Open Enrollment Materials
Medical Documents
Medical Plan Documents
- Building a Relationship with your Provider
- CDHP Full Plan Documents
- CDHP HRA Additional Information
- COBRA Continuance Open Enrollment Guide
- Guest Privileges – Coverage Away from Home
- Transition of Care - Continuity of Care
- Limited Network Directory
- Limited Network Full Plan Documents
- Limited Network Physician Groups
- Open Access Plan Directory
- Open Access Tier 1 Providers
- OAP Full Plan Documents
- Specialties and Service Guides
- Stay Connected to the the Care you Need
- Summary of Benefits and Coverage CDHP - Updated Information
- Summary of Benefits and Coverage Open Access Plan - Updated Information
- Summary of Benefits and Coverage Limited Network Plan Non-CA - Updated Information
- Transgender Customer Service Flyer
Pharmacy Plan Documents
Pharmacy Plan Documents
- Cigna Express Scripts Pharmacy
- CDHP Pharmacy Full Plan
- Limited Network Pharmacy Full Plan
- OAP Pharmacy Full Plan
- Cigna Value Four Tier Prescription Drug List
- Cigna 90 Now Program
- Cigna Preventative Medication Program
- Express Scripts Pharmacy – Home Delivery
- Express Scripts Pharmacy – Home Delivery FAQs
- Cigna Patient Assurance (Insulin) Program
- Cigna Home Delivery Pharmacy LifeScan Blood Glucose Meter Customer Voucher
- PPACA No Cost Share Preventive Medications List Jan 2023
Dental Plan Documents
Dental Documents
- COBRA Continuance Open Enrollment Guide
- Dental Rates and Comparison Chart
- Dental Provider Nomination Form
- DHMO Benefits Summary
- DHMO FAQs
- DHMO Find a Dentist Flyer
- DHMO Orthodontics in Progress FAQs
- DPPO Benefits Summary
- DPPO Find a Dentist Flyer
- DPPO FAQs
- DPPO Orthodontics in Progress
- DPPO Transition of Care FAQs
- Find a Doctor, Dentist, or Facility at myCigna.com
Vision Plan Documents
Flexible Spending Plan Documents
Flexible Spending Plan Documents
- TASC Dependent Care Contract
- HFSA Eligible Expenses
- TASC Card Experience
- TASC Mobile App Guide
- TASC Mobile Experience
- TASC Prescription Order Form
- Beneshop Flyer
- Receipt Repository
- Beneshop Info
- TASC New Benefit Info 2023
Dependent Care Reimbursement Plan Documents
Supplemental Plan Documents
Supplemental Insurance Plan Documents
- Group Accident Insurance Brochure
- Group Critical Illness Insurance Brochure
- Group Hospital Indemnity Insurance Brochure
Other Forms
Benefit Forms
- Conversion Life Insurance Form
- Dependent Care Reimbursement Form
- Dependent Grandchild Certification for Temporary City of Houston Benefits Coverage
- Final Paycheck Beneficiary Form
- Final Paycheck Beneficiary Form
- Financial Dependency Statement
- Life Insurance Conversion Form
- Retiree/Survivor Address Change Form
- Tobacco Usage Discount Form
- CAIC Beneficiary, Name, and Address Change Form
- Retiree Basic Life Insurance Form
- Non-Medicare Retiree Enrollment Form
- Medicare Benefits Enrollment Form
- Retiree Basic Life Insurance Form
- Retiree/Survivor Address Change Form
Life Insurance Documents
Life Insurance Documents
- Term Life Insurance Benefit Booklet
- Voluntary Life Rate Calculation Sheet
- Voluntary Life – Needs Calculator - English
- Voluntary Life – Needs Calculator - Spanish
- Voluntary Life – Travel Resource Services - English
- Voluntary Life – Travel Resource Services - Spanish
- Voluntary Life – Beneficiary Resource Services - English
- Voluntary Life – Beneficiary Resource Services - Spanish
Retirees Under 65 Documents
Retirees Under 65 Documents
Medicare Advantage Documents
Medicare Advantage Documents
- How to log into Benefitplace for Retirees
- Medicare Benefits Enrollment Form
- Medicare Enrollment Guide
- Retiree Basic Life Insurance Form
- Medicare Advantage Plan Open Enrollment Presentation
- Aetna Preferred Pharmacies
- KelseyCare Advantage Website
- Medicare Advantage DocuSign Form
- Aetna Basic PPO Summary of Benefits
- Aetna Premier ESA PPO Summary of Benefits
- KelseyCare Advantage Summary of Benefits
Benefitplace Documents
Benefitplace for Employees
- How to Login to Benefitplace as an Employee
- How to Reset Your Login Credentials
- How to Enroll in Benefits as an Employee (Open Enrollment)
- How to Add a Dependent, Remove a Dependent or Edit Dependent Information
- How to Verify, Add and Update Your Life Insurance Beneficiary Information
- How to Enroll in Benefits as a New Hire Employee (Initial Enrollment)
- How to Verify, Add and Update Your Life Insurance Beneficiary Information
- How to View and Print your Employee Benefit Summary Report
- How to Attach Supplemental Documents for Verification
Benefitplace for Retirees
- Retiree New Way to Enroll flyer
- How to log into BenefitPlace (Retirees)
- How to Reset Your Login Credentials
- How to Enroll in Benefits as a Retiree or Survivor (Open Enrollment)
- How to Verify, Add and Update Your Life Insurance Beneficiary Information
- How to Attach Supplemental Documents for Verification
- How to Enroll in Benefits as a Retiree (Initial Enrollment)
- How to Enroll in Benefits as a Retiree During a Qualifying Life Event (QLE)
- How to View and Print your Benefit Summary Report Event (QLE)
- Benefitplace Webinar for Retirees/Survivors
