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Cigna-PPO

Contact Us

Cigna

P. O. Box 188050
Chattanooga, TN 37422-8050

Hours of Operation

24 hours / 7 days a week

Contact Information

1.800.244.6224
www.mycigna.com

CVS

Contact Us
Non-Medicare Eligible 

CVS/Caremark

PO Box 52136
Phoenix, AZ 85072-2136

Hours of Operation

24 hours / 7 days a week

Contact Information

1-855-264-5048
www.caremark.com

SilverScript_logo_RGB

Contact Us
Medicare Eligible 
 

SilverScript

PO Box 52136
Phoenix, AZ 85072-2136

Hours of Operation

24 hours / 7 days a week

Contact Information

1-844-416-1298
www.mesaaz.silverscript.com

Important Forms & Documents 

Medical Claim Form

Rx Claim Form

Plan Document

Preferred Drug List

Specialty Drug List

Cigna Tools

Cigna Medical Group Preventive Care Incentive

Cigna Medical Group Services/Locations

How to find a Cigna Provider

MyCigna Mobile App

Cigna One Guide App

Cigna One Guide Overview

Preventive Care Overview

Where to get Care

Cigna Telehealth Connection

What is Telehealth

Telehealth Connection Flyer

Amwell Demo

MDLIVE Demo

Medical/Prescription Drug Plans (Retiree)

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About Us Header

City of Mesa Medical Plan

The City of Mesa is contracted 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.

Contact Information/Claims Address:

 Medical Plan administered by: Cigna
 Address: PO Box 188050, Chattanooga, TN 37422-8050
 PPO National Network: Open Access Plus
 Group Number: 3341050
 Customer Service Number: 1.800.244.6224
 Telehealth Connection Services: AmwellforCigna: 1.855.667.9722; or MDLIVEforCigna:  1.888.726.3171
 Pre-Certification Number: 1.800.244.6224
 24 Hour Nurse Help Line: 1.800.244.6224
 Website: www.mycigna.com

Cigna TogetherAllTheWay


City of Mesa Medical Plan Highlights

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

Medical
Features 
Basic Medical Plan Choice Medical Plan Copay Medical Plan
In-Network Out-of-Network In-Network Out-of-Network In-Network Out-of-Network
Annual Deductible  $500/Individual
$1,500/Family
$1,000/Individual
$3,000/Family
 $250/Individual
$750/Family
$1,000/Individual
$3,000/Family
$0 $1,000/Individual
$3,000/Family
Coinsurance
(Plan Pays)
 50% 25% 80% 60% 100% 60%
Out-of-Pocket Medical Maximum
(Includes deductible)
$4,650/Individual
$9,300/Family
Unlimited  $2,600/Individual
$5,200/Family
 Unlimited $3,575/Individual
$7,150/Family
Unlimited
PCP Physician Office Visit
(Member Pays)
 $20 copay 75% after deductible 20% after deductible  40% after deductible $20 copay 40% after deductible
Specialist Office Visit
(Member Pays)
$20 copay 75% after deductible 20% after deductible  40% after deductible $40 copay 40% after deductible
Emergency Room Visit
(Member Pays)
50% after deductible 50% after deductible 20% after deductible  20% after deductible $150 copay
($300 if admitted)
$150 copay
($300 if admitted)
Alternative Health Care
(Plan Pays)
(acupuncture, naturo/homeopath)
Not Covered Not Covered 80% after ded, up to $1,000/year 60% after ded, up to $1,000/year Not Covered Not Covered
Preventive Care & Immunizations
(Plan Pays)
100% Not Covered 100% Not Covered 100% Not Covered


Prescription Drug Plan for Non-Medicare Eligible Retirees and Non-Medicare Eligible Dependents

The City of Mesa is contracted with CVS/Caremark, to provide prescription drug benefit administration to Non-Medicare eligible Retirees.  Prescription drug services include coverage, verification, claims processing, pre-authorization, and specialty drug services.  Members may contact CVS/Caremark Customer Care 24 hours a day, 7 days a week, or visit the member portal to access various tools to navigate your prescription drug care needs to include the CVS Preferred Drug List and Specialty Drug List.

Contact Information/Claims Address:

 Rx Plan administered by: CVS/Caremark
 Address: PO BOX 52136, Phoenix, AZ 85072-2136
 Rx Group Number: RX1119
 Customer Service Number: 1.855.264.5048
 Website: www.caremark.com


Prescription Drug Plan for Medicare-Eligible Retirees and Medicare Eligible Dependents

SilverScript Insurance Company (SSI) is the prescription drug provider sponsored by City of Mesa for Medicare-eligible retirees and covered Medicare-eligible spouses and dependents. 

The SilverScript plan combines the benefits of a standard Medicare Part D prescription drug plan with additional coverage provided by the City of 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 SilverScript’s approximately 66,000 network pharmacies across the country, including retail, mail order, long-term care, home infusion and other pharmacies.  Medicare-eligible retirees and their covered Medicare-eligible spouses and dependents may contact SilverScript Customer Care 24 hours a day, 7 days a week, or visit the member portal to access various tools to navigate your prescription drug care needs.

Contact Information/Claims Address:

 Rx Plan administered by: SilverScript
 Address: PO Box 52136, Phoenix, AZ 85207-2136
 Rx Group Number: RXCVSD
 Customer Service Number: 1.844.416.1298 
 Website: www.mesaaz.silverscript.com    


City of Mesa Prescription Drug (Rx) Plan Highlights

Covered drugs under the City's 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) and 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 (i.e., 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).

 Rx Services Basic Medical Plan Choice Medical Plan Copay Medical Plan
 Out-of-Pocket Rx Maximum
 (Separate from medical)
$2,500/ Individual
$5,000/ Family
$4,550/ Individual
$9,100/ Family
$3,575/ Individual
$7,150/ Family
 Annual Deductible $250 $50
(Waived on Generic and 90 Day)
None
 30 Day – Retail Supply 
 · Generic
 · Preferred Brand
 · Non-Preferred Brand
You Pay
· 20% (min $5 max $50)
    · 25% (min $30 max $100)
    · 40% (min $50 max $200)
You Pay
· 20% (min $5 max $50)
    · 25% (min $30 max $100)
    · 40% (min $50 max $150)
You Pay
· $15
· $50
· $85
 90 Day – Mail Order / CVS Retail 
 · Generic
 · Preferred Brand
 · Non-Preferred Brand
You Pay
· 20% (min $10 max $100)
· 25% (min $50 max $200)
· 40% (min $80 max $300)
You Pay
     · 20% (min $12.50 max $100)
· 25% (min $75 max $200)
  · 40% (min $125 max $300)
You Pay
· $25
· $90
 · $160
 Medicare Eligible Members ONLY
 90 Day – (Non-CVS Retail) 

 · Generic
 · Preferred Brand
 · Non-Preferred Brand
 You Pay
· 20% (min $15 max $150)
· 25% (min $90 max $300)
  · 40% (min $150 max $600)
You Pay
· 20% (min $15 max $150)
· 25% (min $90 max $300)
  · 40% (min $150 max $450)
You Pay
· $45
  · $150
  · $255


Medical/Prescription Plan Monthly Premiums (Retirees):

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.  If you have a question about the calculation of your current retiree premium, please contact the Employee Benefits Office at 480.644.2299 or via email at benefits.info@mesaaz.gov.

FAQs

  • What is Telehealth Connection and how do I use it?
  • What are Mail-order prescriptions and how can it save me money?
  • Why is my pharmacist telling me my medication needs a Prior Authorization? What is it and what do I need to do?
  • How do I register online with Cigna?
  • How do I register online with CVS/Caremark?
  • Why should I go to an In-Network rather than an Out-of-Network provider?
  • So how does the plan choose which provider is In or Out-of-Network?
  • What if my doctor refers me to a specialist who’s not in our network?
  • 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?
  • What about emergency room services? Do I need to worry whether the emergency room and emergency physicians are in or out-of-network?
  • So now that I know the difference between in and out-of-network… how can I make sure my provider is in-network?
  • What does medical plan precertification really mean?
More FAQs