Retiree Medical & Prescription Drug Plans

Medical Plan

We contract with Cigna to deliver the medical benefits program including coverage, verification, network access, claims processing, pre-certification, case management, and disease management. Members may contact Cigna customer care service (24 hours a day, 365 days a year) or visit the member portal to access Explanation of Benefits (EOB)'s, PPO provider directory, and other tools to navigate healthcare needs.

Medical Plan Highlights

Members may choose among three different medical plans depending upon coverage needs

Cigna Tools, Programs & FAQ

Tools

Programs

Telehealth & Virtual Services

Total Behavioral Health

FAQ

How do I register online with Cigna?
Registering your account at Cigna is easy. Simply follow these steps to register:

  1. Go to mycigna.com
  2. Click the "Register Now" link
  3. Enter the member information accordingly
  4. Confirm identity by using any of the three options listed (Subscriber SSN, ID Number, Personal Questionnaire)
    • Note:  If you are registering as an eligible dependent, be sure to enter the primary members (employee, retiree) SSN and zip code
  5. Create UserID as instructed
  6. Review and verify information and click "Submit"
  7. Accept the Agreement
  8. Select your preference for mailed or electronic documents and communications such as EOB's
  9. Complete your registration. You may be asked to verify the email provided

How do I get a Cigna medical ID card?
As of January 1, 2024, Cigna moved from physical medical ID cards to digital medical ID cards – although physical ID cards are still available to members who prefer that version. Physical ID cards received in earlier years are still good as long as you remain enrolled in the same plan.

You can access your digital ID card by either going to www.myCigna.com or by downloading the myCigna app to your phone. To view your digital ID card using the Cigna website, follow the instructions below and instead of clicking the link to submit a request for an ID card, click on the link for “View (Member’s Name) Medical ID card”. You can view an image of the front and back of your ID card and will have the option to download it to your computer.

To view your digital ID card using the myCigna app, simply log into the app using your username and password, then select the “ID Cards” option at the bottom of the screen. You will be able to view you and your family member’s ID cards and will have the option to either share, print or add the ID card to your digital Wallet.

To request new or replacement physical ID cards, you can make a phone call to Cigna’s customer service department at 1-800-244-6224 or go online to www.mycigna.com (member portal). To request online:

  • Log in to mycigna.com with your username and password.
  • Select the “ID Cards” option at the top of the page. You can specify which family member you would like to request a card for.
  • Scroll down to the bottom of the page and click on the link for “…submit a request for (Member’s Name) physical Medical ID card…” and click on the Submit button.
  • Allow up to 2 weeks for card(s) to arrive at the address Cigna has on file for you.

Why should I go to an In-Network rather than an Out-of-Network provider?
Medical services you and your covered family members receive from “in-network” (contracted) providers, result in claims processed with network discounts off of billed charges and generally a richer benefit level for you (e.g. lower deductibles and coinsurance or copay amounts with no “balance billing” by in-network providers for the difference between their billed charges and the discounted allowed charges). There’s no coverage at all for preventive care and immunizations if you use an out-of-network provider. In addition, there are no out-of-pocket maximums to protect your personal financial liability on out-of-network services.

So how does the plan choose which provider is In or Out-of-Network?
The medical plans are contracted with the Cigna Open Access Plus for access to national network providers. This means that Cigna has thousands of provider contracts that they negotiate and manage with physicians, specialists, hospitals, labs, urgent care centers, home health services, facilities and other wide-ranging licensed and credentialed providers who have all agreed to accept negotiated rates for their services—which in turn save you and the Plan money. When you go outside the network, it’s a different story. You will probably pay more because these providers do not have any price agreements in place and expect to get their full billed charges …leaving you to pay the difference between what the plan considers allowed charges and what was billed out-of-network -- this is called “balance billing.”

What if my doctor refers me to a specialist who’s not in our network?
If your doctor refers you to a non-contracted provider, you are not off the hook…it is ultimately your responsibility to make sure you get treatment from an in-network provider if you want the best benefit level under your Plan.

What if I did all my due diligence to make sure that everyone is in-network, but later I get an out-of-network bill from an “unknown” provider that I had not expected to provide service?
Some out-patient surgeries and services will be a combination of service providers like a surgeon/physician, assistant surgeon, operating room/facility, anesthesia and lab/radiology analysis etc. Typically in the out-patient setting and sometimes in the in -patient setting, these services will have separate providers/charges, most of whom you will be aware of before your surgery/ service and will have had an opportunity to review their network status.

However, not all will have a contract with Cigna under the Open Access Plus network. For example, it’s not unusual for anesthesiologists or nurse anesthetists to provide their services at a free-standing surgery center, but not participate in any network including Cigna Open Access Plus. Under these circumstances, you may not even know the out-of-network provider is part of your service delivery until after the fact when their bill is presented.

Also, keep in mind that our medical administrator has no way of knowing whether or not you had a choice and/or did your due diligence to make sure you stayed in-network -- so most likely these services will be separately coded as out-of-network in your Explanation of Benefits (EOB).

That said, the Plan will reasonably review your appeal, and allow you to explain that these out-of-network ancillary services were indeed out of your control. If the Plan accepts your appeal, these charges may be reconsidered and processed as an in-network benefit -- meaning applicable in-network deductibles, coinsurance and out of pocket maximums would apply, but only to the extent of the reasonable and customary billed charge amounts You could still be held responsible for additional fees above and beyond reasonable and customary (balance billing by the out-of-network provider).

What about emergency room services? Do I need to worry whether the emergency room and emergency physicians are in or out-of-network?
Generally a true emergency is defined as life threatening symptoms or an urgent onset of symptoms which if left untreated could result in more severe symptoms, disability or death (including but not limited to cardiac or stroke events, high body temperatures, severe dehydration, unconsciousness, respiratory distress, allergic reactions, severe pain, fractures/breaks, blood loss, trauma injuries etc.). If you are not sure if your needs are a true emergency, you can always call the 24-hour nurse line at 800-244-6224 or your family doctor, who can provide you with some guidance. Keep in mind that emergency room services cost you and the Plan more than regular doctor’s visits or urgent care centers, no matter whether in or out-of-network.

That said, if you have an emergency and need to go to a hospital emergency room, take care of yourself or your covered family member as soon as you can. Emergency services at a hospital emergency room are covered at the preferred in-network benefit level according to your plan design, based on discounted charges for in-network providers and billed charges for out-of-network providers. This could mean an in-network emergency room facility and an out-of-network emergency physician or vice versa on some occasions.

So now that I know the difference between in and out-of-network… how can I make sure my provider is in-network?
First and foremost you can go online to mycigna.com (if you are registered) or simply go to cigna.com to determine Cigna Open Access Plus network status. Additionally, the best advice is for you to contact your provider directly and ask if they “are contracted with Cigna under the Open Access Plus network.” Don’t simply ask “do they take/accept Cigna”. Most provider offices will tell you they take any insurance or network…but that doesn’t necessarily mean they are contracted with the specific network (big difference). Also, it doesn’t hurt to confirm that verbal verification by noting the person’s name, date and time of the call for your records.

Be careful about relying on past history about a provider’s in-network status. Providers are frequently being added (or dropped) from the network…so it wouldn’t hurt to confirm what you read in the online directory or were told by Cigna by calling the provider yourself, just to be sure.

If your doctor needs to refer you to a specialist, ask them to refer you to an in-network provider. And when and if they do, follow the previous procedure and check for yourself. Again, you are ultimately responsible for making in-network choices.

Medical and Prescription Highlights

 

Prescription Drug Plans

Non-Medicare Eligible Retirees or Dependents

We contract with MedImpact to provide prescription drug benefits. Prescription drug services include coverage, verification, claims processing, pre-authorization, and specialty drug services. Members may contact MedImpact Member Services 24 hours a day, 7 days a week, or visit the member portal to access various tools to navigate your prescription drug care needs.

Standard Drug Formulary(PDF, 4MB)

Preferred Drug List(PDF, 204KB)

Medicare Eligible Retirees or Dependents

VibrantRX is the prescription drug provider for Medicare-eligible retirees and covered Medicare-eligible spouses and dependents. 

The VibrantRX plan combines the benefits of a standard Medicare Part D prescription drug plan with additional coverage provided Mesa.  As a result of this combined coverage, drug benefits remain similar to the prescription drug coverage for retirees who are Non-Medicare eligible.

Medicare Eligible Retirees and their Dependents can have prescriptions filled at one of VibrantRX's approximately 66,000 network pharmacies across the country, including retail, mail order, long-term care, home infusion and other pharmacies.

Prescription Drug Plan Highlights

Covered drugs under the Prescription Drug Benefit in each of our Medical Plans are divided into three tiers with progressive cost share for members as you move "up" the tiers.

  • Tier 1 is covered generic drugs.
  • Tier 2 is preferred brand-name drugs (also known as Formulary Drugs)
  • Tier 3 is non-preferred brand name drugs (also known as Non-Formulary Drugs)

Formulary changes can occur at any time under our prescription drug program; new drugs may enter one of the Tiers and drugs may move around the tiers (e.g., a drug can move from Tier 2 to 3 or vice versa). Drugs may also go "off" formulary altogether (no longer available or covered under the Plan).

Changing to a generic or formulary drug alternative, where available, may help you avoid higher copayments.  Contact your doctor and ask whether changing to a preferred alternative would be right for you, where available. It is up to your doctor to choose the best medicine for you.  All medications on the formulary list, including generics, have been FDA approved/indicated and evaluated for effectiveness and safety (e.g., side effects and drug-to-drug interactions).

Medical / Prescription Plan Monthly Premiums

Due to various factors that are considered in calculating individual retiree premiums (years of service, plan, coverage level, ASRS/PSPRS subsidy, Medicare discount, etc.), retiree premiums cannot be posted. This information is communicated directly to each eligible retiree when they first enroll or make a subsequent qualifying event or open enrollment change and/or following general rate changed during open enrollment.

Prescription FAQ

How do I register online with MedImpact?
Registering your account at MedImpact is easy. Simply follow these steps to register:

  1. Go to medimpact.com
  2. Click the "Get Started" button on the Member Sign page
  3. Enter the employee/retiree information accordingly
  4. The Benefit ID number will be the RX ID# on your ID card (for example: RX009999)

What are Mail-order prescriptions and how can it save me money?
Visit medimpact.com/homedeliverymembers for details.

Why is my pharmacist telling me my medication needs a Prior Authorization? What is it and what do I need to do?
Need a link to their website. Cannot use an image like on current site.