Insurance Forms and Documents

Benefit Rates

Benefit Notices

Title
  Important Notices FY22
  Important Notices FY23
  Notice: COBRA Continuation FAQ
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This item is archived and can no longer be modified.  Notice: COBRA General (Initial)
This item is archived and can no longer be modified.  Notice: Creditable Coverage FY21
This item is archived and can no longer be modified.  Notice: Early Retiree Reinsurance Program
This item is archived and can no longer be modified.  Notice: HIPAA privacy
This item is archived and can no longer be modified.  Notice: Marketplace
This item is archived and can no longer be modified.  Notice: Non-Creditable Coverage FY21

Dental Documents

Title
  Dental Choosing A Plan
  Dental Cigna Virtual Care
  Dental HMO Patient Change Schedule W1SV9 AZ FY23
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This item is archived and can no longer be modified.  Dental Choosing A Plan (2)
This item is archived and can no longer be modified.  Dental HMO Patient Charge Schedule W1-SV9 AZ FY22
This item is archived and can no longer be modified.  Dental HMO Patient Charge Schedule W1-V9 AZ FY21
This item is archived and can no longer be modified.  Dental PPO Summary - All Other States FY 22
This item is archived and can no longer be modified.  Dental PPO Summary - AZ Only FY22
This item is archived and can no longer be modified.  Dental PPO Summary FY21

Vision Documents

Title
  Employee Vison Benefit Summary FY23
  Retiree Vison Benefit Summary FY23
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This item is archived and can no longer be modified.  Avesis - City of Tucson Retiree Benefit Summary July 1-2021.pdf
This item is archived and can no longer be modified.  Vision Avesis Benefit Summary Employee FY21
This item is archived and can no longer be modified.  Vision Avesis Benefit Summary Employee FY22
This item is archived and can no longer be modified.  Vision Avesis Benefit Summary Retiree FY21
This item is archived and can no longer be modified.  Vision Avesis Benefit Summary Retiree FY22
Title
Cigna_Virtual_Care.pdf
MEDICAL_Find_a_Doctor1.pdf
MEDICAL_HSA_Bank_Deposit_Account_Agreement_and_Disclosures_Jan_2016.pdf
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This item is archived and can no longer be modified. COT_Creditable_Coverage_Notice_FY_2019_CIGNA_HMO_HRA (1).pdf
This item is archived and can no longer be modified. HMO Booklet Network_SPD_7.1.2019.pdf
This item is archived and can no longer be modified. HRA Booklet.pdf
This item is archived and can no longer be modified. HRA Summary of Benefits.pdf
This item is archived and can no longer be modified. HRA_how_it_works_Flyer_2014-15.pdf
This item is archived and can no longer be modified. HSA COT_Creditable_Coverage_Notice_FY_2019_CIGNA_HMO_HRA (1).pdf
This item is archived and can no longer be modified. medical_hra_proration_april_2012.pdf
This item is archived and can no longer be modified. Network Plan Summary.pdf
This item is archived and can no longer be modified. Vision_Benefit_Summary_7-1-2018_Retiree.pdf
This item is archived and can no longer be modified. Vision_Summary_7-1-2018_Active.pdf
This item is archived and can no longer be modified. Your Cigna Plan Choices 2021-2022.pdf
 

Contact the Benefits team

Contact one of our Vendors

Cigna - medical, dental, EAP

  • 800-244-6224 (members)
  • 888-806-5042 (pre-enrollment)
  • mycigna.com

Avesis - vision

  • 833-282-2438
  • avesis.com
  • Plan 926COT-L2
  • Group 10790-2150 (employees) & 10790-2152 (retirees)

Hartford - life & LTD

  • 888-301-5615 (claims)
  • 800-331-7234 (applications)

ASI Flex (flexible spending accounts)


Colonial (voluntary insurance)


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