Attachment_1_-_3342685_COT_Stop_Loss_Policy_07.01.2025.pdf
PDF 107 KB Posted
- Attached to
- SPECIFIC STOP LOSS INSURANCE
- Solicitation number
- 260220
- Issued by
- Pima County, Arizona
About this file
This is a Stop Loss Insurance Policy Schedule issued by Cigna Health and Life Insurance Company to the City of Tucson for Group Policy No. 3342685, effective July 1, 2025 through June 30, 2026. The City of Tucson, Arizona's second largest city, is seeking specific stop loss insurance coverage for its 4,508 covered employees and retirees, with the policy providing individual stop loss coverage for claims incurred between July 1, 2025 and June 30, 2026. The coverage applies to HRA, HSA, Mental Health/Substance Use Disorders, Network Plan, and Pharmacy Expense benefits administered by Cigna. The policy identifies two high-risk individuals subject to elevated individual stop loss limits of $2,000,000 and $1,600,000 respectively, while standard covered employees have an individual stop loss limit of $1,100,000.
The monthly premium rate is $20.91 per covered employee, with Cigna responsible for 100 percent of claims once the individual stop loss limit is reached. The policy excludes coverage for funds contributed to Health Reimbursement Accounts, Health Savings Accounts, or Flexible Spending Accounts, as well as fixed, per-person, per-period charges to providers and claims for retirees over 65 years of age. Plan-paid medical and prescription drug claims totaled approximately $43.5 million in the most recent 12-month period through March 2026. Effective July 1, 2026, the City will transition to Blue Cross Blue Shield of Arizona for its medical TPA/network services and PBM functions through OptumRx, moving from its current self-funded plan with Cigna that has been in place since July 1, 2019.
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Text version
CIGNA HEALTH AND LIFE INSURANCE COMPANY
(Herein called 'Cigna')
CSL-SCH(10-15) 1
Attached to and made part of Group Policy No. 3342685
It is hereby agreed that said policy is amended as follows:
• Page CSL-SCH(10-15) headed COVERAGE INFORMATION is deleted and the attached
Pages headed COVERAGE INFORMATION is substituted therefore.
CSL-SCH(10-15) 2
Schedule of Insurance
Coverage Information
Policyholder: City of Tucson
Policy Number: 3342685
Effective Date: July 01, 2025
Issue Date: June 05, 2025
Next Renewal Date: July 01, 2026
State or other Jurisdiction of Issue: Arizona
Notices
For the purpose of any notices required under this policy, such notices should be sent to the addresses shown below:
Cigna Health and Life Insurance Company
900 Cottage Grove Road, Hartford, CT 06152
Attn: Stop Loss Unit
City of Tucson
P.O. Box 27210
Tucson, AZ 85726
Attn: Anita Hart anita.hart@tucsonaz.gov
520-837-4304
Notice to Policyholder - ADDITIONAL PROGRAMS – Cigna may, from time to time, offer or arrange for various entities to offer discounts, benefits, services or other consideration to the
Policyholder’s employees for the purpose of promoting their general health and well-being. For details about these programs, contact Cigna. Any such consideration shall be provided by Cigna in connection with its administrative services agreement for the administration of the
Policyholder’s self-insured Plan and shall not be considered a benefit of this policy nor create any relationship between Cigna and the Policyholder’s employees with respect to this policy.
CSL-SCH(10-15) 3
Individual Stop Loss Coverage
Policy Year: July 01, 2025 to June 30, 2026
Covered Expenses: Claims that are Incurred between July 01, 2025 and
June 30, 2026 and that Become Due on and after July 01, 2025
Monthly Premium Rates:
For each covered employee $20.91
Individual Stop Loss Benefit Percentage Payable: 100%
Individual Stop Loss Limit: $1,100,000.00
The following Covered Persons have been identified as High Risk Individuals and shall be subject to the Individual Stop Loss Limit as specified below:
High Risk Individual Relationship Amount
Claimant 1 EE $2,000,000.00
Claimant 2 EE $1,600,000.00
Benefit Plans Covered by Individual Stop Loss Coverage:
Claim Administrator Product
Cigna HRA Open Access Plus
Cigna HSA Open Access Plus
Cigna Mental Health/Substance Use Disorders
Cigna Network Plan
Cigna Pharmacy Expense
Cigna's Maximum Liability per individual: Will be the individual maximum, if any, as set forth in the Benefit Plan less the Individual Stop Loss Limit
Additional exclusions from Individual Stop Loss coverage under this policy:
• Funds contributed by the company or an employee as part of a Health Reimbursement
Account, Health Savings Account or Flexible Spending Account.
• Expenses resulting from fixed, per person, per period charges (fixed charges), if any, i.e., contractually determined periodic payments to certain providers based on the number of Plan participants entitled to receive services from the provider, in return for which, such providers furnish certain agreed-upon services to Plan participants.
• Retirees over 65 years of age
Payment of premium is considered acceptance of this policy and the terms within.
CSL-SCH(10-15) 4
File details come from the government source that posted it. Updated .