Insurance Forms and Documents

Benefit Rates

Title
  Rates FY26
  Rates FY25
  Rates FY24
  Rates FY23
  Rates FY22
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Benefit Forms

Title
  Vision
  Form - Waiver of Premium application rev 2022
  Form: Hartford Long Term Disability Claim
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Benefit Notices

Title
  Important Notices FY 26
  Important Notices FY24
  Important Notices FY25
-- show 9 archived items --
-- hide archives --
This item is archived and can no longer be modified.  Important Notices FY22
This item is archived and can no longer be modified.  Important Notices FY23
This item is archived and can no longer be modified.  Insurance Handbook
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
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Medical Documents

Title
  Fliers
  HRA
  HSA
  Network
  Pharmacy
  SBC
  SPD
  Virtual Care
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Dental Documents

Title
  Dental Choosing A Plan
  Dental Cigna Virtual Care
  Dental HMO Patient Change Schedule W1SV9 AZ FY23
-- show 13 archived items --
-- hide archives --
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 State FY23
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 - All Other States FY24
This item is archived and can no longer be modified.  Dental PPO Summary - AZ FY24
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 - AZ Only FY23
This item is archived and can no longer be modified.  Dental PPO Summary FY21
This item is archived and can no longer be modified.  DHMO FY24 SPD
This item is archived and can no longer be modified.  DPPO FY24 SPD for All Other States
This item is archived and can no longer be modified.  DPPO FY24 SPD for AZ Residents
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Vision Documents

Title
  Avesis vision - Employee FY25
  Avesis Vision - Employee FY26
  Avesis vision - Retiree FY 25
  Avesis Vision - Retiree FY26
  Employee Vision Benefit Summary FY24.pdf
-- show 5 archived items --
-- hide archives --
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
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Life Documents

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

Title
2023 City of Tucson FSA Short Plan Year - Recorded
Benefits Overview Dental, EAP, Programs (pdf)
Child & Adult Backup Care
-- show 12 archived items --
-- hide archives --
This item is archived and can no longer be modified. Benefits Education Opportunities (PDF)
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
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Insurance Handbook: https://oneteam.tucsonaz.gov/our_resources/forms/payroll/benefits~3/benefits_files/insurance_handbook_fy25

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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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