Exhibit 29 - Cal Yr 2025 City of Miami CIGNA OAP No Rx PlanMedical Benefits - Summary Benefits Coverage POST 65.pdf

Summary of Benefits and Coverage: What this Plan Covers & What You Pay for Covered Services Coverage Period: 01/01/2025 - 12/31/2025 City of Miami: Open Access Plus Coverage for: Individual/Individual + Family | Plan Type: OAP

The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. The SBC shows you how you and the plan would share the cost for covered health care services. NOTE: Information about the cost of this plan (called the premium) will be provided separately. This is only a summary. For more information about your coverage, or to get a copy of the complete terms of coverage, go online at www.cigna.com/sp. For general definitions of common terms, such as allowed amount, balance billing, coinsurance, copayment, deductible, provider, or other underlined terms, see the Glossary. You can view the Glossary at https://www.healthcare.gov/sbc-glossary or call 1-800-Cigna24 to request a copy.

Important Questions Answers Why This Matters:

What is the overall deductible?

For in-network providers: $500/individual or $1,000/family For out-of-network providers: $1,000/individual or $2,000/family

Generally, you must pay all of the costs from providers up to the deductible amount before this plan begins to pay. If you have other family members on the plan, each family member must meet their own individual deductible until the total amount of deductible expenses paid by all family members meets the overall family deductible.

Are there services covered before you meet your deductible?

Yes. In-network preventive care & immunizations, Out-of-network preventive care & immunizations through age 17, In-network office visits, In-network diagnostic tests , In-network prescription drugs , emergency room visits, urgent care facility visits. In-network home health care.

This plan covers some items and services even if you haven’t yet met the deductible amount. But a copayment or coinsurance may apply. For example, this plan covers certain preventive services without cost-sharing and before you meet your deductible. See a list of covered preventive services at https://www.healthcare.gov/coverage/preventive-care-benefits/.

Are there other deductibles for specific services? No. You don't have to meet deductibles for specific services.

What is the out-of-pocket limit for this plan?

For in-network providers: $2,000/individual or $4,000/family For out-of-network providers: $4,000/individual or $8,000/family

The out-of-pocket limit is the most you could pay in a year for covered services. If you have other family members in this plan, they have to meet their own out-of-pocket limits until the overall family out-of-pocket limit has been met.

What is not included in the out-of-pocket limit?

Penalties for failure to obtain pre-authorization for services, premiums, balance-billing charges, and health care this plan doesn’t cover.

Even though you pay these expenses, they don't count toward the out-of-pocket limit.

EXHIBIT 29

Important Questions Answers Why This Matters:

Will you pay less if you use a network provider?

Yes. See www.cigna.com or call 1-800-Cigna24 for a list of network providers.

This plan uses a provider network. You will pay less if you use a provider in the plan’s network. You will pay the most if you use an out-of-network provider, and you might receive a bill from a provider for the difference between the provider’s charge and what your plan pays (balance billing). Be aware your network provider might use an out-of-network provider for some services (such as lab work). Check with your provider before you get services.

Do you need a referral to see a specialist? No. You can see the specialist you choose without a referral.

All copayment and coinsurance costs shown in this chart are after your deductible has been met, if a deductible applies.

What You Will PayCommon Medical Event Services You May Need In-Network Provider

(You will pay the least) Out-of-Network Provider (You will pay the most)

Limitations, Exceptions, & Other Important Information

Primary care visit to treat an injury or illness

$25 copay/visit Deductible does not apply 40% coinsurance NoneIf you visit a health care provider's office or clinic Specialist visit $30 copay/visit Deductible does not apply 40% coinsurance None

Common Medical Event Services You May Need

What You Will Pay Limitations, Exceptions, & Other Important InformationIn-Network Provider

(You will pay the least) Out-of-Network Provider (You will pay the most)

Preventive care/ screening/ immunization

No charge/visit** No charge/visit** No charge/visit** No charge/screening** No charge/screening**

No charge/immunizations**

No charge/immunizations** **Deductible does not apply

40% coinsurance/visit** 40% coinsurance/visit Not covered 40% coinsurance/screening** Not covered/screening

40% coinsurance/immunization s** Not covered/immunizations **Deductible does not apply

Coverage birth through age 17 Coverage Well-Woman Coverage age 18 and older Coverage birth through age 17 Coverage age 18 and older

Coverage birth through age 17

Coverage age 18 and older You may have to pay for services that aren’t preventive. Ask your provider if the services needed are preventive.

Then check what your plan will pay for.

Diagnostic test (x-ray, blood work)

No charge Deductible does not apply 40% coinsurance None

If you have a test Imaging (CT/PET scans, MRIs)

No charge Deductible does not apply 40% coinsurance 50% penalty for no out-of-network precertification.

Generic drugs (Tier 1) Not covered Not covered Preferred brand drugs (Tier

2) Not covered Not covered

Non-preferred brand drugs (Tier 3) Not covered Not covered

If you need drugs to treat your illness or condition

More information about prescription drug coverage is available at www.cigna.com Specialty drugs (Tier 4) Not covered Not covered

Contact your employer for non-Cigna coverage that may be available.

If you have outpatient surgery

Facility fee (e.g., ambulatory surgery center) 20% coinsurance 40% coinsurance 50% penalty for no out-of-network precertification.

Medical Event Services You May Need

What You Will Pay Limitations, Exceptions, & Other Important InformationIn-Network Provider

(You will pay the least) Out-of-Network Provider (You will pay the most)

Physician/surgeon fees 20% coinsurance 40% coinsurance 50% penalty for no out-of-network precertification.

Emergency room care $225 copay/visit Deductible does not apply

$225 copay/visit Deductible does not apply

Per visit copay is waived if admitted.

Out-of-network services are paid at the in-network cost share.

Emergency medical transportation 20% coinsurance 20% coinsurance

Out-of-network air ambulance services are paid at the in-network cost share and deductible.

If you need immediate medical attention

Urgent care $25 copay/visit Deductible does not apply

$25 copay/visit Deductible does not apply None

Facility fee (e.g., hospital room) 20% coinsurance 40% coinsurance 50% penalty for no out-of-network precertification.If you have a hospital stay Physician/surgeon fees 20% coinsurance 40% coinsurance 50% penalty for no out-of-network precertification.

Outpatient services No charge/office visit** No charge/all other services** **Deductible does not apply

40% coinsurance/office visit 40% coinsurance/all other services

50% penalty if no precert of out-of-network non-routine services (i.e., partial hospitalization, etc.). Includes medical services for MH/SA diagnoses.

If you need mental health, behavioral health, or substance abuse services

Inpatient services No charge Deductible does not apply 40% coinsurance

50% penalty for no out-of-network precertification. Includes medical services for MH/SA diagnoses.

Office visits 20% coinsurance 40% coinsurance Childbirth/delivery professional services 20% coinsurance 40% coinsurance

If you are pregnant Childbirth/delivery facility services 20% coinsurance 40% coinsurance

Primary Care or Specialist benefit levels apply for initial visit to confirm pregnancy.

Cost sharing does not apply for preventive services.

Depending on the type of services, a copayment, coinsurance or deductible may apply. Maternity care may include tests and services described elsewhere in the SBC (i.e., ultrasound).

Medical Event Services You May Need

What You Will Pay Limitations, Exceptions, & Other Important InformationIn-Network Provider

(You will pay the least) Out-of-Network Provider (You will pay the most)

Home health care No charge Deductible does not apply 40% coinsurance

50% penalty for no out-of-network precertification.

24 hour maximum per day

Rehabilitation services No charge Deductible does not apply

40% coinsurance/PCP visit

40% coinsurance/ Specialist visit

50% penalty for failure to precertify out-of-network speech therapy services. Coverage is limited to annual max of: 180 days for Rehabilitation and Chiropractic care services; 36 days for Cardiac rehab services.

Limits are not applicable to mental health conditions for Physical, Speech and Occupational therapies.

Habilitation services No charge Deductible does not apply

40% coinsurance/PCP visit

40% coinsurance/ Specialist visit

50% penalty for failure to precertify out-of-network speech therapy services. Services are covered when Medically Necessary to treat a mental health condition (e.g. autism) or a congenital abnormality.

Limits are not applicable to mental health conditions for Physical, Speech and Occupational therapies.

Skilled nursing care 20% coinsurance 40% coinsurance 50% penalty for no out-of-network precertification.

Coverage is limited to 180 days annual max.

If you need help recovering or have other special health needs

Durable medical equipment No charge Deductible does not apply Not covered None

Medical Event Services You May Need

What You Will Pay Limitations, Exceptions, & Other Important InformationIn-Network Provider

(You will pay the least) Out-of-Network Provider (You will pay the most)

Hospice services

20% coinsurance/inpatient services No charge/outpatient services** **Deductible does not apply

40% coinsurance/inpatient services 40% coinsurance/outpatient services

50% penalty for failure to precertify out-of-network inpatient hospice services.

Children's eye exam Not covered Not covered None Children's glasses Not covered Not covered NoneIf your child needs dental or eye care Children's dental check-up Not covered Not covered None

Excluded Services & Other Covered Services:

Services Your Plan Generally Does NOT Cover (Check your policy or plan document for more information and a list of any other excluded services.)

Cosmetic surgery Dental care (Adult) Dental care (Children) Eye care (Children)

Hearing aids Long-term care Non-emergency care when traveling outside the

U.S.

Prescription drugs

Private-duty nursing Routine eye care (Adult) Routine foot care Weight loss programs

Other Covered Services (Limitations may apply to these services. This isn’t a complete list. Please see your plan document.)

Acupuncture (20 days) Bariatric Surgery (in-network only)

Chiropractic care (combined with Rehabilitation Services)

Infertility treatment (Lifetime max $20,000)

Your Rights to Continue Coverage:

There are agencies that can help if you want to continue your coverage after it ends. The contact information for those agencies is: Cigna at 1-800-Cigna24, Department of Health and Human Services, Center for Consumer Information and Insurance Oversight, at 1-877-267-2323 x61565 or www.cciio.cms.gov. Other coverage options may be available to you, too, including buying individual insurance coverage through the Health Insurance Marketplace. For more information about the Marketplace, visit www.HealthCare.gov or call 1-800-318-2596.

Your Grievance and Appeals Rights:

There are agencies that can help if you have a complaint against your plan for a denial of a claim. This complaint is called a grievance or appeal. For more information about your rights, look at the explanation of benefits you will receive for that medical claim. Your plan documents also provide complete information on how to submit a claim, appeal or a grievance for any reason to your plan. For more information about your rights, this notice, or assistance, contact: Cigna Customer service at 1-800- Cigna24.

Does this plan provide Minimum Essential Coverage? Yes.

Minimum Essential Coverage generally includes plans, health insurance available through the Marketplace or other individual market policies, Medicare, Medicaid, CHIP, TRICARE, and certain other coverage. If you are eligible for certain types of Minimum Essential Coverage, you may not be eligible for the premium tax credit.

Does this plan meet the Minimum Value Standards? Yes.

If your plan doesn't meet the Minimum Value Standards, you may be eligible for a premium tax credit to help you pay for a plan through the Marketplace.

Language Access Services:

Spanish (Español): Para obtener asistencia en Español, llame al 1-800-244-6224.

Tagalog (Tagalog): Kung kailangan ninyo ang tulong sa Tagalog tumawag sa 1-800-244-6224.

Chinese (中文): 如果需要中文的帮助，请拨打这个号码 1-800-244-6224.

Navajo (Dine): Dinek'ehgo shika at'ohwol ninisingo, kwiijigo holne' 1-800-244-6224.

To see examples of how this plan might cover costs for a sample medical situation, see the next section.

About these Coverage Examples:

This is not a cost estimator. Treatments shown are just examples of how this plan might cover medical care. Your actual costs will be different depending on the actual care you receive, the prices your providers charge, and many other factors. Focus on the cost sharing amounts (deductibles, copayments and coinsurance) and excluded services under the plan. Use this information to compare the portion of costs you might pay under different health plans. Please note these coverage examples are based on self-only coverage.

Peg is Having a Baby

(9 months of in-network pre-natal care and a hospital delivery)

Managing Joe's Type 2 Diabetes (a year of routine in-network care of a well-controlled condition)

Mia's Simple Fracture (in-network emergency room visit and follow up care)

■ The plan's overall deductible $500

■ Specialist copayment $30

■ Hospital (facility) coinsurance 20%

■ Other coinsurance 20%

■ Hospital (facility) coinsurance 20%

■ Other coinsurance 20%

■ Hospital (facility) coinsurance 20%

■ Other coinsurance 20%

This EXAMPLE event includes services like:

Specialist office visits (prenatal care) Childbirth/Delivery Professional Services Childbirth/Delivery Facility Services Diagnostic tests (ultrasounds and blood work) Specialist visit (anesthesia)

This EXAMPLE event includes services like:

Primary care physician office visits (including disease education) Diagnostic tests (blood work) Prescription drugs Durable medical equipment (glucose meter)

This EXAMPLE event includes services like:

Emergency room care (including medical supplies) Diagnostic test (x-ray) Durable medical equipment (crutches) Rehabilitation services (physical therapy)

Total Example Cost $12,700

In this example, Peg would pay:

Cost Sharing

Deductibles $500 Copayments $30 Coinsurance $1,500

What isn't covered Limits or exclusions $30 The total Peg would pay is $2,060

Total Example Cost $5,600

In this example, Joe would pay:

Deductibles $0 Copayments $300 Coinsurance $0

What isn't covered Limits or exclusions $4,300 The total Joe would pay is $4,600

Total Example Cost $2,800

In this example, Mia would pay:

Deductibles $500 Copayments $400 Coinsurance $100

What isn't covered Limits or exclusions $10 The total Mia would pay is $1,010

The plan would be responsible for the other costs of these EXAMPLE covered services.

Plan Name: OAP Plan No Rx Ben Ver: 31 Plan ID: 32183689

Discrimination is against the law.

Medical coverage

Cigna Healthcare complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Cigna Healthcare does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.

Cigna Healthcare:

• Provides free aids and services to people with disabilities to communicate effectively with us, such as:

Qualified sign language interpreters

Written information in other formats (large print, audio, accessible electronic formats, other formats)

• Provides free language services to people whose primary language is not English, such as:

Qualified interpreters

Information written in other languages

If you need these services, contact customer service at the toll-free number shown on your ID card, and ask a Customer Service Associate for assistance.

If you believe that Cigna Healthcare has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance by sending an email to ACAGrievance@Cigna.com or by writing to the following address:

Cigna Healthcare Nondiscrimination Complaint Coordinator P.O. Box 188016 Chattanooga, TN 37422

If you need assistance filing a written grievance, please call the number on the back of your ID card or send an email to ACAGrievance@Cigna.com. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:

U.S. Department of Health and Human Services 200 Independence Avenue, SW Room 509F, HHH Building Washington, DC 20201

1.800.368.1019, 800.537.7697 (TDD)

Complaint forms are available at https://www.hhs.gov/civil-rights/filing-a-complaint/complaint-process/index.html