Overview

To support your health and well-being, the City of Phoenix provides valuable benefits that help you and your family stay healthy or obtain care in the event of illness or injury.

2019 medical plans

The City offers you a choice of medical plans with a range of coverage levels and costs, so you have the flexibility to select the option that’s best for you.

Plan Description
Banner|Aetna HMO The Banner|Aetna HMO is an innovative partnership between a large, successful health care provider and an established health plan administrator. A large local and national network is offered, which includes Phoenix Children’s Hospital, Mayo Clinic, Dignity Health, Honor Health, and others – as well as Banner providers and facilities.
Blue Cross Blue Shield PPO The Blue Cross Blue Shield PPO provides a large national network plus out-of-network coverage at a higher out-of-pocket cost.
BCBS Savers Choice Plan The Savers Choice Plan offers a generous Health Savings Account (HSA) contribution from the City, premium savings, and the same large national network you’d find with the PPO.
Compare the plans

Key features

All City of Phoenix medical plans offer:

  • Comprehensive, affordable coverage for a wide range of health care services.
  • Large, national provider networks.
  • Free in-network preventive care, with services such as annual physicals, recommended immunizations, and routine cancer screenings covered at 100%. See more covered preventive services.
  • Pharmacy benefits, with prescription drug benefits provided by EnvisionRx.
  • Annual out-of-pocket maximums that limit the amount you’ll pay each year.

Banner | Aetna HMO

The HMO plan is a partnership between a successful health care organization and a well-established health plan administrator. This partnership presents a unique opportunity to improve patient outcomes while removing administrative barriers.

The HMO plan gives you access to Banner Health’s large Performance Network of doctors, health centers, clinics, and hospitals, all working together to provide high-quality care. You can also seek care across the even larger Broad Network with slightly higher co-pays.

Plan coverage is not changing as a result of the switch to Banner|Aetna, and co-pays are the same or lower than the current HMO co-pays.

How the Banner | Aetna HMO works

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Co-pay

You pay a portion of the cost of service at the time of service for in-network medical care and prescriptions.

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Deductible

This plan has no annual deductible for in-network care. The plan pays 100% of covered costs after you pay your co-pay.

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Out-of-Pocket Maximum

You’re protected by an annual limit on costs — the plan pays 100% of any further covered expenses for the rest of the year.

Keep in mind: You pay nothing for in-network preventive care — it’s covered in full. However, services received outside the large Banner|Aetna network are not covered.

Use the HMO wisely

Here are ways to make the most of your plan all year long.

  • Pair it with a Flexrap account. If you enroll in Flexrap, you can set aside pre-tax dollars to help pay for your out-of-pocket health care costs. Keep in mind that the money in your Flexrap account does not carry over to the next plan year; you “use it or lose it.”
  • Visit your PCP. Your primary care physician (PCP) will coordinate your care. Search for network providers on the www.aetna.com/cityofphoenix website.
  • Know where to get care. You’ll pay more (and likely face a long wait) if you go to the emergency room for issues that could be resolved at an urgent care center, your doctor’s office, or a convenience care clinic. The HMO plan has no out-of-network coverage, except in the case of an emergency.

Blue Cross Blue Shield PPO

The PPO’s large national network is the same as the Savers Choice Plan network, and similar to the HMO network. The real difference with the PPO is the out-of-network coverage, which if used, will result in a separate, higher deductible and coinsurance, plus balance billing.

How the Blue Cross Blue Shield PPO works

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Co-pay

You pay a small fee at the time of service for a few services, as well as prescriptions.

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Deductible

For most services you pay 100% of the contracted costs until you meet the annual per person deductible.

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Coinsurance

After meeting the deductible, you pay 20% of the contracted costs until you reach $900 out of pocket (per person), including the deductible.

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Out-of-Pocket Maximum

When you’ve reached $900 per person or $2,700 per family of 3 or more, your covered medical services are provided at no cost to you.

Keep in mind: You pay nothing for in-network preventive care — it’s covered in full.

Use the Blue Cross Blue Shield PPO wisely

Here are ways to make the most of your plan all year long.

  • Track your stats. Log on to the Blue Cross Blue Shield of AZ website or download the BCBSAZ app to see how much of your deductible you’ve met, review claims, and more.
  • Pair it with Flexrap. If you enroll in Flexrap, you can set aside pre-tax dollars to help pay for your out-of-pocket costs. Keep in mind that the money in your Flexrap account does not carry over to the next plan year; you “use it or lose it.”
  • Be cost-conscious. Visit the Blue Cross Blue Shield of AZ website to search for in-network providers and use the tools to compare costs for medical services.
  • Avoid out-of-network providers, if possible. Using an out-of-network provider is expensive. You incur a separate deductible, separate coinsurance, and will be responsible for any costs that exceed the allowed amount (known as balance billing).

BCBS Savers Choice Plan

The Blue Cross Blue Shield Savers Choice Plan is the most practical plan for those who expect to incur more than $1,500 (single) or $3,000 (family) in medical costs during the calendar year, or for those who expect to incur very little medical cost. This plan offers the lowest premiums and a tax-free Health Savings Account (HSA). The City will contribute one-half of your annual deductible to your HSA – that’s $750 for employee-only coverage and $1,500 for family coverage. The money in your HSA can be carried forward from year to year and is always yours to keep.

Also, generic medications for a number of chronic health conditions are only a $5 co-pay, bypassing the deductible.

How the Savers Choice Plan works

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Health Savings Account (HSA)

You can set aside tax-free money from your paycheck and receive contributions from the City to help cover your costs — now, or in the future.

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Deductible

You pay 100% of your medical and prescription costs until you meet the annual deductible.

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Coinsurance

There is no coinsurance with the Savers Choice Plan.

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Out-of-pocket maximum

You’re protected by an annual limit on costs — once you’ve fulfilled your deductible, you have no further out-of-pocket costs that year for medical services. Only prescription co-pays will apply.

Plan Comparison

For a detailed comparison of the City’s medical plans, please see pages 15-17 of the 2019 Employee Benefits Guide.

For more information, including your premium costs and out-of-network coverage details, visit the eCHRIS Self-Service website.

Find a Doctor

Using in-network providers saves you money. Here’s how to find doctors in your medical plan network.

Banner|Aetna HMO

  • Visit the www.aetna.com/cityofphoenix website.
  • Enter your location and search parameters.
  • You'll see a teal colored box with "Maximum Savings" when a provider is in the Performance Network, and a dark red box with "Standard Savings" when a provider is in the Broad Network.

Blue Cross Blue Shield PPO and Savers Choice Plan

  • Visit the Blue Cross Blue Shield of AZ website.
  • Click on “Find a Doctor/Rx.”
  • Click on the option that best describes you, and follow the prompts.
warningDon’t have a primary care doctor? You should. Here’s why.

  • Better health. Getting the right health screenings each year can reduce your risk for many serious conditions. Preventive care is free, so there’s no excuse to skip it.
  • A healthier wallet. Having a doctor you can call helps you avoid costly trips to the emergency room and decide when you really need to see a specialist.
  • Peace of mind. Advice from someone you trust ... it means a lot when you’re healthy, but it’s even more important when you’re sick. Your personal doctor gets to know you and your health history and can help coordinate any care you need.

 

Pharmacy Benefits

EnvisionRx is your pharmacy benefits provider for all three medical plans (HMO, PPO, and Savers Choice). EnvisionRx offers comprehensive pharmacy benefits, including home delivery and specialty drug services.

Review Plan Options

Maintenance medication requirements

The City requires you to fill maintenance medications using mail order or at specific retail locations for 90-day fills. The retail locations available for 90-day fills are:

  • CVS
  • Target
  • Fry’s

You pay two co-pays for 90 days of medication.

Drug tiers

The cost of your prescription drugs under the City of Phoenix medical plans depends on the tier of the medication:

  • Generic drugs contain the same active ingredients as their brand-name equivalents and meet the same federal standards for safety, but typically cost significantly less.
  • Formulary drugs are brand-name medications that are favored by a prescription plan based on drug effectiveness and cost.
  • Nonformulary drugs are brand-name medications that are not on a prescription plan's favored list (or formulary) based on drug effectiveness and cost. They may still be covered, but may require prior authorization and cost more.

Mail order

You can set up mail order prescriptions by calling EnvisionRx directly or visiting their website for City of Phoenix employees:

Employee Website: phxrx.envisionrx.com
Preview Code: PHXRX
Phone: (833) 803-4402

Save money

The cost of prescription drugs is rising faster than many other health care services and supplies. But, there are ways for you to save:

  • Ask your doctor about generic medications. Generic medications are generally just as effective as brand-name medications, but they typically cost between 30% and 75% less.

Behavioral Health Benefits

Mental health is as important to our well-being as physical health. Your medical plan covers office visits with licensed psychiatrists, psychologists and counselors, as well as outpatient and inpatient programs for certain needs.

Under the City’s medical plans, your costs for a behavioral health visit are as follows:


Banner|Aetna HMO Blue Cross Blue Shield PPO BCBS Savers Choice Plan
Behavioral health visit $10 for both networks.

You pay 20% of the contracted rate after the deductible is met.

$0 after the calendar-year out-of-pocket maximum is met.

Plan pays 100% of the contracted rate after the calendar-year deductible is met.

You also have access to 12 free counseling sessions for you and your eligible dependents or household members per person, per incident through our Employee Assistance Program (EAP).

Onsite Representatives

Onsite representatives from Blue Cross Blue Shield of Arizona and Banner|Aetna work full-time in the City’s Benefits Office, and they are dedicated to assisting City of Phoenix employees and their covered family members. Feel free to call or email them with any questions or concerns:

Sylvia Macias
Blue Cross Blue Shield
(602) 534-5165
sylvia.macias@phoenix.gov

Devon Moore
Banner | Aetna
(602) 495-5724
devon.moore@phoenix.gov

Tools & Resources

Medical plan tools – Find a doctor, compare costs, manage claims, and more.

Prescription tools – Order or refill prescriptions, sign up for mail order, and more.

Flexrap and HSA tools – Manage your Flexrap account or Health Savings Account.

Telemedicine – Get medical advice from board-certified physicians who are available 24/7, 365 days a year to consult with you over the phone or through live video right from your mobile device or computer. To enroll or learn more, visit:

NurseLine – Nurses are available to answer your health questions and help you get the most out of your medical plan — confidentially and at no cost to you. Your nurse can guide you to the right care for a health problem; coordinate services before, during, and after a hospital stay; or support you while you work toward a health goal. To reach a nurse, call:

Consumer Tips

When it comes to purchasing products, we almost always look at the price tag. Yet with all the money we spend on health care – from premiums to prescriptions to doctor’s office visits – we rarely think about the price of these services. And as health care prices continue to rise, that ends up costing more for you and the City. Here are ways to help control your health spending:

  1. Check first. Check with the Benefits Office or the onsite carrier representative to ensure that a service is covered before you receive care.
  2. Keep up with preventive care. It’s covered in full by all of our medical plans and can help detect and prevent potentially costly health issues early. You pay nothing for annual physicals, recommended immunizations, routine cancer screenings, and more when you see in-network providers.
  3. Use tax-free money to pay for eligible health expenses. Contributing to a Health Savings Account (HSA) and/or a Flexrap account is easy and saves you money on expenses you’d have to pay anyway.
  4. Shop smart for prescriptions. Using generic alternatives will almost always save you money – and they’re just as effective as brand name prescriptions. Also, try calling a few local pharmacies to compare prices before deciding where to fill a prescription. For your ongoing prescriptions, use the mail-order service to save money and time.
  5. Take advantage of the City of Phoenix wellness incentive. Have an in-office visit with an in-network primary care physician, and then complete the online Health Risk Assessment with seven pieces of biometric data, to receive an incentive of $40 or $60 per month.
  6. Compare costs. Use the cost lookup tools on your medical plan carrier’s website — Blue Cross Blue Shield of AZ or www.aetna.com/cityofphoenix — to get informed before getting health care services.
  7. Choose the right place to get care. Facilities charge different amounts for the same services, so think about your options when you or a family member needs medical attention. Going to the right place for your situation will help you save money and get the most appropriate care.
Telemedicine Doctor’s office Urgent care clinic Emergency room
Use it for…
A common, non-emergency medical issue that can be diagnosed by phone or online: A condition that doesn’t need immediate attention and can wait until the next day: A condition that needs immediate care but is not life- or limb-threatening: A life-threatening or potentially crippling condition that needs immediate attention:
Examples
  • Colds and allergies, flu/cough
  • Ear infections, pink eye
  • Behavioral health
  • Sore throat, fever
  • Routine exam, screening
  • Checkup, vaccine, prescription
  • refill
  • Broken bone, severe sprain or strain
  • Cut requiring stitches
  • Anxiety attack
  • Sudden weakness, dizziness, or loss of consciousness
  • Uncontrollable bleeding
  • Chest pain, difficulty breathing
Cost*
Average price: $
$34
Average price: $
$0 (preventive); $176 (non-preventive)
Average price: $$
$229
Average price: $$$
$821 (minor); $1,644 (moderate); $3,069 (severe)
Find it
Blue Cross Blue Shield Telemedicine
Aetna Teledoc
Call your regular doctor or search for an in-network provider on your medical plan carrier’s website Search for urgent care clinics near you at urgentcarelocations.com Call 911 or search online for the nearest hospital

*Average costs are from healthcarebluebook.com. Contact your health insurance carrier for your specific costs.

5 tips to save money