Medical Plan Highlights

• Active employees may participate in a high deductible plan with Health Savings Account (HSA)
• Medical benefits are provided by CIGNA Healthcare
• Enrollment is allowed only as a new hire, through qualifying events, or open enrollment
• Coverage is continuous unless actively changed
• Preventive medical care is covered at 100%

Preventive Services List

• Preventive drugs covered outside of the deductible, at coinsurance level

Preventive Drug List

2-Step Enrollment

There are two steps to enroll in the High Deductible Plan with Health Savings Account:

1. Complete the Medical/Dental/Vision enrollment form

- HSA/HDHP option

- HRA/HDHP option (if you have other insurance coverage, including Medicare, Medicaid, spouse plan, flexible spending, etc.)

2. Complete the Salary Reduction Agreement form (optional)
- if you intend to contribute your own money to your HSA.

- HRA participants cannot contribute their own money.

Provider Look-Up

Provider Look-up
**If no providers are available within 25 miles of your location, contact Cigna for "Medical Certification for Network Adequacy" at:

800-558-3654

Cigna Online

MyCigna.com
Website registration is required

• Track HSA and claims
• Download Explanations of Benefits
• Pay bills out of your HSA
• Verify coverage for prescription drugs
• In-network provider look-up
• Manage plan ID cards

Using MyCigna.com

Using MDLive:

Health Savings Account (HSA)

Highlights

Tax-exempt contributions to an HSA remain exempt if you use them (and their earnings) to pay for qualifying Medical expenses.

Certain restrictions exist for participation in an HSA:

• Must be enrolled in a high deductible health plan.
• Must not have any other insurance coverage.
• Dependents with other coverage may impact the amount you can save.

Eligible HSA Expenses

How much does it cost?

Current Year Medical Premiums

What is covered?

Summary Plan Description (SPD)

Click the SPD to see what your Cigna plan pays.

Legal Plan Document

AUI Comprehensive Medical Plan Document.

Legal document outlining who can be covered and how the plan works.

Enrollment Forms and Links

Medical/Dental/Vision enrollment form

Salary Reduction Agreement - HSA

HSA contributions can be changed at any time during the year.

You must manually assign your beneficiary for your HSA. If you do not do so, your HSA will be assigned to your estate.  See the document below for more information.

HSA Beneficiary Assignment Instructions

Claim and Pre-Authorization Forms

Medical Claim Form
Medical Claim Form for out-of network claims, not for use with prescriptions.

Rx Drug Claim Form
Cigna uses a 3-step plan for prescription drugs. Step-1 and Step-2 drugs don't require pre-authorization. Use this form to file claims.

Rx Pre-Authorization Form
Use this form to receive pre-authorization for Step-3 prescription drugs.

Health Reimbursement Account (HRA)

Highlights

Individuals who are not eligible for an HSA due to other medical coverage (Medicare, Medicaid, spouse insurance, flexible spending accounts, etc.) may receive the employer contribution given to HSAs through an HRA.

"Summary of Coverage and Benefits" document

The Patient Protection and Affordable Care Act (PPACA) requires the AUI Comprehensive Medical Insurance Plan to provide a “Summary of Coverage and Benefits” to plan participants prior to the close of annual open enrollment.

These documents were produced by Cigna HealthCare and follow specific federal guidelines. Please note that these are only summaries and do not outline the comprehensive details of your plan. For complete coverage details you should refer to the Summary Plan Description for your plan as posted on this site.

The updated current year Summary Plan Descriptions will be available online and in hard copy form upon request in the first quarter of the current year.

You have a right to receive a paper copy of the Summary of Coverage and Benefits upon request at no charge to you. If you would like to request a paper copy, or if you have any questions, please contact the benefits office.