Exhibit 17c - Cal Yr 2025 City of Miami CIGNA Healthcare Massachusetts Rider for OAP Plans HC-RDR1.pdf

PDF 723 KB Posted

Attached to
RFP No. 2130386 - Employee Health Benefits Plan
Solicitation number
RFP No. 2130386
Issued by
Florida

About this file

Written by GovTribe AI ·

This document is a Certificate Rider issued by Cigna Health and Life Insurance Company for the City of Miami, specifically targeting employees residing in Massachusetts. The rider is effective January 1, 2025, and relates to an Open Access Plus Medical Benefits health plan with policy numbers 3202272-OAPAE, OAPCE, OAPCX, and OAPNX. The document outlines the insurance eligibility requirements for employees, stating that coverage begins on the date an employee becomes eligible, provided they are in Active Service or not excluded due to health status.

The certificate rider is specifically designed to meet Massachusetts' Minimum Creditable Coverage standards and satisfy the state's individual health insurance mandate for residents 18 years and older. The plan ensures that Massachusetts residents purchasing this Cigna health insurance will comply with the state's Health Care Reform Law requirements. The document emphasizes that the coverage standards are effective January 1, 2025, and advises policy holders to review their health plan material annually to confirm continued compliance with the latest state standards.

View the file

Other files

File Type Posted
Exhibit 50 - Cal Yr 2024 City of Miami CIGNA Vision Plans Claim Summary Report.pdf PDF
Exhibit 39 - Cal Yr 2024 City of Miami Stop Loss - High Claimant Report De-ID Dx.xlsx XLSX spreadsheet
Exhibit 14b - Cal Yr 2025 City of Miami CIGNA Medicare Benefits - Comp EEs No Rx Plan 70 Percent Ded 300 Max Out Of Pocket 1K ASO69.pdf PDF
Questionnaire No. 2 - Stop Loss Insurance.pdf PDF
Exhibit 46 - Cal Yr 2025 City of Miami Benefit Eligible Employees as of Sep 2025.xlsx XLSX spreadsheet
Exhibit 69 - Cal Yr 2024 City of Miami RX CAP Report Plan Exec Summ and Top 20 Therapeutic Drugs.ppt PPT presentation
Exhibit 01a - Cal Yr 2025 YTD as of June City of Miami Monthly Healthcare Detail Experience - Stop Loss ALL claims.xlsx XLSX spreadsheet
Exhibit 68 - Cal Yr 2024 City of Miami RX Stats by Ther Class _ Brand Healthcare Spend and Trend.xlsx XLSX spreadsheet
Exhibit 57b - Cal Yr 2025 City of Miami YTD as of Apr Stats by Ther Class _ Brand - Healthcare Spend and Trend - Pharmacy - Paid.xlsx XLSX spreadsheet
Exhibit 51 - Cal Yr 2023 City of Miami CIGNA Claims by Benefits and ASO Fees Monthly Healthcare Experience by Benefit Option Rolling 12 BenOpt-1.xlsx XLSX spreadsheet
Exhibit 52a - Cal Yr 2022 City of Miami CIGNA Pooled Stop Loss High Claims Greater than 50K Experience De-ID.xlsx XLSX spreadsheet
Questionnaire No. 7 - Flexible Spending Accounts.pdf PDF
Exhibit 06c - Cal Yr 2025 City of Miami CIGNA Dental PPO Certificate Riders and Coverage for other states ETALLD25B Plan 3202272 HC-IMP35.pdf PDF
Exhibit 47 - Cal Yr 2023 City of Miami CIGNA Dental Exp.xlsx XLSX spreadsheet
Questionnaire No. 5 - Group Benefit Vision Plan.pdf PDF
Exhibit 29 - Cal Yr 2025 City of Miami CIGNA OAP No Rx PlanMedical Benefits - Summary Benefits Coverage POST 65.pdf PDF
Exhibit 25 - Cal Yr 2025 City of Miami Cobra Monthly Premiums.pdf PDF
Exhibit 03 - City of Miami AFSCME 1907 General Employees Union Contract Oct 1 2023 - Sep 30 2026.pdf PDF
Exhibit 45 - Cal Yr 2024 City of Miami EAP - EAP Utilization.pptx PPTX presentation
Exhibit 05 - Cal Yr 2024 City of Miami CIGNA Dental HMO Plan Document.pdf PDF
2130386 - Sample PSA.pdf PDF
Exhibit 38 - Cal Yr 2023 City of Miami Stop Loss - Greater than 50K High Claimant Report De-ID Dx.xlsx XLSX spreadsheet
Exhibit 44 - Cal Yrs 2025 _ 2026 EAP Renewal Letter.pdf PDF
Exhibit 74 - Cal Yr 2023 City of Miami ASO Fixed Charges and Fees Per Product Type Monthly Healthcare Detail Experience.xlsx XLSX spreadsheet
Exhibit 37 - Cal Yr 2022 City of Miami Stop Loss - Greater than 50K High Claimant Report De-ID Dx.xlsx XLSX spreadsheet
Questionnaire No. 8 - COBRA.pdf PDF
Exhibit 55 - Cal Yr 2025 as of Apr EAP Network Analysis Report Access 118974.pdf PDF
Exhibit 57c - Cal Yr 2025 YTD as of Jul - City of Miami CIGNA Pharmacy RX Dispensed Report.xlsx XLSX spreadsheet
Exhibit 08 - Cal Yr 2024 City of Miami CIGNA EGWP Medicare Formulary.pdf PDF
Exhibit 62 - Cal Yr 2025 City of Miami CIGNA FSA Healthcare - Summary Plan Document.pdf PDF
Exhibit 16 - Cal Yr 2024 City of Miami CIGNA Open Access Plan (OAP) Medicare No Rx - Comp EEs Plan 80 Percent Ded 500 Max Out of Pocket 2K ASO66.pdf PDF
Exhibit 49 - Cal Yr 2023 City of Miami CIGNA Vision Plans Claim Summary Report.pdf PDF
Exhibit 54b - Cal Yr 2025 City of Miami Stop CIGNA ISL and ASL Coverage Information Amendment Plan 3202272 CSL-SCH(10-15).pdf PDF
Exhibit 34 - Cal Yr 2025 City of Miami CIGNA Dental HMO Summary with Patient Charge Schedule.pdf PDF
Exhibit 42 - Cal Yr 2025 City of Miami CIGNA TC19 Disruption Report - Total Records Total Claimants Total Eligible Charges Summary.xlsx XLSX spreadsheet
Exhibit 61 - Cal Yr 2025 City of Miami CIGNA FSA Dependent Care - Summary Plan Document.pdf PDF
Exhibit 41a - Cal Yr 2025 City of Miami CIGNA Medical - Disruption Detail with Provider TIN - Option 1 - OAP-OA001 RITM9284277_TC19.xlsx XLSX spreadsheet
Exhibit 59 - City of Miami CIGNA Medical - Professional Services Agreement AMENDMENT NO 1 May 6 2021 ASO Agreement with Fees.pdf PDF
Exhibit 02 - City of Miami AFSCME 871 Sanitation Employees Union Contract Oct 1 2023 - Sep 30 2026.pdf PDF
Exhibit 15 - City of Miami Cal Yr 2024 CIGNA Medical - Comp EEs Plan 70 Percent Ded 300 Max Out of Pocket 1K ASO64.pdf PDF
Exhibit 30a - Cal Yr 2025 City of MIami CIGNA VIS Vision Benefit imbedded in Medical Plan Document ASO71.pdf PDF
Exhibit 18 - Cal Yrs 2023 _ 2024 City of Miami CIGNA FIXED Charges Report - PRR.xlsx XLSX spreadsheet
Exhibit 22 - Cal Yr 2025 City of Miami CIGNA Sum Ben Cov Comp EEs No Rx- Out Of Area Plan - Plan 70 Pct Ded 300 Max Out of Pocket 1K ASO67.pdf PDF
Attachment A - City of Miami Living Wage Ordinance.pdf PDF
Exhibit 19 - Cal Yr 2025 City of Miami CIGNA Medical - SBC Comp Ded 300 Max Out of Pocket 1K.pdf PDF
Exhibit 63 - Aug 2024 to Jul 2025 City of Miami CIGNA Claims by Benefits and ASO Fees Monthlty Healthcare Experience by Ben Option Rlg 12.xlsx XLSX spreadsheet
Exhibit 54a - Cal Yr 2025 City of Miami CIGNA Medical - Administrative Services Only ASO And Stop Loss Fees Schedule.pdf PDF
Exhibit 05c - Cal Yr 2025 City of Miami CIGNA Dental HMO Certificate Riders and Coverage for 7 States ETALLD25A Plan 3202272 HC-ETRDR.pdf PDF
Exhibit 06d - Cal Yr 2025 City of Miami CIGNA Dental PPO Territorial Legislation - 23 States ETALLD25B.pdf PDF
Exhibit 31 - Cal Yr 2024 City of Miami CIGNA Lag Report Incurred Date included - Monthly Healthcare Experience by Acct Rolling 12-1.xlsx XLSX spreadsheet
Show 40 more

Latest 50 of 114 listed here. See the rest on GovTribe.

On GovTribe

Work with this file

  • Download the original file
  • Contacts named in this file
  • Similar government files
  • Ask GovTribe AI about this file
Try for free Login

Text version

The file's text, extracted by GovTribe without its formatting.

myCigna.com1

Home Office: Bloomfield, Connecticut

Mailing Address: Hartford, Connecticut 06152

CIGNA HEALTH AND LIFE INSURANCE COMPANY

a Cigna company (hereinafter called Cigna)

CERTIFICATE RIDER

No. CR7MNASO67-1

CR7MNASO68-1

CR7MNASO69-1

CR7MNASO70-1

Policyholder: City of Miami

Rider Eligibility: Each Employee who resides in Massachusetts

Policy No. or Nos. 3202272-OAPAE, OAPCE, OAPCX, OAPNX

EFFECTIVE DATE: January 1, 2025

You will become insured on the date you become eligible if you are in Active Service on that date or if you are not in Active Service on that date due to your health status. If you are not insured for the benefits described in your certificate on that date, the effective date of this certificate rider will be the date you become insured.

This certificate rider forms a part of the certificate issued to you by Cigna describing the benefits provided under the policy(ies) specified above.

HC-RDR1 04-10

V1

EXHIBIT 17c myCigna.com2

The pages coded HC-MACR1V1 and HC-MACR2 V12 attached to this certificate rider are added to your certificate.

myCigna.com3

Notice To Massachusetts Residents This Open Access Plus Medical Benefits health plan meets Minimum Creditable Coverage standards and will satisfy the individual mandate that you have health insurance. For additional information, please see the section “Massachusetts Requirement to Purchase Health Insurance,” immediately preceding the Schedule.

HC-MACR1V1

myCigna.com4

Massachusetts Requirement To Purchase Health Insurance:

As of January 1, 2009, the Massachusetts Health Care Reform Law requires that Massachusetts residents, eighteen

(18) years of age and older, must have health coverage that meets the Minimum Creditable Coverage standards set by the Commonwealth Health Insurance Connector, unless waived from the health insurance requirement based on affordability or individual hardship. For more information call the Connector at 1-877-MA-ENROLL or visit the Connector website (www.mahealthconnector.org).

This Open Access Plus Medical Benefits health plan meets Minimum Creditable Coverage standards that are effective January 1, 2025 as part of the Massachusetts Health Care Reform Law. If you purchase this plan, you will satisfy the statutory requirement that you have health insurance meeting these standards.

THIS DISCLOSURE IS FOR MINIMUM COVERAGE STANDARDS THAT ARE EFFECTIVE JANUARY 1, 2025.

BECAUSE THESE STANDARDS MAY CHANGE, REVIEW YOUR HEALTH PLAN MATERIAL EACH YEAR TO

DETERMINE WHETHER YOUR PLAN MEETS THE LATEST STANDARDS.

HC-MACR2 01-25

V12

File details come from the government source that posted it. Updated .