Insurance Forms and Documents

Benefit Rates

Title
  Rates FY22
  Rates FY21

Benefit Forms

Title
  Form: Benefits Change Form FY22
  Form: Hartford Long Term Disability Claim
  Form: Hartford Portability and Conversion
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Benefit Notices

Title
  Important Notices FY22
  Notice: COBRA Continuation FAQ
  Notice: COBRA General (Initial) 20-21
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Medical Documents

Title
  Fliers
  HRA
  HSA
  Network
  Pharmacy
  SBC
  Virtual Care

Dental Documents

Title
  Dental Choosing A Plan
  Dental Choosing A Plan (2)
  Dental Cigna Virtual Care
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Vision Documents

Title
  Avesis - City of Tucson Retiree Benefit Summary July 1-2021.pdf
  Vision Avesis Benefit Summary Employee FY21
  Vision Avesis Benefit Summary Employee FY22
  Vision Avesis Benefit Summary Retiree FY21
  Vision Avesis Benefit Summary Retiree FY22

Life Documents

Title
  Hartford Basic Life Booklet 07.17
  Hartford Basic Life Highlights
  Hartford Basic Life Rider 07.17
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Benefits Documents

Title
Cigna_Virtual_Care.pdf
COT_Creditable_Coverage_Notice_FY_2019_CIGNA_HMO_HRA (1).pdf
HMO Booklet Network_SPD_7.1.2019.pdf
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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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