Benefits enrollment guide for state of Arizona employees

              Enrollment at a Glance . . . . . . . . . . . . . . . . . . . 2
Open Enrollment 2001 . . . . . . . . . . . . . . . . . . . . 3
What’s New This Plan Year. . . . . . . . . . . . . . . . 3
Medical Plan Options . . . . . . . . . . . . . . . . . . 3
Prescription Drug Program. . . . . . . . . . . . . . 4
Vision Plan Carrier. . . . . . . . . . . . . . . . . . . . 5
Improved Enrollment Process . . . . . . . . . . . . 5
Enroll on Time!. . . . . . . . . . . . . . . . . . . . . . . . . 5
Costs for Coverage . . . . . . . . . . . . . . . . . . . . . . 6
Eligibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Pre-Tax Benefits . . . . . . . . . . . . . . . . . . . . . . . . 7
Social Security . . . . . . . . . . . . . . . . . . . . . . . 8
Qualified Status Changes . . . . . . . . . . . . . . . . . 8
Open Enrollment Meetings . . . . . . . . . . . . . . . . 8
Saguaro Program Medical Plans . . . . . . . . . . . 11
If You and Your Spouse are State Employees. . 12
Transition of Care . . . . . . . . . . . . . . . . . . . . . . 12
Important Things to Consider When Making
Your Medical Coverage Election . . . . . . . . . . . 13
Medical Plans Comparison Chart. . . . . . . . . . . 14
Saguaro Program Dental Plans . . . . . . . . . . . . 17
Dental Plans Comparison Chart. . . . . . . . . . . . 18
Additional Employee Benefit Plans . . . . . . . . . 19
Vision Care Insurance . . . . . . . . . . . . . . . . . . . 19
Life Insurance . . . . . . . . . . . . . . . . . . . . . . . . . 20
Short-Term Disability Insurance . . . . . . . . . . . 21
Flexible Spending Accounts . . . . . . . . . . . . . . 21
Health Care Spending Account . . . . . . . . . . 22
Dependent Care Spending Account . . . . . . . 22
Flexible Spending IRS Information . . . . . . . 23
How To Enroll in a Flexible
Spending Account . . . . . . . . . . . . . . . . . . . . 23
Using Your Flexible Spending Accounts . . . 24
How Much Can You Save? . . . . . . . . . . . . . 24
Determining Your Flexible Spending
Account Contributions. . . . . . . . . . . . . . . . . . . 25
Enrolling in Saguaro Benefits . . . . . . . . . . . . . 26
New for 2001/2002—Online Enrollment—
the Preferred Option!. . . . . . . . . . . . . . . . . . . . 26
New for 2001/2002—Telephone Enrollment—
an Alternative Option . . . . . . . . . . . . . . . . . . . 28
Paper Enrollment—One Last Option. . . . . . . . 29
Enrollment Worksheet . . . . . . . . . . . . . . . . . . . 30
Completing Your Enrollment. . . . . . . . . . . . . . 32
Other Important Information . . . . . . . . . . . . . 32
Payroll Deductions . . . . . . . . . . . . . . . . . . . . . 32
About this Booklet . . . . . . . . . . . . . . . . . . . . . 32
Frequently Asked Questions . . . . . . . . . . . . . . 33
Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Table of Contents
1
It is very important that you review this booklet
so you can fully understand how the Saguaro
Benefits Program works.
This year, since we are changing our medical plan
options, every employee who wants medical plan
coverage for plan year 2001/2002 must enroll
during the open enrollment period.
Important enrollment activities:
• This year you may enroll for benefits two new
ways, the online or interactive voice response
(IVR) telephone systems.
• When electing HMO or POS medical plan coverage,
you will need to record a Primary Care Physician
(PCP) for yourself and each covered dependent.
• When electing EDS or PDC dental plan coverage,
you will need to record a Primary Care Dentist
(PDP) for yourself and each covered dependent.
• You will need to enter your Social Security
number in the enrollment system.
• You will need to enter the Social Security number
for each person you are covering in the medical,
dental or vision plans.
Use the following list to help you quickly find the
information you need to successfully enroll.
ADOAHuman
ResourcesWeb Site www.hr.state.az.us/benefits
Costs for Coverage page 6
Open Enrollment Meeting Schedule pages 9-10
CIGNA Physician Directory Information
www.cigna.com
(through 9/30/01) 1-800-613-4563
(after 9/30/01) HMO/POS: 1-800-244-6224
(after 9/30/01) PPO: 1-800-280-7651
Enrollment Worksheet page 30
Online Enrollment Web Site www.az.gov
Telephone Enrollment System (IVR) 1-866-740-7153
Personal Identification Number
(PIN) Replacement 1-866-251-5672
or www.az.gov
Arizona Benefits Help Desk 1-866-251-5672
(24 hours a day/7 days a week)
Open Enrollment Dates:
August 13 through September 7, 2001
2
Enrollment at a Glance
3
Open enrollment is your opportunity to make
changes to your coverage(s) that are appro-priate
for both you and your family. As a
State of Arizona benefits-eligible employee, you may
take the following actions during this year’s open
enrollment period:
• Make elections for the medical, vision and flexible
spending accounts (FSA) plans. You must
enroll/re-enroll in the medical, vision and FSA
plans to have coverages during the upcoming
plan year.
• Make elections for dental and life insurance
coverages.
• Add/drop short-term disability (STD) insurance
coverage.
• Add/drop dependents from your medical, dental,
vision and life insurance coverage(s).
• Increase/decrease life insurance.
Note: All of our benefit plans are independent of
each other. For example, you can elect medical
coverage without electing dental coverage.
The open enrollment period begins on August 13 and
continues through September 7. Changes that you
make during open enrollment will go into effect on
the first day of the new plan year - October 1, 2001.
While STD and life insurance coverages are effective
October 1, if you are being covered by either of these
plans for the first time and are absent from work due
to illness or injury on that date, the coverage doesn’t
begin until you return to your job.
What’s New This Plan Year
Medical Plan Options
For our upcoming plan year, based on where you live,
you will have up to three medical plan options: a
Health Maintenance Organization (HMO), a Point of
Service (POS) plan or Preferred Provider Organization
(PPO) plan. See page 12 to learn the differences
between these three types of plans.
These CIGNA plans have been selected because:
• The State has an established, successful working
relationship with CIGNA. They have a proven
track record with us and other large employers for
providing quality health care, claims administration
and customer service.
• By consolidating all of our medical plan coverages,
we are able to purchase more with our health care
dollars. With all of our employees covered by this
one carrier, we are able to negotiate better rates for
the benefits they provide. Having one primary
carrier allows us to better control our health care
costs and yours!
• By consolidating all of our medical coverages, we
can administer our health care plans more consis-tently
and efficiently.
• CIGNA has one of the largest networks of high-quality
physicians and hospitals across the country,
so in-network coverage may be available even out
of state.
When electing HMO or POS medical coverage, you
must choose a PCP actively participating in the
CIGNA plan you are selecting. You are encouraged to
visit CIGNA’s web site (www.cigna.com) or to call
Open Enrollment 2001
their toll-free number (1-800-613-4563) to determine
whether your doctor is a member of their network.
As we are changing our medical plan options, it is
necessary for every employee to make a medical
plan election for the upcoming plan year. If you don’t
enroll for medical coverage by September 7, 2001,
you will have no medical coverage for the
2001/2002 plan year unless you elect it after you
have a qualified status change.
The Super Saver Medical Savings Account Plan is
being discontinued effective October 1, 2001. If you
participate in this plan or have participated and have
an account balance, additional information will be
mailed to you.
Depending on the plan option you select when you
enroll for health benefits, you may find that your
current provider does not participate in your new
plan’s network. If you are actively undergoing treat-ment
from a non-participating provider at the time of
enrollment, you may be eligible for “Transition of
Care” service. See page12 for more information.
Prescription Drug Program
Whichever medical plan you elect, you will automat-ically
participate in a three-tier prescription drug
plan. You will always pay the lesser of the copay or
actual cost for a prescription.
Your Copay
Tier Prescription Type (for up to 30-day supply)
1 Generic $10
2 Preferred Brand $20
3 Non-Preferred Brand $40
Mail order prescriptions are also covered under
CIGNA’s online/mail/phone order program, Tel-Drug
(www.teldrug.com). Prescriptions in this program are
delivered to your home sealed in tamper-evident,
discreetly labeled packaging. You can e-mail, phone
or mail in most orders and refills and save the
amount of one copay for a 90-day prescription.
Mail Order Copay
Tier Prescription Type (for up to 90-day supply)
1 Generic $20
2 Preferred Brand $40
3 Non-Preferred Brand $80
About the Prescription Drug Tiers:
CIGNA maintains a formulary, an extensive list of
safe and effective generic and preferred brand-name
prescription drugs. CIGNA HealthCare’s Pharmacy
and Therapeutics Committee develops the list and
updates it on a regular basis. Only those medications
that have successfully passed federally required clin-ical
testing and evaluation and have been proven
effective are included in the list.
4
Getting the most from your pharmacy
benefit:
1. Ask your practitioner to prescribe:
• 1st choice: a generic drug
• 2nd choice: a brand name drug from the
Preferred Brand list
2.Fill your prescriptions at a CIGNA network or
contracted pharmacy or through the Tel-Drug
program. Visit CIGNA’s web site at www.cigna.com
or call 1-800-613-4563 to find the network phar-macy
nearest you.
3.Pay your portion of prescription charges using
pre-tax dollars reimbursed from your Health Care
Spending Account. Be sure to adjust your Health
Care Spending Account election to cover any out-of-
pocket prescription costs you expect to have
during the 2001/2002 plan year. For more informa-tion
on using the Health Care Spending Account,
see page 22.
The three tiers covered under the prescription drug
plan are:
Generic - These are generic drugs on CIGNA’s
formulary. A generic drug usually has a brand name
equivalent. Generic drugs must meet the same FDA
standards as brand-name drugs and are tested and
certified by the FDA to be as effective as their brand
name counterparts.
Preferred Brand - These are brand-name drugs on
CIGNA’s formulary.
Non-Preferred Brand - These are brand-name drugs
that are not on CIGNA’s formulary. Typically, they
are not on the formulary because they have equally
effective and less costly generic equivalents or one
or more preferred-brand options.
Vision Plan Carrier
The State has chosen a new vision provider. The new
vision plan features higher benefit levels and lower
costs. The new vision plan carrier is Avesis, Inc.
Plan features under the new provider are described
on page 19.
Improved Enrollment Process
We are excited to offer two new and much easier
ways to enroll in Saguaro Benefits for the 2001/2002
plan year—you can use the Web or our new phone
enrollment system. Either one of these options allows
you to make all of your benefit choices in one
connection, including your Flexible Spending
Accounts election.
If you are unable to enroll using the Web or the
phone system, you will need to fill out a Benefits
Election (BE-1) form. In addition, you will need to
complete a Flexible Spending Account (BE-5) form to
continue or start participating in the Flexible Spending
Accounts. The BE-1 and Flexible Spending Account
forms can be obtained by contacting your benefits
liaison or you can pick up a form at an open enroll-ment
meeting (schedule of meetings on pages 9-10).
You are strongly encouraged to use the Web or tele-phone
to make your elections. Complete instructions on
how to enroll in Saguaro Benefits begin on page 26.
Enroll on Time!
If you fail to enroll by the annual enrollment deadline,
September 7, 2001, you will receive no medical or
vision plan coverage for the 2001/2002 plan year. You
will continue all of your other active elections, with
the exception of the Health Care Spending Account
and Dependent Care Spending Account which will
default to “No Participation.” Be sure to review your
paycheck to see how your payroll deduction is
affected by your enrollment.
If using the Web or phone enrollment systems, you’ll
have until midnight on September 7, 2001, to enroll.
If using paper enrollment, your forms must reach
your benefits liaison no later than September 7, 2001.
5
6
MONTHLY PREMIUMS—VISION PLAN
Avesis, Inc. SINGLE FAMILY
Employee Employee
Coverage $6.48 $17.54
MONTHLY PREMIUMS—SUPPLEMENTAL EMPLOYEE LIFE/AD&D
INSURANCE PLAN
Employee Per $5,000
Your Age of Coverage
Under 30 $0.50
30 – 39 $0.70
40 – 49 $1.80
50 – 59 $3.80
60 – 69 $6.70
70+ $10.60
MONTHLY PREMIUMS—DEPENDENT LIFE
INSURANCE PLAN
Coverage Amount Employee
$2,000* $0.92
$4,000 $1.84
$6,000 $2.76
$12,000 $5.52
*This coverage is only available to employees currently covered at this level.
MONTHLY PREMIUMS—SHORT-TERM DISABILITY PLAN
Employee
$.89 per $100 of your monthly base salary, to a maximum of $5,000
Example:
Monthly salary = $2,500
Monthly premium = $22.25
Costs for Coverage
Use these charts to determine what your 2001/2002 benefit costs will be.
MONTHLY PREMIUMS — MEDICAL PLANS
SINGLE FAMILY
Employee State Total Employee State Total
Maricopa County and the town of Apache Junction
HMO $25.00 $209.76 $234.76 $125.00 $461.88 $586.88
POS $100.62 $209.76 $310.38 $314.04 $461.88 $775.92
PPO $135.36 $244.76 $380.12 $403.44 $546.88 $950.32
Pima County
HMO $25.00 $193.82 $218.82 $125.00 $422.04 $547.04
POS $76.82 $193.82 $270.64 $254.56 $422.04 $676.60
PPO $144.18 $228.82 $373.00 $425.44 $507.04 $932.48
Remaining Counties (excluding town of Apache Junction)
PPO $25.00 $320.12 $345.12 $125.00 $737.82 $862.82
Out of State
PPO $25.00 $410.30 $435.30 $125.00 $963.24 $1,088.24
Your available medical plan options and their costs will be based on the address of your primary residence. Seasonal or secondary addresses cannot be used.
MONTHLY PREMIUMS—DENTAL PLANS
SINGLE FAMILY
Employee State Total Employee State Total
Delta Dental $8.22 $15.24 $23.46 $34.44 $41.48 $75.92
MetLife Dental $6.02 $15.92 $21.94 $25.94 $44.62 $70.56
Employers Dental
Services (EDS) $2.76 $5.82 $8.58 $15.12 $9.78 $24.90
Protective
DentalCare $2.50 $6.00 $8.50 $14.00 $10.28 $24.28
Eligibility
All state employees regularly scheduled to work 20
hours or more each week, except those listed below,
and their eligible dependents may participate in the
Saguaro Benefits Program, provided they comply
with the contractual requirements of their selected
health care plan.
These employees are not eligible for Saguaro
Benefits:
• employees who work less than 20 hours/week
(or 40 hours bi-weekly);
• employees in seasonal, temporary, emergency or
clerical pool positions;
• patients or inmates employed in State Agency
institutions;
• non-state employee officers and enlisted personnel
of the National Guard of Arizona; and
• employees in positions established for rehabilita-tion
purposes.
Your eligible dependents are:
• your legal spouse.
• your unmarried children who are under age 19 or
under age 25 if considered by an educational insti-tution
(trade school, community college, or univer-sity)
to be a full-time student. Children can be
natural/birth, adopted, placed by court order or
placed in the home pending adoption, foster chil-dren
or step-children. Step-children must reside in
the household of the employee.
(If your dependent child is attaining the maximum
age and is disabled, immediately contact your bene-fits
liaison regarding procedures to continue coverage
for that dependent in accordance with A.R.S. Section
20-1407.)
Pre-Tax Benefits
Since some of your monthly insurance premiums and
contributions to your flexible spending account(s)
are made on a pre-tax basis, your taxable income is
reduced. This means you will be paying less state,
federal and social security (FICA) taxes.
The Internal Revenue Service (IRS) restricts the enroll-ment
status changes that you can make during the plan
year when your monthly insurance premiums and
contributions to flexible spending account(s) are paid
on a pre-tax basis. IRS rules allow enrollment changes:
• During annual open enrollment.
• In the event you have a qualified status change.
If you have a qualified status change, you have 31
days to change your affected benefit elections.
The employee benefits that are eligible for pre-tax
premium payments or contributions under the Saguaro
Benefits Program are:
• Medical plan
• Dental plan
• Vision plan
• Flexible Spending Accounts
• Health Care Spending Account
• Dependent Care Spending Account
• Life insurance plan (up to $35,000)
After-tax plans do not have the same IRS restrictions
during the plan year. You can reduce or cancel after-tax
plans during the plan year without an enrollment event.
Examples of after-tax plans are:
• Short-term disability insurance plan
• Life insurance plan (over $35,000)
• Dependent life insurance plan
If you are thinking of reducing or canceling any
coverage, be sure to consider any carrier restrictions
that may apply. For example, annual increases to
Supplemental Life Insurance are limited.
7
Social Security
Any reduction in your taxable pay for Social Security
purposes could lead to a reduction in your future
Social Security benefits. For most employees, the
reduction in Social Security benefits will be insignifi-cant
when compared to the value of paying lower
taxes today. However, if this is of concern to you,
please consult a tax advisor.
Qualified Status Changes
A qualified status change permits employees to make
certain mid-year changes to their benefits that are
consistent with the qualifying event. If you have a
qualified status change and want to make a change in
benefits, you must notify your benefits liaison, in
writing, within 31 days of the event to request the
change. Following is a list of some, but not all,
eligible qualified status changes:
• Change in employee’s marital status - marriage,
divorce, legal separation, annulment, death of
spouse
• Change in dependent status - birth, adoption, place-ment
for adoption, death, or dependent eligibility
due to age, marriage, student status
• Change in employment status - employee, spouse,
dependent
• Change in work schedule - increase/decrease in
hours worked by employee, spouse, dependent
• Change in residence or place of work causing
change in health plan availability - employee,
spouse, dependent
• Significant change in spouse’s group benefit cost or
coverage
Open Enrollment Meetings
Open enrollment meetings are located throughout the
State of Arizona to assist you in making informed
decisions concerning your health benefits. This year we
have scheduled presentation meetings, question and
answer (Q&A) sessions and benefit festivals.
Summaries of the features of our new medical plans
will be available at all of these open enrollment events.
Presentation meetings are an opportunity for
employees to hear the insurance representatives make
formal presentations about their plans. The presenta-tion
meetings will begin at the time designated on the
schedule that follows and are approximately two
hours in length.
Q&A sessions are in a different format. These
sessions are designed for you to discuss the plans
with carrier and ADOA representatives, and obtain
literature such as provider directories. All Q&A
sessions have starting and ending times designated
on the schedule. You may arrive when it is conven-ient
for you during this time period. If you have
specific questions on the open enrollment materials
that you received, please bring the materials with you
to the session.
During this year’s benefit festivals, you can talk to
the carriers one-on-one, enroll for benefits online
using the new Saguaro Program Online Enrollment
System and attend briefings. Note: You must have
your Personal Identification Number (PIN) to enroll
online. The Festivals begin at 9:00 and end at 2:00.
Throughout the day, at regular intervals, the medical
and vision plan carriers will hold briefings (please
see the schedule that follows for starting times). The
carriers will have information such as plan literature
and provider directories available for you at the festi-vals.
ADOA benefits representatives will also be
available to answer any questions that you may have.
Due to security regulations, some meetings are
restricted to employees of that particular agency only.
An example would be Corrections personnel
employed at a prison.
8
9
Presentation (P),
Q&A, Briefing (B)
City Address Date or Festival (F) Time
Bellemont   Navajo Depot, Arizona Army National Guard, August 13 P 2:00p
Training Building #3
Bisbee DES, Conference Room, 209 Bisbee Rd. August 28 Q&A 1:30p - 3:00p
Bullhead City DES, FAA Conference Room, 829 Hancock Rd. August 31 P 1:30p
Chinle ↔DES, FAA, N. Hwy 191 Building 7395A, August 29 P 2:30p DST ✹
Intersection U.S. 191, Indian Route (I.R. 7)
Coolidge Arizona Training Center, 2800 N. Highway 87, Gym August 17 P 9:00a
DJC Catalina   DJC, Catalina, Chapel, 14500 N. Oracle Rd. August 16 P 1:00p
Douglas DES, Conference Room, 615 2nd Street August 28 Q&A 8:00a - 9:30a
Douglas Prison   Douglas Prison, Admin. Conference Room, Route 191 August 28 Q&A 10:00a - 11:30a
Flagstaff City Hall, Council Chambers, 211 W. Aspen August 13 P 9:30a
Flagstaff ↔City Hall, Council Chambers, 211 W. Aspen August 22 P 9:00a
Florence Prison   ASPC, East Butte Ave., South Unit Visitation Room August 17 Q&A 1:00p - 2:30p
Fort Grant   Fort Grant Prison, Highway 266, August 23 Q&A 1:30p - 3:00p
Warden’s Conference Room, Admin Bldg.
Fredonia Fire Department, 20 W. Brown August 20 Q&A 1:00p - 2:30p
Globe DES, 605 S. 7th St., Large Conference Room August 23 Q&A 8:30a - 10:00a
Holbrook ADOT, 2407 E. Navajo Blvd., Training Facility August 28 P 1:30p
Kayenta ↔DES, Conference Room, Highway 163 August 21 Q&A 2:00p DST ✹
Kingman Police Department, Conference Room, August 30 P 10:00a
2730 E. Andy Divine Ave.
Kingman Police Department, Conference Room, August 30 P 1:30p
2730 E. Andy Divine Ave.
Lake Havasu Police Department, 2630 N. McCulloch Blvd. August 31 P 9:00a
Mesa Sheraton, 200 N. Centennial Way August 22 P 8:00a
Nogales City Hall, Council Chambers, 1018 Grand Avenue August 29 P 8:30a
Page ↔City Hall, Council Chambers, 697 Vista Ave. August 21 P 8:30a
Payson Town Hall, Council Chambers, 303 N. BeeLine Hwy. August 28 Q&A 9:00a - 10:30a
Phoenix 1700 W. Washington, Lobby August 13 F 9:00a - 2:00p
Phoenix 1700 W. Washington, Grand Canyon Room August 13 B 7:30a - 3:30p
Phoenix 1700 W. Washington, Lobby August 14 F 9:00a - 2:00p
Phoenix 1700 W. Washington, Grand Canyon Room August 14 B 7:30a - 3:30p
Phoenix   Courts, 1501 W. Washington, Training Room August 15 P 9:00a
Phoenix Attorney Generals Office, 15 S. 15th Ave., August 15 P 1:00p
Basement Capital Center, Rooms A&B
Phoenix Environmental Quality, 3033 N. Central, Room 1709 August 16 P 1:30p
Phoenix Industrial Commission, 800 W. Washington, Auditorium August 16 P 8:30a
Phoenix Arizona Ind. for the Blind, 3013 W. Lincoln, Lunch Room August 17 P 1:30p
Phoenix Military Affairs, 5636 E. McDowell, Auditorium August 17 P 8:00a
Phoenix ADOT, Auditorium, 206 South 17th Ave. August 20 P 9:00a
Phoenix ASRS, Boardroom, 3300 N. Central, 10th Floor August 21 P 8:30a
Phoenix Water Resources, 500 N. 3rd Street, August 23 P 8:30a
Conference Rooms A&B
Open Enrollment Meeting Schedule
10
Presentation (P),
Q&A, Briefing (B)
City Address Date or Festival (F) Time
Phoenix   DJC/Adobe Mountain, 2800 W. Pinnacle Peak Rd., August 24 Q&A 8:00a - 9:30a
Visitation Room
Phoenix   DJC/Black Canyon, 24601 N. 29th Ave., Training Room August 24 Q&A 10:00a - 11:30a
Phoenix   DPS, 2102 W. Encanto, East Classroom August 24 P 1:30p
Phoenix AHCCCS, 701 E. Jefferson, Gold Room August 28 P 8:30a
Phoenix Industrial Commission, 800 W. Washington, Auditorium August 28 P 1:30p
Phoenix Crowne Plaza, 2532 W. Peoria August 29 P 8:00a
Phoenix ADOT, Auditorium, 206 S. 17th Ave. August 30 P 1:00p
Phoenix Arizona State Hospital, 2500 E. Van Buren, August 30 P 7:00a
Training Education Building Rm. 4&5
Phoenix   ASPC, Buckeye, 26701 S. State, Route 85, August 31 Q&A 10:00a - 11:30a
Large Visitation Room
Phoenix   ASPC, Lewis, 26700 S. State, Route 85, August 31 Q&A 8:00a - 9:30a
Training Room
Phoenix   ASPC, Perryville, 2014 North Citrus Rd., August 31 Q&A 1:45p - 3:15p
Training Room
Phoenix ADOA Training, 1616 W. Adams, Auditorium (Basement) September 4 P 8:30a
Phoenix State Capital, Governors Reception Room, September 6 P 7:30a
1700 W. Washington, 2nd Floor
Prescott Yavapai College, Prescott, 1100 E. Sheldon Street August 14 P 9:30a
Bld. #3, Room #131
Prescott Yavapai College, Prescott, 1100 E. Sheldon Street August 14 P 1:30p
Bld. #3, Room #131
Safford Library Phelps Dodge Room, 808 7th Ave. August 24 P 9:00a
Safford Prison   Safford Prison, Graham Visitation Rm., 8000 Cook Rd. August 24 Q&A 1:00p - 2:00p
Show Low Council Chambers, 200 W. Cooley August 29 P 8:30a
Sierra Vista Police Department, Conf. Rm., 911 N. Coronado Drive August 27 Q&A 1:30p - 3:00p
Tucson 400 W. Congress August 15 F 9:00a - 2:00p
Tucson 400 W. Congress, Conference Room #444 August 15 B 9:00a - 4:00p
Tucson Tucson Deaf & Blind Performing Arts Auditorium, August 27 P 9:00a
1200 W. Speedway (West of I-10)
Tucson Prison   Tucson Prison, Building #47, 10000 S. Wilmont Rd. August 16 P 8:30a
Winslow ↔Adobe Inn, Banquet Room, 1701 N. Park Dr. August 30 Q&A 8:30a - 10:00a
Winslow Prison   Coronado Visitation Room, 2100 S. Highway 87 August 30 Q&A 10:30a - 12:00p
Yuma Convention Center, 1440 Desert Hills Dr., East Wing September 5 P 10:30a
Conference Room
Yuma Convention Center, 1440 Desert Hills Dr., East Wing September 5 P 1:30p
Conference Room
Yuma Prison   Yuma Prison, 23115 S. Avenue “B”, September 6 P 8:30a
Cheyenne Visitation Unit
Open Enrollment Meeting Schedule
Key:
Q&A Question and Answer Session
  Restricted Access
↔ Navajo Translation Services by ADOA
✹ Chinle and Kayenta are on Day Light Savings Time
Persons with a disability may request a reasonable accommoda-tion
by calling (602) 542-5008 or by sending an e-mail to bene-fits@
ad.state.az.us. Please make your request as early as possible
prior to the meeting, so the accommodation can be made.
In the plan year 2001/2002, benefits-eligible state
employees, depending on where they live, may
choose from up to three medical plan options: a
Health Maintenance Organization (HMO), a Point of
Service (POS) plan or Preferred Provider
Organization (PPO) plan.
• Employees residing in Pima and Maricopa coun-ties
and in the town of Apache Junction can elect
coverage under the HMO, POS or PPO options. In
an HMO, you are covered for in-network care only,
except in case of emergency. Under the POS plan,
you have an in-network benefit that works like an
HMO, with an out-of-network benefit like a PPO.
In a PPO, you don’t have to select a primary care
physician; you can use any provider, but the plan
will pay more if you use in-network physicians,
hospitals or facilities.
• Employees residing in remaining Arizona coun-ties
(excluding the town of Apache Junction) or
outside the State can elect coverage under the
PPO option. In a PPO, you don’t have to select a
primary care physician; you can use any provider,
but the plan will pay more if you use in-network
physicians, hospitals or facilities.
• Current Arizona State law allows employees to
enroll in an HMO (with certain restrictions) even
if they do not live in the HMO’s service area. If
you live outside of the HMO service area and you
want to enroll in an HMO, please contact your
benefits liaison.
Medical plan comparison charts contain a partial
listing of the benefits. A more detailed summary of
the plans’ features will be available at this year’s
open enrollment meetings and benefits festivals. All
benefits are subject to plan limitations and exclu-sions.
The comparison chart begins on page 14.
Definitions for many of the terms in the chart can
be found in the Glossary in this booklet.
After you enroll for coverage, please review the
materials mailed to you by the medical plan carrier
so you are familiar with and understand the terms
and conditions of the new plan before you begin to
use services. Specific questions concerning a plan
can be directed to the CIGNA Member Services
department. Their phone number is listed inside the
back cover of this booklet.
11
Saguaro Program
Medical Plans
12
If You and Your Spouse are State Employees
If both spouses are State of Arizona employees:
• Both may elect single medical plan coverage.
• One may elect family medical plan coverage while
the other opts for no coverage.
• One spouse may elect single medical plan coverage
and one spouse may elect family coverage (if they
have one or more eligible dependents). Note: the
total premium may exceed the statutory monthly
employer contribution and result in an additional
employee payroll deduction for medical plan
coverage.
Transition of Care
Depending on the plan option you select when you
enroll for health benefits, you may find that your
current provider does not participate in the CIGNA
HealthCare network for the medical plan option you
selected. If you are actively undergoing treatment
from a non-participating provider at the time of
enrollment, you may be eligible for “Transition of
Care” service.
Situations eligible for transition of care services
include:
• Women in their second or third trimester of preg-nancy
at the time of eligibility.
• Acute conditions in active treatment or chronic
conditions being actively treated at the time of plan
eligibility.
• Terminal conditions as defined by Hospice.
• Members actively engaged in certain rehabilitation
programs.
Three Medical Choices
Where they are available, the Saguaro Program
offers these types of medical plan options:
Health Maintenance Organization (HMO)—You
receive all your care from HMO providers only,
except in emergencies. You select a Primary Care
Physician (PCP) to manage your health care in the
network. You can select a different PCP for you
and each covered family member. (PCP identifica-tion
number(s) will be required when enrolling for
this coverage.)
Point of Service (POS)—Every time you need care,
you choose from two ways to access it: in-network
(from the plan’s network providers) or out-of-network
(from the providers of your choice). Your
costs are typically less when you receive in-network
services and some services are covered
in-network only. When enrolling in a POS plan, you
must name a Primary Care Physician (PCP) who
will coordinate all of your in-network care. You can
select a different PCP for you and each covered
family member. (PCP identification number(s) will
be required when enrolling for this coverage.)
Preferred Provider Organization (PPO)—A PPO
plan is a network of hospitals, doctors and service
providers that agree to discounted fees. While you
can use any provider for care, typically your costs
are less when you receive services in-network. If
you go to a provider who is not a member of the
PPO network, after you first satisfy a deductible,
the plan generally pays 70 percent of the usual,
customary and reasonable cost for care and you
pay the remaining 30 percent, plus any costs not
covered by the plan.
If you wish to request transition services, you and
your provider will need to complete the “CIGNA
HealthCare Medical Transition Care Benefit Request
Form” Copies of this form will be available at all
enrollment meetings or you can request one by
calling CIGNA’s Member Services department.
You’ll need to submit this form directly to CIGNA
Health Services department, along with supporting
medical information, prior to receiving services from
any non-participating provider and within the first 30
days of enrollment as a CIGNA HealthCare member.
A separate form is needed for each provider involved
in your care.
Contact CIGNA Member Services at the phone
number listed inside the back cover of this booklet
for more information.
Important Things to Consider When Making
Your Medical Coverage Election
• You can waive medical plan coverage. Typically,
you will only want to decline coverage through the
State if you have coverage from another source.
• To receive benefits under the HMO plan and maxi-mize
your benefits under the POS plan, your care
must be coordinated through a Primary Care
Physician (PCP). Your PCP must provide referral to
any specialists. Under the PPO plan, referrals to
specialists are not required. Your PPO benefit will
be based on whether the specialist is a network
member or not.
• The provider networks are different for each of the
medical plan options (HMO, POS and PPO).
Review the medical plan provider directories to see
if your doctors are in the option you are electing.
Remember, a doctor may be in more than one
network. For example, a doctor can be both an
HMO and POS in-network provider.
• You receive no coverage for routine vision care
under any of the medical plan options. You may
choose coverage for care and materials under the
State’s vision plan. (See page 19.)
• You can pay for your out-of-pocket medical
expenses for yourself and your eligible dependents
with pre-tax dollars when you participate in the
Health Care Spending Account.
• Medical, dental and vision are separate plans. In
addition, you may choose a different coverage cate-gory
for each plan. For example, you can choose
dental coverage for yourself and your family and
medical for yourself only.
13
When you access the CIGNA website or call their member services department, you will want to refer to the following names:
The Retail Pharmacy The Mail Order Pharmacy
If you enroll in this plan: The Plan Name is: Your Network is: Plan Name is: Plan Name is:
HMO • CIGNA Healthplan (CHP) • Phoenix CareNetwork HMO • Managed Care Pharmacy • Tel-Drug
• Southern Arizona Network
HMO (Tucson)
POS • CIGNA Point of Service • Central and Northern Arizona • Managed Care Pharmacy • Tel-Drug
(POS) Network POS (Phoenix)
• Southern Arizona Network
POS (Tucson)
PPO • Preferred Provider • Preferred Provider • RxPrime • Tel-Drug
Organization (PPO) Organization (PPO)
CIGNA Plan Names (as of 7/17/01, based on your location)
14
Individual Deductible N/A N/A $300 None $300
Family Deductible N/A N/A $600 None $600
Coinsurance Maximum N/A N/A $3,000/$6,000 $1,000/$2,000 $3,000/$6,000
(excluding Deductible)
Lifetime Maximum N/A N/A $2,000,000 N/A $2,000,000
Lifetime Maximum for TMJ, N/A N/A Covered in-network N/A N/A
orthognathic surgical only
Treatment or vestibuloplasty
Room & Board (private room when
medically necessary) No charge No charge 30% No charge 30%
Intensive Care Unit No charge No charge 30% No charge 30%
Physician Hospital Visits No charge No charge 30% No charge 30%
Surgery/Anesthesia/Asst Surgeon No charge No charge 30% No charge 30%
X-Ray and Laboratory No charge No charge 30% No charge 30%
In-Patient Mental Illness and No charge No charge Covered in-network No charge 30%
Substance Abuse only
Physician Office Visits $10 copay per visit. $10 copay per visit. 30% $10 copay per visit. 30%
Maximum 1 copay Maximum 1 copay Maximum 1 copay
per day per provider. per day per provider. per day per provider
Specialist Visits $10 copay per visit. $10 copay per visit. 30% $10 copay per visit 30%
Maximum 1 copay Maximum 1 copay
per day per provider. per day per provider.
Childhood Immunizations-Well child No charge No charge Covered in-network $10 copay per visit 30%
only
Well-Baby Visit $10 copay per visit $10 copay per visit Covered in-network $10 copay per visit 30%
only
Well-Woman Care (GYN visit & $10 copay per visit $10 copay per visit Covered in-network $10 copay per visit 30%
Pap smear test) only
Periodic Adult Physical Exam $10 copay per visit $10 copay per visit Covered in-network $10 copay per visit 30%
only
Adult Immunizations $10 copay per visit $10 copay per visit Covered in-network $10 copay per visit 30%
(e.g. pneumoc., flu) only
Well Man Care (Office visit and $10 copay per visit $10 copay per visit Covered in-network $10 copay per visit 30%
PSA blood test) only
Allergy Testing $10 copay $10 copay Covered in-network $10 copay 30%
only
Antigen Administration $10 copay $10 copay Covered in-network $10 copay 30%
(desensitization/treatment) only
Family Planning Services:
Voluntary Tubal Ligation $10 copay $10 copay 30% $10 copay 30%
Vasectomy $10 copay $10 copay 30% $10 copay 30%
Implantable contraceptive products $10 copay (covered $10 copay (covered 30% Covered as any other 30%
(1 per 5 yrs) as any other as any other procedure
procedure) procedure)
Contraceptive appliances during $10 copay $10 copay 30% $10 copay 30%
office visit
Infertility visits $20 copay $20 copay Covered in-network $20 copay 30%
only
Saguaro Program Medical Plans – October 1, 2001
HMO Point-Of-Service PPO
In-Network
Basic Covered Services (Copayment) In-Network Out-of-Network In-Network Out-of-Network
Out-of-Network benefit levels are subject to reasonable and customary limitations.
Medical Plans Comparison Chart
15
Infertility Treatment (excluding in vitro, 50% coinsurance 50% coinsurance Covered in-network 50% coinsurance 50% coinsurance
embryo/zygote transfer, GIFT, only
donor sperm expenses)
X-Ray and Laboratory No charge No charge 30% No charge 30%
Prenatal Care and Program $10 copay for initial $10 copay for initial Covered in-network $10 copay for initial 30%
visit for diagnosis of visit for diagnosis of only diagnosis, 100%
pregnancy pregnancy thereafter
Mammography Screening: No charge; (although No charge; (although Covered in-network No charge 30%
Age 35 – 39 = 1 baseline, physicians may use physicians may use only
40 – 49 = every 2 yrs, age schedule as a age schedule as a
50 and older = annual) guideline, actual guideline, actual
screening is based screening is based
on patient need) on patient need)
Surgery Facility and Associated
Physician Fees
In physician’s office $10 copay $10 copay 30% $10 copay 30%
In freestanding ambulatory facility No charge No charge 30% No charge 30%
In hospital outpatient surgical center No charge No charge 30% No charge 30%
Outpatient Mental Illness $10 copay $10 copay Covered in-network $10 copay 30%
only
Outpatient Substance Abuse $10 copay $10 copay Covered in-network $10 copay 30%
only
Hospital Emergency Room $75 copay, waived $75 copay, waived Emergency paid at $75 copay, waived $75 additional
if admitted if admitted in-network benefit if admitted deductible
level
Out of Area Emergencies $75 copay, waived $75 copay, waived Emergency paid at $75 copay, waived Emergency paid at
if admitted if admitted in-network benefit if admitted in-network benefit
level level
Urgent Care Center $20 copay $20 copay 30% $20 copay 30%
Ambulance (for medical emergency or No charge No charge Emergency paid at No charge Emergency paid at
required interfacility transport) in-network benefit in-network benefit
level level
Prescription Drugs
Retail
30 day supply/copay; The following Rx obtained at Rx obtained at
items are also covered: network pharmacy is network pharmacy is
birth control pills, insulin, insulin covered at in-network covered at in-network
syringes, diabetic supplies such level, even if level, even if
as lancets, glucose strips, reagent a non-participating a non-participating
and a serum glucose monitoring provider issues provider issues
device. Also covered: drugs prescriptions prescriptions
for attention deficit disorder; obesity
reduction under provider guidance.
Generic $10 copay $10 copay $10 copay $10 copay $10 copay
Preferred Brand $20 copay $20 copay $20 copay $20 copay $20 copay
Non-Preferred Brand $40 copay $40 copay $40 copay $40 copay $40 copay
Saguaro Program Medical Plans – October 1, 2001
HMO Point-Of-Service PPO
In-Network
Basic Covered Services (Copayment) In-Network Out-of-Network In-Network Out-of-Network
Out-of-Network benefit levels are subject to reasonable and customary limitations.
16
Prescription Drugs (continued)
Mail Order (90-day supply)
Generic $20 copay $20 copay $20 copay $20 copay $20 copay
Preferred Brand $40 copay $40 copay $40 copay $40 copay $40 copay
Non-Preferred Brand $80 copay $80 copay $80 copay $80 copay $80 copay
Organ and Tissue Transplantation & No charge No charge Covered in-network No charge 30%
Donor Coverage only
Hearing Exam (every 12 months) $10 copay per exam $10 copay per exam Covered in-network $10 copay per exam 30%
only
Hearing Aids 100% up to $2,000 100% up to $2,000 Covered in-network 100% up to $2,000 100% up to $2,000
per member per year per member per year only per member per year per member per year
at CIGNA contracted at CIGNA contracted
hearing center. hearing center.
Rehabilitation Services, Short-Term Rehabilitation limited Rehabilitation limited 30% to a maximum Inpatient – no charge; 30% to a maximum
Physical Therapy to 60 visits per to 60 visits per of $5,000 per year; Outpatient – Rehab of $5,000 per year
Occupational Therapy contract year with contract year with reduced by in-network limited to 60 visits
Speech Therapy a $10 copay a $10 copay. benefits per contract year
Inpatient Rehab Setting with a $10 copay
Respiratory Therapy per visit
Cardiac Rehab
Skilled Nursing Facility No charge; maximum No charge; maximum 30% up to 90 days No charge, 90 day 30%, up to 90 days
90 days per contract 90 days per contract per year; reduced by limit per year
year. year. in-network benefits
Home Health/Home Infusion Care No charge, no limit No charge, no limit 30% No charge, no limit 30%
Hospice Care (Inpatient facility or No charge, no limit No charge, no limit 30% No charge, no limit 30%
home hospice for Life expectancy of
6 months or less)
Durable Medical Equipment (DME) No charge No charge Covered in-network No charge 30%
Includes equipment which can only
withstand repeated use, serves a
medical purpose, not useful
in absence of Illness/injury, not
disposable. Also included, is standard
power operated wheelchair when
medically necessary.
Corrective Appliances (Orthotics and No charge No charge Covered in-network No charge 30%
Prosthetics): only
Orthotics to include items which
support a weakened body part and
prosthetics to include items which
replace a missing body part. Includes
initial fitting and purchase of
standard model unless patient’s
Medical needs cannot be met, then
upgrade as medically necessary.
repair, replacement and servicing
payable as medically necessary.
Chiropractic Comparison 12 visits per year at 12 visits per year at Covered in-network Rehab limited to 30%
$10 copay $10 copay only 60 visits per contract
year with a $10
copay per visit
Saguaro Program Medical Plans – October 1, 2001
HMO Point-Of-Service PPO
In-Network
Basic Covered Services (Copayment) In-Network Out-of-Network In-Network Out-of-Network
Out-of-Network benefit levels are subject to reasonable and customary limitations.
17
Following is a brief description of the dental plans
that are available to eligible Saguaro Benefits
Program participants. The dental comparison
chart that follows on page 18 is not a complete listing
and description of the dental benefits. All benefits are
subject to plan limitations and exclusions. Employees
and their eligible dependents who reside out-of-state
may choose from the two Indemnity/PPO dental plans
for coverage.
Delta Dental Plan of Arizona Indemnity/
PPO Plan:
Those covered by Delta Dental Plan of Arizona may
see a licensed dentist anywhere in the world. More
than 80% of Arizona’s dentists participate in the
Delta Dental Plan and agree to accept Delta’s allow-able
fee as payment in full (after any deductible
and/or copayments are met). Amounts in excess of
the allowable fee will not be billed to the patient. In
addition, even if you choose to see a non-partici-pating
dentist, Delta still provides benefits, although
typically at reduced levels.
MetLife Dental Indemnity/PPO Plan:
Participants are free to choose a participating (PDP)
or non-participating (non-PDP) dentist anywhere in
the world. After the plan year deductible and copay-ments
are met, PDP dentists accept negotiated fees as
payment in full; these fees are typically 15-30%
below average charges. Non-covered services
provided by a PDP dentist are also charged at the
lower rate. Covered expenses from a non-partici-pating
dentist are considered at the reasonable and
customary allowance (greater than or equal to the
90th percentile of the charges made by dentists in the
area for the same procedure).
Employers Dental Services (EDS)
Prepaid Plan:
Founded in 1974, EDS provides one of the most
extensive Arizona networks and local customer
service. EDS’s Customer Service Department,
located in Tucson, is open Monday - Friday during
regular business hours, for your convenience. There
are no deductibles, no claim forms and no yearly
maximums. EDS also offers a prescription benefit
through Arizona Prescription Network (APN). APN
offers substantial discounts on prescription drugs
purchased through affiliated pharmacies for your
entire household.
Protective DentalCare Prepaid Plan
(formerly United Dental Care):
Members must access care through their pre-selected
family dentist. Each family member may select his/her
own family dentist from the Protective DentalCare
Directory of Dentists. You may select or change your
family dentist by calling Protective’s Customer
Service at the number listed on the inside of the back
cover of this booklet. Members may self-refer for
specialty care. All covered services through Protective
DentalCare contracted family dentists will be provided
at the copayment as listed in the Benefits Schedule for
Protective’s Pinnacle Plan.
Saguaro Program
Dental Plans
18
* Requires you to select a Participating Dental Provider
(PDP) when enrolling. In addition, if you are
selecting a PDP listed as “roster only,” it takes time
to get on the roster after enrollment. You must be on
the roster prior to receiving non-emergency care.
See carrier materials for benefit and provider details
and any extras.
Preventive care: Indemnity/PPO plans, two normal
cleanings and exams/plan year; prepaid, once/six
months generally.
Before having major services performed,
contact your dentist and/or your plan to
determine your costs.
Employers Dental Protective DentalCare*
Benefit Delta Dental MetLife Dental Services/EDS* (formerly UDC)
Plan Type Indemnity/PPO Indemnity/PPO Prepaid Prepaid
Deductibles $50/$150 $50/$150 No Deductibles No Deductibles
Preventive Care 100% paid 100% paid 100% paid, after 100% paid, after
applicable copay applicable copay
Office Visit Deductible Deductible $3/visit copay $5/visit copay
Oral Exam waived waived No charge No charge
Prophylaxis/cleaning No charge $3 copay
Fluoride treatment No charge for child No charge
X-rays No charge No charge
Basic Restorative 80% paid 80% paid Fixed Copays: Fixed Copays:
Office Visit $3 $5
Sealants (to age 19) $12/tooth $5/tooth
Fillings $12-$25 (amalgam) $9-$20 (amalgam)
Extractions $15 (single) $15 (single)
Periodontal $50/quadrant $50/quadrant
Oral Surgery Copay/procedure Copay/procedure
Major Restorative 50% paid 50% paid Fixed Copays: Fixed Copays:
Office Visit $3 $5
Crowns $170-$275 $235
Dentures copay copay
Fixed Bridgework copay copay
Crown/Bridge Repair lab fees $20 (crown/brdg)
Inlays (Allowance Given) (Covered Expense) $112-$125 $130-$215
Orthodontia 50% paid 50% paid By Treatment Plan: By Treatment Plan:
Child $1,800/$2,475 25% discount off Plan
Adult $2,000/$2,675 Specialist’s normal retail
charges
TMJ Services No Coverage No Coverage Fixed Copays: Fixed Copays:
Exams, Services, etc. $0-$850 $85-$115
Maximum Benefits Per Person Per Person No Dollar Limit No Dollar Limit
Annual combined $1,000/person $1,000/person Benefits paid for participating Benefits paid for participating
preventive, basic and dentists and/or orthodontists dentists and/or orthodontists
major services only. only.
Orthodontia Lifetime $1,500/person $1,500/person
Dental Plans Comparison Chart
19
Vision Care Insurance
You may elect vision coverage for yourself, or for
yourself and your family, through the State’s new
vision plan carrier, Avesis, Inc. You pay all premiums
for the plan. Please note that employees with single
medical coverage may elect family vision coverage
through Avesis or vice versa. State employees who
waive health coverage may elect vision coverage.
You may choose from a participating network provider
or non-participating provider. However, when you
select a participating network provider you receive a
higher benefit. If you purchase non-covered options
from a participating network provider, the providers
have contracted with Avesis to provide these options
at a reduced rate to Avesis members.
When visiting an In-Network Provider: Choose one
of these three options for receiving your benefit:
1.You pay an annual $10 copayment for their exam
and receive covered optical materials (standard
spectacle lenses and frame, within plan allowance)
with no additional copayment per plan year. OR
2.You may utilize their benefits for elective contact
lenses. You make a $10 copayment for an exam and
receive an additional $130 allowance toward the
cost of contact lenses and related professional serv-ices
per plan year. Contact lenses are covered 100%
after the copayment if Avesis determines that they
are medically necessary. The contact lens benefit is
in lieu of the exam, spectacle lenses and frame for
that plan year. OR
3.You may receive a $150 one time (lifetime) benefit
allowance (in-network only) toward the cost of
Lasik surgery in place of all other benefits for that
plan year.
When visiting an Out-of-Network Provider: You
must pay the provider and submit an itemized state-ment
for reimbursement of vision care expenses.
Avesis will then reimburse you up to the amounts
shown in the plan’s fee schedule listed below. Please
provide the following information with your itemized
statement when filing a claim: member I.D., member
name, patient name and date of birth, member mailing
address and the group plan (State of Arizona).
When visiting an out-of-network provider, you will be reimbursed for eligible
expenses according to the following fee schedule:
Vision Examination: $50
Single Vision Lenses: $30
Bifocal Lenses: $45
Trifocal Lenses: $55
Lenticular Lenses: $110
Frames: $50
Contact Lenses:
Elective: $150 (in place of all other benefits for that plan year)
Medically Necessary: $300 (in place of all other benefits for that plan year)
Lasik Surgery: Not covered
To receive additional information about the coverages
provided through Avesis, please contact them directly
at the phone number listed inside the back cover of
this booklet. When calling Avesis, please tell them
you are a State of Arizona employee.
Additional Employee
Benefit Plans
20
Life Insurance
Benefits-eligible employees are automatically
enrolled for $12,000 of basic life insurance coverage
at no cost to the employee. The State also pays for an
additional $12,000 of Accidental Death and
Dismemberment (AD&D) insurance coverage, all or
a portion of which is payable in the event of your
accidental death or dismemberment. A $12,000 Seat
Belt Benefit may also be payable if you die in an
automobile accident and are wearing a seat belt. The
life insurance coverage is provided through Standard
Insurance Company.
Additional employee supplemental life insurance
coverage is available to employees at the cost listed
in the Premium Rate Chart on page 6. The premium
rates are based on how old you are and increase at
these ages: 30, 40, 50, 60, 70. Please check your rate
each year. The employee supplemental AD&D
coverage is the same as the supplemental life amount
that you elect.
During open enrollment you may increase or
decrease your supplemental coverage, in multiples of
$5,000, or cancel your supplemental coverage.
• The maximum annual increase that you can elect is
$20,000.
• The maximum amount of supplemental life insur-ance
that you can have through the State’s group
plan is three times your annual salary, or $200,000,
whichever is less.
Supplemental coverage above $35,000 is paid on an
after-tax basis, so:
• Supplental coverge may be cancelled or reduced to
$35,000 at any time.
• Supplemental coverage up to $35,000 can only be
changed during open enrollment or in conjunction
with a qualified status change, subject to annual
maximum increase rules and maximum coverage
limits.
Spouse and dependent life insurance coverage is
available to employees at the cost listed on the
Premium Rate Chart on page 6. Your spouse and
eligible children (to 19 years of age or to 25 years of
age, if full-time student) are each insured for the
amount you elect: $4,000, $6,000 or $12,000.
(Those currently enrolled in the $2,000 coverage
level will be able to maintain that coverage;
however, no new enrollments will be allowed at the
$2,000 level.) The premium you will pay is for all
your eligible dependents, no matter how many
eligible dependents you have. All dependent life
premiums are on an after-tax basis.
In the event of your death, employee life and AD&D
benefits are paid to your designated beneficiary. If
you decide to elect coverage for your dependents,
you are automatically the beneficiary for your spouse
and children.
Note: When designating a beneficiary for your life
insurance, please keep in mind that minor benefici-aries
usually cannot directly receive an insurance
benefit until reaching age 18. While parents are
usually guardians of their minor children’s person, in
most states, unless previously established by a court
of law, parents are not the guardian of their minor
children’s estate. Minor beneficiary designations
cause delays in benefit processing until an appro-priate
method of payment has been established, such
as through probate court.
It is important to keep your beneficiary information
current. During open enrollment, you may change
your beneficiary using the Web or IVR enrollment
systems or by completing a BE-1 or BE-2 form. You
may change your beneficiary designation during the
year by completing a BE-1 or a BE-2.
21
Short-Term Disability Insurance
If you elect the Group Short-Term Disability (STD)
Plan and become unable to work due to illness, preg-nancy,
or injury, you receive a weekly benefit from
Standard Insurance Company. There are no pre-existing
condition limitations, but you must meet the
actively at work provision on or after the effective
date of October 1, 2001 if electing STD during open
enrollment.
You are considered disabled if you are unable to
perform with reasonable continuity the material
duties of your occupation. The disability cannot be
self-inflicted, work-related or a result of war. Benefit
payments continue up to six months if you remain
disabled. Benefits are prorated for each day of a
partial week of disability after the commencement
of benefits.
If you are electing STD coverage as a newly hired
employee or continuing STD coverage for the
2001/2002 plan year, your benefits will start on
your first day of disability due to accident or the
31st day of disability due to illness or pregnancy.
However, if you previously waived STD coverage,
are enrolling in the plan during this year’s open
enrollment period (or when you have a qualified
change in status) and become disabled during the
first 12 months following the coverage effective
date, your benefits will start on the 61st day of
disability due to illness or pregnancy.
Upon receipt of verifying documentation and approval
by Standard Insurance Company, you receive sixty-six
and two thirds percent (662/3%) of your base pay. The
weekly minimum benefit is $57.69; the weekly
maximum is $769.27. Group STD benefits are in addi-tion
to any sick leave to which you may be entitled.
Your monthly cost for STD coverage is $.89/$100 of
your monthly base salary, to a maximum of $5,000 of
monthly salary. This employee paid premium is
deducted after taxes. This means that any benefits you
may receive will be tax free. The table below will give
you an idea of the cost and benefit on a monthly basis.
MONTHLY MONTHLY MONTHLY
SALARY PREMIUM DISABILITY BENEFIT
$1,200.00 $10.68 $ 800.00
$1,500.00 $13.35 $1,000.00
$2,000.00 $17.80 $1,333.33
$2,500.00 $22.25 $1,666.66
Because you pay STD coverage on an after-tax basis,
you may drop your STD coverage during the year.
However, mid-year enrollment can only occur in
conjunction with an appropriate qualified status
change if the request is made within 31 days of the
change. (See page 8 for more information.)
Flexible Spending Accounts
A Flexible Spending Account (FSA) allows you,
through payroll deduction, to deposit money in an
account on a pre-tax basis. The funds that you
deposit can then be used to pay for eligible expenses
that are not covered by other benefits of the Saguaro
Program.
As you review your open enrollment materials, it is
an excellent time to weigh your options concerning
Flexible Spending Accounts. The Internal Revenue
Service (IRS) code provides taxpayers with two
methods to assist with health and dependent care
expenses. The first method is Federal and/or State
income tax credits. The second method is Flexible
Spending Accounts. You may choose to utilize one
method or the other; however, while you can use
both methods, you may not use both methods for the
same expense.
22
There are two types of Flexible Spending Accounts
offered to State employees during open enrollment and
upon qualified status change events. These accounts
cover completely different types of expenses. The first
account is for reimbursement of health care expenses
for you and your dependents. The second account helps
you pay for day care expenses for your dependents.
ASI administers our Flexible Spending Accounts.
See the inside back cover of this booklet for their
contact information.
Health Care Spending Account
The Health Care Spending Account utilizes pre-tax
dollars to assist employees with coverage for health
expenses not paid through other Saguaro Benefits
Program coverage. Examples include: copayments
for office visits or prescription drugs, coinsurance,
health care expenses in excess of plan maximums,
annual deductibles and excluded plan expenses, such
as for acupuncture. This plan is for expenses incurred
by you and all of your eligible dependents, even if
you or your dependents aren’t covered under the
State’s health plans.
You determine and direct a specific dollar amount to
be deposited into your account each year. Then,
through payroll deduction, a specified pre-tax dollar
amount is deposited in your account each pay period.
The maximum annual amount that you can deposit
into your Health Care Spending Account is $5,000.
The funds in your account are available for reimburse-ment
to you, to recoup your eligible payments.
Federal law requires that if you are filing for reim-bursement
of medical expenses and the amount
submitted is greater than your accrued account
balance, your reimbursement will be for the amount
of the claim up to the annual amount you elected to
contribute to your Health Care Spending Account,
less any previous claim reimbursements.
It is important to decide the amount that you will have
withheld for the year carefully. Federal law directs that
any remaining balance at the end of the plan year
cannot be refunded to you, transferred to another
account, or carried forward to the next plan year.
Dependent Care Spending Account
The Dependent Care Flexible Spending Account is a
benefit that helps employees recoup eligible payments
for child care and elder care expenses by utilizing
pre-tax dollars. This account is for dependent care
expenses not dependent medical expenses. Dependent
medical expenses are covered under the Health Care
Spending Account previously discussed.
The purpose of Dependent Care Spending Account
is to allow you, or you and your spouse if you are
married, to work while your eligible dependents are
cared for. Eligible dependents are children under 13
years of age, disabled dependents of any age, a
disabled spouse and/or a dependent parent. If you
request reimbursement for a dependent from your
Dependent Care Spending Account, you must also
be claiming them as dependents on your federal
income tax.
You determine and direct a specific dollar amount to
be deposited into your account each year. Then,
through payroll deduction, a specified pre-tax dollar
amount is deposited in your account each pay period.
The maximum annual amount that you can deposit
into your Dependent Care Spending Account is $5,000
for single employees or married employees filing a
joint federal income tax return. The limit is $2,500 for
married employees filing separate tax returns.
These additional IRS rules apply to your Dependent
Care Spending Account contributions:
• While you can contribute up to $5,000 each year,
the amount you contribute cannot be greater than
your annual income or the annual income of your
spouse. For example, if your spouse earns $4,500
per year, your maximum annual contribution is
$4,500.
• If your spouse is a full-time student or disabled,
you can also participate. If that is the case, your
spouse’s income is assumed to be $200 per month
if you have one person who qualifies for dependent
care—and $400 when two or more dependents
qualify. Therefore, if you claim one person who is
being cared for, your spouse’s annual salary is
assumed to be $2,400. If two or more of your
dependents are being cared for, your spouse’s
annual salary is assumed to be $4,800.
If you are filing for reimbursement of dependent care
expenses and the amount submitted is in excess of
your accrued account balance, your reimbursement
will be paid up to your current account balance. Each
time your account is credited, you will automatically
be reimbursed until your entire claim has been paid
or you reach the maximum you contributed for the
plan year.
You must carefully plan the dollar amount deposited
into your account, because federal law directs that
any remaining balance at the end of the plan year
cannot be refunded, transferred or carried forward to
the next plan year.
Flexible Spending IRS Information
For more information about the allowable expenses
for the medical reimbursement account, please see
IRS Publication 502. The ASI web site
(www.asiflex.com) also has information regarding
allowable expenses.
You cannot change your elections to your Health
Care Spending Account or Dependent Care
Spending Account accounts after open enrollment
unless you have a status change as defined by the
IRS. The requested change must be consistent with
and because of the status change and be submitted
within 31 days of the change. (See page 8.) If you
have a status change:
• You may increase the amount in either account:
Health Care Spending Account or Dependent Care
Spending Account
• Mid-year reductions are not permitted for Health
Care Spending Account accounts
• Mid-year reductions are permitted for Dependent
Care Spending Account accounts
How To Enroll in a Flexible Spending Account
This year, when you enroll in the Saguaro Program
using the Web or telephone enrollment systems, you
will also be able to elect FSA participation. No
separate enrollment will be necessary. If you are
unable to enroll online or on the phone, you will
need to get a Flexible Spending Account election
(BE-5) form from your benefits liaison or at an
open enrollment meeting. Complete, sign and date
the form authorizing the State to establish your
personal reimbursement account with ASI, our flex-ible
spending account administrator. Return the
completed form to your benefits liaison by
September 7, 2001.
23
No matter how you enroll, you can use the work-sheet
on page 25 to help you determine the amount
that you wish to deposit in your account(s). When
you decide how much you want to set aside for the
entire year, from October 1, 2001 through
September 30, 2002, divide the amount by 26 pay
periods to calculate how much will be deducted
from each paycheck during the year for deposit into
your personal account.
Important Notice: If you are enrolling for participa-tion
using the Flexible Spending Accounts form, be
sure that the annual amount you show matches the
per pay period deduction amount. For example, you
cannot exactly make a $1,000 annual deduction. You
must choose to elect one of the following if you
decide on a $1,000 deduction:
• $999.96 divided by 26 = $38.46 per pay period OR
• $1,000.22 divided by 26 = $38.47 per pay period
Not matching the annual amount and the pay
period amount on the enrollment form will result in
a delay of your enrollment.
Using Your Flexible Spending Accounts
Once enrolled, ASI (the flexible spending account
administrator), will mail you an Enrollment Kit which
will include your first few claim forms. You may
obtain more claim forms from your benefits liaison,
ASI’s web site, ASI or by photocopying one.
You may file claims for reimbursement of eligible
expenses as often as you like. ASI processes and
pays claims daily. Many plan participants have their
reimbursement electronically transferred to their
bank account (direct deposit) and receive confirma-tion
by mail or e-mail.
Along with the completed, signed and dated claim
form, you need to submit a copy of the itemized bill,
statement or insurance carrier’s Explanation of
Benefits (EOB) form indicating the eligible expense.
It must include:
• the provider’s name
• the service provided and the charge for that service
• the date the service was provided (not just the date
paid)
• the name of the family member concerned
You have 90 days following the end of the plan year
to submit all remaining claims incurred during the
plan year. All claims for the October 1, 2001 through
September 30, 2002 plan year must be filed by
December 31, 2002.
24
How Much Can You Save?
Save money using the Health Care Spending
Account for expenses that aren’t covered under your
medical, dental and vision options. Save more money
using the Dependent Care Spending Account for
expenses that you pay so you can work. These
spending accounts allow you to put money into them
before taxes are taken and then, when you need the
money to pay eligible expenses, you ask to be reim-bursed
from your account.
Here’s a per pay period example:
Without an FSA Account With an FSA Account
Gross Salary $1000 Gross Salary $1000
Federal/State Taxes (27%) - 270 Day Care - 175
Net Take Home $ 730 Prescription Co-Pays - 30
Day Care - 175 Major Dental Work - 35
Prescription Co-Pays - 30 Net Pay Before $ 760
Major Dental Work - 35 Federal/State Taxes (27%) - 205
Net Pay $ 490 Net Pay $ 555
This employee takes home an additional $65 per
paycheck without changing any expenses or working
more hours. That’s an additional $1,690 per year.
PART 1: ESTIMATED HEALTH CARE EXPENSES NOT PAID BY INSURANCE
MEDICAL EXPENSES (including vision and hearing services):
HMO, In-Network POS, In-Network PPO Out-of Network POS, Out-of-Network PPO
$__________ Physician copayments $__________ Annual Deductible
__________ Number of visits/year $__________ Co-insurance, covered expenses
$__________ Prescription copayments $__________ Prescription copayments
$__________ Immunizations/allergy shots $__________ Annual physical
$__________ Other medical services $__________ Other Medical Expenses
$__________ Non-covered exams; e.g., for school $__________ Vision and hearing exams
$__________ Glasses, contacts $__________ Glasses, contacts or Lasik surgery
$__________ Hearing aids (above plan payment) $__________ Hearing aids (above plan payment)
$__________ Noncovered services
DENTAL EXPENSES:
Prepaid/Managed Plan Indemnity/PPO Plan
$__________ Copayments $__________ Annual Deductible
$__________ Fillings $__________ Co-insurance, basic restorative
$__________ Crowns, bridges $__________ Co-insurance, major restorative
$__________ Periodontal work $__________ Orthodontics (Braces)
$__________ Orthodontics (Braces) $__________ Other dental services
$__________ Other dental services
PART 2: ESTIMATED DEPENDENT CARE EXPENSES
$__________ Preschool
$__________ After-school
$__________ Day care for eligible children or disabled adults
$__________ Other dependent care expenses
PART 3: TOTAL EXPENSES
$__________ Total Unpaid Health Care Expenses To estimate your tax savings using the reimbursement
$__________ Total Dependent Care Expenses
accounts multiply your total by 30%. (Your actual savings
will be based on your marginal tax rate.)
$__________ Total Eligible Expenses
__________________ x 0.30 = _________________
(Total Eligible Expenses) (Estimated Tax Savings)
Determining Your Flexible Spending Account Contributions
INSTRUCTIONS: Use this form to estimate the expenses that will be incurred for services from October 1, 2001
through September 30, 2002, by all members of your family who qualify as dependents (IRS definition).
Health Care Spending Account: You should include medical, dental and vision expenses that will not be paid
by insurance. Dependent Care Spending Account: Consider only dependent care expenses you incur to
enable you and your spouse (if you’re married) to be employed or attend school on a full-time basis. Hint: You
may want to review bills and your checkbook register over the past year to aid in projecting these expenses.
25
This year, since we are changing our medical
plan options, every employee who wants
medical plan coverage for 2001/2002 must
enroll during the open enrollment period. You can
enroll in the Saguaro Benefits Program one of three
ways—you can use the Web, our new interactive
voice response (IVR) telephone enrollment system,
or a Benefits Election (BE-1) form. You must select
and use one enrollment method. You are strongly
encouraged to use the Web or telephone to make
your elections.
Please note: It is important to make sure that all
dependents you want covered under the medical,
dental, vision or life plans are added during open
enrollment. If you are enrolling a spouse or
dependent not previously enrolled whose last name is
different from yours, please provide backup docu-mentation,
such as a marriage license or birth certifi-cate,
to your benefits liaison. Any dependents not
listed during open enrollment cannot be added until
the next open enrollment period unless you have an
appropriate qualified status change. (See page 8
for more information about qualified status changes.)
Prior to October 1, a confirmation statement will be
sent to your home. Once you’ve received your copy,
keep it as a record of your final elections. Don’t
forget to verify your payroll deductions once your
new elections become effective. For medical, dental,
life, vision and short-term disability insurances the
new deductions will appear on your October 19,
2001, paycheck. For flexible spending accounts the
new deductions will appear on your October 5,
2001, paycheck.
New for 2001/2002—Online Enrollment—
the Preferred Option!
Preparing To Enroll
Web site enrollment has numerous advantages:
• It’s easy.
• It’s simple.
• It’s more accurate.
• You see your recorded elections immediately.
• You get e-mail confirmation of your elections
immediately.
We encourage you to use our online enrollment system
when making your 2001/2002 benefit elections.
26
Enrolling in Saguaro
Benefits
About Your Personal Identification
Number (PIN)
You will need a Personal Identification Number (PIN)
to enroll via the Web or IVR systems. Your PIN will
be mailed to you in early August. If you haven’t
received yours by August 13, or if you lose or forget
your PIN, a replacement can be obtained by:
• Calling the Arizona Benefits Help Desk (available
24 hours a day/7 days a week) at 1-866-251-5672
and choosing the PIN option; or
• Using Arizona Benefits on the Web (www.az.gov)
and making a PIN request online.
For security reasons, the Help Desk will not issue and
mail a new PIN to any address other than the official
one on file. Therefore, please ensure that your bene-fits
liaison has your current mailing address on file.
To Enroll (24 hours a day / 7 days a week) : www.az.gov or 1-866-740-7153
Read your enrollment materials and complete the
information on your Enrollment Worksheet (see page
30) before you access the web site to ensure that you
have the essential items you will need handy.
Additionally, please make sure you have all your
dependent and beneficiary information available, as
requested on the worksheet.
Web Enrollment
• Enroll early, beginning August 13 and no later than
the enrollment deadline, September 7, 2001.
• Access the online enrollment system at
http://www.az.gov. Select the
ArizonaBenefits@YourService link.
• Input your Social Security number and personal
identification number (PIN) as requested.
You will access various panels to make elections and
changes.
• Benefits Election Panels Make your elections
(medical, dental, vision, life insurance, dependent
life insurance, short-term disability insurance and
FSAs).
• Dependent Data Panels Add or remove depend-ents
for medical, dental, vision and life insurance
coverage.
• Beneficiary Data Panel Declare beneficiaries for
your life insurance.
The Benefits Election Panels list all of your avail-able
benefit options. Adding/changing information
on the Benefits Elections Panels can be completed
by entering the requested information or correcting
any incorrect information. For example, if you wish
to change your dental coverage from single to
family, you select the dental plan option and make
your election.
Note: If you select the HMO or POS medical plan,
the Web will prompt you to input the Primary
Care Physician (PCP) I.D. number for yourself
and each of your covered dependents. You can
find PCP I.D. numbers for CIGNA at
www.cigna.com or by calling 1-800-613-4563.
PCP directories will also be available at open
enrollment meetings or from your benefits
liaison. You will be required to enter the PCP
I.D. number prior to advancing to the next
Benefits Election Panel. (You can opt for the
system to assign PCPs.) You will also need to
indicate if the covered person is a new patient
to the PCP selected.
For dependents, PCP selections are made on
the Dependent Panel.
27
Welcome to Arizona Benefits - The Saguaro Program
We hope you will find this web site an easy and convenient way to select your health
benefits. Prior to beginning your online enrollment process, you will need to have:
• Your Social Security Number (University ID for ASU or AU)
• Your Personal Identificaiton Number (PIN) that was mailed to your home address
• Reviewed your benefit choices and the provider directory via the Benefits web site at
www.hr.state.az.us/benefits
• Selected a Physician/Dentist for yourself and dependents
(some plan options require this information or provide you
with the option to allow the carrier to assign one)
Elections on the Benefits Election Panels can be
completed by following these steps:
1. Review the plan information provided
on the screen.
2. Select the plan name you want to enroll in with
the appropriate coverage level.
3. Click on the CONTINUE button after
each election.
4. Repeat steps one, two and three for each
coverage you wish to enroll in/change/leave
as is/decline.
5. If you wish to add/remove dependents for
medical, dental or vision coverage, go to the
Dependent Data Panels and do so.
Completing Your Enrollment
After pressing the final CONTINUE button, the
system will display the final review page. On this
page you can make corrections to any item where an
error has been detected by selecting the corresponding
button. Verify your elections carefully since you
cannot change your elections after the enrollment
deadline unless you have a qualified status change.
You will then need to press the SUBMIT button
which will advance you to the confirmation page
where you will be prompted to enter your e-mail
address to receive confirmation. Press the SUBMIT
button to process your enrollment and print your elec-tions
summary. You will then be instructed to EXIT
the browser.
New for 2001/2002—Telephone Enrollment—
an Alternative Option...
Preparing To Enroll
Read your enrollment materials and complete the
information on your Enrollment Worksheet (see page
30) before you call the interactive voice response
(IVR) telephone system to enroll. Make sure you
have the essential items you will need handy.
Additionally, please make sure you have all your
beneficiary and dependent information available, as
requested on the worksheet.
Telephone Enrollment
• Enroll early, beginning August 13 and no later than
September 7, 2001. Keep in mind that phone lines
typically get busier the closer you get to the dead-line.
• Call 1-866-740-7153. If busy, consider using the
online enrollment system or call back at a different
time (but before your deadline!).
• Input your Social Security number and personal
identification number (PIN) as requested.
Main Menu
• Select the appropriate option to make your benefit
elections.
• Select the appropriate option to add or change
dependent or beneficiary information.
You will be prompted to make a decision about each
benefit (medical, dental, vision, life insurance,
dependent life insurance, short-term disability insur-ance,
Health Care Spending Account and Dependent
Care Spending Account).
When making your medical, dental, and vision
choices, you will be required to first select the plan.
You will then be prompted to select the level of
coverage (single or family). If you select family
coverage, you will be asked to name (speak) the
dependents to be covered under that plan.
28
Note: If you select the HMO or POS medical plan,
the IVR system will prompt you to input the
Primary Care Physician (PCP) I.D. number for
yourself and each of your covered dependents.
You can find PCP I.D. numbers for CIGNA at
www.cigna.com or by calling 1-800-613-4563.
PCP directories will also be available at open
enrollment meetings or from your benefits
liaison. You will be required to enter the PCP
I.D. number prior to advancing to the next
enrollment step. (You can opt for the system to
assign PCPs.) You will also need to indicate if
the covered person is a new patient to the PCP
selected.
Once you have completed your enrollment, follow the
system instructions to review your elections. Verify
your elections carefully since you cannot change
your elections after your enrollment deadline
unless you have a qualified status change.
Completing Your Enrollment
• You will enter some enrollment information using
your phone’s dial pad and some will be provided
verbally. Speak clearly when prompted to provide
your enrollment information, such as dependent
and beneficiary information. If you have multiple
dependents and/or beneficiaries to record, you may
want to consider using our online enrollment
system.
• After every election you make, the system will
repeat your selection and ask you to confirm it.
• If you elect to contribute to the Health Care or
Dependent Care Spending Accounts, the system
will ask you to enter your per pay period election.
• After you have finished making your elections, the
system will ask where you want your confirmation
statement sent—to a facsimile or to your home
address.
Paper Enrollment—One Last Option...
Paper enrollment will still be available if you are
unable to enroll via the Web or IVR telephone system.
You will need to fill out a BE-1 form. The BE-1 form
can be obtained by contacting your benefits liaison or
you can pick up a form at an open enrollment meeting.
You must also complete a Flexible Spending Account
enrollment form to participate in the Flexible
Spending Accounts. (See pages 21-25 for more infor-mation
on Flexible Spending Accounts.)
29
Instructions for Completing a BE-1 Form:
Section A: If changing current information or coverages,
you must complete all areas.
Section B: If you want medical coverage, you must
complete all areas.
Section C: Only complete this section if making
coverage changes.
Section D: If enrolling for medical or vision plan
coverage, or changing your dental election, be sure to
list all family members you want covered. You must
include birth dates and providers, as required, for your
spouse and each dependent. If you are adding a
dependent who is not your natural/birth child or a spouse
with a different last name, be sure to attach copies of
the applicable document such as a birth certificate, court
papers or marriage certificate.
Section E: Only complete this section if making changes.
Section F: The amount of life insurance you indicate is
the total amount of coverage desired excluding the
basic $12,000 life paid by the State. If increasing or
decreasing your supplemental life and AD&D insurance,
be sure to elect a new total amount of coverage; don’t
select only the amount of the change.
Section G: If you want vision coverage, you must check
“single” or “family”.
Section H: If changing current information or coverages,
you must sign and date the form.
Keep the last copy for your records and as a temporary
I.D. card. Return the rest of the form to your benefits
liaison by the enrollment deadline, September 7, 2001.
2001/2002 Enrollment Worksheet
USE THIS WORKSHEET TO MAKE YOUR BENEFIT SELECTIONS BEFORE VISITING THE WEB SITE (www.az.gov) OR CALLING THE TELEPHONE
ENROLLMENT SYSTEM (1-866-740-7153). The systems will be open August 13 through September 7, 2001.
Remember, everyone who wants medical, vision or FSA plan coverage for the new plan year must make new benefit elections in these areas. The rates for your
benefits are shown on page 6 of this booklet so you can calculate your monthly benefit costs.
Your location (affects medical plan premium and options available):
Maricopa County or the town of Apache Junction Pima County Social Security number: ______________________________
Remaining Counties (excluding Apache Junction) Out of State Enrollment system PIN: ______________________________
1) MEDICAL
Coverage level: Single Family
CIGNA HMO* CIGNA PPO I.D. # for your PCP*: _______________
CIGNA POS* Decline coverage
*When electing HMO or POS medical plan coverage, you will need to record a PCP I.D. number for
yourself and each covered dependent and indicate if the covered person is a new patient for that PCP.
Visit CIGNA’s web site (www.cigna.com) or call 1-800-613-4563 for a listing of PCP I.D. numbers.
Note dependent PCP information on the back of this worksheet. Your monthly cost: $_______________
2) DENTAL
Coverage level: Single Family
Delta Denta Protective DentalCare (PDC)* I.D. # for your PDP*: _______________
MetLife Dental Decline coverage
Employers Dental Services (EDS)* Leave As Is
*When electing EDS or PDC dental plan coverage, you will need to record a participating dentist (PDP)
for yourself and each covered dependent. Visit the plan’s web site or call them for a listing of PDP I.D.
numbers. Note dependent PDP I.D. numbers on the back of this worksheet. Your monthly cost: $_______________
3) VISION
Coverage level: Single Family Enroll
Decline coverage Your monthly cost: $_______________
4) EMPLOYEE LIFE/AD&D INSURANCE
You automatically receive $12,000 basic life insurance coverage. Additional coverage amounts must
be in increments of $5,000. Increases each year may not exceed $20,000. Your total additional life
coverage amount cannot exceed three times annual salary or $200,000.
Elect additional coverage Decrease existing coverage
I am a smoker Decline coverage Increase/Decrease amount $ _______________
I have not smoked in six months Leave As Is
(If you are a non-smoker, your additional
coverage benefit amount is increased by
$1,000 at no additional charge.)
Each employee must record a beneficiary for their insurance benefit. Note beneficiary information
on the back of this worksheet. Your monthly cost: $_______________
5) DEPENDENT LIFE INSURANCE
$4,000 Leave As Is
$6,000 Decline Coverage
$12,000 Your monthly cost: $_______________
6) SHORT-TERM DISABILITY
Enroll Leave As Is
Decline coverage Your monthly cost: $_______________
Total Monthly Cost for Benefits Above (1 - 6): $_____________
7) HEALTH CARE SPENDING/REIMBURSEMENT ACCOUNT
Annual contribution (maximum of $5,000/yr.): $________________
Decline enrollment Divide annual amount by 26 to calculate per-pay-period amount to be entered into enrollment system: $________________
8) DEPENDENT CARE SPENDING/REIMBURSEMENT ACCOUNT
Annual contribution (maximum of $5,000/yr.): $________________
Decline enrollment Divide annual amount by 26 to calculate per-pay-period amount to be entered into enrollment system: $________________
30
Dependent Enrollment
List the dependents you want covered when electing family benefit coverage and/or dependent life insurance. When enrolling dependents for HMO or POS medical
plan coverage, you will need to select and record a Primary Care Physician (PCP) for each covered dependent. Visit CIGNA’s web site (www.cigna.com) or call
1-800-613-4563 for a listing of PCP I.D. numbers. When enrolling dependents for EDS or PDC dental coverage, you will need to select and record a Participating
Dental Provider (PDP) I.D. # for each covered dependent. You can enter up to 14 dependents. (Use an additional sheet if you need more space.)
Full-Time Medical New PCP Dental
Dependent Name SSN Date of Birth Relationship Student? PCP I.D. # * Patient? PDP I.D. # **
Sample 123-44-5678 07-12-1954 Wife Yes 1041234 Yes 0001234
No No
Yes Yes
No No
Yes Yes
No No
Yes Yes
No No
Yes Yes
No No
Yes Yes
No No
Yes Yes
No No
Yes Yes
No No
Yes Yes
No No
*Required if this person will be covered under CIGNA HMO or POS medical plan.
**Required if this person will be covered under EDS or PDC dental plan.
Beneficiary Data
List your beneficiary(ies) for your Life/AD&D Insurance. In the event of your death, employee life and AD&D benefits are paid to your designated trust or
beneficiary(ies). If you decide to elect Dependent Life Insurance coverage, you are automatically the beneficiary for your spouse and children. You can enter up to
15 beneficiaries. (Use an additional sheet if you need more space.) If the Beneficiary is a Trust, provide the following information: Name of Will, Trust or Legal
Agreement; Address Where Filed; Administrator Where Filed; Date of Will or Trust.
Beneficiary
Beneficiary Name, Address and Phone SSN* Date of Birth Relationship Designation
Sample 123-44-5678 07-12-1954 Wife Primary
123 First Street Contingent
Phoenix, AZ 12345
(602) 123-4567
Primary
Contingent
Primary
Contingent
*Not a required field.
x x
x
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Completing Your Enrollment
We Value Your Opinion!
When enrolling for the Saguaro Program online via
the Web or using the IVR telephone system, you will
be asked to complete a survey about your enrollment
experience. Please take the time to give us your feed-back
about this important process.
Contact Information
ADOA Human
Resources web site www.hr.state.az.us/benefits
Online enrollment web site www.az.gov
Telephone enrollment system (IVR) 1-866-740-7153
Arizona Benefits Help Desk 1-866-251-5672
(24 hours a day/7 days a week)
Other Important Information
Payroll Deductions
Don’t forget to verify your payroll deductions for
changes you made to your plans or rate changes that
are to be effective October 1, 2001. Changes will
show on your mid-October 2001 paycheck. If you
feel your payroll deduction is not accurate, you must
notify your benefits liaison within 30 days of your
payroll deduction change.
About this Booklet
Information provided in this booklet is intended
solely as a guide to help you make important enroll-ment
decisions.
The benefits described are highlights of the State
of Arizona’s benefit program provided through the
Arizona Department of Administration.
This is a brief summary of the State’s official plan
documents and contracts that govern the plans. If
there is any discrepancy between this information
and the official documents, the official documents
will always govern.
The State of Arizona reserves the right to change
or terminate any of its plans, in whole or in part,
at any time.
Published by:
Arizona Department of Administration - Human
Resources - Employee Benefits Program
1624 West Adams, 4th Floor, Phoenix, AZ 85007
Phone: (602) 542-5008 or 1-800-304-3687
FAX: (602) 542-4744
e-mail: benefits@ad.state.az.us
Web Site: www.hr.state.az.us/benefits
If you need this booklet in an alternative format,
call Benefits at (602) 542-5008.
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September 7, 2001 is the enrollment
deadline!
If you fail to enroll by the annual enrollment deadline,
September 7, 2001, you will receive these default cover-ages
for the 2001/2002 plan year:
Medical – no coverage
Vision – no coverage
Flexible Spending Accounts – no participation
All of your other active elections – continued coverage
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1 I didn’t receive a personal identification
number (PIN) in the mail. What should I do?
You must have a PIN to enroll in the Saguaro
Program using the Web or phone enrollment
systems. Yours will be mailed to you in early
August. If you haven’t received yours by August
13, or if you lose or forget your PIN, a replace-ment
can be obtained by:
• Calling the Arizona Benefits Help Desk at
1-866-251-5672 and choosing the PIN option; or
• Using Arizona Benefits on the Web
(www.az.gov) and making a PIN request online.
For security reasons, the Help Desk will not
issue and mail a new PIN to any address other
than the official one on file. Therefore, please
ensure that your benefits liaison or university
benefits office has your current mailing address
on file.
2 Both my spouse and I are State employees.
What are our enrollment options?
While each of you must enroll for Saguaro
Program coverages, you can elect the following:
• For medical, dental or vision coverage:
If you have no dependents: Both can choose
single coverage or one can elect family coverage
while the other waives it.
If you have one or more dependents: Only one
of you will want to elect family coverage for the
entire family, if the family wants medical
coverage through the State. Whichever spouse
elects the family coverage has the deductions
taken out of his or her paycheck. (The other
spouse should waive coverage. Selecting single
and family medical or dental coverage can result
in additional payroll deductions since the State’s
share of the combined premium cost will exceed
the statutory monthly employer contribution
amount for family coverage.)
• For Short Term Disability (STD):
This is a plan for employees only. Spouses must
maketheir own elections.
• For Employee Supplemental Life/AD&D
Insurance:
This is a plan for employees only. Spouses must
maketheir own elections.
• For Dependent Life Insurance:
Both spouses may elect dependent coverage.
• For the Health Care Spending Account:
Each spouse can elect up to the annual maximum
contribution.
• For the Dependent Care Spending Account:
Your combined contribution can’t exceed the
annual maximum contribution.
Frequently
Asked Questions
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3 What should I do if my spouse has benefits
through another employer?
Coordinate your coverages. Study what your spouse
has and choose the Saguaro Program options that
provide you with the most appropriate overall
coverage. It is usually best to pick coverage that
complements, not duplicates, the other coverage.
4 How are Saguaro Program costs changing for
the 2001/2002 plan year?
Any change in the amount of your monthly
medical plan cost depends on the plan in which
you are currently enrolled and the new medical
plan you select. The dental premium (the total
cost) has increased, however the State will pay
more so your cost will remain the same as last
year. Vision plan benefits have increased while
premiums have been reduced. Short-Term
Disability Insurance premiums have been reduced.
Employee Life Insurance premiums for employees
age 40 or older have gone up slightly. Dependent
Life Insurance premiums have remained the same.
5 What is the advantage of paying for benefits
with pre-tax dollars?
Using pretax dollars to pay for benefits reduces
your taxable income. When taxable income is
reduced, you pay less in federal, state (if appli-cable),
and Social Security taxes.
6 If I don’t enroll by the September 7, 2001
deadline, what will happen?
If you fail to enroll by the annual enrollment
deadline, you will receive no medical or vision
plan coverage for the 2001/2002 plan year. You
will continue all of your other active elections,
with the exception of the Health Care Spending
Account and Dependent Care Spending Account
which will default to “No Participation.”
7 Why do I have to enroll for medical and
vision coverages this year? In the past, if we
didn’t enroll, our elections would just remain
the same for the new plan year.
Since we are changing our medical and vision
plan options, the plan you’re in now will not be
available next year. That’s why it will be neces-sary
for every employee to make new medical and
vision plan elections. If you don’t enroll during
open enrollment, you will have no medical or
vision plan coverage for the 2001/2002 plan year.
8 What is the best way to determine which
medical plan is right for me?
There’s a lot to consider. The key is for you to
look at your own situation, study what the plans
offer and their corresponding costs, and decide
what is best for you.
9 After enrollment, how will I know my choices
have been properly recorded?
A confirmation statement will be mailed to your
home address during October—keep this as a
record of your final elections. Don’t forget to verify
your payroll deductions in mid October, once your
new elections become effective. Report any
discrepancies to your benefits liaison immediately.
It is important that you report any enrollment
discrepancy to your benefits liaison no later than
30 days from the scheduled start of your changed
deductions. After this 30-day grace period, we
will be unable to make any adjustments.
10 When will I receive an identification (I.D.)
card if I enroll for medical coverage?
New enrollees will receive a packet of informa-tion
about using their new plan. You will also
receive a medical plan identification card by the
end of September. If your card doesn’t arrive by
then, please contact your benefits liaison. Until
you receive your card, your provider can call the
medical plan’s member services department to
verify your enrollment.
After October 1, you can contact member services
to request an additional I.D. card, change PCP, etc.
11 I’m enrolling for family coverage in the
HMO. Can I select one Primary Care
Physician (PCP) for my whole family?
While you can select one PCP for everyone, you
may want to choose different PCPs for each
family member. Each covered family member can
have his or her own PCP. You will need to record
a PCP for each covered person, even if you all use
the same one.
12 How do I use my Primary Care Physician
(PCP) and what kind of doctors are available
to choose from when selecting a PCP?
Your HMO or POS plan PCP is responsible for
directing all your care, including referrals to
specialists and obtaining necessary precertifica-tions.
PCPs are General Practice, Family Practice,
Pediatric or Internal Medicine specialists. Women
can self-refer to an in-network OB/GYN.
13 How do I access the new enrollment system?
To access the Web enrollment system, using any
Internet-ready computer, go to www.az.gov. For
the telephone (IVR) system, dial 1-866-740-7153.
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36
Actively at Work Plan provision that requires the employee to
be performing the duties of his occupation where the employee
normally works in order for coverage to commence. If the
employee is absent due to illness or injury, the coverage doesn’t
commence until the employee returns. This rule doesn’t include
adding a newborn to health insurance (such as an employee on
maternity leave) nor does it extend to absences for annual leave
provided the employee was not ill on the last scheduled day
before annual leave.
Allowed Fees Term used by some dental plans for their partici-pating
dentist fees and/or maximum payable for a non-partici-pating
dentist.
Billed Charge The amount the provider bills for services
rendered.
Coinsurance The division of the allowed amount to be paid by
the insurance company and the patient; i.e., 70/30 or 90/10. (The
first percentage is paid by the company – 70 or 90).
Copayment The fixed fee that must be paid to the provider at
the time services are provided, such as the pharmacist for a
prescription (Rx).
Deductible The initial amount the patient must pay out of their
pocket for covered services before benefits are payable by the
insurance carrier for out-of-network POS or PPO plan services.
Emergency Defined by each plan in accordance with their
standard definitions.
Health Maintenance Organization (HMO) A medical plan
providing comprehensive medical benefits, including preventive
care, when you agree to use a select group of network providers.
Generally, all care is directed by your chosen Primary Care
Physician (PCP). Your PCP will refer you to a specialist if
medically appropriate.
Indemnity Plan A health care plan that allows you to choose
any licensed provider to receive care. Members are reimbursed
for eligible health care expenses according to the benefit
schedule in effect, including deductibles and coinsurance.
In-Network Services provided by a contracted provider in
accordance with all plan requirements.
Non-participating Provider A provider with no contractual
limitation on what he/she may bill and thus may practice
balance-billing, as well as require payment at the time services
are rendered.
Point of Service (POS) Plan A plan that provides benefits in
two ways: in the plan’s network or outside the network. Your
costs are typically less when you receive services from inside the
network and some services are only covered in-network. When
enrolling in a POS plan, you must name a Primary Care
Physician (PCP) who will coordinate all of your in-network care.
Preferred Provider A provider who has signed an agreement
with the insurance carrier not to charge that carrier’s members
more than the insurer’s allowed fees.
Precertification Review process that verifies the medical
necessity and appropriateness of proposed services or supplies.
Pre-existing Condition A condition diagnosed and/or treated
prior to the effective date of your coverage or for which a
prudent person would have been treated.
Preferred Provider Organization (PPO) Plan A plan that
provides benefits in an indemnity fashion, but pays a higher
percentage of the cost of services if patients use a PPO-network
provider than if they use non-PPO providers. If you go to a
provider who is not a member of the PPO network, after you
first satisfy a deductible, the plan generally pays 70 percent of
the cost for care and you pay 30 percent.
Primary Care Physician (PCP) The physician responsible in
an HMO or in-network in a POS plan for directing all patient
care including referrals to specialists and obtaining necessary
precertifications. This physician is a General Practice, Family
Practice, Pediatric or Internal Medicine specialist. Women can
self-refer to an in-network OB/GYN.
Rehabilitation Usually physical therapy, speech therapy and/or
occupational therapy.
Glossary