For specific premium cost and a brief summary of all benefits please see the Benefits Guide FY 2017-18

MEDICAL INSURANCE INFORMATION & FORMS




  • SIS GAP INSURANCE INFORMATION

    Gap insurance is a voluntary benefit to the employee to assist with medical deductible and out of pocket expenses.  If you have elected this benefit you are eligible for:

    • $2,000 In-Patient Benefit – this means a stay in the hospital over night
      • 1 benefit per family member per year
    • $1,000 Out-Patient Benefit
      • 3 benefits per family per year
      • Out-patient includes ER, Out-patient procedures, day surgery, Major Imaging services.

    This benefit is for PPO Participants only and only applies towards eligible medical expenses.


  • To file a claim you will need:

    To file a claim provide the provider your SIS Supplemental Insurance Card. If the provider will not file a secondary insurance claim on your behalf the procedures to file for reimbursement are below.

    Claim Filing Procedures

    Supplemental Gap Insurance Claim Form

    1. Claim Form
    2. Itemized statement such as HCFA 1500 or UB04 from provider – must include BOTH procedure AND diagnostic codes. If doctor or facility will not provide this form to you, have them file the secondary claim on your behalf.
    3. EOB from Meritain proving amount was applied toward deductible and/or Out of Pocket.
    4. Receipt(s) of payment if you made payments toward your medical bill.
  • FLEXIBLE SPENDING ACCOUNTS

    tasc-logoFlexible Spending allows you to elect up to a maximum specified amount to use, PRE-TAX, for unreimbursed medical, prescriptions, dental, and vision related costs. This would be the costs, you as the employee, pay for co-pays, prescription co-pays, dental work, glasses, contacts, LASIK, etc. The elected amount is taken out in equal installments via payroll pre-tax. Meaning the deduction decreases your taxable income.

    FSA Eligible Expenses

    Dependent Day care is another benefit that allows you to elect up to a maximum specified amount to use for child care costs. Please see below for further explanation between Child Care Credit vs. Daycare Flexible Spending. Which is better for you?

    Dependent Care Info


  • 2017 Maximum Amounts

    • TASC-Mobile$ 2,600 – Unreimbursed health
    • $ 5,000 – Dependent Day Care

    To check you FSA balances anytime, anywhere….download the app.

    To log in, order new cards, add a dependent card, file for reimbursement please visit TASC

  • H.S.A. - Health Savings Account

    City contributes up to $1,000 per year for individual and $2000 for family coverage into a Health Savings Account for participants in the High Deductible Medical Plan.
    Below is H.S.A. Banking information.

    HSA Banking Information

    Participants can only use H.S.A. contribution funds on certain qualified expenses. Please see the list below for Qualified Expenses.

    HSA Qualified Medical Expenses

    For further information on your account and to log in please see HSA Participant Guide.

    For further information and account set up, visit H.S.A. – TASC website.

DENTAL AND VISION

  • DENTAL INFORMATION - CIGNA Plan # 3339059

    cigna_logo_hmTo access your claim information and print cards visit myCigna. To register you will need either your social or use the above plan number.

    To view network dentists, visit Cigna Dental Directory

    For smart phone app savvy users – download the MyCigna app to view your dental information.


  • VISION INFORMATION - CIGNA Plan # 3339059

    To register an account to view claims and locate a provider, visit Cigna Vision Website

    Unfortunately the dental and vision accounts are not linked in one location. Vision is a separate site.

  • CIGNA - EXTRA BENEFITS

    Just by being a Cigna customer you have access to extra benefits such as Will Preparation, Identify Theft Program, and Discounts.  Please see the flyer – CIGNA Extra Benefit Flyers