2025-2026_health_benefits_overview_guide.pdf

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Health Benefits Guide
2025 - 2026
Town of Centreville

Table of Contents
Welcome to Your Health Benefits Guide ................................................................... 3
What’s New July 1 ...................................................................................................... 4
Benefits Eligibility ....................................................................................................... 6
When to Enroll............................................................................................................. 8
How to Enroll .............................................................................................................. 8
Your Cost for Health Coverage ................................................................................. 11
Medical and Pharmacy Coverage .............................................................................. 12
Insurance Cards Have Gone Digital! ........................................................................ 30
Skip the Waiting Room! Use MDLIVE .................................................................... 30
Connect Care 3 .......................................................................................................... 31
Pharmacy Coverage ................................................................................................... 32
Dental Coverage ........................................................................................................ 33
Vision Coverage ........................................................................................................ 35
On Your Way to Wellness ......................................................................................... 38
Prepare for the Unthinkable ...................................................................................... 39
Protect Your Income! ................................................................................................ 41
Secure Your Future (NEW!) ..................................................................................... 43
Additional Benefits .................................................................................................... 44
Employee Assistance Program (EAP)....................................................................... 50
Retirement Plans – Planning Your Future ................................................................ 50
Questions? ................................................................................................................. 53
Annual Notices .......................................................................................................... 54
Helpful Contacts ........................................................................................................ 62
General Glossary of Terms ........................................................................................ 63
2025 – 2026 Health Benefits Guide 2

Welcome to Your Health Benefits Guide
The Town of Centreville (“Town”) takes pride in offering a comprehensive and competitive benefits package to
our employees. The Town, through all our benefits partners, offers you a benefits program that allows choice
and flexibility. Through this guide, you can select benefits that work best for you and your family.
2025-2026 Plan Year
• Benefits will be effective for the July 1, 2025 – June 30, 2026, plan year.
• The Town continues to evaluate ways to improve the quality of your healthcare and keep our health
plans competitively priced, while controlling costs for you and the Town. We encourage staff to become
and remain engaged in these efforts by being educated on the plans and using them wisely. Be sure to
participate in Employee Wellness programs and activities, and partner with your physician to get
appropriate preventive screenings. Also, consider programs like mail order pharmacy and generic
prescriptions to lower your copays and overall plan costs.
• When reviewing your benefits, please be aware of the difference between the following terms:
o Calendar Year – runs from January 1 to December 31 and resets each January 1.
o Plan Year – Town benefit plan year, which runs from July 1 to June 30.
o Every 12 months – a rolling 12 months that begins on the date of your most recent service.
It is important to take time to review the plan options available to you prior to making your
selections. Consider each benefit and the associated costs carefully and choose the benefits package
that will meet your and your family’s needs throughout the year.
For details about each specific plan, review the sections in this guide or refer to the Helpful Contact section for
contact information for each of the plans. OR Email Human Resources: hr@townofcentreville.org for a copy of
the specific plan document you are requesting.
THIS GUIDE IS NOT A CONTRACT
This guide is a summary of the general benefits available to Town of Centreville employees and eligible retirees
and describes the highlights of our benefits in non-technical language. Our specific rights to benefits under the
plan are governed solely, and in every respect, by the official documents and not the information in this
summary. If there is any discrepancy between the descriptions of the programs as contained in this guide and
the official plan documents, the language of the official document shall prevail as accurate. Please refer to the
plan-specific documents for detailed plan information. Any plan benefits may be modified in the future to meet
Internal Revenue Service rules as decided by the Town.
2025 – 2026 Health Benefits Guide 3

What’s New July 1
• Medical Premium Rates Decreased! – Please refer to page 11 for details.
Dental and Vision premium rates remain the same.
• Health Holidays Are Coming! – The Town received over $90k in health
surplus because of lower claim costs! (Great job in maintaining preventive
care and continuing to strive for a healthy lifestyle!). The Council approved to
give those funds back to employees by paying for their health insurance
premiums as described below:
o Hourly employees will not pay their health insurance premiums on the
following check dates:
▪ 11/07/2025
▪ 11/21/2025
▪ 12/05/2025
▪ 12/19/2025
o Salary employees will not pay their health insurance premiums on the
following check dates:
▪ 12/05/2025
▪ 12/19/2025
• Secure Your Future – Universal Life with Long-Term Care coverage is now
available to eligible employees. Please refer to page 43 for plan and
enrollment details.
• Passive Enrollment - beginning May 7th and ending May 30th. Passive
enrollment means employees only need to complete open enrollment in the
employee portal (CHR), if the following apply:
o Making changes to your enrollment selections. (Adding/removing
dependents, changing plans, adding/removing plans, etc.)
o If currently enrolled in Flexible Spending (FSA) and/or Dependent Care
(DCA), you MUST re-enroll every year.
2025 – 2026 Health Benefits Guide 4

Employee Portal – Centrally HR (CHR)
INSTRUCTIONS:
• Your username is your first initial and last name (i.e. – John Smith = JSmith). Usernames are NOT case
sensitive.
• First time users must type in their username and click forgot password to reset their password. A
temporary password will be emailed to your primary work email address (@qac.org for CPD employees,
@townofcentreville.org for all other employees).
• CHR is accessible via the mobile app, Town website (found under Human Resources, Employee Portal),
or via CHR URL logon page
https://secure5.entertimeonline.com/ta/CBIZ20602.login?rnd=CPW&%40rtm=1
2025 – 2026 Health Benefits Guide 5

Benefits Eligibility
Employee Eligibility
All Town employees, as defined by the Town of Centreville, are benefits eligible (full-time employees and
permanent part-time employees who work 20 or more hours a week).
Dependent Eligibility
You may enroll your eligible dependents in the same plans you choose for yourself. Eligible dependents include
your legal spouse, dependent children, and disabled adult child. The Dependent Eligibility Documentation
Requirements are outlined on page 10 of this guide.
The Town of Centreville provides a generous benefit package to eligible employees with benefit options from
healthcare to income protection. The following chart outlines your benefit options for plan year:
July 1, 2025 – June 30, 2026
Benefit Options
Plan Options Coverage Who Is Eligible*
Medical and Pharmacy Cigna Choice Fund Open Begins the 1st day that all Regular Full-time
Access Plus In-Network eligibility requirements employees working at
are met if enrolling. least 40 hours per week.
Coverage ends on the last Regular Part-time
day of employment or the employees working at
date that the employee is least 20 hours per week.
no longer eligible.
Dental United Concordia Begins the 1st day that all Regular Full-time
eligibility requirements employees working at
are met if enrolling. least 40 hours per week.
Coverage ends on the last Regular Part-time
day of employment or the employees working at
date that the employee is least 20 hours per week.
no longer eligible.
Vision National Vision Begins the 1st day that all Regular Full-time
Administration, LLC eligibility requirements employees working at
(NVA) are met if enrolling. least 40 hours per week.
Coverage ends on the last Regular Part-time
day of employment or the employees working at
date that the employee is least 20 hours per week.
no longer eligible.
Group Life and AD&D Lincoln Financial Group Begins the 1st day of full Regular Full-time
Insurance month that all eligibility employees working at
requirements are met. least 40 hours per week.
Coverage ends on the last
day of employment or the
2025 – 2026 Health Benefits Guide 6

date that the employee is
no longer eligible.
Voluntary Life Insurance Lincoln Financial Group Begins the 1st day that all Regular Full-time
eligibility requirements employees working at
are met if enrolling. least 40 hours per week.
Coverage ends on the last
day of employment.
Continuing coverage may
be available. Contact
Lincoln Finance for more
information on
continuing coverage.
Flexible Spending CareFlex Begins the 1st day of the Active employees
Accounts next month following working 30 or more
your date of hire. hours per week or 130
hours per month and
eligible for the group
health plan.
Accident, Cancer, AFLAC Begins in the pay cycle Active employees
Hospital, Critical Care following enrollment and
confirmation of
deduction by Insurance
Rep.
457 (b) Deferred Corebridge Financial Begins in the pay cycle Active employees
Compensation OR following enrollment and
Mission Square confirmation of
deduction by Insurance
Rep.
*To be eligible, you must meet the eligibility requirements as outlined in the Eligibility section of this guide.
2025 – 2026 Health Benefits Guide 7

When to Enroll
NEW HIRE ELIGIBILITY* QUALIFYING LIFE EVENTS OPEN ENROLLMENT
As a newly hired benefits-eligible Certain events in your life (i.e.,
employee, you are offered an marriage, divorce, gain or loss of
initial enrollment period to elect coverage due to a job change, etc.)
benefits. allow you to make changes to your
benefit plan(s). May 7th – May 30th
Elections made as a new hire will
stay in effect for the entire plan If you experience a qualifying life CHR Employee Portal
year and cannot be changed until event during the Plan year, you
the next plan year during Open must contact HR to make changes
Enrollment or within 30 calendar within 30 calendar days
days following a qualifying life following the qualifying event
event. date, even if the supporting
documentation is not yet available.
EFFECTIVE DATE EFFECTIVE DATE EFFECTIVE DATE
Date of hire. Date of qualifying event. Open Enrollment elections will
become effective July 1 of the
new plan year.
How to Enroll
This chart outlines how you enroll and the deadline for enrollment for each benefit. The Town is working
diligently to provide employees with the ability to enroll and make benefit change requests online.
HOW TO ENROLL DEADLINE TO ENROLL
BENEFIT AUTO WITHIN 30 DAYS NO
ONLINE PAPER OF A QUALIFYING
ENROLLED DEADLINE
LIFE EVENT
Health
(Medical, Rx, X X X
Dental, Vision)
Healthcare
Flexible
X X
Spending
Account (FSA)
Dependent Care
Flexible
X X
Spending
Account (FSA)
Group Term
Life Insurance* X X X
2025 – 2026 Health Benefits Guide 8

Optional Life
Insurance* X X
MD State
Retirement X X
457B –
Deferred Comp X X
AFLAC X
(If enroll outside of
X
election period,
contributions will be
after tax)
Christmas Club
X September
YMCA
X X
*Evidence of Insurability/medical underwriting is required for enrollment after new hire eligibility period.
Human Resources manages the Town’s Open Enrollment process. If you have any questions regarding the
Town’s benefits and/or need assistance in the employee portal (CHR) please contact HR at (410) 758-1180
ext.12 or by email at hr@townofcentreville.org.
Enrollment Reminders
• If you are adding a spouse and/or child(ren) to your health insurance, you must upload the
appropriate dependent documentation into your employee portal. A marriage certificate is
required for a spouse and a birth certificate for each child being enrolled along with Social
Security cards. Social Security cards will be required for any new dependent(s).
2025 – 2026 Health Benefits Guide 9

Making Changes to Lifestyle Change/Event Documentation Required
Marriage Certificate & Social
Your Benefits
Marriage
Security Cards
The choices you make when you are first
Divorce Divorce Decree
eligible are in effect for the remainder of
the plan year that ends on June 30. Once
you enroll, you must wait until the next Separation Agreement where
Open Enrollment period to change your Legal Separation the terms of the agreement
benefits or add or remove coverage for permit a change in coverage
dependents, unless you have a qualifying
event as defined by the IRS.
Birth Certificate or Adoption
Birth or Adoption
papers & Social Security Cards
The following are examples of a qualifying
life event:
• Marriage, divorce, legal separation, Change in employment status
No documentation required –
annulment, or death of a spouse. from part-time to full-time or
Human Resources will confirm
• Birth, adoption or placement for vice versa
adoption.
• Loss of health coverage Your child loses eligibility
No documentation required
• Change in your dependent’s for dependent coverage
eligibility status because of age or
any similar circumstance.
Your spouse gains or loses Letter from spouse’s employer
coverage under another plan verifying the change
Life event changes must be made within
30 days of the qualifying event. Effective
dates of coverage depend on the qualifying
You go on or return from No documentation required –
event. *
leave of absence Human Resources will confirm
*Birth, adoption, or placement for adoption begin coverage no later than the day of the event. Marriage or loss
of eligibility for other coverage, your new coverage will begin on the first day of the first month after the plan
receives the enrollment request. If the plan receives the request on January 3, for example, coverage will begin
on February 1.
2025 – 2026 Health Benefits Guide 10

Your Cost for Health Coverage
Your PER PAYCHECK payroll deductions for medical, dental, and vision coverages are shown in the tables
below. Premiums are deducted pretax from 24 paychecks, July 2025 through June 2026. The actual payroll
amounts below may vary depending on the coverage(s) selected.
Medical, Dental, and Vision Premiums
Cigna Choice Fund Health Reimbursement Account (HRA) Open Access Plus In-Network (Cigna):
Gold Plan – 85/15
Coverage Level Employee Pays Town Pays
Employee $85.33 $483.55
Employee + Spouse $196.30 $1,112.36
Employee + Child $157.85 $894.47
Family $238.96 $1,354.12
Deductible – Employee* $0 $1,300
Deductible – Family* $0 $2,600
Silver Plan – 85/15
Coverage Level Employee Pays Town Pays
Employee $75.62 $428.52
Employee + Spouse $173.97 $985.81
Employee + Child $139.89 $792.68
Family $211.77 $1,200.05
Deductible – Employee* $0 $2,000
Deductible – Family* $0 $4,000
* The Town established a health reimbursement account (HRA) and contributes up to 100% to pay for your
eligible out-of-pocket expenses during the plan year.
United Concordia:
Dental Plan – 85/15
Coverage Level Employee Pays Town Pays
Employee $2.10 $11.88
Family $6.62 $37.47
National Vision Administrators, LLC (NVA):
Vision Plan – 85/15
Coverage Level Employee Pays Town Pays
Employee $0.35 $2.00
Family $0.88 $4.99
2025 – 2026 Health Benefits Guide 11

Medical and Pharmacy Coverage
Main Features of Your Plan
Town of Centreville offers Cigna Open Access Plus In-Network with HRA which gives you access to a quality
network of doctors, hospitals, facilities, and labs that have contracted with your plan, and is located across the
United States. Primary Care Provider (PCP) is optional but recommended to coordinate care. Cigna does not
require a referral to see specialists. However, this plan covers you for in-network providers only. You will pay
100% of out-of-network care, except for emergencies. Both Cigna plans offered include medical, behavioral
health, and Pharmacy coverage.
SILVER PLAN BENEFIT SUMMARY
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GOLD PLAN BENEFIT SUMMARY
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Insurance Cards Have Gone Digital!
• Medical Plan ID Cards are no longer being mailed. You can access your digital Insurance card by
logging into your www.mycigna.com account and downloading it to your mobile device.
Skip the Waiting Room! Use MDLIVE
• Connect to doctors in minutes, from home, work, or on-the-go, 24/7/365.
• Download the MDLIVE mobile app now!
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Connect Care 3
Empowering a healthier workforce
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Pharmacy Coverage
Some prescription drugs require prior authorization. This ensures you achieve the maximum clinical benefit
from the use of specific targeted drugs. Your physician or pharmacist must call to begin the prior authorization
process. For the most up-to-date prior authorization list, visit:
Prescription Drug Copay: Brand Name vs. Generic Equivalent
The copay is the dollar amount the pharmacy will collect for your prescriptions. If you choose a brand name
prescription drug when a generic prescription drug is available, you will pay the appropriate copay plus the
difference in cost between the brand name and the generic drug. Copays are determined by the type of
prescription drug purchased.
Home Delivery Pharmacy Helps Save You Money
Home Delivery Pharmacy service offers a convenient and cost-effective way to fill prescriptions with fast,
accurate home delivery. Plus, it is an easy way to save money on your maintenance medications. Once enrolled,
you may take advantage of online self-service capabilities. Register at www.mycigna.com and have access to:
• Convenient switch to home delivery service.
• Set-up automatic refills using Express Scripts Pharmacy from Cigna Healthcare.
• View claims, balances, and prescriptions history.
• Manage account settings and payment methods.
2025 – 2026 Health Benefits Guide 32

Dental Coverage
DENTAL PLAN SUMMARY (Group# 925724-000)
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Understanding Your Dental Benefits Plan
Good dental hygiene is important for your overall health. The Preferred Dentist Program was designed to help
you get the dental care you need and help lower your costs. You get benefits from a wide range of covered
services – both in and out of the network. The goal is to deliver affordable protection for a healthier smile and a
healthier you. Once enrolled, you may take advantage of online self-service capabilities. Register at
https://www.unitedconcordia.com/login and have access to:
• Check the status of your claims.
• Locate a participating dentist.
• Access United Concordia Oral Health Library.
• Elect to view your Explanation of Benefits online.
2025 – 2026 Health Benefits Guide 34

Vision Coverage
VISION PLAN BENEFIT
SUMMARY (Group Number #51381)
DOWNLOAD
THEIR
MOBILE APP!
Search for NVA Vision
or call 1-800-672-7723
* Does not apply to Wal-Mart/Sam’s Club or Lens Crafters locations or for certain proprietary brands.
**Does not apply to Wal-Mart/Sam’s Club, Lens Crafters, Contact Fill (NVA Mail Order) or certain locations at: Target,
Sears, Pearle, & K-Mart and may be prohibited by some manufacturers.
***Pre-approval from NVA required.
To verify your benefit eligibility, visit www.e-nva.com or download their mobile app. You may also contact
Customer Service at 1-800-672-7723 (TDD line 1-888-820-2990) or the Interactive Voice Response (IVR).
Customer Service is available 24/7 and 365 days a year.
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Note: This vision benefit summary is intended as a program overview only and is not a certified document of
the individual plan parameters. Please contact Human Resources, for details.
2025 – 2026 Health Benefits Guide 37

On Your Way to Wellness
The Human Resources Department is seeking volunteers to join our Wellness Committee. The purpose of this
committee is to support all our efforts to enhance wellness throughout the Town:
• Improve and maintain your health, which is essential to enjoying a long life.
• Reduce healthcare costs so that these dollars can be used for other purposes such as salaries, benefits,
and Town services.
• Increase the use of your preventive services; if you can identify an issue early on, it is much easier to
correct with a higher success rate (remember there are no copays!)
• Have fun with your co-workers competing in events and you can earn $$$!
Please contact Human Resources at hr@townofcentreville.org, if interested.
Cigna Healthcare offers a variety of Wellness Programs; listed below are a few which may interest you and
your family. These programs are free to you and any dependent enrolled in the health plan.
Mental Health Support
As part of your medical coverage, you have access to mental health support services. Clinicians are available to
provide support 24/7 at (800) 244-6224. Search for a provider in your area whom you can see face-to-face or
discover a multitude of digital and virtual provider options by logging onto your myCigna account.
One-on-One Coaching
As part of your medical coverage, you have access to personal health coaching. To learn more about the
coaching program, or to join, call (800) 244-6224. You may receive a call inviting you to participate. We
encourage you to take advantage of this voluntary and confidential phone-based program that can help you
achieve your best possible health. Not only can you decide how involved you want to be, but you also can leave
the program at any time.
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Prepare for the Unthinkable
Group Term Life and Accidental Death & Dismemberment (AD&D) Insurance
Town of Centreville provides Lincoln Term Life Insurance and Accidental Death and Dismemberment
(AD&D) Insurance to all full-time eligible employees. The coverage is automatic, and the premiums are 100%
employer paid.
GROUP TERM LIFE AND AD&D BENEFIT SUMMARY
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Protect Your Income!
Voluntary Life Insurance with Accidental Death and Dismemberment (AD&D)
SUMMARY
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Secure Your Future (NEW!)
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Additional Benefits
AFLAC Benefits
Employees may participate in an array of voluntary benefits including Accident, Cancer, Critical Care and
Short-term Disability insurance. For more information, contact Matt Pastva, AFLAC Account Manager at 410-
463-4162.
Flexible Spending Account (FSA) and Dependent Care (DCA)
https://fsastore.com/
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Worker’s Compensation
All employees are covered by Worker’s Compensation for injuries or illnesses occurring while performing
normal work duties. For more information, refer to the Job-Injury Leave and Worker’s Compensation Reporting
Process Policy in the Personnel Manual.
Annual Leave
Full-time employees earn annual leave based on years of service as outlined below.
• Zero through the end of 4 years of service: 4 hours per pay (Month = 8.67 hrs; Year = 104 hrs)
• Beginning the 5th year through 9 years of service: 6 hours per pay (Month = 13 hrs; Year = 156 hrs)
• Beginning the 10th year through duration of service: 8 hours per pay (Month = 17.33 hrs; Year = 208
hrs)
Employees accrue annual leave, as outlined in the above schedule and in accordance with Town policy from
date of hire and may begin using this time following six months of employment.
Sick Leave
Full-time employees earn 4 hours of sick leave for every pay period worked. Sick leave is prorated for part-time
employees. Sick leave can be accumulated toward employee’s state retirement in that every 22 days of sick
leave is counted as one month of service toward retirement.
Personal Leave
Annually in January, full-time employees receive 24 hours of personal leave to use during the calendar year.
For employees hired after January, personal leave hours are prorated.
Holidays
Full-time employees receive 14 paid holidays annually. The recognized holidays are:
New Year’s Day Labor Day
Dr. Martin Luther King, Jr. Day Columbus Day
President’s Day Veteran’s Day
Good Friday Thanksgiving Day
Memorial Day Day After Thanksgiving
Juneteenth Christmas Eve
Independence Day Christmas Day
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Employee Assistance Program (EAP)
Real support for real life. Confidential and no cost to you.
We recognize you may experience issues that affect your quality of life at home and at work, which has a great
impact on your health. Cigna EAP provides access to work/life resources, and licenses clinicians to help you
cope with a wide variety of concerns. Coverage is active for anyone who lives with the plan subscriber,
including a nanny, parent, or in-law. Find out more by calling 1-800-244-6224, 24/7 or going online at
www.mycigna.com.
The EAP Can Help with Many Issues Including: Program Benefits Include:
• Workplace Stress. • Up to 6 FREE counseling sessions with an
EAP professional for you and your
• Depression, stress, or anxiety.
household members
• Coping with illness.
• FREE financial consultation & referrals
• Adjusting to life challenges.
• FREE legal consultation & referrals
• Marriage and Relationship concerns.
• FREE childcare resources & referrals
• Drug and Alcohol dependency.
• FREE eldercare resources & referrals
• And more!
• FREE online Resource Library, with
thousands of resources tailored to your
specific life needs.
Benefits are free, voluntary, and confidential. For more information about the EAP services through Cigna,
contact Cigna Healthcare at 1-800-244-6224 or see your Human Resources Representative.
Retirement Plans – Planning Your Future
Pension Plan
Town of Centreville is a proud member of the Maryland State Retirement and Pension System. Full-time and
permanent part-time employees are enrolled in the plan and contribute 7% of your base annual salary on a
pretax basis. Likewise, the Town makes a mandatory contribution. Employees are vested after 10 years with full
retirement and benefits paid after the employee has a combination of years of service and age totaling 90. The
Law Enforcement Officers Pension System (LEOPS) is offered to sworn personnel working for the Centreville
Police Department.
Deferred Compensation Plans
To enhance retirement savings, employees have the option of participating in a deferred compensation program,
also called a 457(b) plan. A 457(b) plan allows employees to set aside funds on a pretax basis for retirement.
The Town is happy to offer Mission Square and Corebridge Financial, from which employees can select to
invest.
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Retiree Health Reimbursement Account (HRA) Stipend
The Town offers eligible retirees the opportunity to receive a stipend through the HRA if 10 years of service has
been vested with the Town prior to their effective retirement date and were enrolled in the Town’s Group
Health Plan. Please review the Summary Plan Description (SPD) or contact Human Resources for more details.
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Questions?
Your Benefits Contacts
Benefit Contact Phone Website or Email
General Benefit kebaugh@townofcentreville.org
410-758-1180 Ext. 12
Human Resources
Questions 410-758-1180 Ext. 31 twright@townofcentreville.org
Medical and
Cigna Healthcare 1-800-244-6224 www.mycigna.com
Pharmacy
United Concordia
Dental 1-800-332-0366 www.unitedconcordia.com
Customer Support
Vision NVA Customer Support 1-800-672-7723 www.e-nva.com
1-800-423-2765;
Life Insurance Lincoln Financial reference ID: www.LincolnFinancial.com
TOOFCEN2
1-800-423-2765;
Disability
Lincoln Financial reference ID: www.LincolnFinancial.com
Insurance
TOOFCEN2
Flexible Spending
Care Flex 410-763-8787 www.careflex.com
Account
Matt Pastva, Account
AFLAC 410-463-4162 Matthew_pastva@us.aflac.com
Manager
Corebridge Financial
457(b) – Deferred 410-859-2164 Susan.gallant@corebridgefinancial.com
Mission Square
Compensation 800-669-7400 CSorokos@missionsq.org
Retirement
Maryland State
Pension Plan Retirement and Pension 410-625-5555 www.sra.maryland.gov
System
Retiree HRA 410-758-1180
Human Resources kebaugh@townofcentreville.org
Stipend Ext. 12
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Annual Notices
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Helpful Contacts
AFLAC:
Matt Pastva, Account Manager
Direct Line 410-463-4162
Email matthew_pastva@us.aflac.com
Cigna Healthcare:
Accredo 1-877-826-7657
Benefits & Coverage 1-800-244-6224
Employee Assistance Program 24/7 1-800-244-6224
Health Information Line 1-855-673-3063
Health Reimbursement Account (HRA) 24/7 1-800-244-6224
Home Delivery Pharmacy 1-800-835-3784
Mental Health/Substance Use Coverage 1-800-433-5768
Medical Coverage 1-800-244-6224
MyCigna Website Help 1-800-853-2713
Traveling Abroad Coverage 1-866-763-8442
Cigna by Mail:
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General Glossary of Terms
AD&D Accidental Death & Dismemberment (AD&D) Insurance pays a
benefit if you suffer certain types of injuries, such as the loss of a
hand, foot, or eye as a result of an accident, or if you die as a
result of an accident. AD&D coverage is automatically provided
as part of your Basic Life Insurance.
Allowed Benefit The fee an insurance company has negotiated with a provider to
charge for covered services. Payment for covered services is
based on this negotiated amount.
Annual Benefits Election Period A designated timeframe for eligible employees to elect coverage
who did not enroll during their initial eligibility period or for
employees to make changes to their current benefits. Also referred
to as Open Enrollment.
Basic Life Insurance The group term life insurance provided at no cost to eligible
employees.
Beneficiary A person(s) or an entity (such as an association or organization)
that you name to receive your life and AD&D insurance benefits
if you die while covered; or to receive your vested account
balances in your Retirement and Savings Program if you should
die.
Brand Name Drug A drug sold under a patented name by one company. Not all
products identified as a “brand name” by the manufacturer,
Pharmacy or your Physician may be classified as a Brand Drug
under the plan.
Calendar Year The period spanning from January 1 to December 31 of each year.
Coordination of Benefits (COB) A provision of the insurance industry which limits benefits if you
are covered under multiple insurance plans. Benefits are limited to
100% of covered expenses. The order in which insurance
companies are paid is also designated by this provision.
Coinsurance After you’ve reached your deductible, you and your plan share
some of your medical costs. The portion of covered expenses you
are responsible for is called Coinsurance. Coinsurance is not the
same as and does not include copay.
Copayment (Copay) A flat fee you pay for certain covered services such as doctor’s
visits or prescriptions.
Covered Expenses Charges that are paid in part, or in full, by the plan.
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Deductible A flat dollar amount you must pay out of your own pocket before
your plan begins to pay for covered services.
Dependent The definition of a “dependent” will vary according to each plan.
Dependents under the medical, dental, vision, or health flexible
spending plan are: 1) an employee’s law spouse; and 2) and
employee’s child who a) is less than 26 years old, b) 26 or more
years old, unmarried, and primarily supported by you and
incapable of self-sustaining employment by reason of mental or
physical disability which arose while the child was covered as a
Dependent under this Plan, or while covered as a dependent under
a prior plan with no break in coverage. Please contact Human
Resources for details.
Dependent Care Expenses Monthly expenses charged by a daycare provider (maximum of
$5,000 per plan year) who is not your spouse, or someone claimed
by you as a dependent.
Fiscal Year A fiscal year is a 12-month accounting period that a business uses
for financial and tax reporting purposes. A fiscal year is also
known as a financial year. The Town recognizes their fiscal year
beginning July 1 and ending June 30 of the following year. The
benefit plan year follows the Town’s fiscal year for budgeting
purposes.
Flexible Spending Account (FSA) Flexible Spending Account (FSA) allows you to set aside pre-tax
dollars for unreimbursed medical, prescription, vision, and dental
expenses, and dependent care costs.
Generic Drug A drug that may be sold under more than one name, by more than
one company. Not all products identified as a “generic” by the
manufacturer, Pharmacy or your Physician may be classified as a
Generic Drug under the plan.
Guaranteed Issue A provision that allows you to purchase insurance coverage
regardless of the health of you and/or your spouse.
Health Reimbursement Account (HRA) An employer-funded account that helps pay for qualified health
care expenses.
In-Network Benefits Benefits that are paid at a higher level when you use network
participating providers.
Long-Term Disability (LTD) This type of insurance provides a percentage of your income if
you become totally disabled. It is intended to protect your income
for a long duration after you have depleted short-term disability or
any sick leave your company may offer.
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Medical Evidence of Insurability If you do not purchase life insurance when it is first offered, or
within 30 days of your date of eligibility, you must complete a
health questionnaire in order to be approved for the plan, thus
providing evidence that you are insurable. The insurance
company will review your health information and determine
whether or not they will provide coverage to you. The insurance
company may take several months to determine whether or not
they will provide you with coverage.
Non-Preferred Provider A provider who does not have any agreement with your insurance
plan to accept copays or reduced fees for services rendered.
Open Access Plus (OAP) Network Is a group of doctors, hospitals, facilities and labs that have
contracted with your plan, and is located across the United States.
Open Enrollment See “Annual Benefits Election Period”.
Out-of-Pocket Maximum Specific limits for the total amount you will pay out of your own
pocket before your plan coinsurance percentage no longer applies.
Once you meet these maximums, your plan then pays 100% of the
“Maximum Reimbursable Charges” or negotiated fees for covered
services.
Out-of-Network Benefits Benefits that are paid at a lower level when you use out-of-
network providers.
Participating Provider A provider that has a direct or indirect contractual arrangement
with Cigna to provide covered services and/or supplies, the
Chares for which are Covered Expenses. It includes an entity that
has directly or indirectly contracted with Cigna to arrange,
through contracts with providers of services and/or supplies, for
the provision of any services and/or supplies, the Charges for
which are Covered Expenses.
Place of Service Your plan pays based on where you receive services. For
example, for hospital stays, your coverage is paid at the inpatient
level.
Plan Year The period spanning from the beginning of the benefit plan year
to the end of the benefit plan year. Currently for Town of
Centreville this is from July 1 to June 30 of the following year.
Plan Document A comprehensive written instruction describing the operation and
administration of an employer’s plan. The plan document is
written in legalese and may be difficult for the average participant
to read and understand. Section 402 of ERISA requires that
benefit plans subject to the regulations must be established and
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maintained according to a written instrument. The plan document
tells the plan participants about the benefits they are entitled to
under the plan and provides guidelines to be used by the plan
administrator in decision-making when it comes to plan
operations. It is not required to be distributed to the participants
unless requested.
Pre-Existing Condition Any health condition for which the patient has already received
medical advice or treatment prior to the effective date of a new
insurance plan. Benefits for this condition may not be paid for the
first 12 months of coverage. See specific plan details of the
benefit plan for more information.
Premium Only Plan (POP) Also referred to as “Section 125 Plan”. According to Internal
Revenue Code (IRC) Section 125 allows eligible employees to
elect to pay for their portion of insurance premiums on a pre-tax
basis. This Plan is for the exclusive benefit of the Participants and
the Participant’s Beneficiaries. Refer to Plan Documents for
participation eligibility requirements. Contact Human Resources
for more details.
Prescription Drug List The list of prescription brand and generic drugs covered by your
pharmacy plan, or that by law must be dispensed with a
prescription.
Qualifying Event An occurrence that entitles a person to select or change benefits
outside of the defined “Open Enrollment” period. Events could
include but are not limited to termination of employment, death of
a covered person, marriage, divorce, birth, adoption, Medicare
eligibility, a dependent child’s loss of dependent status, or
commencement of or return from an unpaid leave of absence.
Short-Term Disability (STD) This type of insurance provides a percentage of your income if
you become temporarily disabled.
Summary Plan Description (SPD) A summary of the plan document required to be written in such a
way that the participants of the benefits plan can easily understand
it. SPD is required to be distributed to plan participants.
Transition of Care Provides in-network health coverage to new customers when the
customer’s doctor is not part of the Cigna network and there are
approved clinical reasons why the customer should continue to
see the same doctor.
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