT TAKEN:

PLAN A, PREMIER PLAN, HEALTH ASSESSMENT NOT TAKEN 25 or more Years of Service 15 or more Years of Service 10 or more Years of Service Less than 10 Years of Service

OLD rate NEW rate OLD rate NEW rate OLD rate NEW rate OLD rate NEW rate Retiree Only $224.82 $269.78 $291.80 $350.16 $358.76 $430.51 $963.73 $999.08 Retiree + One $840.66 $1,008.79 $907.62 $1,089.14 $974.60 $1,169.52 $1,927.46 $1,998.16 Family $1,333.34 $1,600.01 $1,400.30 $1,680.36 $1,467.26 $1,760.71 $2,608.31 $2,703.99 Dependent Spouse $594.04 $594.04 $594.04 $594.04 $594.04 $594.04 $594.04 $594.04

PLAN B, CLASSIC PLAN, HEALTH ASSESSMENT NOT TAKEN 25 or more Years of Service 15 or more Years of Service 10 or more Years of Service Less than 10 Years of Service

OLD rate NEW rate OLD rate NEW rate OLD rate NEW rate OLD rate NEW rate Retiree Only $210.54 $252.65 $277.50 $333.00 $344.46 $413.35 $909.51 $942.88 Retiree + One $808.56 $970.27 $875.98 $1,050.62 $942.48 $1,130.98 $1,819.03 $1,885.76 Family $1,286.98 $1,544.38 $1,353.92 $1,624.70 $1,420.90 $1,705.08 $2,461.58 $2,551.87 Dependent Spouse $560.68 $560.68 $560.68 $560.68 $560.68 $560.68 $560.68 $560.68

CHOICE FUND (HIGH DEDUCTIBLE PLAN WITH HSA), HEALTH ASSESSMENT NOT TAKEN 25 or more Years of Service 15 or more Years of Service 10 or more Years of Service Less than 10 Years of Service

OLD rate NEW rate OLD rate NEW rate OLD rate NEW rate OLD rate NEW rate Retiree Only $173.38 $208.05 $228.52 $274.23 $283.66 $340.40 $748.99 $776.47 Retiree + One $665.85 $799.02 $721.00 $865.19 $776.54 $931.37 $1,497.99 $1,552.93 Family $1,044.44 $1,253.33 $1,098.78 $1,318.53 $1,153.13 $1,383.75 $1,997.69 $2,070.97 Dependent Spouse N/A $560.68 N/A $560.68 N/A $560.68 N/A $560.68


HEALTH ASSESSMENT TAKEN BY ONE INDIVIDUAL: I.e. retiree but not spouse has taken health assessment, or spouse but not retiree has taken health assessment

PLAN A, PREMIER PLAN, NOT COMPLETED BY BOTH RETIREE AND SPOUSE 25 or more Years of Service 15 or more Years of Service 10 or more Years of Service Less than 10 Years of Service

OLD rate NEW rate OLD rate NEW rate OLD rate NEW rate OLD rate NEW rate Retiree + One $840.66 $882.69 $907.62 $953.00 $974.60 $1,023.33 $1,927.46 $1,998.16 Family $1,333.34 $1,400.01 $1,400.30 $1,470.32 $1,467.26 $1,540.62 $2,608.31 $2,703.99

PLAN B, CLASSIC PLAN, NOT COMPLETED BY BOTH RETIREE AND SPOUSE 25 or more Years of Service 15 or more Years of Service 10 or more Years of Service Less than 10 Years of Service

OLD rate NEW rate OLD rate NEW rate OLD rate NEW rate OLD rate NEW rate Retiree + One $808.56 $848.99 $875.98 $919.30 $942.48 $989.61 $1,819.03 $1,885.76 Family $1,286.98 $1,351.33 $1,353.92 $1,421.62 $1,420.90 $1,491.95 $2,461.58 $2,551.87

CHOICE FUND (HIGH DEDUCTIBLE PLAN WITH HSA), NOT COMPLETED BY BOTH RETIREE AND SPOUSE 25 or more Years of Service 15 or more Years of Service 10 or more Years of Service Less than 10 Years of Service

OLD rate NEW rate OLD rate NEW rate OLD rate NEW rate OLD rate NEW rate Retiree + One $665.85 $699.14 $721.00 $757.04 $776.54 $814.95 $1,497.99 $1,552.93 Family $1,044.44 $1,096.66 $1,098.78 $1,153.72 $1,153.13 $1,210.78 $1,997.69 $2,070.97


Source: Department of Human Resources Memo provided to the RRS on October 21, 2016 (attached)

January1,2017OpenEnrollment–ActiveEmployees Page1

DATE: October 19, 2016

TO: All Eligible City Retirees

FROM: Johnny L. McLean

Director of Human Resources

SUBJECT: RETIRED EMPLOYEES ‐ Benefits Open Enrollment – Calendar Year 2017

Open Enrollment for your benefits for calendar year 2017 is October 31, 2016 through November 21, 2016. The City of Richmond is pleased to announce for the 5th year in a row, there will be no increase in healthcare insurance premiums for retirees who have completed the health assessment!

Healthcare Premium Incentive:

1) The healthcare insurance premium differential for those retirees who did not complete the online

health assessment will be 20%.

2) If you have a spouse on your healthcare plan with Cigna, BOTH the retiree AND spouse must have

completed the online health assessment by October 31, 2016 to receive the full healthcare premium

incentive for 2017. If only one of you completed the Health Assessment, you will receive a portion

(75%) of the premium incentive for 2017.

What You Need to Know:

Retirees can make benefit changes for Medical and Dental during this Open Enrollment period. All changes will be effective January 1, 2017.

It is strongly recommended that you attend an Open Enrollment session (schedule is on page 5 of this memorandum).

During Open Enrollment, you may enroll in, decline or make changes to your current medical and dental plan elections. If you do not make any changes to your medical or dental plans, you will continue with the coverage you currently have.

If you wish to add dependents to your plan(s), you must provide documentation that the dependents you are adding are eligible for coverage. If documentation is not received by November 21, 2016, your dependents will not be added to your coverage effective January 1, 2017. You do not need to submit dependent verification for dependents already covered under your plan. If you have questions about documentation, contact Human Resources at 646‐5660.

Health Savings Account (HSA): If you enroll in, or stay in, the Choice Fund High Deductible Medical Plan and wish to make contributions to your HSA, you must complete a new HSA Employee Annual Election Form. If you contributed to the HSA in 2016, that election does NOT automatically roll over to 2017. The City will


make a contribution to your HSA even if you choose not to contribute. The City will contribute $500 for Retiree Only Coverage and $1,000 for Retiree plus Dependents (prorated for enrollments during the year). Please note you are no longer eligible for the HSA upon attaining age 65.

Human Resources will be hosting informational sessions during open enrollment (October 31, 2016 through November 21, 2016). Representatives from our vendors will also be in attendance.

Completed enrollment forms must be received by 5:00 p.m. on Monday, November 21, 2015 in the Richmond Retirement System’s office at 730 East Broad Street, Suite 900, Richmond, VA 23219.

Deadline for this Open Enrollment period is 11:59 p.m. on Monday, November 21. CIGNA Dental Plans Rates: The CIGNA dental rates will remain the same in 2017 as they were in 2016.

Dental HMO Dental PPO

Monthly Bi‐weekly Monthly Bi‐weekly

EE Only $17.25 $8.63 $24.40 $12.20

EE + 1 Child $28.23 $14.12 $40.27 $20.14

EE + Spouse $35.16 17.58 $50.27 $25.14

EE Family $48.14 $24.07 $79.45 $39.73


CIGNA Medical Plan Rates – Plan A, Premier Plan

Your medical contributions will vary depending upon your years of service with the City and upon whether you and your spouse have taken the Health Risk Assessment.

ALL ELIGIBLE RETIREES

Cigna Medical Total monthly What COR contributes

monthly What you pay monthly

Plan A – Premier Plan 0% City Contribution – Health Assessment Completed Retiree Only $999.08 $0.00 $999.08 Retiree + 1 $1,998.16 $0.00 $1,998.16 Retiree + Family $2,703.99 $0.00 $2,703.99 0% City Contribution – Health Assessment NOT Completed by BOTH Employee AND Spouse Retiree + 1 $1,998.16 $0.00 $1,998.16 Retiree + Family $2,703.99 $0.00 $2,703.99 0% City Contribution – Health Assessment Not Completed Retiree Only $999.08 $0.00 $999.08 Retiree + 1 $1,998.16 $0.00 $1,998.16 Retiree + Family $2,703.99 $0.00 $2,703.99 50% City Contribution – Health Assessment Completed Retiree Only $999.08 $640.32 $358.76 Retiree + 1 $1,998.16 $1,023.56 $974.60 Retiree + Family $2,703.99 $1,236.73 $1,467.26 50% City Contribution – Health Assessment NOT Completed by BOTH Employee AND Spouse Retiree + 1 $1,998.16 $974.83 $1,023.33 Retiree + Family $2,703.99 $1,163.37 $1,540.62 50% City Contribution – Health Assessment Not Completed Retiree Only $999.08 $568.57 $430.51 Retiree + 1 $1,998.16 $828.64 $1,169.52 Retiree + Family $2,703.99 $943.28 $1,760.71 75% City Contribution – Health Assessment Completed Retiree Only $999.08 $707.28 $291.80 Retiree + 1 $1,998.16 $1,090.54 $907.62 Retiree + Family $2,703.99 $1,303.69 $1,400.30 75% City Contribution – Health Assessment NOT Completed by BOTH Employee AND Spouse Retiree + 1 $1,998.16 $1,045.16 $953.00 Retiree + Family $2,703.99 $1,233.68 $1,470.32 75% City Contribution – Health Assessment Not Completed Retiree Only $999.08 $648.92 $350.16 Retiree + 1 $1,998.16 $909.02 $1,089.14 Retiree + Family $2,703.99 $1,023.63 $1,680.36 100% City Contribution – Health Assessment Completed Retiree Only $999.08 $774.26 $224.82 Retiree + 1 $1,998.16 $1,157.50 $840.66 Retiree + Family $2,703.99 $1,370.65 $1,333.34 100% City Contribution – Health Assessment NOT Completed by BOTH Employee AND Spouse Retiree + 1 $1,998.16 $1,115.47 $882.69 Retiree + Family $2,703.99 $1,303.98 $1,400.01 100% City Contribution – Health Assessment Not Completed Retiree Only $999.08 $729.30 $269.78 Retiree + 1 $1,998.16 $989.37 $1,008.79 Retiree + Family $2,703.99 $1,103.98 $1,600.01


CIGNA Medical Plan Rates – Plan B, Classic Plan





Plan B – Classic Plan 0% City Contribution – Health Assessment Completed Retiree Only $942.88 $0.00 $942.88 Retiree + 1 $1,885.76 $0.00 $1,885.76 Retiree + Family $2,551.87 $0.00 $2,551.87 0% City Contribution – Health Assessment NOT Completed by BOTH Employee AND Spouse Retiree + 1 $1,885.76 $0.00 $1,885.76 Retiree + Family $2,551.87 $0.00 $2,551.87 0% City Contribution – Health Assessment Not Completed Retiree Only $942.88 $0.00 $942.88 Retiree + 1 $1,885.76 $0.00 $1,885.76 Retiree + Family $2,551.87 $0.00 $2,551.87 50% City Contribution – Health Assessment Completed Retiree Only $942.88 $598.42 $344.46 Retiree + 1 $1,885.76 $943.28 $942.48 Retiree + Family $2,551.87 $1,130.97 $1,420.90 50% City Contribution – Health Assessment NOT Completed by BOTH Employee AND Spouse Retiree + 1 $1,885.76 $896.16 $989.61 Retiree + Family $2,551.87 $1,059.93 $1,491.95 50% City Contribution – Health Assessment Not Completed Retiree Only $942.88 $529.53 $413.35 Retiree + 1 $1,885.76 $754.78 $1,130.98 Retiree + Family $2,551.87 $846.79 $1,705.08 75% City Contribution – Health Assessment Completed Retiree Only $942.88 $665.38 $277.50 Retiree + 1 $1,885.76 $1,010.24 $875.52 Retiree + Family $2,551.87 $1,197.95 $1,353.92 75% City Contribution – Health Assessment NOT Completed by BOTH Employee AND Spouse Retiree + 1 $1,885.76 $966.47 $919.30 Retiree + Family $2,551.87 $1,130.26 $1,421.62 75% City Contribution – Health Assessment Not Completed Retiree Only $942.88 $609.88 $333.00 Retiree + 1 $1,885.76 $835.14 $1,050.62 Retiree + Family $2,551.87 $927.17 $1,624.70 100% City Contribution – Health Assessment Completed Retiree Only $942.88 $732.34 $210.54 Retiree + 1 $1,885.76 $1,077.20 $808.56 Retiree + Family $2,551.87 $1,264.89 $1,286.98 100% City Contribution – Health Assessment NOT Completed by BOTH Employee AND Spouse Retiree + 1 $1,885.76 $1,036.77 $848.99 Retiree + Family $2,551.87 $1,200.54 $1,351.33 100% City Contribution – Health Assessment Not Completed Retiree Only $942.88 $690.23 $252.65 Retiree + 1 $1,885.76 $915.49 $970.27 Retiree + Family $2,551.87 $1,007.49 $1,544.38


CIGNA Medical Plan Rates – Choice Fund High Deductible Plan with Health Savings Account





Choice Fund HDHP with HSA 0% City Contribution – Health Assessment Completed Retiree Only $776.47 $0.00 $776.47 Retiree + 1 $1,552.93 $0.00 $1,552.93 Retiree + Family $2,070.97 $0.00 $2,070.97 0% City Contribution – Health Assessment NOT Completed by BOTH Employee AND Spouse Retiree + 1 $1,552.93 $0.00 $1,552.93 Retiree + Family $2,070.97 $0.00 $2,070.97 0% City Contribution – Health Assessment Not Completed Retiree Only $776.47 $0.00 $776.47 Retiree + 1 $1,552.93 $0.00 $1,552.93 Retiree + Family $2,070.97 $0.00 $2,070.97 50% City Contribution – Health Assessment Completed Retiree Only $776.47 $492.81 $283.66 Retiree + 1 $1,552.93 $776.79 $776.14 Retiree + Family $2,070.97 $917.85 $1,153.12 50% City Contribution – Health Assessment NOT Completed by BOTH Employee AND Spouse Retiree + 1 $1,552.93 $737.98 $814.95 Retiree + Family $2,070.97 $860.19 $1,210.78 50% City Contribution – Health Assessment Not Completed Retiree Only $776.47 $436.07 $340.40 Retiree + 1 $1,552.93 $621.56 $931.37 Retiree + Family $2,070.97 $687.22 $1,383.75 75% City Contribution – Health Assessment Completed Retiree Only $776.47 $547.95 $228.52 Retiree + 1 $1,552.93 $831.94 $720.99 Retiree + Family $2,070.97 $972.19 $1,098.78 75% City Contribution – Health Assessment NOT Completed by BOTH Employee AND Spouse Retiree + 1 $1,552.93 $795.89 $757.04 Retiree + Family $2,070.97 $917.25 $1,153.72 75% City Contribution – Health Assessment Not Completed Retiree Only $776.47 $502.24 $274.23 Retiree + 1 $1,552.93 $687.74 $865.19 Retiree + Family $2,070.97 $752.44 $1,318.53 100% City Contribution – Health Assessment Completed Retiree Only $776.47 $603.09 $173.38 Retiree + 1 $1,552.93 $887.08 $665.85 Retiree + Family $2,070.97 $1,026.53 $1,044.44 100% City Contribution – Health Assessment NOT Completed by BOTH Employee AND Spouse Retiree + 1 $1,552.93 $853.79 $699.14 Retiree + Family $2,070.97 $974.31 $1,096.66 100% City Contribution – Health Assessment Not Completed Retiree Only $776.47 $568.42 $208.05 Retiree + 1 $1,552.93 $753.91 $799.02 Retiree + Family $2,070.97 $817.64 $1,253.33


City of Richmond Active Employees and Retirees

Open Enrollment Dates: October 31 – November 21, 2016

Changes Effective January 1, 2017

Date Time Location

Monday, October 31 9 ‐ 11 a.m. Richmond Police Academy; 1202 West Graham Road, Room 103

2 – 4 p.m. Oliver Hill Courts Building; 1600 Oliver Hill Way

Tuesday, November 1 8 ‐ 10 a.m. DPU Water Plant ‐ 3920 Douglasdale Road

Noon – 2 p.m. Richmond Police Headquarters; 200 West Grace Street, Focus Room

Wednesday, November 2 8:30 – 10:30 a.m. Fire Headquarters; 201 East Franklin Street, Auditorium

2 ‐ 4 p.m. DPU – 730 East Broad Street; Lower Level

Thursday, November 3 8 ‐ 10 a.m. DPW ‐ 3506 North Hopkins Road

4 ‐ 6 p.m. Richmond Justice Center; 1701 Fairfield Way

(RICHMOND SHERIFF’S OFFICE EMPLOYEES ONLY)

Friday, November 4 8 – 10 a.m. DPU Operations Center; 400 Jefferson Davis Highway, Atrium

Monday, November 7 10 a.m. – noon Fire Station #23; 495 Labrook Concourse

Tuesday, November 8 8 – 10 a.m. DPU – Wastewater Treatment Plant;

1400 Brander Street, Warehouse

1 – 3 p.m. John Marshall Courts Building;

400 North 9th Street, Lower Level Jury Room

Wednesday, November 9 10 a.m. – noon Fire Station #10 – 914 Hermitage Road

2 – 4 p.m. City Hall; 900 East Broad Street, 2nd floor, City Council Chambers

Thursday, November 10 9 – 11 a.m. City Hall; 900 East Broad Street, 2nd floor, City Council Chambers

1 – 3 p.m. Richmond Police Academy; 1202 West Graham Road, Room 103

Monday, November 14 8 – 10 a.m. Richmond Justice Center; 1701 Fairfield Way

(RICHMOND SHERIFF’S OFFICE EMPLOYEES ONLY)

1 – 3 p.m. DSS – Marshall Plaza; 900 East Marshall Street,

3rd Floor Training Rooms A‐B

Tuesday, November 15 7 – 9 a.m. DEC ‐ 3516 North Hopkins Road

11 a.m. – 1 p.m. DSS – Southside Plaza; 4100 Hull Street, Conference Room A

Wednesday, November 16 7 – 9 a.m. DEC ‐ 3516 North Hopkins Road

Thursday, November 17 8 – 10 a.m. DPU Operations Center; 400 Jefferson Davis Highway, Atrium

Friday, November 18 8 – 10 a.m. City Hall; 900 East Broad Street, 2nd floor, City Council Chambers

11 a.m. – 1 p.m. City Hall; 900 East Broad Street, 2nd floor, City Council Chambers

Important Note: Formal presentations will be conducted the 1st hour of the meeting. The remaining time will be for questions and answers and assisting employees with RAPIDS Employee Self-service (making benefit changes).


Benefits at A Glance – Effective January 1, 2017

Premier Plan A Classic Plan B Cigna Choice Fund with HSA In-Network Out-of-Network In-Network Out-of-Network In-Network Out-of-Network

Member Coinsurance

10%

50%

20%

50%

30%

50%

Deductible $250 Single

$500 Family $1,000 Single $2,000 Family

$500 Single $1,000 Family

$1,000 Single $2,000 Family



Out-of-Pocket Maximum







HSA Contribution from Employer

$0

$0

$0

$0

$500 Single $1,000 Family

Preventive Care 100%;

No Deductible Deductible, 50% Coinsurance

100%; No Deductible

Deductible, 50% Coinsurance

100% Coinsurance

Not Covered

If you choose to receive care outside of your plan’s network, only covered expenses will be applied to your deductible – subject to your plan’s Maximum Reimbursable Charge provisions. See your enrollment materials for more information.

Premier and Classic plans only have a non‐collective (embedded) deductible. Once each family member meets his or her individual deductible, insurance begins paying claims at the member coinsurance level, regardless of whether the larger family deductible is met. HSA plan only has a collective or non‐embedded deductible where the total family deductible must be paid out of pocket before claims are paid at the coinsurance level of 70/30. Out‐of‐Pocket Maximums on all plans are non‐collective – each family member is only responsible for the individual out‐of‐pocket maximum amounts.

Medical Plans – Three Options Effective January 1, 2017

Premier Plan A Classic Plan B Cigna Choice Fund with HSA In-Network Out-of-Network In-Network Out-of-Network In-Network Out-of-Network

Office Visits $20 PCP

$40 Specialist Deductible,

50% Coinsurance

$25 PCP $50 Specialist




Inpatient Admission

Deductible, $500 Copay, 10%






Outpatient Facility Deductible,

$250 Copay, 10% Deductible, 50% Coinsurance





Emergency Room

$200 Copay, 10%

$200 Copay, 10%

$250 Copay, 20%

$250 Copay, 20%



Urgent Care

$40 Copay

$40 Copay

$50 Copay

$50 Copay



HSA plan only – All covered medical services are subject to the deductible and coinsurance outside of Preventive Care.


Prescription

Premier Plan A Classic Plan B Cigna Choice Fund with HSA

In-Network Retail

(30 Day Supply) Home Delivery (90 Day Supply)

Retail (30 Day Supply)

Home Delivery (90 Day Supply)



Rx

$10/$30/$55 $10/$60/$165 $10/$30/$55 $10/$60/$165

Deductible, 30% Coinsurance subject to

maximum of $200

Deductible, 30% Coinsurance subject to

maximum of $400

Out-of-Network







Rx

Not Covered

Not Covered

Not Covered

Not Covered



New Programs Added for 2017 Cigna Telehealth – Now Cigna provides access to two telehealth services as part of your medical plan – AmWell and MDLIVE. Cigna Telehealth Connection lets you get the care you need – including most prescriptions – for a wide range of minor conditions. You can connect with a board‐certified doctor via secure video chat or phone, without leaving your home or office. When, where and how it works best for you! Choose when: Day or night, weekdays, weekends and holidays. Choose where: Home, work or on the go. Choose how: Phone or video chat. Choose who: AmWell or MDLIVE doctors. AmWell and MDLIVE are easy to use! Just register for one or both so you will be ready to use telehealth service when and

where you need it!

AmWellforCigna.com – 855.667.9722 or MDLIVEforCigna.com – 888.726.3171

Cigna 90 Now ‐ Cigna now provides a maintenance medication program called Cigna 90 Now. Maintenance

medications are the medications you take regularly, over time, to treat an ongoing health condition. Now you can

choose to have your medication filled in a 90 day supply at the retail pharmacy.

Here’s how it works:

■ If you choose to fill your prescription in a 30‐day supply, you can use any retail pharmacy in your plan’s new network, or Cigna Home Delivery Pharmacy

OR ■ If you choose to fill your prescription in a 90‐day supply, you can use a 90‐day retail pharmacy

in your plan’s new network, or Cigna Home Delivery Pharmacy. ***Some of the 90‐day retail pharmacies in the network are: CVS, Target, Walmart, Kroger, Good Neighbor Pharmacies***


Planning for Your Cigna Vision Expenses

Coverage In‐Network Benefit Out‐of‐Network Benefit Frequency Period Exam Copay $15 N/A 12 months

Exam Allowance (once per frequency period)

Covered 100% after Copay Up to $45 12 months

Materials Copay $0 N/A 12 months

Eyeglass Lenses Allowances

Covered in Full

Up to $32

12 months(once pair per frequency period) Single Vision Bifocal Covered in Full Up to $55 12 monthsTrifocal Covered in Full Up to $65 12 monthsLenticular Covered in Full Up to $80 12 months

Contacts Lenses Allowances (once pair or single purchase per frequency period) Elective Therapeutic

Covered in Full Covered in Full

Up to $87 Up to $210

12 months 12 months

Frame Retail Allowance (once per frequency period)

Covered in Full Up to $55 24 months

Call to find provider 1‐877‐478‐7557

Planning for Your Cigna Dental Expenses

The amount your plan will pay for covered services received through the Cigna DPPO network and out of network will be subject to your plan’s maximum reimbursable charge or maximum allowable charge provisions. When visiting a dentist in the Cigna DPPO network or going out‐of‐network, you may be balance‐billed by the dentist for any charges that exceed what your plan reimburses for covered expenses. **Waiting periods may apply

All plans have exclusions and Limitations. Please refer to your Benefit Summary for details about your specific plan.

Coverage Total DPPO Total DHMO (Refer to DHMO Patient Charge

Schedule) In‐network Benefits Out‐of‐Network Benefit

Annual Deductible

$50 Individual

$150 Family

$50 Individual

$150 Family

None

Class I – Preventive Care

100%, No Deductible

100%, No Deductible

Refer to CIGNA Dental Care (DHMO) Patient Charge Schedule

Class II – Basic Restorative **

80%, After Deductible



Class III – Major Restorative **




Class IV – Orthodontia

Coverage for Eligible Children Only

50% No Orthodontia Deductible

Lifetime Maximum $1000

50% No Orthodontia Deductible

Lifetime Maximum $1000


In‐Network Year 1 ‐ $1500 Year 2 ‐ $1600 Year 3 ‐ $1700 Year 4 ‐ $1800

Out‐of‐Network Year 1 ‐ $1500 Year 2 ‐ $1100 Year 3 ‐ $1200 Year 4 ‐ $1300

Calendar Year Maximum No Maximum

Documents

Health and Dental Insurance Open Enrollment is Monday ... · 26/10/2016 · Health and Dental Insurance Open Enrollment is Monday, October 31, 2016 to Monday, November 21, 2016