Open Enrollment 2019
The annual Open Enrollment period is closed for the January 1, 2019 – December 31, 2019 plan year.
This is your opportunity to review your current benefit elections, make changes to your medical, dental, and life insurance coverage, as well as enroll (or re-enroll) in a health care or dependent care Flexible Spending Account (FSA) for an effective date of January 1, 2019. You must enroll in the Flexible Spending Accounts during this Open Enrollment period in order to participate (your current FSA election, if applicable, will not automatically roll over into the new plan/calendar year).
Open Enrollment, for the new plan year (from January 1, 2019 through December 31, 2019), will be completed online via an electronic open enrollment form. The form allows you to login with your Portal credentials and enroll or change your benefits online – at work, at home, or from any computer with Internet access –at any time during the Open Enrollment period. Note: VPN access is NOT required. After successful completion of the process, you will receive a confirmation via e-mail to your Pace account.
Both the In-Net 50 medical plan and the 100/70 medical plan will be discontinued completely as of January 1, 2019. It is recommended that those enrolled in either plan elect a new medical plan during this annual Open Enrollment period. If an election is not made, employees enrolled in the In-Net 50 plan will be enrolled in the Network Core plan and those enrolled in the 100/70 plan will be enrolled in the Choice PPO plan (formerly the 90/70 plan) for an effective date of January 1, 2019.
If you do not have changes to make and do not wish to participate in the Flexible Spending Accounts, it is not necessary to complete the Open Enrollment form – your benefits will continue as they are. However, please review the “Updates for January 1, 2019 – December 31, 2019” section below (including the General Reminders), as there are some plan modifications that will take effect on January 1, 2019.
All changes made during this Open Enrollment period will take effect on January 1, 2019* and will remain in effect through December 31, 2019. You cannot change your benefit selections until the next Open Enrollment period (which will be in fall 2019 for an effective date of January 1, 2020), unless you experience a qualifying change in family status during the new plan year.
*With the exception of voluntary life insurance changes for those currently on short-term disability, Family and Medical Leave, New York Paid Family Leave, or unpaid personal leave. Such changes will become effective on the first of the month following the employee’s return to work.
Updates For January 1, 2019 – December 31, 2019
Consumer core HDHP Plan, Network Core Plan, Dental Plans, Vision Plan, Voluntary Life Insurance
We are pleased to announce that the premiums and plan designs will remain unchanged for the following Cigna plans :
- Consumer Core HDHP Medical Plan
- Network Core Medical Plan
- DHMO Dental Plan
- PPO Dental Plan
- Vision Plan
- Voluntary Life Insurance
Discontinuation of Grandfathered Plans - In-Net 50 and 100/70 Medical Plans
The In-Net50 Plan and the 100/70 Plan will be discontinued as of January 1, 2019. Those currently enrolled must select an alternate medical plan during this Open Enrollment period. If a new plan is not selected, those enrolled in the In-Net 50 Plan will be mapped to the Network Core Plan and those enrolled in the 100/70 Plan will be mapped to the Choice PPO Plan.
changes to choice ppo medical plan (formerly network choice 90/70 plan)
- Retaining co-payments of $30 to see a Primary Care Physician and $50 to see a Specialist (although preventive care visits will continue to be covered at 100% under all plans)
- Retaining pharmacy co-payments of $20 (generic medications), $45 (preferred brand medications), and $70 (non-preferred brand medications) after the calendar year deductible, for non-generic prescriptions, has been satisfied
- In-Network deductible (individual/family) increased from $250/$500 to $750/$1,500
- In-Network employee coinsurance increased from 10% to 15%
- In-Network out-of-pocket maximum increased from $1,200/$2,400 to $2,000/$4,000
- Out-of-Network deductible (individual/family) increased from $1,200/$2,400 to $2,000/$4,000
- Out-of-Network employee coinsurance increased from 30% to 35%
- Out-of-Network out-of-pocket maximum (individual/family) increased from $2,500/$5,000 to $5,000/$10,000
- New ID cards will be generated by Cigna for this plan. If you have not received your ID card by January 1st, you will be able to print a temporary ID via www.mycigna.com.
HSA Contribution Limits
Coverage Type: Individual $3,500
Coverage Type: Family $7,000
Health Care FSA and Dependent Care FSA Limits
The limit for the Health Care FSA (for January 1, 2019 – December 31, 2019) is $2,700 ($112.50 per paycheck)
The limit for the Dependent Care FSA (for January 1, 2019 – December 31, 2019) is $5,000 ($208.33 per paycheck); $2,500 ($104.16 per paycheck) if both spouses contribute via separate employers.
You must enroll, during each Open Enrollment period, in order to participate for the new plan year.
Reminder: Deductibles and annual limits are calculated on a calendar year basis. Please plan accordingly.
Per Paycheck Premiums (January 1, 2019 – December 31, 2019)
medical plan waiver reimbursement for those newly waiving coverage
For those who are currently covered under our Cigna medical plans and will be waiving coverage for the first time as of January 1, 2019, you will receive an annual (12-month) reimbursement of $1,800 ($75 per paycheck). After 1 year (as of January 1, 2020), your annual (12-month) reimbursement will revert to $750 ($31.25 per paycheck). Those who are currently waiving medical coverage, and will continue to do so as of January 1, 2019, will receive an annualized reimbursement of $750 ($31.25 per paycheck).
Coverage to end of calendar year in which dependent turns age 26
A dependent is eligible for coverage under the medical/vision and dental plans until the end of the calendar year in which he/she turns age 26. A dependent who ages off the plans at age 26 will be offered the opportunity to continue dental coverage on COBRA and medical coverage on COBRA or under the New York State Young Adult Option (premiums are 2% less than COBRA).
continuation of value prescription drug list
- $0 co-payments for generic preventive medications on this list (PDF)
- narrowing the list of high-cost brand drugs used to treat the same medical condition (unless proven clinically necessary through the medical exception process)
- moving certain drugs on the formulary to another tier
Cigna will restore coverage for certain therapeutic medications (such as those used to treat stomach acid conditions and non-sedating antihistamines for allergies), which are currently also available over-the-counter (OTC). When you access your account on mycigna.com or the Cigna Mobile App (PDF), the generics will appear as covered.
Please review the Cigna Value 3-Tier Prescription Drug List (PDF), especially the section entitled, “Medications That Are Not Covered” (beginning on Page 18) and discuss covered alternative medications with your physician prior to January 1st.
urgent care facilities
In recent years, many Urgent Care centers have emerged in towns and cities, including within drug stores and medical groups. Urgent Care centers provide individuals with care when the situation isn’t life threating, but requires immediate attention. Urgent Care centers will typically cover conditions such as: earaches and infections, minor cuts, sprains and burns, fever and flu. Pace’s Network Core and Choice PPO plans require a co-payment of $30 for Urgent Care vs. an Emergency Room co-payment of $85. If a participant is enrolled in the Consumer Core HDHP, the cost of services will be less at an Urgent Care center than at the Emergency Room, so out-of-pocket costs will be less.
It is important to note that while a facility may be advertised as “Urgent Care”, the Urgent Care center or medical offices providing “urgent care services” could very well not be contracted with Cigna as a participating Urgent Care facility. Cigna participants have encountered this issue when a medical group has an Urgent Care center; however, this center is actually contracted with Cigna as a “specialist provider.” In this case, the Network Core and Choice PPO specialist co-payment – of $50 - applies. In order to find a contracted Urgent Care center ($30 co-payment), please contact Cigna or utilize the Cigna Mobile App (PDF) and search for “Urgent Care.”
For severe and life-threatening conditions (such as shortness of breath, chest pain, uncontrollable bleeding, etc.), the Emergency Room could be the more appropriate setting and a hospital will be better-equipped to handle these situations.
Cigna participants can see a board-certified doctor with private, online, and live appointments via a secure video or phone conversation. Participants are able to choose from two Telehealth vendors, American Well and MDLIVE, how they want to connect, and the time and day that works best for them with medical Telehealth services available 24/7/365. Telehealth doctors can treat many common health issues including cold & flu, joint aches and pains, fever, bronchitis and more. Participants with children can also turn to CignaTelehealth services for non-emergency pediatric care. Telehealth services provide a more immediate and potentially lower cost alternative to traditional ‘in person’ care, such as hospital ERs and Urgent Care clinics.
For more information - Cigna Telehealth (PDF).
Cigna Lab Services
In most instances you should not experience any issues, as your physician automatically sends your lab work to the correct Cigna-participating lab. However, if the in-network provider sends your lab work to a non-participating vendor, the claim will be processed at the out-of-network level or not covered at all (if you are enrolled in an in-network only plan). As such, we strongly recommend that you inform your provider of the participating labs whenever you utilize these services. The following provides some guidance on how to best handle these services.
What you need to do when lab work is needed:
- Find network labs by going to mycigna.com or calling the number on your Cigna ID card.
- Tell your doctor you want to use a Cigna network lab.
- If your doctor takes a sample in the office, tell him/her to send it to a Cigna network lab.
- Bring a print-out of participating labs to your appointment. Make sure that the lab is an in-network lab. Just because a lab accepts your Cigna ID card, it doesn’t necessarily mean that the lab is contracted within the Cigna Open Access Plus network.
If an in-network doctor does not send your lab work to a participating provider and your claim is processed at the out-of-network level (or not covered at all, if you are in the Consumer Core HDHP, Network Core, or In-Net 50 plan), you do have the right to appeal the decision. Please contact Cigna’s customer service department at the number listed on your ID card.
Annual Deductibles, Out-Of-Pocket Maximums, Etc.
Annual deductibles, out-of-pocket maximums, etc. are based upon a calendar year.
Benefits to Consider During this Open Enrollment period:
- Cigna Medical Plans
- Medical Plan Waiver
- Cigna Vision Plan
- Cigna Dental Plans
- Health Care Flexible Spending Account (FSA)
- Child and Dependent Care Flexible Spending Account (FSA)
- Cigna Voluntary Life Insurance
Benefits to Consider Throughout the Plan Year (Can be Changed During the Year):
- Commuter Reimbursement Accounts (CRA)
- New York 529 College Savings Program
- Long Term Care
- Employee Assistance Program (EAP)
- 403b Defined Contribution Retirement Plan