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Active Employees, COBRA and Non-Medicare Eligible Retirees Medical Plans

2019 Highlights!

Cigna Healthcare rates and plan design changes are pending final negotiations and ratification with the Unions and Board approval. If premium and plan design changes occur, you will be notified and will be given another opportunity to make any necessary changes to your healthcare coverage.

Cigna healthcare plans continue to be offered to eligible retirees, and dependents who are under age 65, or dependents over age 65 and not Medicare eligible: Cigna OAP 10 (only offered to current participants), Cigna OAP 20 and Cigna LocalPlus. Cigna LocalPlus is comprised of a network of physicians who have demonstrated the best outcomes. Check to see if your doctor has been added.

  • These healthcare plans are offered on a guaranteed basis.
  • If enrolling in a Cigna Healthcare plan, you and your eligible dependent must enroll in the same healthcare plan.
  • You are not required to select a Primary Care Physician and referrals are not needed when seeking services from a specialist.
  • We strongly encourage you and/or your covered dependent(s) to establish a relationship with a physician.
  • In accordance with the Affordable Care Act (ACA) medical, Rx costs, deductibles and co-insurance are counted toward your Annual Maximum Out-of-Pocket (MOOP). Participants save more, because once the MOOP has been reached; the participant will be covered 100 percent and will have no other healthcare costs to pay.

Frequently Asked Questions

Click on the question to view the answer

What is a co-payment?

A co-payment is a fixed dollar amount you pay for covered healthcare services. The amount will vary by type of plan and covered service.

What is a Cigna Care Network (CCN) specialist?

A CCN Specialist is a Specialist of a designated network that has been identified by Cigna to have demonstrated the best outcome in management in patient treatment. This network includes both primary care physicians and specialists.

What specialties are included in this network?

There are 22 specialist providers located in South Florida.

How do I determine if my specialist is on the CCN network?

Log-in to www.cigna.com and click on Find a Doctor. You can search by name or specialty. Once you’re on the online directory, look for the Special Cigna Care Designated Symbol.

What is an annual deductible?

An annual deductible is the annual amount you are responsible for medical services provided in a hospital or hospital-affiliated facility. This amount is separate from any co-payments.

What does the annual maximum out-of-pocket (MOOP) mean?

The annual maximum out-of-pocket is the amount you are responsible for before the plan pays 100 percent.

What does the plan co-insurance mean?

The plan co-insurance is the percentage by plan you pay for medical services provided in a hospital or hospital-affiliated facility. Co-insurance does not apply to fixed co-payments.

What happens if I am hospitalized?

Hospital admissions are subject to deductibles and co-insurance.

What are convenience care centers and what are the co-payments for these centers?

Convenience care centers are located in retail stores and pharmacies; they’re often open at night and on weekends. These centers are staffed by board-certified nurse practitioners and physician assistants to treat minor medical concerns that are not life threatening.

What are urgent care centers and what are the co-payments?

Those are centers for medical conditions that are not life-threatening. Urgent Care Centers are staffed with nurses and doctors, and always are open on evenings and weekends. Both in and out-of-networks Urgent Care Centers are covered at 100 percent after paying the set co-payment.

What’s an emergency room and what is my co-payment?

Emergency rooms are located in all hospitals and are for immediate treatment of critical injuries or illnesses. Services are covered 100 percent after set co-payment after the plan deductible is met.

What is Cigna 90 Now?

With Cigna 90 Now, you are offered a retail pharmacy network that gives you more choice in where you can fill your your 90-day prescriptions. Maintenance medications have to be filled in a 90-day supply at one of the participating retail pharmacies or Cigna Home Delivery Pharmacy.

How are Prescription Drugs Retail (up to 31-day supply) classified?

Tier 1 – Generic Medications
Tier 2 – Preferred Brand Medications (when generic is not available)
Tier 3 – Co-insurance (minimum $ & maximum $) Non-Preferred Brand Medications (These medications have a generic or a Tier 2 alternative within the same drug class.)

What’s a Retail Pharmacy Network?

This is a network of participating pharmacies where prescriptions can be filled. All other pharmacies are not participating in the plan.

Which are the pharmacies participating in the Retail Pharmacy Network?

CVS (including Target and Navarro), Walgreens, Walmart, Publix and specifically identified independent pharmacies are in the network.

What pharmacies offer discounts on prescriptions outside of the School Board’s healthcare plan?

Some retail pharmacies offer very low prices on selected generic drugs, often less than the co- payment on your Cigna Plan. These alternative prescription programs are offered at:
• Walmart
• Target
• Walgreens
• CVS Pharmacy
• Publix

What’s the coverage for Durable Medical Equipment (DME)?

After you have satisfied the annual deductible:
OAP 20 Plan will pay 70% in network and 50% non-network.
OAP 10 Plan will pay 80% in network and 50% non-network.
Cigna LocalPlus will pay 30% in network and 50% non-network.
Once you have met your maximum out of pocket, the coverage will be 100%.

Is there a cost when enrolling in Cigna LocalPlus?

No, there is no cost for the Cigna LocaPlus plan for employee-only coverage (applies to full-time active benefits eligible employees).

Is there a cost when enrolling in Cigna OAP 10 or OAP 20?

Yes, both plans have a cost share based on the employee’s benefit salary band (applies to benefits-eligible full-time employees). OAP 10 is no longer available to new participants.

Can I decline healthcare coverage?

Yes, active benefits-eligible employees can decline healthcare coverage and, you will receive a monthly contribution of $100 paid through the payroll system based on your deduction schedule (subject to withholding and FICA).

Additionally, you must be enrolled in a group or state funded healthcare plan to decline healthcare coverage. You will be required to submit proof of this other enrollment. If proof is not submitted, your declination selection will be cancelled and you will automatically be enrolled in Cigna LocalPlus employee-only coverage.

What number do I call for additional information on the healthcare plan?

Call Cigna Healthcare at 1.800.806.3052, 24-hours/7 days a week.

What number do I call for additional information on my enrollment and all other benefits?

Call the FBMC Service Center at 1.855.MDC.PS4U (1.855.632.7748), Monday through Friday, 7 a.m. – 7 p.m. ET.

Cigna Healthcare
24 hours / Seven days a week
1-800-806-3052

M-DCPS Logo in white

Office of Risk and Benefits Management
1501 N.E. 2nd Avenue, Suite 335
Miami, Florida 33132
Mon - Fri, 8 a.m. to 4:30 p.m. ET
www.dadeschools.net
305-995-7129

FBMC Service Center
Mon - Fri, 7 a.m. to 7 p.m. ET
1-855-MDC-PS4U (1-855-632-7748)