250052-CONTRACT.PDF

CONTRACT EMPLOYEE PREPAID DENTAL PLAN 
250052-RFP 
This contract is entered into this 25th day of June, 2025 by and between Maricopa County (“County”), a 
political subdivision of the State of Arizona, and Cigna Health and Life Insurance Company dba Cigna 
Healthcare, a Connecticut corporation (“Contractor”) for the purchase of fully insured Prepaid Dental Plan 
(Plan) services with coverage commencing January 1, 2026 for employees and their dependents. Awarded 
contract implementation activity commences June 1, 2025. 
The term "Cigna" refers to the various entities which will provide the coverage and/or services described, 
including, but not limited to, Connecticut General Life Insurance Company, Cigna HealthCare, Cigna 
Dental, Intracorp, and Cigna Behavioral Care. 
1.0 
CONTRACT TERM 
This contract is for a term of three years, beginning on 1st day of January, 2026 and ending the 31st 
Day of December, 2028.  
2.0 
OPTION TO RENEW 
The County may, at its option and with the concurrence of the Contractor, renew the term of this 
contract up to a maximum of three additional years, (or at the County’s sole discretion, extend the 
contract on a month-to-month basis for a maximum of six months after expiration). The Contractor 
shall be notified in writing by the Office of Procurement Services of the County’s intention to renew 
the contract term at least 60 calendar days prior to the expiration of the original contract term. 
3.0 
CONTRACT COMPLETION 
In preparation for contract completion, the Contractor shall make all reasonable efforts for an 
orderly transition of its duties and responsibilities to another provider and/or to the County. This 
may include, but is not limited to, preparation of a transition plan and cooperation with the County 
or other providers in the transition. The transition includes the transfer of all records and other data 
in the possession, custody, or control of the Contractor that are required to be provided to the 
County either by the terms of this agreement or as a matter of law. The provisions of this clause 
shall survive the expiration or termination of this agreement. 
4.0 
PRICE ADJUSTMENTS 
Any requests for reasonable price adjustments must be submitted 60 calendar days prior to 
contract expiration. Requests for adjustment in cost of labor and/or materials must be supported 
by appropriate documentation. The reasonableness of the request will be determined by comparing 
the request with the Consumer Price Index or by performing a market survey. If County agrees to 
the adjusted price terms, County shall issue written approval of the change and provide an updated 
version of the contract. The new change shall not be in effect until the date stipulated on the 
updated version of the contract.

SERIAL 250052-RFP 
5.0 
INVOICES AND PAYMENTS 
5.1 
As consideration for performance of the duties described herein, County shall pay 
Contractor the sum(s) stated in Exhibit D – Pricing Sheet. 
5.2 
Payment shall be made upon the County’s receipt of a properly completed invoice. 
5.3 
Invoices 
5.3.1 
The Contractor shall submit one legible copy of their detailed invoice before 
payment(s) will be made. Incomplete invoices will not be processed. At a 
minimum, the invoice must provide the following information: 
•
Company name, address, and contact information
•
County bill-to name and contact information
•
Contract serial number
•
County purchase order number
•
Project name and/or number
•
Invoice number and date
•
Payment terms
•
Date of service or delivery
•
Quantity
•
Contract item number(s)
•
Description of purchase (product or services)
•
Pricing per unit of purchase
•
Total amount due
5.3.2 
Problems regarding billing or invoicing shall be directed to the department as 
listed on the purchase order. 
5.3.3 
Payment shall only be made to the Contractor by Accounts Payable through the 
Maricopa County Vendor Express Payment Program.  This is an Electronic 
Funds Transfer (EFT) process.  After Contract Award the Contractor shall 
complete the Vendor Registration Form located on the County Department of 
Finance Vendor Registration Web Site 
(https://www.maricopa.gov/5169/Vendor-Information). 
5.3.4 
Discounts offered in the contract shall be calculated based on the date a properly 
completed invoice is received by the County. 
5.3.5 
EFT payments to the routing and account numbers designated by the Contractor 
shall include the details on the specific invoices that the payment covers. The 
Contractor is required to discuss remittance delivery capabilities with their 
designated financial institution for access to those details. 
6.0 
APPLICABLE TAXES 
6.1 
It is the responsibility of the Contractor to determine any and all applicable taxes and 
include those taxes in their proposal. The legal liability to remit the tax is on the entity 
conducting business in Arizona. Tax is not a determining factor in contract award. 
6.2 
The County will look at the price or offer submitted and will not deduct, add, or alter pricing 
based on speculation or application of any taxes, nor will the County provide Contractor 
any advice or guidance regarding taxes. If you have questions regarding your tax liability, 
seek advice from a tax professional prior to submitting your bid. You may also find 
information at https://azdor.gov/business. Once your bid is submitted, the offer is valid for 
the time specified in this solicitation, regardless of mistake or omission of tax liability. If the 
County finds overpayment of a project due to tax consideration that was not due, the 
Contractor will be liable to the County for that amount, and by contracting with the County

SERIAL 250052-RFP 
agrees to remit any overpayments back to the County for miscalculations on taxes included 
in a bid price. 
6.3 
Tax Indemnification: Contractor and all subcontractors shall pay all Federal, State, and 
local taxes applicable to their operation and any persons employed by the Contractor. 
Contractor shall, and require all subcontractors to, hold Maricopa County harmless from 
any responsibility for taxes, damages, and interest, if applicable, contributions required 
under Federal and/or State and local laws and regulations, and any other costs including: 
transaction privilege taxes, unemployment compensation insurance, Social Security, and 
workers’ compensation. Contractor may be required to establish, to the satisfaction of 
County, that any and all fees and taxes due to municipality or the State of Arizona for any 
license or transaction privilege taxes, use taxes, or similar excise taxes are currently paid 
(except for matters under legal protest). 
7.0 
AVAILABILITY OF FUNDS 
7.1 
The provisions of this contract relating to payment for services shall become effective when 
funds assigned for the purpose of compensating the Contractor as herein provided are 
actually available to County for disbursement. The County shall be the sole judge and 
authority in determining the availability of funds under this contract. County shall keep the 
Contractor fully informed as to the availability of funds. 
7.2 
If any action is taken by, any State agency, Federal department, or any other agency or 
instrumentality to suspend, decrease, or terminate its fiscal obligations under, or in 
connection with, this contract, County may amend, suspend, decrease, or terminate its 
obligations under, or in connection with, this contract. In the event of termination, County 
shall be liable for payment only for services rendered prior to the effective date of the 
termination, provided that such services are performed in accordance with the provisions 
of this contract. County shall give written notice of the effective date of any suspension, 
amendment, or termination under this section, at least 10 days in advance. 
8.0 
INTERGOVERNMENTAL COOPERATIVE PURCHASING AGREEMENTS (ICPAs) 
County currently holds ICPAs with numerous governmental entities. These agreements allow those 
entities, with the approval of the Contractor, to purchase their requirements under the terms and 
conditions of the County contract. It is the responsibility of the non-County government entity to 
perform its own due diligence on the acceptability of the contract under its applicable procurement 
rules, processes, and procedures. Certain governmental agencies may not require an ICPA and 
may utilize this contract if it meets their individual requirements. Other governmental agencies may 
enter into a separate Statement of Work with the Contractor to meet their own requirements. The 
County is not a party to any uses of this contract by other governmental entities. 
9.0 
POST AWARD MEETING 
The contractor may be required to attend a post-award meeting with the department to discuss the 
terms and conditions of this contract. This meeting will be coordinated by the procurement officer of 
the contract. 
10.0 
DUTIES 
10.1 
The Contractor shall perform all duties stated in Exhibit B – Scope of Work, or as otherwise 
directed in writing by the procurement officer. 
10.2 
PLAN YEAR 
10.2.1 The Plan year runs from January 1st to December 31st, with open enrollment for 
the following Plan year typically held from October to November prior to the start 
of the Plan year.

SERIAL 250052-RFP 
10.2.2 Awarded contract implementation activity commences June 2025. Contract 
effective date is January 1, 2026. 
10.3 
GENERAL MINIMUM CONTRACTOR QUALIFICATIONS 
10.3.1 Contractor shall maintain the following qualifications throughout the term of the 
contract: 
10.3.1.1 Be properly licensed, certified, and credentialed to operate in Arizona, 
including licenses and certificate of authority to operate as a prepaid 
dental plan organization throughout the term of the contract. 
10.3.1.2 Have an A.M. Best or Standard & Poor insurance rating of no less than 
A. An A- rating does not meet the requirement.
10.3.1.3 Have an existing office in Arizona. 
10.3.1.4 Have and operate their own provider network. Contractor shall not sub-
contract to a separate provider network. 
10.3.1.5 Have ability to integrate with Workday such that they are able to manage 
enrollments/disenrollments in the County’s dental Plan, and process 
eligibility and demographic changes. 
10.3.1.5.1 Contractor’s benefit enrollment system must be able to 
accept eligibility data in a HIPAA compliant format 
transmitted from the County’s current Benefit Enrollment 
System, Workday.  
10.3.1.6 Not have: 
10.3.1.6.1 Bankruptcy filings within the last five years 
10.3.1.6.2 An officer or director with felony conviction on record 
10.4 
EMPLOYEE ELIGIBILITY 
10.4.1 Eligibility Period/Enrollment Effective Date: 
Coverage begins the first day of the month following date of hire for active 
employees and eligible dependents (coverage-begin date). Benefit deductions 
begin the first day of the pay period in which the coverage-begin date falls. 
10.4.2 Employee eligibility shall be determined by the County. A regular status employee 
scheduled to work at least 20 hours per week, and Consolidated Omnibus Budget 
Reconciliation Act (COBRA) members, have met the criteria for benefit eligibility. 
Eligibility will conform to the Federal regulations including 26 US Code 125, 
Internal Revenue Code of 1986, Patient Protection and Affordable Care Act 
(PPACA), COBRA, Family and Medical Leave Act (FMLA), Medicare, Medicaid 
and Uniformed Services Employment and Reemployment Rights Act (USERRA). 
The County shall be the final authority in deciding eligibility of members. 
10.4.3 Contractor shall be able to accept the subscriber identification number as the 
employee identification number, a nine (9) digit County-assigned number, unique 
to Maricopa County employees.

SERIAL 250052-RFP 
10.4.4 Contractor shall be able to accept weekly eligibility files for active employees via 
custom electronic interfaces created with data from the County’s system, Workday. 
The Contractor shall be able to accept and process eligibility files within 24 hours 
of receipt.  Contractor shall also be able to generate an electronic exception report 
for the County within two business days after processing eligibility files. 
10.4.5 Contractor shall mail initial ID cards for new participants (newly eligible employees 
and their covered dependents) within 10 working days of receipt of the eligibility 
file.  
10.4.6 The County shall make the final determination on errors and has ultimate authority 
to correct any and all administrative errors. 
10.4.7 The County’s Consolidated Omnibus Budget Reconciliation Act (COBRA) 
Administrator shall handle eligibility notifications, terminations and premium 
payments for COBRA participants.  
10.5 
MANDATORY CONTRACTOR REQUIREMENTS 
10.5.1 The contract and rates shall not include any commission load. 
10.5.2 Contractor shall not subcontract for the performance of administration and provider 
network contracting. 
10.5.3 Contractor’s provider network shall include throughout County a minimum of the 
following number of providers with current active contracts to provide services 
members and who have openings to new patients: 250 General Dentists, 100 
Pediatric Dentists, and 100 Specialists. 
10.5.3.1 Providers with more than one location should not be counted more than 
once to meet network requirements. 
10.5.3.2 Contractor shall maintain throughout the term of the contract, at a 
minimum, the required number of providers identified in the respondent’s 
geo access report (Attachment E) at time of bid. 
10.5.4 Contractor’s  network shall be able to provide services in the event of emergency, 
after hours or on weekends and holidays. 
10.5.5 Contractor shall have a credentialing process in place to validate the background 
and quality of its providers. 
10.5.6 Contractor shall have the ability to administer Plan design. The County shall 
self-administer premiums. Premiums shall be paid monthly. 
10.5.7 Contractor shall maintain a current list (provider directory)  of current General 
Dentists, Pediatric Dentals and Specialists accessible online to County and 
members with information about  whether their practices are currently open or 
closed to new members/patients. The directory shall also include provider’s office 
address and phone number. 
10.5.7.1 Provider information shall be updated online no later than 10 days after 
contractor is made aware of changes to provider information (including 
addition and termination of providers and provider information changes). 
10.5.8 Contractor shall notify the County in writing at least nine months prior to the end of 
Plan year three with any rate change for Plan years four, five, six (same rate for all 
three years) and any Plan changes (e.g., benefit changes, network changes, etc.). 
Plan changes approved by the County in writing shall be effective at time of 
renewal.

SERIAL 250052-RFP 
10.6 
IMPLEMENTATION 
10.6.1 The contractor is required to adhere to any non-negotiable milestone dates agreed 
upon between the contractor and the County as part of a final detailed 
implementation plan agreed upon by the County’s Benefits and Wellness Division 
management and contractor. 
10.6.2 Implementation and project management shall be a joint effort with contractor and 
the County. 
10.6.3 Contractor will negotiate final implementation plans with the County after contract 
award. 
10.6.4 Contractor shall be required to: 
10.6.4.1 Meet with the  Benefits and Wellness Division management to establish 
administrative and claims payment procedures. 
10.6.4.2 Set-up client accounts according to a comprehensive timeline which will 
identify tasks, dates, and responsible parties. 
10.6.4.3 Establish banking and/or payment arrangements, including providing a 
copy of the banking process overview, funding and account monitoring 
options, and cash management program reports. 
10.6.4.4 Provide implementation and ongoing educational materials describing 
the contractor and their services on an ongoing basis. 
10.6.5 Contractor shall implement the services and the Plan for Maricopa County within the 
implementation period (June 2025 – January 1, 2026) and accomplish the following 
tasks: 
10.6.5.1 Set up eligibility data (subscriber eligibility, dependents eligibility, selected 
Plan, effective dates, etc.) 
10.6.5.2 Set up the account structure and corresponding subgroups 
10.6.5.3 Set up integration file 
10.6.5.4 Set up the Plan design in-network and out-of-network along with Plan 
limitations and exclusions 
10.6.5.5 Implement a transition-related coordination of care and services process 
10.6.5.6 Provide timely ID cards to participants within 10 days of receiving eligibility 
files from the County 
10.7 
PROGRAM ADMINISTRATION 
10.7.1 Contractor shall provide a dedicated team of professionals, who will be responsible 
to see that all contract requirements and service deliverables are met by the 
contractor. The County reserves the right to approve and/or request changing the 
staffing of the client service team. 
10.7.1.1 Contractor shall provide a dedicated account manager, claims advocate 
and eligibility contact and agree to change those contacts upon request 
of the County) to:

SERIAL 250052-RFP 
10.7.1.1.1 Provide day-to-day consultation on matters pertaining to 
claim 
status, 
discrepancies, 
disputes 
and 
Plan 
interpretation to County team in a timely manner.  
10.7.1.1.2 Perform research and provide responses to questions from 
County team in timely manner. 
10.7.1.1.3 Provide training to County team regarding Plan and or 
internal Plan systems 
10.7.2 Contractor shall have the capability to accept electronic fund transfers. 
10.7.3 Contractor shall maintain a comprehensive Business Continuity Plan detailing how 
business would continue to be conducted accurately and timely in the event of a 
natural disaster or an unforeseen event that has the potential to interrupt normal 
business operations for longer than one business day. The Plan shall include 
detailed steps the contractor shall take to protect the integrity and privacy of all 
data pertaining to the County and its employees. 
10.7.4 Takeover shall be on a “no-loss, no-gain” basis.  Contractor shall have a process 
to handle dental treatment already in process but not completed by the beginning 
of this contract. 
10.7.5 Contractor shall include transitional orthodontia dental care as a covered benefit 
under the dental Plan. If there is a change in dental providers as a result of this 
solicitation process, contractor shall request, from the current provider, the 
pretreatment program as well as the number of months treatment is anticipated, 
amount already paid to the provider, etc. This transitional care will provide a no 
loss, no gain provision as a result of a change in providers even if the patient has 
already been banded for braces. 
10.7.6 Contractor shall be responsible for drafting, producing and distributing, subject to 
County review and approval, all communication materials, certificates of coverage, 
Plan summaries and administrative forms.  Such documents shall be finalized prior 
to the annual Open Enrollment period or by any other dates negotiated by all 
parties.  All documents shall be available electronically for posting on the County’s 
intranet and internet websites.    
10.7.6.1 Program Review: Contractor shall participate in an annual program review 
with the County. 
10.7.7 Contractor shall meet periodically, at least quarterly, with the Benefits and 
Wellness Division management to conduct operational and strategic meetings 
regarding benefit Plan operations, issue resolution, customer service, and Plan 
direction. 
10.7.8 Contractor shall respond to account issues and member services issues within one 
business day and shall include in its response the root cause of the issue, a plan 
to resolve the issue and timeframe established to do so. 
10.7.9 As required and at no additional charge to the County, Contractor shall provide 
personnel to attend and facilitate presentations at Open Enrollment fairs, benefit 
fairs, and other periodic employee informational meetings, (e.g.; transition of 
services meetings) and  health fairs focused on wellness and prevention.  Meetings 
may be scheduled at County locations throughout Maricopa County. 
10.7.10 Contractor shall provide educational information to be used in newsletters to 
promote wellness and preventive care.

SERIAL 250052-RFP 
10.7.11 Contractor shall administer the Plan for participants electing to continue their 
dental plans under COBRA. 
10.7.12 Contractor shall conduct business in compliance with HIPAA (Health Information 
Portability and Accountability Act), HITECH (Health Information Technology for 
Economic and Clinical Health Act, and applicable State statutes. 
10.7.12.1  Contractor shall sign a HIPAA Business Associate Agreement (BAA) 
with the County for any awarded contract at time of award. (See Exhibit 
4 Maricopa County HIPAA Business Associate Agreement).  
10.7.13 Contractor shall inform the County of any security incidents, breaches, or 
breaches of security of a system impacting members, regardless of where breach 
occurs. Disclosure shall include breach description, number of impacted County 
members, type of confidential information involved in the breach, a summary of 
the mitigation efforts, a copy of notices or communications provided to impacted 
members, and copies of required regulatory government agency reporting. If 
breach occurs, contractor will provide members with no less than one year of 
enrollment in credit monitoring services with national reporting agency at 
contractor's cost and expense, regardless of the type of breach. This obligation 
extends to any subcontractors of Contractor, and/or anyone providing services 
under this contract. 
10.7.14 Contractor shall offer, throughout the term of the contract, performance 
guarantees. At a minimum, guarantees shall be offered in the areas of financial 
accuracy, processing accuracy, customer services, and satisfaction, with final 
details to be agreed upon during contract award negotiations.  
10.7.15 Contractor shall comply with all state and Federal laws, regulations, and executive 
orders applicable to contractor and the delivery of the scope of work, including, 
but not limited to, Title VI of the Civil Rights Act of 1964 (as amended), the 
Americans with Disabilities Act of 1990 (as amended), the PPACA, including the 
nondiscrimination requirements of Section 1557 of the PPACA, and the Health 
Insurance Portability and Accountability Act of 1996 (HIPAA) (as amended) to 
include the Health Information Technology for Clinical Health (HITECH) Act of 
2009. 
10.7.16 Contractor will inform County Benefits of any pending legislation affecting the 
administration of dental Plan. If relevant legislation is enacted, provide County 
and its consultant with a cost analysis and implementation plan to ensure dental 
Plan complies with new requirements. 
10.8 
CUSTOMER SERVICE 
10.8.1 
Contractor shall not out-source customer service to a subcontractor, partner, or 
third-party provider without the County’s express written approval prior to use the 
subcontractor. 
10.8.1.1 
Customer service must be provided by customer service agents 
located in the United States. No off-shore agents may be used for 
customer service delivery for this contract. 
10.8.2 
Contractor shall provide a quality assurance program that addresses how quality 
of care is assured to the members and that includes goals, objectives, planned 
activities, and quality assurance initiatives. 
10.8.3 
Contractor shall mail replacement ID cards within seven working days upon 
request from the participant, at no additional cost to the County.

SERIAL 250052-RFP 
10.8.4 
Contractor shall enable download and printing of replacement ID Cards from the 
County-specific website at no additional cost to the County. 
10.8.5 
Contractor shall ensure that phone calls, chat outreach, and all correspondence 
are handled by a reasonable number of service personnel to maintain required 
service levels and who have been trained in the area of customer service and are 
familiar with the County’s programs. 
10.8.6 
Customer service representatives must have the ability to view member 
information regarding eligibility and claims status, and must be trained to explain 
benefits, claims denials, pending status, reason for pending status, and claims 
payment results to members. 
10.8.7 
Contractor shall provide, at minimum: 
10.8.7.1 
Customer service with representatives available between the hours of 
7:00 a.m. and 7:00 p.m. MST (Phoenix Local Time), Monday through 
Sunday, except on County holidays.  
10.8.7.2 
A toll-free telephone number for members to call for to customer service 
10.8.7.3 
Chat option to communicate directly with a customer service 
representative during the required business hours 
10.8.7.3.1 AI chat option is acceptable, however must be able to link 
customer to a live representative as requested/needed. 
10.8.7.4 
Customer service representatives who can assist callers in both 
English and Spanish 
10.8.8 
Contractor shall maintain the following customer service response rates and shall 
maintain performance guarantees against these metrics in the contractor’s 
service level agreement with the County: 
10.8.8.1 
Average speed of answering customer calls: Less than 30 seconds 
10.8.8.2 
Call abandonment rate: Less than five percent 
10.8.9 
Contractor shall maintain a website where employees may look up current 
providers, view explanation of benefits, and print temporary ID cards. 
10.8.10 
Contractor shall produce and distribute all collateral materials for employees in 
both English and Spanish. 
10.9 
COUNTY RIGHTS AND OBLIGATIONS 
10.9.1 
The County, upon awarding a contract, assumes responsibility for the following 
actions: 
10.9.1.1 
Distribute announcement of new contractor, Plan design as provided 
by the contractor, and enrollment requirements. 
10.9.1.2 
Review and approve all communications materials targeted towards 
employees, including, but not limited to, summary Plan description, 
benefit summaries, forms, booklets, newsletters, letters, and any 
other employee communication material prior to printing and 
distribution and posting on the Maricopa County website.

SERIAL 250052-RFP 
10.10 
REPORTING 
Contractor shall provide quarterly County-specific reports that summarize utilization, 
customer service requirements, call center statistics, problem resolution, and appeals 
activity and outcomes. 
10.11 
TRANSITION AT END OF CONTRACT 
10.11.1 Upon the completion of the contract term, contractor shall provide the County, at 
no additional charge to the County, communications and data support for a 
successful transition to a new contractor. This will include, but is not limited to, 
requested reports, data files, and dedicated staff necessary to ensure an efficient 
and timely transition. 
10.11.2 Contractor shall provide run out services for a minimum of 18 months following the 
termination of the contract. 
10.11.3 Contractor agrees that benefits shall not be paid for services provided after 
contract ends except for multiple appointment procedures which were started while 
covered and completed within 30 days from the date coverage ended. Such 
benefits shall be subject to all conditions specified in the contract. 
11.0 
TERMS AND CONDITIONS 
11.1 
INDEMNIFICATION 
To the fullest extent permitted by law, and to the extent that claims, damages, losses, or 
expenses are not covered and paid by insurance purchased by the contractor, the 
contractor shall defend, indemnify, and hold harmless the County (as Owner), its agents, 
representatives, officers, directors, officials, and employees from and against all claims, 
damages, losses, and expenses (including, but not limited to attorneys' fees, court costs, 
expert witness fees, and the costs and attorneys' fees for appellate proceedings) arising 
out of, or alleged to have resulted from, the negligent acts, errors, omissions, or mistakes 
of the contractor, a subcontractor, anyone directly or indirectly employed by them, or 
anyone for whose acts they may be liable relating to the performance of this contract. 
11.1.1 Contractor's duty to defend, indemnify, and hold harmless the County, its agents, 
representatives, officers, directors, officials, and employees shall arise in 
connection with any claim, damage, loss, or expense that is attributable to bodily 
injury, sickness, disease, death, or injury to, impairment of, or destruction of 
tangible property, including loss of use resulting therefrom, caused by negligent 
acts, errors, omissions, or mistakes in the performance of this contract, but only to 
the extent caused by the negligent acts or omissions of the contractor, a 
subcontractor, anyone directly or indirectly employed by them, or anyone for 
whose acts they may be liable, regardless of whether or not such claim, damage, 
loss, or expense is caused in part by a party indemnified hereunder. 
11.1.2 The amount and type of insurance coverage requirements set forth herein will in 
no way be construed as limiting the scope of the indemnity in this section. 
11.1.3 The scope of this indemnification does not extend to the sole negligence of County. 
11.2 
INSURANCE
11.2.1 Contractor, at Contractor’s own expense, shall purchase and maintain, at a 
minimum, the herein stipulated insurance from a company or companies duly 
licensed by the State of Arizona and possessing an AM Best, Inc. category rating 
of B++. In lieu of State of Arizona licensing, the stipulated insurance may be 
purchased from a company or companies, which are authorized to do business in

SERIAL 250052-RFP 
the State of Arizona, provided that said insurance companies meet the approval of 
County. The form of any insurance policies and forms must be acceptable to 
County. 
11.2.2 All insurance required herein shall be maintained in full force and effect until all 
work or service required to be performed under the terms of the contract is 
satisfactorily completed and formally accepted. Failure to do so may, at the sole 
discretion of County, constitute a material breach of this contract. 
11.2.3 In the event that the insurance required is written on a claims-made basis, 
Contractor warrants that any retroactive date under the policy shall precede the 
effective date of this contract and either continuous coverage will be maintained, 
or an extended discovery period will be exercised for a period of two years 
beginning at the time work under this contract is completed. 
11.2.4 Contractor’s insurance shall be primary insurance as respects County, and any 
insurance or self-insurance maintained by County shall not contribute to it. 
11.2.5 Any failure to comply with the claim reporting provisions of the insurance policies 
or any breach of an insurance policy warranty shall not affect the County’s right to 
coverage afforded under the insurance policies. 
11.2.6 The insurance policies may provide coverage that contains deductibles or self-
insured retentions. Contractor shall be solely responsible for the deductible and/or 
self-insured retention. 
11.2.7 The insurance policies required by this contract, except Workers’ Compensation 
and Errors and Omissions, shall name County, its agents, representatives, officers, 
directors, officials, and employees as additional insureds. 
11.2.8 The policies required hereunder, except Workers’ Compensation and Errors and 
Omissions, shall contain a waiver of transfer of rights of recovery (subrogation) 
against County, its agents, representatives, officers, directors, officials, and 
employees for any claims arising out of Contractor’s work or service. 
11.2.9 If available, the insurance policies required by this contract may be combined with 
Commercial Umbrella Insurance policies to meet the minimum limit requirements. 
If a Commercial Umbrella insurance policy is utilized to meet insurance 
requirements, the Certificate of Insurance shall indicate which lines the 
Commercial Umbrella Insurance covers. 
11.2.9.1 Commercial General Liability 
Commercial General Liability (CGL) insurance and, if necessary, 
Commercial Umbrella insurance with a limit of not less than $2,000,000 
for each occurrence, $4,000,000 Products/Completed Operations 
Aggregate, and $4,000,000 General Aggregate Limit. The policy shall 
include coverage for premises liability, bodily injury, broad form property 
damage, personal injury, products and completed operations and 
blanket contractual coverage, and shall not contain any provisions which 
would serve to limit third party action over claims. There shall be no 
endorsement or modifications of the CGL limiting the scope of coverage 
for liability arising from explosion, collapse, or underground property 
damage.

SERIAL 250052-RFP 
11.2.9.2 Automobile Liability 
Commercial/Business Automobile Liability insurance with a combined 
single limit for bodily injury and property damage of not less than 
$2,000,000 each occurrence with respect to any of the Contractor’s 
owned, hired, and non-owned vehicles assigned to or used in 
performance of the Contractor’s work or services or use or maintenance 
of the premises under this contract.  
11.2.9.3 Workers’ Compensation 
11.2.9.3.1 Workers’ compensation insurance to cover obligations 
imposed by Federal and State statutes having jurisdiction of 
Contractor’s employees engaged in the performance of the 
work or services under this contract; and Employer’s 
Liability insurance of not less than $1,000,000 for each 
accident, $1,000,000 disease for each employee, and 
$1,000,000 disease policy limit.  
11.2.9.3.2 Contractor, its subcontractors, and sub-subcontractors 
waive all rights against this contract and its agents, officers, 
directors, and employees for recovery of damages to the 
extent these damages are covered by the workers’ 
compensation and Employer’s Liability or Commercial 
Umbrella Liability insurance obtained by Contractor, its 
subcontractors, and its sub-subcontractors pursuant to this 
contract. 
11.2.9.4 
Errors and Omissions/Professional Liability Insurance 
Errors and Omissions (Professional Liability) insurance which will insure 
and provide coverage for errors or omissions or professional liability of 
the contractor, with limits of no less than $2,000,000 for each claim. 
11.2.10 Certificates of Insurance 
11.2.10.1 Prior to contract award, Contractor shall furnish the County with valid 
and complete Certificates of Insurance, or formal endorsements as 
required by the contract in the form provided by the County, issued by 
Contractor’s insurer(s), as evidence that policies providing the required 
coverage, conditions and limits required by this contract are in full force 
and effect. Such certificates shall identify this contract number and title. 
11.2.10.2 In the event any insurance policy(ies) required by this contract is (are) 
written on a claims-made basis, coverage shall extend for two years 
past completion and acceptance of Contractor’s work or services and 
as evidenced by annual certificates of insurance. 
11.2.10.3 If a policy does expire during the life of the Contract, a renewal 
certificate must be sent to County 15 calendar days prior to the 
expiration date. 
11.2.10.4 Certificates of Insurance shall identify Maricopa County as the 
certificate holder as follows: 
Maricopa County 
c/o Risk Management 
301 W Jefferson St, Suite 910 
Phoenix, AZ 85003

SERIAL 250052-RFP 
11.2.11 Cancellation and Expiration Notice 
Applicable to all insurance policies required within the insurance requirements of 
this contract, Contractor’s insurance shall not be permitted to expire, be 
suspended, be canceled, or be materially changed for any reason without 30 days 
prior written notice to Maricopa County. Contractor must provide to Maricopa 
County, within two business days of receipt, if they receive notice of a policy that 
has been or will be suspended, canceled, materially changed for any reason, has 
expired, or will be expiring. Such notice shall be sent directly to Maricopa County 
Office of Procurement Services and shall be mailed, or hand delivered to 301 W. 
Jefferson, Suite 700, Phoenix, AZ 85003, or emailed to the procurement officer 
noted in the solicitation. 
11.3 
FORCE MAJEURE 
11.3.1 Neither party shall be liable for failure of performance, nor incur any liability to the 
other party on account of any loss or damage resulting from any delay or failure to 
perform all or any part of this contract, if such delay or failure is caused by events, 
occurrences, or causes beyond the reasonable control and without negligence of 
the parties. Such events, occurrences, or causes include, but are not limited to, 
acts of God/nature (including fire, flood, earthquake, storm, hurricane, or other 
natural disaster), war, invasion, act of foreign enemies, hostilities (whether war is 
declared or not), civil war, riots, rebellion, revolution, insurrection, military or 
usurped power or confiscation, terrorist activities, nationalization, government 
sanction, lockout, blockage, embargo, labor dispute, strike, and interruption or 
failure of electricity or telecommunication service, and pandemic. 
11.3.2 Each party, as applicable, shall give the other party notice of its inability to perform 
and particulars in reasonable detail of the cause of the inability. Each party must 
use best efforts to remedy the situation and remove, as soon as practicable, the 
cause of its inability to perform or comply. 
11.3.3 The party asserting Force Majeure as a cause for non-performance shall have the 
burden of proving that reasonable steps were taken to minimize delay or damages 
caused by foreseeable events, that all non-excused obligations were substantially 
fulfilled, and that the other party was timely notified of the likelihood or actual 
occurrence which would justify such an assertion, so that other prudent 
precautions could be contemplated. 
11.4 
ORDERING AUTHORITY 
Any request for purchase shall be accompanied by a valid purchase order issued by a 
County department or directed by a Certified Agency Procurement Aid (CAPA) with a 
purchase card for payment. 
11.5 
PROCUREMENT CARD ORDERING CAPABILITY 
County may opt to use a procurement card (Visa or Master Card) to make payment for 
orders under this contract. 
11.6 
INTERNET ORDERING CAPABILITY 
It is the intent of Maricopa County to use the Internet to communicate and to place orders 
under this contract.

SERIAL 250052-RFP 
11.7 
NO MINIMUM OR MAXIMUM PURCHASE OBLIGATION 
This contract does not guarantee any minimum or maximum purchases will be made. 
Orders will only be placed under this contract when the County identifies a need, and 
proper authorization and documentation have been approved. 
11.8 
PURCHASE ORDERS 
11.8.1 County reserves the right to cancel purchase orders within a reasonable period of 
time after issuance. Should a purchase order be canceled, the County agrees to 
reimburse the Contractor for actual and documentable costs incurred by the 
Contractor in response to the purchase order. The County will not reimburse the 
Contractor for any costs incurred after receipt of County notice of cancellation, or 
for lost profits, or for shipment of product prior to issuance of purchase order. 
11.8.2 Contractor agrees to accept verbal notification of cancellation of purchase orders 
from the County procurement officer with written notification to follow. Contractor 
specifically acknowledges to be bound by this cancellation policy. 
11.9 
BACKGROUND CHECK 
Respondents may be required to pass multiple background checks (e.g. Sheriff’s Office, 
County Attorney's Office, Courts, as well as Maricopa County general government) to 
determine if the respondent is acceptable to do business with the County. This applies to, 
but is not limited to, the company, subcontractors, and employees, and the failure to pass 
these checks shall deem the respondent non-responsible. 
11.10 
SUSPENSION OF WORK 
The procurement officer may order the Contractor, in writing, to suspend, delay, or interrupt 
all or any part of the work of this contract for the period of time that the procurement officer 
determines appropriate for the convenience of the County. No adjustment shall be made 
under this clause for any suspension, delay, or interruption to the extent that performance 
would have been so suspended, delayed, or interrupted by any other cause, including the 
fault or negligence of the Contractor. No request for adjustment under this clause shall be 
granted unless the claim, in an amount stated, is asserted in writing as soon as practicable 
after the termination of the suspension, delay, or interruption, but not later than the date of 
final payment under the contract. 
11.11 
STOP WORK ORDER 
11.11.1 The procurement officer may, at any time, by written order to the Contractor, 
require the Contractor to stop all, or any part, of the work called for by this contract 
for a period of 90 calendar days after the order is delivered to the Contractor, and 
for any further period to which the parties may agree. The order shall be specifically 
identified as a stop work order issued under this clause. Upon receipt of the order, 
the Contractor shall immediately comply with its terms and take all reasonable 
steps to minimize the incurrence of costs allocable to the work covered by the order 
during the period of work stoppage. Within a period of 90 calendar days after a 
stop work order is delivered to the Contractor, or within any extension of that period 
to which the parties shall have agreed, the procurement officer shall either: 
11.11.1.1 cancel the stop work order; or 
11.11.1.2 terminate the work covered by the order as provided in the Termination 
for Default or the Termination for Convenience clause of this contract. 
11.11.1.3 The procurement officer may make an equitable adjustment in the 
delivery schedule and/or contract price, and the contract shall be

SERIAL 250052-RFP 
modified, in writing, accordingly, if the Contractor demonstrates that the 
stop work order resulted in an increase in costs to the Contractor 
11.12 
TERMINATION FOR CONVENIENCE 
Maricopa County may terminate the resultant contract for convenience by providing 60 
calendar days advance notice to the Contractor. 
11.13 
TERMINATION FOR DEFAULT 
11.13.1 The County may, by written Notice of Default to the Contractor, terminate this 
contract in whole or in part if the Contractor fails to: 
11.13.1.1 deliver the supplies or to perform the services within the time specified 
in this contract or any extension; 
11.13.1.2 make progress, so as to endanger performance of this contract; or 
11.13.1.3 perform any of the other provisions of this contract. 
11.13.2 The County’s right to terminate this contract under these subparagraphs may be 
exercised if the Contractor does not cure such failure within 10 business days (or 
more if authorized in writing by the County) after receipt of a Notice to Cure from 
the procurement officer specifying the failure. 
11.14 
PERFORMANCE 
It shall be the Contractor’s responsibility to meet the proposed performance requirements. 
Maricopa County reserves the right to obtain services on the open market in the event the 
Contractor fails to perform. 
11.15 
ACCEPTANCE 
Upon completion of services, service delivery shall be deemed accepted and the warranty 
period shall begin when the department has deemed all service/work completed, including 
but not limited to (and as applicable), any inspection, repair, installation, design, 
development, deployment, operation, and initial training. Additionally, all documentation 
shall be completed prior to final acceptance. 
11.16 
CONTRACTOR EMPLOYEE MANAGEMENT 
11.16.1 Contractor shall not reassign any key personnel identified in their contract without 
the express consent of the County. Contractor shall provide a minimum of two 
weeks’ notice to the County of any changes to key personnel on the County’s 
account. 
11.16.2 County reserves the right to request the replacement of any Contractor personnel 
at any time, for any reason. 
11.17 
TRAINING 
Contractor shall provide training services to completely train County personnel. All training 
shall take place on-site in Maricopa County, unless otherwise negotiated with County.

SERIAL 250052-RFP 
11.18 
WARRANTY OF SERVICES 
11.18.1 The Contractor warrants that all services provided hereunder will conform to the 
requirements of the contract, including all descriptions, specifications, and 
attachments made a part of this contract. County’s acceptance of services or 
goods provided by the Contractor shall not relieve the Contractor from its 
obligations under this warranty. 
11.18.2 In addition to its other remedies, County may, at the Contractor's expense, require 
prompt correction of any services failing to meet the Contractor's warranty herein. 
Services corrected by the Contractor shall be subject to all the provisions of this 
contract in the manner and to the same extent as services originally furnished 
hereunder. 
11.19 
INSPECTION OF SERVICES 
11.19.1 The Contractor shall provide and maintain an inspection system acceptable to 
County covering the services under this contract. Complete records of all 
inspection work performed by the Contractor shall be maintained and made 
available to County during contract performance and for as long afterwards as the 
contract requires. 
11.19.2 County has the right to inspect and test all services called for by the contract, to 
the extent practicable at all times and places during the term of the contract. 
County shall perform inspections and tests in a manner that will not unduly delay 
the work. 
11.19.3 If any of the services do not conform to contract requirements, County may require 
the Contractor to perform the services again in conformity with contract 
requirements, at no cost to the County. When the defects in services cannot be 
corrected by re-performance, County may: 
11.19.3.1 require the Contractor to take necessary action to ensure that future 
performance conforms to contract requirements; and 
11.19.3.2 reduce the contract price to reflect the reduced value of the services 
performed. 
11.19.4 If the Contractor fails to promptly perform the services again or to take the 
necessary action to ensure future performance in conformity with contract 
requirements, County may: 
11.19.4.1 by contract or otherwise, perform the services and charge to the 
Contractor, through direct billing or through payment reduction, any 
cost incurred by County that is directly related to the performance of 
such service; or 
11.19.4.2 terminate the contract for default. 
11.20 
USAGE REPORT 
The Contractor shall furnish the County a usage report, upon request, delineating the 
acquisition activity governed by the contract. The format of the report shall be approved by 
the County and shall disclose the quantity and dollar value of each contract item by 
individual unit of measure.

SERIAL 250052-RFP 
11.21 
STATUTORY RIGHT OF CANCELLATION FOR CONFLICT OF INTEREST 
Notice is given that, pursuant to A.R.S. § 38-511, the County may cancel any contract 
without penalty or further obligation within three years after execution of the contract, if any 
person significantly involved in initiating, negotiating, securing, drafting, or creating the 
contract on behalf of the County is at any time, while the contract or any extension of the 
contract is in effect, an employee or agent of any other party to the contract in any capacity 
or consultant to any other party of the contract with respect to the subject matter of the 
contract. Additionally, pursuant to A.R.S. § 38-511, the County may recoup any fee or 
commission paid or due to any person significantly involved in initiating, negotiating, 
securing, drafting, or creating the contract on behalf of the County from any other party to 
the contract arising as the result of the contract. 
11.22 
OFFSET FOR DAMAGES 
In addition to all other remedies at Law or Equity, the County may offset from any money 
due to the Contractor any amounts Contractor owes to the County for damages resulting 
from breach or deficiencies in performance of the contract. 
11.23 
SUBCONTRACTING 
11.23.1 Cigna recommends: By signing this agreement, Contractor shall ensure 
compliance with all terms and conditions of this agreement by all of its contractors 
or sub-subcontractors performing services hereunder. 
11.23.2 The subcontractor’s rate for the job shall not exceed that of the prime Contractor’s 
rate, as bid in the pricing section, unless the prime Contractor is willing to absorb 
any higher rates. The subcontractor’s invoice shall be invoiced directly to the prime 
Contractor, who in turn shall pass-through the costs to the County, without mark-
up. A copy of the subcontractor’s invoice must accompany the prime Contractor’s 
invoice. 
11.24 
AMENDMENTS 
All amendments to this contract shall be in writing and approved/signed by both parties. 
Maricopa County Office of Procurement Services shall be responsible for approving all 
amendments for Maricopa County. 
11.25 
ADDITIONS/DELETIONS OF REQUIREMENTS 
The County reserves the right to add and/or delete materials and services to a contract. If 
a service requirement is deleted, payment to the Contractor will be reduced proportionately, 
to the amount of service reduced in accordance with the bid price. If additional materials 
or services are required from a contract, prices for such additions will be negotiated 
between the Contractor and the County. 
11.26 
RIGHTS IN DATA 
11.26.1 The County shall have the use of data and reports resulting from a contract without 
additional cost or other restriction except as may be established by law or 
applicable regulation. Each party shall supply to the other party, upon request, any 
available information that is relevant to a contract and to the performance 
thereunder. 
11.26.2 Data, records, reports, and all other information generated for the County by a third 
party as the result of a contract are the property of the County and shall be provided 
in a format designated by the County or shall be and remain accessible to the 
County into perpetuity.

SERIAL 250052-RFP 
11.27 
ACCESS TO AND RETENTION OF RECORDS FOR THE PURPOSE OF AUDIT AND/OR 
OTHER REVIEW 
11.27.1 In accordance with Section MC1-372 of the Maricopa County Procurement Code, 
the Contractor agrees to retain (physical or digital copies of) all books, records, 
accounts, statements, reports, files, and other records and back-up documentation 
relevant to this contract for six years after final payment or until after the resolution 
of any audit questions, which could be more than six years, whichever is longest. 
The County, Federal or State auditors and any other persons duly authorized by 
the department shall have full access to and the right to examine, copy, and make 
use of, any and all said materials. 
11.27.2 If the Contractor’s books, records, accounts, statements, reports, files, and other 
records and back-up documentation relevant to this contract are not sufficient to 
support and document that requested services were provided, the Contractor shall 
reimburse Maricopa County for the services not so adequately supported and 
documented. 
11.28 
AUDIT DISALLOWANCES 
If at any time it is determined by the County that a cost for which payment has been made 
is a disallowed cost, the County shall notify the Contractor in writing of the disallowance. 
The course of action to address the disallowance shall be at sole discretion of the County, 
and may include either an adjustment to future invoices, request for credit, request for a 
check, or a deduction from current invoices submitted by the Contractor equal to the 
amount of the disallowance, or to require reimbursement forthwith of the disallowed amount 
by the Contractor by issuing a check payable to Maricopa County. 
11.29 
STRICT COMPLIANCE 
Acceptance by County of a performance that is not in strict compliance with the terms of 
the contract shall not be deemed to be a waiver of strict compliance with respect to all other 
terms of the contract. 
11.30 
VALIDITY 
The invalidity, in whole or in part, of any provision of this contract shall not void or affect 
the validity of any other provision of the contract. 
11.31 
SEVERABILITY 
The removal, in whole or in part, of any provision of this contract shall not void or affect the 
validity of any other provision of this contract. 
11.32 
RELATIONSHIPS 
11.32.1 In the performance of the services described herein, the Contractor shall act solely 
as an independent Contractor, and nothing herein or implied herein shall at any 
time be construed as to create the relationship of employer and employee, co-
employee, partnership, principal and agent, or joint venture between the County 
and the Contractor. 
11.32.2 The County reserves the right of final approval on proposed staff. Also, upon 
request by the County, the Contractor will be required to remove any employees 
working on County projects and substitute personnel based on the discretion of 
the County within two business days, unless a different time period was previously 
approved by the County.

SERIAL 250052-RFP 
11.33 
NON-DISCRIMINATION 
Contractor agrees to comply with all provisions and requirements of Arizona Executive 
Order 2009-09, including flow down of all provisions and requirements to any 
subcontractors. Executive Order 2009-09 supersedes Executive Order 99-4 and amends 
Executive Order 75-5 and is hereby incorporated into this contract as if set forth in full 
herein. During the performance of this contract, contractor shall not discriminate against 
any employee, client, or any other individual in any way because of that person’s age, race, 
creed, color, religion, sex, disability, or national origin. (Arizona Executive Order 2009-09 
can be viewed at https://apps.azsos.gov/public_services/register/2009/46/governor.pdf) 
11.34 
WRITTEN CERTIFICATION PURSUANT to A.R.S. § 35-393.01 
If vendor engages in for-profit activity and has 10 or more employees, and if this agreement 
has a value of $100,000 or more, vendor certifies it is not currently engaged in, and agrees 
for the duration of this agreement to not engage in, a boycott of goods or services from 
Israel. This certification does not apply to a boycott prohibited by 50 U.S.C. § 4842 or a 
regulation issued pursuant to 50 U.S.C. § 4842. 
11.35 
CERTIFICATION REGARDING DEBARMENT AND SUSPENSION 
11.35.1 The undersigned (authorized official signing on behalf of the Contractor) certifies 
to the best of his or her knowledge and belief that the Contractor, its current 
officers, and directors: 
11.35.1.1 are not presently debarred, suspended, proposed for debarment, 
declared ineligible, or voluntarily excluded from being awarded any 
contract or grant by any United States department or agency or any 
state, or local jurisdiction; 
11.35.1.2 have not within a three-year period preceding this contract: 
11.35.1.2.1 been convicted of fraud or any criminal offense in 
connection with obtaining, attempting to obtain, or as the 
result of performing a government entity (Federal, State or 
local) transaction or contract; or 
11.35.1.2.2 been convicted of violation of any Federal or State antitrust 
statutes or conviction for embezzlement, theft, forgery, 
bribery, falsification or destruction of records, making false 
statements, or receiving stolen property regarding a 
government entity transaction or contract; 
11.35.1.3 are not presently indicted or criminally charged by a government entity 
(Federal, State or local) with commission of any criminal offenses in 
connection with obtaining, attempting to obtain, or as the result of 
performing a government entity public (Federal, State or local) 
transaction or contract; 
11.35.1.4 are not presently facing any civil charges from any governmental entity 
regarding obtaining, attempting to obtain, or from performing any 
governmental entity contract or other transaction; and  
11.35.1.5 have not within a three-year period preceding this contract had any 
public transaction (Federal, State or local) terminated for cause or 
default.

SERIAL 250052-RFP 
 
11.35.2 The Contractor shall include, without modification, this clause in all lower tier 
covered transactions (i.e. transactions with subcontractors or sub-subcontractors) 
and in all solicitations for lower tier covered transactions related to this contract. If 
this clause is applicable to a subcontractor or sub-subcontractor, the Contractor 
shall include the information required by this clause with their bid. 
 
11.36 
VERIFICATION REGARDING COMPLIANCE WITH A.R.S. § 41-4401 AND FEDERAL 
IMMIGRATION LAWS AND REGULATIONS 
 
11.36.1 By entering into the contract, the Contractor warrants compliance with the 
Immigration and Nationality Act (INA using E-Verify) and all other Federal 
immigration laws and regulations related to the immigration status of its employees 
and A.R.S. § 23-214(A). The Contractor shall obtain statements from its 
subcontractors certifying compliance and shall furnish the statements to the 
procurement officer upon request. These warranties shall remain in effect through 
the term of the contract. The Contractor and its subcontractors shall also maintain 
Employment Eligibility Verification forms (I-9) as required by the Immigration Reform 
and Control Act of 1986, as amended from time to time, for all employees performing 
work under the contract and verify employee compliance using the E-Verify system 
and shall keep a record of the verification for the duration of the employee’s 
employment or at least three years, whichever is longer. I-9 forms are available for 
download at www.uscis.gov. 
 
11.36.2 The County retains the legal right to inspect documents of Contractor and 
subcontractor employees performing work under this contract to verify compliance 
with paragraph 11.36.1 of this section. Contractor and subcontractor shall be given 
reasonable notice of the County’s intent to inspect and shall make the documents 
available at the time and date specified. Should the County suspect or find that the 
Contractor or any of its subcontractors are not in compliance, the County will 
consider this a material breach of the contract and may pursue any and all remedies 
allowed by law, including, but not limited to: suspension of work, termination of the 
contract for default, and suspension and/or debarment of the Contractor. All costs 
necessary to verify compliance are the responsibility of the Contractor. 
 
11.37 
CONTRACTOR LICENSE REQUIREMENT 
 
11.37.1 The Contractor shall procure all permits, insurance, and licenses, and pay the 
charges and fees necessary and incidental to the lawful conduct of his/her 
business, and as necessary complete any requirements, by any and all 
governmental or non-governmental entities as mandated to maintain compliance 
with and remain in good standing. The Contractor shall keep fully informed of 
existing and future trade or industry requirements, and Federal, State, and local 
laws, ordinances, and regulations which in any manner affect the fulfillment of a 
contract and shall comply with the same. Contractor shall immediately notify both 
the Office of Procurement Services and the department of any and all changes 
concerning permits, insurance, or licenses. 
 
11.38 
INFLUENCE 
 
11.38.1 As prescribed in MC1-1203 of the Maricopa County Procurement Code, any effort 
to influence an employee or agent to breach the Maricopa County Ethical Code of 
Conduct or any ethical conduct, may be grounds for disbarment or suspension 
under MC1-902. 
 
11.38.2 An attempt to influence includes, but is not limited to:

SERIAL 250052-RFP 
 
11.38.2.1 A person offering or providing a gratuity, gift, tip, present, donation, 
money, entertainment or educational passes or tickets, or any type of 
valuable contribution or subsidy that is offered or given with the intent 
to influence a decision, obtain a contract, garner favorable treatment, 
or gain favorable consideration of any kind. 
 
11.38.3 If a person attempts to influence any employee or agent of Maricopa County, the 
chief procurement officer, or his designee, reserves the right to seek any remedy 
provided by the Maricopa County Procurement Code, any remedy in equity or in 
the law, or any remedy provided by this contract.  
 
11.39 
CONFIDENTIAL INFORMATION 
 
11.39.1 Any information obtained in the course of performing this contract may include 
information that is proprietary or confidential to the County. This provision 
establishes the Contractor’s obligation regarding such information. 
 
11.39.2 The Contractor shall establish and maintain procedures and controls that are 
adequate to assure that no information contained in its records and/or obtained 
from the County or from others in carrying out its functions (services) under the 
contract shall be used by or disclosed by it, its agents, officers, or employees, 
except as required to efficiently perform duties under the contract. The Contractor’s 
procedures and controls, at a minimum, must be the same procedures and controls 
it uses to protect its own proprietary or confidential information. If, at any time 
during the duration of the contract, the County determines that the procedures and 
controls in place are not adequate, the Contractor shall make reasonable efforts 
to institute any new and/or additional measures requested by the County within 15 
business days of the written request to do so. 
 
11.39.3 Any requests to the Contractor for County proprietary or confidential information 
shall be referred to the County for review and approval, prior to any dissemination. 
 
11.40 
PUBLIC RECORDS 
 
Under Arizona law, all offers submitted and opened are public records and must be 
retained by the County at the Maricopa County Office of Procurement Services. Offers shall 
be open to public inspection and copying after contract award and execution, except for 
such offers or sections thereof determined to contain proprietary or confidential information 
by the Office of Procurement Services. If an offeror believes that information in its offer or 
any resulting contract should not be released in response to a public record request, under 
Arizona law, the offeror shall indicate the specific information deemed confidential or 
proprietary and submit a statement with its offer detailing the reasons that the information 
should not be disclosed. Such reasons shall include the specific harm or prejudice which 
may arise from disclosure. The records manager of the Office of Procurement Services 
shall determine whether the identified information is confidential pursuant to the Maricopa 
County Procurement Code. 
 
11.41 
INTEGRATION 
 
This contract represents the entire and integrated agreement between the parties and 
supersedes 
all 
prior 
negotiations, 
proposals, 
communications, 
understandings, 
representations, or agreements, whether oral or written, expressed, or implied. 
 
11.42 
UNIFORM ADMINISTRATIVE REQUIREMENTS 
 
By entering into this contract, the Contractor agrees to comply with all applicable provisions 
of Title 2, Subtitle A, Chapter II, Part 200-UNIFORM ADMINISTRATIVE REQUIREMENTS, 
COST PRINCIPLES, AND AUDIT REQUIREMENTS FOR FEDERAL AWARDS contained 
in Title 2 C.F.R. § 200 et seq.

SERIAL 250052-RFP 
 
 
11.43 
GOVERNING LAW 
 
This contract shall be governed by the laws of the State of Arizona. Venue for any actions 
or lawsuits involving this contract will be in Maricopa County Superior Court, Phoenix, 
Arizona. 
 
11.44 
FORCED LABOR 
 
11.44.1 By submitting a bid for this solicitation and/or entering into a contract as a result of 
this solicitation, contractor agrees to comply with all applicable portions of Arizona 
Revised Statutes Section 35-394. Contracting; procurement; prohibition; written 
certification; remedy; termination; exception; definitions. 
 
11.44.2 Contractor certifies that it does not currently, and agrees for the duration of the 
contract, that it will not use:  
 
11.44.2.1 The forced labor of ethnic Uyghurs in the People’s Republic of China. 
 
11.44.2.2 Any goods or services produced by the forced labor of ethnic Uyghurs 
in the People’s Republic of China.  
 
11.44.2.3 Any contractors, subcontractors or suppliers that use the forced labor 
or any good or services produced by the forced labor of ethnic Uyghurs 
in the People’s Republic of China. 
 
11.44.3 If contractor becomes aware during the term of the agreement that contractor is 
not in compliance with this paragraph, the contractor shall notify the County within 
five business days after becoming aware of the noncompliance. If the contractor 
fails to provide a written certification to the County that the contractor has remedied 
the noncompliance within 180 days after notifying the County of its noncompliance, 
then the agreement terminates, except that if the agreement termination date 
occurs before the end the 180 day period, the agreement terminates on the 
agreement termination date. 
 
11.45 
PRICES 
 
Contractor warrants that prices extended to County under this contract are no higher than 
those paid by any other customer for these or similar services. 
 
11.46 
ORDER OF PRECEDENCE 
 
In the event of a conflict in the provisions of this contract and Contractor’s service 
agreement, if applicable, and contract exhibits, the terms of this contract and the Maricopa 
County HIPAA Business Associates Agreement exhibit shall prevail. 
 
11.47 
UNIQUE ENTITY IDENTIFIER (UEI) AND SYSTEM FOR AWARD MANAGEMENT 
REGISTRATION 
 
All 
contractors 
that 
receive 
funding 
must 
have 
a 
UEI 
number 
through 
https://sam.gov/content/entity-registration. Contractor must also remain current with the 
System for Award Management (www.sam.gov) throughout the term of the contract. 
 
11.48 
RELIGIOUS ACTIVITIES 
 
The contractor agrees that costs, planned or claimed, including costs incurred, shall not 
include any expense for any religious activity.

SERIAL 250052-RFP 
 
11.49 
POLITICAL ACTIVITY PROHIBITED 
 
None of the funds, materials, property, or services contributed by the County or the 
contractor under the agreement shall be used in the performance of this agreement for any 
partisan political activity, or to further the election or defeat of any candidate for public 
office. 
 
11.50 
EQUAL EMPLOYMENT OPPORTUNITY 
 
11.50.1 The contractor shall not discriminate against any employee or applicant for 
employment because of race, age, disability, color, religion, sex, or national origin. 
The contractor shall take affirmative action to ensure applicants are employed and 
that employees are treated during employment without regard to their race, age, 
disability, color, religion, sex, or national origin. Such action shall include but is not 
limited to the following: employment, upgrading, demotion or transfer, recruitment, 
or recruitment advertising, lay-off or termination, rates of pay or other forms of 
compensation, and selection for training, including apprenticeship. 
 
11.50.2 Contractor shall comply with the following provisions: 
 
11.50.2.1 Title VI and VII of the Civil Rights Act of 1964, as amended (42 U.S.C. 
§§ 2000a, et seq.); 
 
11.50.2.2 The Rehabilitation Act of 1973, as amended (29 U.S.C. §§ 701, et 
seq.); 
 
11.50.2.3 The Age Discrimination in Employment Act of 1967, as amended 
(29U.S.C. §§ 621, et seq.); 
 
11.50.2.4 The Americans With Disabilities Act of 1990 (42 U.S.C. §§ 12101, et 
seq.); and Arizona Executive Order 2009-09, as amended, et seq. 
which mandates that all persons shall have equal access to 
employment opportunities. 
 
11.50.2.5 Contractor understands that the United States has the right to seek 
judicial enforcement of this assurance. 
 
11.51 
CERTIFICATION REGARDING LOBBYING 
 
11.51.1 Contractor certifies, to the best of their knowledge and belief, that: 
 
11.51.1.1 No federal appropriated funds have been paid or will be paid, by or on 
behalf of the contractor, to any person for influencing or attempting to 
influence an officer or employee of any agency. This applies to a 
Member of Congress, an officer or employee of Congress, or an 
employee of a Member of Congress in connection with the awarding of 
any federal contract, the making of any federal grant. Including the 
making of any federal, loan the entering into of any cooperative 
agreement, and the extension, continuation, renewal, amendment, or 
modification of any federal contract, grant, loan, or cooperative 
agreement. 
 
11.51.2 If any funds other than federal appropriated funds, have been paid or will be paid 
to any person for influencing or attempting to influence an officer or employee of 
any agency, member of Congress, an officer or employee of Congress, or an 
employee of a member of Congress in connection with this federal contract, grant, 
loan, or cooperative agreement, the undersigned shall complete and submit 
Standard Form-LLL, “Disclosure Form to Report Lobbying,” in accordance with its 
instructions.

SERIAL 250052-RFP 
 
 
11.51.3 Contractor shall include Lobbying Certification language in the award documents 
for all subcontractors (including sub-grants, and contract under grants, loans, and 
cooperative agreements) and that all sub-recipients shall certify and disclose 
accordingly. 
 
11.51.3.1 The Lobbying Certification is a material representation of fact upon 
which reliance was placed when this transaction is made or entered 
into. Submission of this certification is prerequisite for making or 
entering into this transaction imposed by section 1352, Title 31, U.S. 
Code. Any successful proposer(s) who fail to file the required 
certification shall be subject to a civil penalty of not less than 
$10,000.00 and not more than $100,000.00 for each such failure. 
 
11.52 
CLEAN AIR ACT & CLEAN WATER ACT 
 
Contractor must comply with all applicable standards, orders, or requirements issued under 
section 306 of the Clean Air Act (42 U.S.C. 7606), section 508 of the Clean Water Act (33 
U.S.C. 1368) Executive Order 11738, and Environmental Protection Agency regulations. 
 
11.53 
ENERGY POLICY AND CONSERVATION ACT 
 
Contractor must adhere to the standards and policies relating to energy efficiency, which 
are contained in the State energy conservation plan issued in compliance with the Energy 
Policy and Conservation Act (Pub. L. 94-163, 89 Stat.871). 
 
11.54 
CONTRACT DISPUTES  
 
All Contract disputes will be handled in accordance with the Maricopa County Procurement 
Code, MCI-906 
 
11.55 
INCORPORATION OF DOCUMENTS 
 
11.55.1 The following are to be attached to and made part of this Contract: 
 
11.55.1.1 Exhibit A - Vendor Information and Premium Rate Fee Pricing 
 
11.55.1.2 Exhibit B - Scope of Work (including County accepted information from 
responses to Proposal Supplement Questionnaire at time of proposal 
 
11.55.1.3 Exhibit C – Employee Prepaid Dental Plan Design 
 
11.55.1.4 Exhibit D – Implementation Plan 
 
11.55.1.5 Exhibit E - Service Level Agreement with Performance Guarantees 
including Fees at Risk 
 
11.55.1.6 Exhibit F - Maricopa County Business Associates Agreement 
 
11.56 
NOTICES 
 
All notices given pursuant to the terms of this contract shall be addressed to: 
 
For County: 
 
Maricopa County 
Office of Procurement Services 
301 W. Jefferson St. Suite 700 
Phoenix, Arizona 85003-1647

SERIAL 250052-RFP 
 
 
For Contractor: 
Cigna Health and Life Insurance Company dba Cigna Healthcare 
900 Cottage Grove Road 
Hartford, CT 06152 
 
11.57 
INQUIRIES 
 
11.57.1 Administrative telephone/email inquiries shall be addressed to: 
 
ELIZABETH KUTTNER, PROCUREMENT OFFICER 
TELEPHONE: (602) 506-0099  
elizabeth.kuttner@maricopa.gov 
 
11.57.2 Inquiries may be submitted by telephone but must be followed up in writing. No 
oral communication is binding on Maricopa County.

SERIAL 250052-RFP 
IN WITNESS WHEREOF, this contract is executed on the date set forth above. 
CONTRACTOR 
AUTHORIZED SIGNATURE 
PRINTED NAME AND TITLE 
ADDRESS 
DATE 
MARICOPA COUNTY 
CHAIRMAN, BOARD OF SUPERVISORS 
DATE 
ATTESTED: 
CLERK OF THE BOARD 
DATE 
APPROVED AS TO FORM: 
DEPUTY COUNTY ATTORNEY  
DATE 
Pete Chuchro, Market Growth Leader of AZ
8888 E. Raintree Drive, Scottsdale, AZ  85260
6/3/2025

SERIAL 250052-RFP 
 
 
EXHIBIT A - VENDOR INFORMATION AND PRICING 
 
COMPANY NAME: 
Cigna Health and Life Insurance Company 
DOING BUSINESS AS (dba): 
Cigna Healthcare 
MAILING ADDRESS: 
900 Cottage Grove Road, Hartford, CT 06152 
REMIT TO ADDRESS: 
900 Cottage Grove Road, Bloomfield, CT 06002 
TELEPHONE NUMBER: 
860-226-6000 
FAX NUMBER: 
N/A 
WWW ADDRESS: 
www.cigna.com 
REPRESENTATIVE NAME: 
Lindsay Bourgeois, Client Manager 
REPRESENTATIVE TELEPHONE NUMBER: 
480-426-6756 
REPRESENTATIVE EMAIL ADDRESS 
lindsay.bourgeois@cignahealthcare.com 
UNIQUE ENTITY IDENTIFIER (SAM.GOV) 
WR9YMDERSQ45 
  
  
YES 
NO 
REBATE 
WILL ALLOW OTHER GOVERNMENTAL ENTITIES TO 
PURCHASE FROM THIS CONTRACT:  
☐ 
☒ 
 
WILL ACCEPT PROCUREMENT CARD FOR PAYMENT: 
☐ 
☒ 
  
 Payment Terms: Net 30 Days 
 
PRICING 
 
1.0 Premium Rate Per Month Per Employee (fill in below) 
1.1 GUARANTEED RATES - MUST BE THE SAME FOR YEARS 1, 2, & 3 
  
EMPLOYEE 
ONLY 
  
EMPLOYEE 
+ SPOUSE 
  
EMPLOYEE 
+ CHILDREN 
  
EMPLOYEE 
+ FAMILY 
YEAR 1 (1/1/2026 - 
12/31/2026) 
YEAR 2 (1/1/2027 - 
12/31/2027) 
YEAR 3 (1/1/2028- 12/31/2028) 
$10.85  
$18.35  
$25.40  
$29.91  
 
1.2 A GUARANTEED MAXIMUM RATE INCREASE PERCENTAGE* 
NOTE THAT GUARANTEED RATES FOR YEARS 4, 5, & 6 MUST BE THE SAME.  
 
YEAR 4 (1/1/2029 - 
12/31/2029) 
YEAR 5 (1/1/2030 - 
12/31/2030) 
YEAR 6 (1/1/2031 - 
12/31/2031) 
11.70% 
11.70% 
11.70% 
11.70%  
 
*Renewal increase effective 01/01/2029 is guaranteed not to exceed 11.7%. Renewal increase 
01/01/2030 and 01/01/2031 is guaranteed not to exceed 0%. 
 
Rate Guarantees and Caps: 
- The above renewal rates are guaranteed for 36 months. (01/01/26 to 12/31/28) 
- The renewal increase effective 01/01/29 is guaranteed not to exceed 11.7%. 
- The renewal increase effective 01/01/30 is guaranteed not to exceed 0.0%. 
- The renewal increase effective 01/01/31 is guaranteed not to exceed 0.0%.

SERIAL 250052-RFP 
 
 
Underwriting Caveats: 
- Rates contain 0% commission. 
- Renewal rates assume a guaranteed cost, non-participating funding arrangement. 
- Renewal rates do not include the cost of specialized printing, mailing, or special enrollment fees. 
- Renewal rates are valid only where there is an existing Cigna Dental Care Access network in place. 
- Rates assume no change to current Employer contributions. 
 
Regulatory Caveats: 
- The dental insurance coverage shall be provided under a standalone group insurance policy and is 
an “excepted benefit” as defined in Public Health Service Act Section 2721(c) and (d). 
- Cigna reserves the right to modify rates as agreed upon in writing and through amendment by the County, 
should there be any change in future regulation. 
- The term "DHMO" is used to refer to product designs that may differ by state of residence of enrollee, 
including but not limited to, prepaid plans, managed care plans, and plans with open access 
features. The Cigna DHMO is not available in the following states: AK, ME, MT, NH, NM, ND, PR, 
SD, VI, VT, and WY. 
- Cigna HealthCare sponsors programs to inform benefit advisors about Cigna HealthCare's plan 
coverage and services (including producer advisory councils). The cost of these events is funded 
through Cigna HealthCare's general overhead.

SERIAL 250052-RFP 
 
 
EXHIBIT B - SCOPE OF WORK 
 
The following information is from contractor responses to the solicitation Proposal Supplement 
Questionnaire. 
  
4.0 Benefit Provisions 
4.1 Describe your pre-determination of benefits process (offered in County’s current plan), including 
whether it is mandatory or optional.  
Predetermination for general dentistry is not required because we provide network general dentists 
with coverage guidelines for the range of services they perform. These include diagnostic and 
preventive services, restorative dentistry, crowns and bridges, partial/complete dentures, root canal 
therapy, minor oral surgery, preliminary periodontal therapy. 
The network general dentist directs most referrals for specialty care (with the exception of orthodontic 
care, which the member can access directly without a referral, and pediatric care, since children under 
age 13 may have a network pediatric dentist as their primary care dentist). Referrals to obtain care with 
a network specialist do not require prior authorization. Predetermination for network specialist care is 
also not required but is available upon request. 
Patient charges listed on the patient charge schedule (PCS) may apply at the specialist’s office based 
on the specialty care coverage for the specific PCS. If a member elects to have treatment not covered 
on the PCS, they are responsible for paying the dentist’s normal fee. 
Specialty referrals are valid for 90 days from the date of issuance. After the expiration date, the system 
automatically purges the specialty referral. 
We send notifications of predetermination-of-coverage decisions to dentists by mail and make them 
available to members through myCigna, a secure website. We send notification of claim payment 
decisions to members and dentists in writing (by mail), and we only call the dentist when we need 
additional information or clarification (verbal) to make a predetermination decision. 
4.2 Describe in detail how you will handle dental treatment already in process at the beginning of 
the contract. Include orthodontia coverage in your response. 
As the incumbent carrier, this is not applicable to current members. 
For new members, inlays/onlays initiated prior to Cigna must be completed under the terms of the 
previous carrier. 
There may be a contribution toward orthodontic benefits in progress. The contribution, if any, is a 
predetermined amount based on the coverage/number of months remaining (excluding the months for 
retention) at the start date to complete the interceptive or comprehensive treatment. It is important to 
note that enrollment does not modify any obligation members have to their original contract with their 
orthodontist, even if the dentist participates in our dental network. 
4.3 Describe in detail how you will handle dental treatment already in process at the end of the 
contract. Include orthodontia coverage in your response. 
Coverage for a dental procedure (crown, root canal treatment, bridge, denture, and partials) that 
starts before disenrollment from the dental plan extends for 90 days after disenrollment, unless 
attributed to nonpayment of premiums.  
4.4 Explain continuity of care arrangements for procedures started but not completed at the 
beginning and end of the contract (must, at a minimum, meet those in current contract). 
Coverage for a dental procedure (crown, root canal treatment, bridge, denture, and partials) that 
starts before disenrollment from the dental plan extends for 90 days after disenrollment, unless 
attributed to nonpayment of premiums. 
4.4.1 
Describe any pre-existing condition limitations in your plan. 
The product does not exclude pre-existing conditions when the treatment is generally otherwise 
covered by a procedure code(s) listed on the Patient Charge Schedule. 
4.5 Indicate all benefit limitations and/or exclusions in your contract proposal. 
As the incumbent, we do not have any benefit limitations/exclusions. 
5.0 Implementation/Enrollments 
5.1 Confirm ability to start implementation in June 2025 for a contract start date of January 1, 2026.   
Confirmed.  
5.2 Confirm there are no additional implementation costs not already included in your quoted rates 
on Attachment D – Premium Rate Pricing Sheet.    
Cigna's proposed fees include all implementation costs.

SERIAL 250052-RFP 
5.3 Describe your preferred method of communicating the new plan to our employees. 
As the incumbent carrier, Maricopa County employees are familiar with our DHMO plan offering. 
However, we welcome opportunities to ‘reeducate’ employees through recorded webinars, onsite 
meetings, and home mailers to review the benefits of the DHMO plan.  
5.4 Confirm you will provide sample communication materials with your proposal submission. 
Confirmed. Samples are included with our submission. 
5.4.1 
Confirm communication materials can be customized. 
Confirmed. 
5.4.2 
Confirm you will do direct mailing to employees’ homes. If not, explain. 
Confirmed. 
5.4.3 
Confirm you will do direct email to employee’s preferred email address. If not, explain. 
Confirmed. Our member engagement campaign sends messages to members whose email 
addresses we have on file (from client eligibility files or through myCigna registration) on the 
importance of preventive dental care. 
5.4.4 
Confirm that the cost of printing and distribution of communication materials is included 
in your quoted rates on Attachment D – Premium Rate Pricing Sheet. explain. 
Confirmed. 
5.5 Provide a sample of enrollment materials that the County would be able to include on the County 
benefits website. Submit with proposal submission.  explain. 
Confirmed, we have included enrollment materials with our proposal submission. 
5.6 Confirm that the cost of providing a representative for the initial enrollment meetings for service 
year 2026-2027 and for each annual open enrollment meeting thereafter is included in your 
quoted rates on Attachment D – Premium Rate Pricing Sheet. explain. 
Confirmed. 
5.7 Confirm the cost of providing a representative for employee meetings and ongoing service 
according to a predetermined schedule is included in your quoted rates on Attachment D – 
Premium Rate Pricing Sheet. explain. 
Confirmed. 
5.8 Confirm that the cost of providing a representative for ongoing service has been included in your 
quoted rates on Attachment D – Premium Rate Pricing Sheet. explain. 
Confirmed. 
5.9 Confirm that you will provide draft and final plan documents and/or evidence of coverage booklets 
to the County in electronic format, and that the final documents will be provided before the start 
of the County’s open enrollment period. 
Confirmed. 
5.9.1 
Confirm that the cost for draft plan documents is included in your quoted rates on 
Attachment D – Premium Rate Pricing Sheet and that they are provided to the County 
at no additional cost. 
As a fully insured client, the County will receive a copy of the certificate of coverage electronically via 
PDF at no additional cost (we cannot provide it in Word format). 
6.0 Communication: Provider Information and  ID Cards 
6.1 Describe your Internet capabilities for provider information access including plan and claim 
documents. 
The following member information and self-service functions are available through myCigna: 
•
coverage details lookup
•
network dentist search, with the ability to book appointments for selected dentists and see
offices on a map
•
dental prevention and wellness information, including WebMD articles
•
glossary of dental terms
•
ability to print temporary dental ID cards
•
dental claim office phone number(s) and address(es) and customer service contact
information
•
dental treatment cost estimator
•
FAQ
•
information about our Healthy Rewards® discount program
Online Dental Tools: At Cigna Healthcare, we believe that dental coverage should be easy and offer 
the same transparencies and tools that members expect in every other part of their lives, so we

SERIAL 250052-RFP 
 
launched online tools to make these and other services possible. This innovative technology is 
available on myCigna, and our mobile app. Available 24 hours a day, 7 days a week, 365 days a year, 
these features provide on-the-go access anytime, anywhere. The tools include the following: 
• 
Brighter Score Ranking - Use this scoring method developed by www.brighter.com to 
compare dentists based on factors such as affordability, patient experience, and professional 
history (may not be available with all Cigna Healthcare dental plans). 
• 
Dental Office Reviews/Comparisons - Find detailed information to compare dental offices, 
including dentist profiles with pictures, video content, and verified patient reviews (may not be 
available with all Cigna Healthcare dental plans). 
• 
Enhanced Search/Transparent Pricing - Search for a dentist by procedure or group of 
procedures and get personalized information based on the plan; results show pricing inclusive 
of coinsurance, copays, and deductibles (may not be available with all Cigna Healthcare dental 
plans). 
6.1.1 
Confirm your electronic provider directories updated are updated within 10 days of 
notification to the contractor of a termination or addition of a provider.        
Confirmed. 
6.2 Confirm I.D. cards are mailed to members within 10 business days of receipt of the eligibility file, 
and replacement ID cards within 7 business days  upon request from the member?         
Confirmed. 
6.2.1 
Confirm members are able to order online for I.D. Cards to be mailed to them.  
Confirmed. 
6.2.2 
Confirm members are able to download and print I.D. cards.        
Confirmed. 
6.2.3 
Confirm I.D. cards are personalized.        
Confirmed. 
6.2.4 
Confirm there is no additional cost to mail a member a new replacement I.D. Cards upon 
request.        
Confirmed. 
6.2.5 
 Provide a sample of your I.D. card.    
A sample ID card has been included with our submission. 
7.0 Customer Service/Telephone and Portal Access   
7.1 Provide a customer service program description, including the specific functions of the customer 
service department.         
Across the nation, we have transitioned from a partial to a fully virtual US-based customer service 
advocates (CSAs) working from home. They are supported by our advanced suite of virtual 
collaboration tools and platforms, and a number of physical meeting spaces spanning the country. 
Our dental claim service model leverages our technology to support a highly efficient virtual network of 
experienced claim processors. To ensure optimal accuracy, we pay claims across the network based 
on processor expertise within specific claim categories. 
Cigna’s Customer Service Advocates do the following:   
•  Help Clients, Members, and Health Care Providers Understand Our Business a Little Better - In 
customer service roles, questions about determination of payments and claims (e.g., medical and 
dental procedures, office and hospital visit costs) are common. 
•  Make It Easy for Members to Work with Us - Our customer service staff take ownership of member 
issues and work to resolve them over the phone the first time, every time. 
•  Be an Advocate for Health and Wellness - Our staff educate members on disease management 
programs and recommend appropriate healthy living programs. 
•  Access Regular Development Opportunities and Mentorships - We offer extensive hands-on training 
and guided on-the-job trainings. 
Our customer service staff receive several types of initial and ongoing training on topics such as the 
following: 
•  company history and service philosophy 
•  our general customer service policy 
•  phone skills and etiquette, including call handling techniques 
•  computer skills 
•  HIPAA 
•  client-specific plans 
•  our capabilities and programs, including those that are new or revised

SERIAL 250052-RFP 
 
•  our member-centric focus 
7.2 Provide a description of the customer service training program.         
We provide seven weeks of in-depth training to our customer service advocates (CSAs). CSAs spend 
the first three weeks in a classroom environment where they learn how to handle member coverage 
and eligibility questions. The new hires then receive a week of on-the-job training handling live 
coverage and eligibility calls. During the next two weeks, they receive training on more complex 
member and dentist questions, followed by a week of additional on-the-job training. We then assess 
and verify their skills through testing and hands-on demonstration of simulated and live calls. 
Following these seven weeks, trainees receive a permanent assignment. The manager and quality 
management team continually monitor staff to ensure they are providing quality service. We measure 
this through live call monitoring, post-recorded call handling, and external customer service survey 
responses. Trainers communicate performance expectations throughout training, and their manager 
reinforces it through routine counseling. CSAs’ customer service skills continue to be developed on 
the floor through experience, targeted coaching, and additional training pushed to each CSA’s 
desktop through an automated learning management system. 
7.3 Where is the location of the customer service center(s) that would handle our account?         
We have transitioned to a fully virtual workforce staffing strategy, with all of our US-based CSAs 
working from home. 
7.3.1 
Confirm that customer service representatives are located in the United States and 
that no customer service representatives will be providing services from off-shore 
locations.             
Confirmed. 
7.4 Indicate how many members the customer service center currently serves for the customer 
service center(s) location(s) that would service this contract.         
We have transitioned to a fully virtual workforce staffing strategy, with all of our US-based customer 
service advocates (CSAs) working from home.  Currently 17,174,056 members are serviced by our 
customer service.  
7.5 Will you provide a dedicated customer service team to handle inquiries from County members?   
While not dedicated, Maricopa County will continue to be serviced by our customer service center, 
which is available 24 hours a day, 7 days a week, 365 days a year. 
7.6 Confirm that customer service representatives have the ability to view member information 
regarding benefits, eligibility and claims status, and are trained to explain claims denials, pending 
status, reason for pending status, and claims payment results to employee members.          
Confirmed. 
7.7 Confirm that customer service representatives responding to calls are able to provide bilingual 
services (English and Spanish).         
Confirmed. 
7.7.1 
Indicate number of bilingual Customer Staff (English/Spanish) and their availability 
during County business hours, on weekends, afterhours, and on County holidays.         
We have approximately 30 Spanish-speaking staff members in customer service. 
7.7.2 
Describe how telephone calls from non-English speaking members are handled in your 
customer service department, including non-Spanish languages (e.g., Vietnamese).         
When calling the toll-free customer service line, callers have the option to continue in English or 
Spanish. Those requesting Spanish can speak to or leave a message for a Spanish-speaking CSA. 
We also use LanguageLine Solutions, an interpretation service that provides translation for more 
than 200 languages. 
7.7.3 
Describe how calls for members who are deaf are handled.         
We provide access to our customer service system for callers with hearing and speech disabilities; 
they can reach us through the national relay system using 711. Operators translate the conversations 
from text to speech to our customer service advocates (CSAs) and back from speech to text to the 
caller. 
7.8 County requires that members are available to communicate directly with a customer service 
representative/advocate regarding their benefits and claims, at a minimum, 7 A.M. through 7 
P.M. MST (local time) Monday through Sundays, except on County holidays. Note that County 
prefers 24/7, 365 days a year customer service availability.         
Confirmed.

SERIAL 250052-RFP 
7.8.1 
If you customer service hours of availability exceed the required availability, what are 
your customer service hours of availability for phone call service? 
Members can call our toll-free customer service number, 800.Cigna24, 24 hours a day, 7 days a 
week, 365 days a year to talk to a CSA about coverage, claims, procedures, or any other concerns. 
In addition, our voice response system is also available 24 hours a day, 7 days a week, 365 days a 
year.       
7.9 Confirm you have an online and a mobile app chat function that allows members to communicate 
with customer service representative during required customer service  hours. 
Live chat assistance is available from 9:00 a.m. to 8:00 p.m. (EST), Monday through Friday. 
7.9.1 
If your chat availability with a customer service representative exceed the required 
availability, what are your customer service hours of availability for chat service? 
Live chat assistance is available from 9:00 a.m. to 8:00 p.m. (EST), Monday through Friday. 
7.9.2 
If your chat availability with an AI interaction for customer service exceed the required 
availability, what are your customer service hours of availability for AI chat service? 
This is not currently available. 
7.10 Confirm you have dedicated email address for members to use to communicate with customer 
service. 
We have the capability to allow our members and CSAs to interact via a secure emailing channel, 
through the “Contact Us” functionality on their myCigna dashboard (web only), under the dropdown 
menu on the member's name. This option allows our members who are registered on myCigna to 
receive and send files. Members will receive a response back, standardly within two business days 
through the inbox on their myCigna dashboard.  
7.10.1 Indicate the response time for members to receive responses via email. 
Our response turnaround time target is 100% responded within two business days. Our most recent 
overall averages were: 2024 – 2.4 business days          2023 – 0.6 business days           2022 - 0.6 
business days 
7.11 Confirm you have a member website and mobile access where members can access up-to-
date participating provider information. dedicated email address for members to use to 
communicate with customer service. 
Confirmed. Members will continue to access provider information on our member website, myCigna. 
7.11.1 Is information available in English and Spanish? dedicated email address for members 
to use to communicate with customer service. 
Confirmed. 
7.11.2 Confirm member portal has an online tool where members can review benefit options. 
Confirmed. 
8.0 Customer Service Performance 
8.1 Describe your customer service call recording system, inquiry tracking system, metric tracking, 
and reporting capabilities. 
Cigna uses Verint software to record 99 percent of incoming phone calls (1 percent are not recorded 
due to system maintenance and downtime). The tool captures and stores every aspect of a call to aid 
in performance evaluation and identify training needs. Callers hear a message informing them their 
call may be recorded or monitored for quality assurance. 
As part of Cigna’s continuous quality improvement (CQI) efforts, our CSAs use OneView, our desktop 
inquiry tracking system, to document every contact with members, whether received via phone, mail, 
or online. We track the following information: 
•
date of contact
•
member’s name and ID
•
nature of and reason for the inquiry
•
steps to resolve the issue
•
action taken to address inquiries not initially resolved and progress status
•
the representative who handled the call
•
the date the inquiry was closed out
Calls are not documented verbatim; they are summarized and formatted with codes within OneView. 
CSAs must complete documentation of the call before the call can be closed. 
We have the ability to provide the following reports monthly, quarterly, or annually, as requested: 
•
Phone Responsiveness - monitors telephone system accessibility/use; available on an ad
hoc basis at the client and service center level

SERIAL 250052-RFP 
•
Call Type - identifies the type and number of calls received over a specified period, sorted
by client; available on an ad hoc basis at the client level
•
Open Call - identifies and tracks open or unresolved inquiries; available on an ad hoc basis
at the client and service center level
8.1.1 
Provide sample client-specific reports generated from your customer service inquiry 
tracking system. 
Customer service uses several reports to identify trends and make process improvements. 
The following reports are available to Maricopa County: 
-
Phone Responsiveness - These client-specific reports monitor phone system accessibility
and use. They are available on an ad hoc basis at the client and service center level and
measure several performance metrics: number of calls received; number of calls answered;
call abandonment rate; average speed of answer (ASA).
-
Call Type - These reports, sorted by client, identify the type and number of calls received as
well as the resolution action that occurred over a specified period. They are available on an ad
hoc basis at the client level.
-
Open Call - These reports identify and track open or unresolved inquiries; they are available
on an ad hoc basis at the client and service-center level.
We are unable to provide samples of client-specific phone responsiveness and call type reports. These 
are only produced on an ad hoc basis and are considered proprietary. 
Describe your telephone call documentation requirements. 
We track correspondence in our call tracking database. The customer service department (verbal 
inquiries and complaints) or correspondence unit (written inquires) investigates and responds, 
preferably at first contact. We refer written general complaints, including those that relate to a request 
to overturn a coverage decision, to the national appeals team to handle as an appeal. We respond in 
writing (acknowledgement/resolution) within 30 days to members who have submitted a written 
complaint. 
For every type of complaint or inquiry, we enter pertinent information in the call tracking system. 
Documentation in the system should include the following: 
-
Who - member’s name and ID number; dentist’s name and ID number, if applicable
-
What - details of the member’s inquiry or complaint about Cigna Healthcare, dentists, or other
-
When - date of occurrence
-
Where - place of service
-
Why - member’s reason for inquiry or complaint and expected results from Cigna Healthcare
(We document what the CSA] or correspondence unit staff conveyed to the member.)
-
How - how the CSA or correspondence unit staff attempted to resolve the member’s issue
(We document the attempt, including information like dates and names of persons contacted;
CSAs must obtain a member’s permission to use their name when contacting the dental
office.)
Describe ability to document telephone metrics (average speed of answer and abandonment rate). 
Confirmed. We have the ability to document and measure customer service metrics. 
What is your 2024 year-to-date call abandonment rate for the customer service center? 
 In 2024, our abandonment rate was 1.0%. 
Provide your customer service center metrics for the last three months for all customer service 
options (call, chat, email). 
Year to date customer service metrics are not available. 
9.0 Employer Support 
9.1 Provide a description of your provider relations program including, but is not limited to, the 
process for dispute resolution between the member and the provider when a quality of care or 
quality of service issue arises. 
We match quality-of-service and quality-of-care complaints and inquiries to the treating health care 
provider via call documentation records that link the provider’s name and/or ID to the issue. The 
medical director or provider relations representative works with the provider to resolve the issue, 
keeping the member’s information confidential (as requested). We track complaints and use the 
information for trend reporting. 
9.2 Confirm you have a dedicated employer portal or website for the County. 
Confirmed.

SERIAL 250052-RFP 
 
9.2.1 
Describe the extent of data available for review by the employer including network 
providers and any network tiers/levels, enrollment, claims payments, and customer 
contacts, appeals, and grievances.   
Maricopa County will continue to have access to our dental microsite. The microsite can help Maricopa 
County find detailed information about our dental plans, programs, and offerings. On the marketing 
microsite, we host a variety of resources and tools so that clients can learn about everything that is 
available to them and to their employees with us. The site features up-to-date thought-leadership 
content, a welcome guide introducing you to your dental plan, dental health podcasts and videos, and 
more. Additionally, our client website provides tools and information to support clients in the following 
key areas: 
• 
claim inquiry  
• 
eligibility and coverage inquiry  
• 
automated eligibility management and reporting tool  
• 
employee enrollment and maintenance  
• 
eligibility reports and statistics 
• 
premium/fee invoices and online bill payment  
Monthly reports are available by the 10th business day of the following month; weekly reports are 
available the 1st business day of the following week. 
9.3 Confirm online access where the County can check or add eligibility for an employee and/or 
dependent.   
Confirmed. 
10.0 Network  
10.1 Confirm you are in compliance with the mandatory requirement that the network is owned by 
the proposer.   
Confirmed. 
10.2 Describe your network that is available to all members. Make sure your description includes 
where the network is currently operating and how long the network has been operating.      
The Cigna Dental Care® (DHMO) plan is operational in 41 states. Our dental networks are among the 
largest in the country, with more than 25,000 dentists in our DHMO Access Plus network—the largest 
of its kind in the country. We have specialized in dental program management since 1974, when 
Florida granted Dental Health, Inc., a certificate of authority to provide managed dental care. In 1984, 
Dental Health, Inc., became a subsidiary of The Cigna Group, marking the first entry of a major 
national insurance organization into the managed dental care field. 
In Arizona, our initial DHMO operation date is 1995. 
10.3 Confirm you have providers available in the event of an emergency, including after hours and 
on weekends.   
Confirmed. Our agreements with dentists require them to provide or arrange for emergency care 24 
hours a day, 7 days a week, 365 days a year and to provide emergency attention within 24 hours of 
requests. If a member experiences a true dental emergency and receives care at an out-of-network 
dental office, the related bills are payable at the in-network level. Services and materials that are not 
considered an emergency are paid at out-of-network levels if care is received from an out-of-network 
dentist. 
10.4 Confirm there are no restrictions on provider access (e.g., limitation on new patients for certain 
providers).    
Dental offices may elect to restrict a portion of their practice to a particular insurance category. Once 
the practice reaches that level, the dentist may choose to raise the limit or block new enrollment to the 
office. We do not assign new members to offices that are not accepting new patients. 
10.4.1 If you are unable to confirm there are no restrictions  on provider access, note each 
individual provider currently under such restrictions.   
Network managers regularly monitor office capacity and projected growth. They contact dentists to 
discuss capacity expansion through staff increases or office hour changes. If these actions are not 
feasible, we consider adding more dental offices in that area. 
Dental offices may elect to restrict a portion of their practice to a particular insurance category. Once 
the practice reaches that level, the dentist may choose to raise the limit or block new enrollment to the 
office. We do not assign new members to offices that are not accepting new patients. 
We initiate enrollment blocking to a dental office should appointment wait times become excessive. 
Should a member select a closed dental office, we proactively assign that member to another office

SERIAL 250052-RFP 
 
accepting new patients (of which the member approves). If an office is closed to new enrollments, that 
office may make an exception if the member requesting transfer is already a patient of record. 
Members can always call us to request an override; a customer service advocate (CSA) immediately 
calls the office for approval. 
10.5 What is your current capacity to enroll new members with the current provider base?    
Currently, approximately 90% of network providers are open to new patients. 
10.6 What criteria do you use for the selection/credentialing of providers, if any?   
Each dentist interested in joining our network must go through a rigorous screening process to show 
they are licensed and that their certifications and credentials meet our standards. Our credentialing 
department/network managers review the following for each dentist to help ensure members receive 
the best care: 
• 
licensure in the state they provide services 
• 
compliance with OSHA and the CDC 
• 
current malpractice insurance and state license information 
• 
graduation from an accredited dental school 
• 
history of conviction for fraud or a felony as well as disciplinary action or litigation 
(Medicare/Medicaid 
opt-out, 
System 
for 
Award 
Management/General 
Services 
Administration/Office of Inspector General) 
• 
malpractice history from the National Practitioner Data Bank (NPDB) 
• 
specific office standards 
• 
collected general office and dentist data 
• 
board certification (if applicable) 
• 
DEA or state-controlled dangerous substance certificate (if applicable) 
• 
verification of specialty training (if applicable) 
We reverify the credentials of each participating dentist every three years. 
10.7 Describe any special training dentists receive from you, if any.   
To ensure a smooth transition into the Cigna Dental Care® Access network, we provide extensive 
training to dentists on how to successfully manage the program within their practice. 
Our professional relations managers review with new dentists the information in the Dental Office 
Reference Guide, which contains participation guidelines dentists must adhere to and includes a review 
of the program’s policies and procedures; the patient charge schedules (PCSs); and the compensation 
arrangement. They also conduct periodic phone conferences and onsite visits to provide dental offices 
with ongoing member feedback and transfer trends. In addition, our convenient website allows dentists 
to securely conduct transactions with Cigna and provides one-stop online access to information such 
as reference materials and forms needed to administer the plan. 
Further, the quality management department will provide an onsite audit and send a letter to the dentist 
afterward about quality-of-care and service issues. If necessary, the dental director, quality manager, 
or network manager will conduct additional phone conferences with the dentist to review the findings. 
The dental director coordinates the educational follow-up of network dentists about issues identified in 
the performance monitoring program. 
10.8 How many members do you currently service under your network program in Arizona? What is 
your provider to member ratio?      
Cigna has 604,035 members in the state of Arizona with a provider to member ratio of 1:92 for 
General Practice providers.  
10.9 What are your network development plans in Maricopa County and/or Arizona for 2026, 2027 
and 2028.       
Our standard plan designs offer a list of covered services for pre-negotiated fees no balance billing or 
claims to file. Plans that encourage a member's wellness promote efficient and cost-effective dental 
care that neither stimulate overutilization nor inhibit delivery of proper care. They also minimize 
member out-of-pocket expenses for diagnostic and preventive care, which are often a significant 
barrier to proper dental care. Rates are tied directly to the coverage under the plan. If member 
charges are lower, premiums are higher, so dentists are fairly paid. Conversely, if member charges 
are increased, premiums can be lowered. 
10.10 Describe the nature and length of the contract between your providers and your organization.  
Dental provider agreements expire on December 31 of each year; they automatically 
renew unless Cigna or the dentist ends the contract.  
10.11 If network gaps exist in areas where employees are concentrated, how would your firm 
propose to extend the network?

SERIAL 250052-RFP 
 
We strive for continued network growth to serve our members, and we have experienced significant 
growth year over year. When developing our recruitment plan, we identify 
• 
gaps between competitor offerings and our own; 
• 
additional member-access needs; and 
• 
any future needs for additional client acquisition. 
We also plan for growth that is due to client-specific requests. 
Please see page 4 of GeoAccess report where any gaps are reflected. 
10.12 Describe your utilization review procedure in terms of provider networks.   
A trained, experienced, licensed dental provider is responsible for performing the audit when an onsite 
review is warranted for existing network offices. This audit may include a chart review that investigates 
evidence of proper diagnosis, quality and quantity of radiographs, appropriate treatment planning, and 
appropriate treatment of any relevant dental conditions. The audit must show the adequate application 
of the available preventive and diagnostic measures. Network management staff and dental directors 
may counsel dentists as part of this focused audit. 
The results of office assessments are confidential in order to protect the patient's and dentist's 
confidentiality. 
10.13 Provide your unduplicated total network size in Maricopa County for each of the last three 
years: 2022, 2023 and 2024.     
2023: 2,853 providers      2024: 3,032 providers      2025: 3,081 providers 
10.14 If a member is having difficulty scheduling an appointment, what type of assistance does your 
company provide?     
We do not set the office hour requirements for network dentists; however, our Dental Office Reference 
Guide outlines expectations about the scheduling of dental appointments. Our target is for 
appointments to be provided at the same level as they would be for fee-for-service (FFS) patients and 
that members should be able to receive an appointment for routine care within four weeks of calling an 
office. Dentist contracts require dentists to provide or arrange for emergency care 24 hours a day, 7 
days a week and to provide emergency appointments within 24 hours of requests. 
Every inquiry about excessive wait time is investigated, and corrective action is taken if we determine 
that timely and efficient dental care was available and not provided. If we determine that excessive wait 
time was the result of insufficient capacity, we initiate actions to expand the dentist’s capacity or recruit 
additional dentists in that particular area. 
10.15 What are your requirements of the contracted general dentists when they are requesting 
authorization from your company, or anyone else, before they can refer a patient to a 
specialist?     
Network general dentists initiate patient referrals for endodontic and periodontal treatment as well as 
oral surgery. Referrals are confirmed for 90 days from the approval date. Specialty referrals are not 
required for orthodontic treatment or pediatric care for children up to 13 years old as long as members 
visit network specialists. Although not required for payment of services, the network specialist may 
submit a request for prior authorization to us for oral surgery and periodontal services. Members are 
responsible for the applicable patient charges listed on the patient charge schedule (PCS) for covered 
procedures. After specialty treatment is finished, the member should return to the network general 
dentist for care. 
If a network specialist is not available, the general dentist will refer the member to an out-of-network 
specialist and the member will only be responsible for charges listed on the PCS; however, Cigna 
Dental Care® Access (DHMO) network general dentists render the range of services that are required 
for graduation from dental school, including diagnostic treatment, preventive treatment, operative 
dentistry, crowns and bridges, partial and complete dentures, root canal therapy, minor oral surgery, 
preliminary periodontal therapy, and pediatric dentistry. Referral details follows: 
• 
Endodontist: Network general dentists refer members directly to a network specialist for 
treatment. 
• 
Periodontist: Network general dentists refer members directly to a network specialist for 
evaluation. 
• 
Oral Surgeon: Network general dentists refer members directly to a network specialist for 
evaluation. 
• 
Pediatric Dentist: Members can select a network pediatric dentist for children under age 13 
as their primary care dentist. (Although referrals are not required, a network general dentist 
may recommend that a child up to age 13 visit a network pediatric dentist for evaluation and 
treatment.)

SERIAL 250052-RFP 
 
• 
Orthodontist: Members can directly access care without a referral when seeing a network 
orthodontist. 
For each of the above, specialists may submit the treatment plan to us for coverage determination. We 
communicate the approved coverage to the specialist, network general dentist, and member. The 
specialist contacts the member to arrange treatment. Then, after the treatment is finished, we pay the 
specialist directly. 
12.0 
Eligibility 
12.1 Confirm your eligibility system is capable of receiving a HIPAA and HITECH Act compliant file 
generated from the County Benefit Enrollment System, Workday.   
Confirmed. 
12.3 
Describe your process for handling eligibility exceptions. 
Two options are available for urgent care (also called access to care) updates: 
• 
Phone – Maricopa County may contact its assigned eligibility account specialist at 
the specialist’s direct phone number. If the assigned specialist is not available, Maricopa 
County can contact our client care center at 800.592.9219 between 8:00 a.m. and 8:00 p.m. 
(EST). Once received, we make these updates in real time. 
• 
Email – Maricopa County may email its assigned eligibility account specialist or our manual 
eligibility email box with the request. In the subject line, Maricopa County needs to write 
either “urgent” or “access to care” to flag the email. We complete these updates within four 
hours. 
12.4 In the event of an emergency, state your average turnaround time for loading eligibility.  
Confirmed. We will continue to process Maricopa County’s eligibility quickly.  
12.5 Confirm 24 hour turnaround time for loading eligibility files received from the County Benefit 
Enrollment System.   
Confirmed. We will continue to process Maricopa County’s eligibility quickly and the County will 
continue to have access to their eligibility analyst who will work to provide eligibility updates, answer 
questions, or explain processes as needed. 
In addition, Maricopa County has access to our client portal, Cigna For Employers, so they have 
access and management capabilities which includes the ability to add, edit, and terminate 
dependents, as well as view the history of these transactions.  
12.6 Confirm process adjustments/corrections to the contractor’s eligibility data shall be completed 
within 
two 
working 
days 
following 
response 
from 
the 
County 
to 
contractor’s 
reconciliation/exception report.   
Confirmed. 
12.7 Describe your procedures to verify the continued eligibility of certain types of employees or 
dependents with respect to limiting ages, COBRA eligibility, and survivor eligibility?   
We do not verify student status. More specifically, we do not verify a dependent's age, student status 
(unless directly requested by the client), or disabled status. In addition, we do not provide over-age 
dependent verification, nor do we notify parents that their children are no longer eligible for coverage 
when they reach the dependent age limit. 
13.0 
Minimum Employee Participation Requirement 
12.8 Indicate any minimum requirement for employee and dependent participation in the plan.   
The Cigna Dental Care® plan requires a minimum of 51 eligibles or a minimum enrollment of 10 
employees; however, we do not require a minimum percentage of dependents to enroll in the 
program.

SERIAL# 250052-RFP 
EXHIBIT C – EMPLOYEE PREPAID DENTAL PLAN DESIGN 
DENTAL CARE ACCESS PLUS NETWORK (DCAP) WITH PATIENT CARE SCHEDULE (PCS) GX-V9 AZ 
Cigna Dental Care®  Plan Patient Charge Schedule 
This Patient Charge Schedule lists the benefits of the Dental Plan including covered procedures and 
patient charges. 
Important Highlights 
This Patient Charge Schedule applies only when covered dental services are performed by the member’s
Network Dentist, unless otherwise authorized as described in the member’s plan documents. Not all Network
Dentists perform all listed services and it is suggested that the member check with the member’s Network
Dentist in advance of receiving services. 
This Patient Charge Schedule applies to Specialty Care when an appropriate referral is made by the member’s
Network General Dentist to a Network Specialty Endodontist, Periodontist or Oral Surgeon. A referral is not
required for Specialty Care at a Network Specialty Pediatric Dentist or Orthodontist. The member may select 
a Network Pediatric Dentist for the member’s child under the age of 13 by calling Customer Service at
1.800.Cigna24 to get a list of Network Pediatric Dentists in the member’s area. Coverage for treatment by a
Pediatric Dentist ends on the member’s child’s 13th birthday; however, exceptions for medical reasons may
be considered on an individual basis. The member’s Network General Dentist will provide care upon the
member’s child’s 13th birthday. 
Procedures not listed on this Patient Charge Schedule are not covered and are the patient’s responsibility at 
the dentist’s usual fees. 
Infection control and/or sterilization are considered to be incidental to and part of the charges for services 
provided and not separately chargeable. 
This Patient Charge Schedule is subject to annual change in accordance with the terms of the group
agreement. 
Procedures listed on the Patient Charge Schedule are subject to the plan limitations and exclusions described
in the member’s plan book/certificate of coverage and/or group contract. However, additional benefits may be
available in certain states (e.g. Arizona), for Covered Services otherwise subject to a frequency limitation,
dependent upon the member’s Network General Dentist’s certification of dental necessity. Should any
applicable state regulation require coverage for a particular service, the listed exclusion or limitation for that
service shall not apply. 
All patient charges must correspond to the Patient Charge Schedule in effect on the date the procedure is
initiated. 
Current Dental Terminology ("CDT") codes are established by the American Dental Association (ADA) Council
on Dental Benefit Programs in accordance with authority granted by the federal government under the Health
Insurance and Portability and Accountability Act of 1996 (HIPAA) as the national terminology for reporting 
dental services, and are recognized as the industry standard. The ADA publishes CDT as part of a reference
manual and may periodically change CDT Codes or definitions. Different codes may be used to describe these
covered procedures. The language in italics is intended to clarify the members’ benefit. 
Code 
Procedure Description 
Patient Charge 
Office visit fee (Per patient, per office visit in addition to any other applicable patient charges) 
Office visit fee 
$5.00 
Diagnostic/preventive – Oral evaluations are limited to a combined total of 4 of the following evaluations 
during a 12 consecutive month period: periodic oral evaluations (D0120), comprehensive oral evaluations 
(D0150), comprehensive periodontal    evaluations (D0180) and oral evaluations for patients under 3 years 
of age (D0145). 
D9310 
Consultation (diagnostic service provided by dentist or physician 
other than requesting dentist or physician) 
$0.00

SERIAL 250052-RFP 
 
D9311 
Consultation with a medical health care professional 
$0.00 
D9430 
Office visit for observation – No other services performed 
$0.00 
D9450 
Case presentation, subsequent to detailed and extensive 
treatment planning 
$0.00 
D0120 
Periodic oral evaluation – Established patient 
$0.00 
D0140 
Limited oral evaluation – Problem focused 
$0.00 
D0145 
Oral evaluation for a patient under 3 years of age and 
counseling with primary caregiver 
$0.00 
D0150 
Comprehensive oral evaluation – New or established patient 
$0.00 
D0160 
Detailed and extensive oral evaluation - Problem focused, by 
report (limit 2 per calendar year; only covered in conjunction with 
Temporomandibular Joint (TMJ) evaluation) 
$0.00 
D0170 
Re-evaluation – Limited, problem focused (established patient; 
not post-operative visit) 
$0.00 
D0171 
Re-evaluation – Post-operative office visit 
$0.00 
D0180 
Comprehensive periodontal evaluation – New or 
$70.00 
  
established patient 
  
D0210 
X-rays intraoral – Comprehensive series of radiographic 
$0.00 
  
images (limited to 1 D0210 or D0709 every 3 years) 
  
D0220 
X-rays intraoral – Periapical – First radiographic image 
$0.00 
D0230 
X-rays intraoral – Periapical – Each additional 
$0.00 
  
radiographic image 
  
D0240 
X-rays intraoral – Occlusal radiographic image 
$0.00 
D0250 
X-rays extra-oral – 2D projection radiographic image 
$0.00 
  
created using a stationary radiation source, and detector 
  
D0251 
X-rays extra-oral posterior dental radiographic image 
$0.00 
  
(limit 1 D0251 or D0705 per calendar year) 
  
D0270 
X-rays (bitewing) – Single radiographic image 
$0.00 
D0272 
X-rays (bitewings) – 2 radiographic images 
$0.00 
D0273 
X-rays (bitewings) – 3 radiographic images 
$0.00 
D0274 
X-rays (bitewings) – 4 radiographic images 
$0.00 
D0277 
X-rays (bitewings, vertical) – 7 to 8 radiographic images 
$0.00 
D0330 
X-rays (panoramic radiographic image) – (limited to 1 
$0.00 
  
D0330 or D0701 every 3 years) (when utilized for orthodontic 
  
  
services, see D8999) 
  
D0340 
2D cephalometric radiographic image - Acquisition, 
$0.00 
  
measurement and analysis (when utilized for orthodontic 
  
  
services, see D8999) 
  
D0350 
2D oral/facial photographic images obtained intra-orally 
$0.00 
  
or extra-orally (when utilized for orthodontic services, see 
  
  
D8999) 
  
D0368 
Cone beam CT capture and interpretation for TMJ series 
$240.00 
  
including two or more exposures (limit 1 per calendar 
  
  
year; only covered in conjunction with Temporomandibular 
  
  
Joint (TMJ) evaluation) 
  
D0372 
Intraoral tomosynthesis – Comprehensive series of 
$0.00 
  
radiographic images 
  
D0373 
Intraoral tomosynthesis – Bitewing radiographic image 
$0.00 
D0374 
Intraoral tomosynthesis – Periapical radiographic image 
$0.00 
D0387 
Intraoral tomosynthesis – Comprehensive series of 
$0.00 
  
radiographic images – Image capture only 
  
D0388 
Intraoral tomosynthesis – Bitewing radiographic image 
$0.00 
  
– Image capture only 
  
D0389 
Intraoral tomosynthesis – Periapical radiographic image 
$0.00 
  
– Image capture only 
  
D0391 
Interpretation of diagnostic image by a practitioner not 
$0.00

SERIAL 250052-RFP 
associated with capture of the image, including report 
D0393 
Virtual treatment simulation using 3D image volume or 
$0.00 
surface scan 
D0394 
Digital subtraction of two or more images or image 
$0.00 
volumes of the same modality 
D0395 
Fusion of two or more 3D image volumes of one or more 
$0.00 
modalities 
D0396 
3D printing of a 3D dental surface scan 
$0.00 
D0414 
Laboratory processing of microbial specimen to include 
$0.00 
culture and sensitivity studies, preparation, and 
transmission of written report 
D0431 
Oral cancer screening using a special light source 
$50.00 
D0460 
Pulp vitality tests 
$14.00 
D0470 
Diagnostic casts (when utilized for orthodontic services, 
$0.00 
see D8999) 
D0472 
Pathology report – Gross examination of lesion (only 
$0.00 
when tooth related) 
D0473 
Pathology report – Microscopic examination of lesion 
$0.00 
(only when tooth related) 
D0474 
Pathology report – Microscopic examination of lesion 
$0.00 
and area (only when tooth related) 
D0600 
Non-ionizing diagnostic procedure capable of 
$0.00 
quantifying, monitoring and recording changes in 
structure of enamel, dentin and cementum 
D0701 
X-rays (panoramic radiographic image) – Image capture
$0.00 
only (limited to 1 D0330 or D0701 every 3 years) (when
utilized for orthodontic services, see D8999)
D0702 
2D cephalometric radiographic image – Image capture 
$0.00 
only (when utilized for orthodontic services, see D8999) 
D0703 
2D oral/facial photographic image obtained intra-orally 
$0.00 
or extra-orally – Image capture only (when utilized for 
orthodontic services, see D8999) 
D0705 
X-rays extra-oral posterior dental radiographic image –
$0.00 
Image capture only (limited to 1 D0251 or D0705 per
calendar year)
D0706 
X-rays intraoral – Occlusal radiographic image – Image
$0.00 
capture only
D0707 
X-rays intraoral – Periapical radiographic image – Image
$0.00 
capture only
D0708 
X-rays intraoral – Bitewing radiographic image – Image
$0.00 
capture only
D0709 
X-rays intraoral – Comprehensive series of radiographic
$0.00 
images – Image capture only (limit 1 D0210 or D0709 every
3 years)
D0801 
3D dental surface scan – Direct (when utilized for 
$0.00 
orthodontic services, see D8999) 
D0802 
3D dental surface scan – Indirect (when utilized for 
$0.00 
orthodontic services, see D8999) 
D0803 
3D facial surface scan – Direct (when utilized for 
$0.00 
orthodontic services, see D8999) 
D0804 
3D facial surface scan – Indirect (when utilized for 
$0.00 
orthodontic services, see D8999) 
D1110 
Prophylaxis (cleaning) – Adult (limit 2 per calendar year) 
$0.00 
Additional prophylaxis (cleaning) – In addition to the 2 
$45.00 
prophylaxes (cleanings) allowed per calendar year 
D1120 
Prophylaxis (cleaning) – Child (limit 2 per calendar year) 
$0.00

SERIAL 250052-RFP 
 
  
Additional prophylaxis (cleaning) – In addition to the 2 
$30.00 
  
prophylaxes (cleanings) allowed per calendar year 
  
D1206 
Topical application of fluoride varnish (limit 2 per calendar 
$0.00 
  
year). There is a combined limit of a total of 2 D1206s and/ 
  
  
or D1208s per calendar year. 
  
  
Additional topical application of fluoride varnish in 
$15.00 
  
addition to any combination of two (2) D1206s (topical 
  
  
application of fluoride varnish) and/or D1208s (topical 
  
  
application of fluoride - excluding varnish) per calendar year 
  
D1208 
Topical application of fluoride - Excluding varnish (limit 
$0.00 
  
2 per calendar year) There is a combined limit of a total of 
  
  
2 D1208s and/or D1206s per calendar year. 
  
  
Additional topical application of fluoride - Excluding 
$15.00 
  
varnish - In addition to any combination of two (2) 
  
  
D1206s (topical applications of fluoride varnish) and/or 
  
  
D1208s (topical application of fluoride - excluding 
  
  
varnish) per calendar year 
  
D1310 
Nutritional counseling for control of dental disease 
$0.00 
D1330 
Oral hygiene instructions 
$0.00 
D1351 
Sealant – Per tooth 
$17.00 
D1352 
Preventive resin restoration in a moderate to high caries 
$17.00 
  
risk patient – Permanent tooth 
  
D1353 
Sealant repair – Per tooth 
$11.00 
D1354 
Application of caries arresting medicament - Per tooth 
$0.00 
D1355 
Caries preventive medicament application – Per tooth 
$0.00 
D1510 
Space maintainer – Fixed - Unilateral - Per quadrant 
$110.00 
D1516 
Space maintainer – Fixed – Bilateral, upper 
$170.00 
D1517 
Space maintainer – Fixed – Bilateral, lower 
$170.00 
D1520 
Space maintainer – Removable - Unilateral - Per quadrant 
$110.00 
D1526 
Space maintainer – Removable – Bilateral, upper 
$170.00 
D1527 
Space maintainer – Removable – Bilateral, lower 
$170.00 
D1551 
Re-cement or re-bond bilateral space maintainer – Upper 
$0.00 
D1552 
Re-cement or re-bond bilateral space maintainer – Lower 
$0.00 
D1553 
Re-cement or re-bond unilateral space maintainer – Per 
$0.00 
  
quadrant 
  
D1556 
Removal of fixed unilateral space maintainer – Per 
$0.00 
  
quadrant 
  
D1557 
Removal of fixed bilateral space maintainer – Upper 
$0.00 
D1558 
Removal of fixed bilateral space maintainer – Lower 
$0.00 
D1575 
Distal shoe space maintainer – Fixed, Unilateral - Per 
$121.00 
  
quadrant 
  
Restorative (fillings - primary or permanent teeth, including polishing) 
D2140 
Amalgam – 1 surface, primary or permanent 
$23.00 
D2150 
Amalgam – 2 surfaces, primary or permanent 
$28.00 
D2160 
Amalgam – 3 surfaces, primary or permanent 
$33.00 
D2161 
Amalgam – 4 or more surfaces, primary or permanent 
$40.00 
D2330 
Resin-based composite – 1 surface, anterior 
$33.00 
D2331 
Resin-based composite – 2 surfaces, anterior 
$40.00 
D2332 
Resin-based composite – 3 surfaces, anterior 
$47.00 
D2335 
Resin-based composite – 4 or more surfaces, anterior 
$88.00 
D2390 
Resin-based composite crown, anterior 
$140.00 
D2391 
Resin-based composite – 1 surface, posterior 
$47.00 
D2392 
Resin-based composite – 2 surfaces, posterior 
$59.00 
D2393 
Resin-based composite – 3 surfaces, posterior 
$82.00 
D2394 
Resin-based composite – 4 or more surfaces, posterior 
$115.00

SERIAL 250052-RFP 
 
Crown and bridge – All charges for crowns and bridges (fixed partial dentures) are per unit (each replacement 
or supporting tooth equals 1 unit). Coverage for replacement of crowns and bridges is limited to 1 every 5 
years. 
For single crowns, retainer (“abutment”) crowns, and pontics: The charges below include the cost of 
predominantly base metal alloy. Patient may be charged an additional amount, based on the type of material 
the dentist uses for patient’s restoration. Patient may be charged: 
• No more than $80.00 per tooth for any noble metal alloys 
• No more than $130.00 per tooth for any high noble metal alloys, titanium or titanium alloys 
• No more than $100.00 per tooth for any porcelain fused to metal (only on molar teeth) 
• No more than $100.00 per tooth if an indirectly fabricated (“cast”) post and core is made of high noble 
metal alloy 
• Porcelain/ceramic substrate crowns on molar teeth are not covered. 
If patient’s dentist offers same day in-office CAD/CAM (ceramic) services, they may charge an additional fee 
of no more than $150.00 per tooth/unit for crowns, bridges, inlays, onlays, post and cores, and veneers. 
Same day in-office CAD/ CAM (ceramic) services refer to dental restorations that are created and delivered 
in the dental office the same day using a digital impression and an in-office CAD/CAM milling machine. 
D2510 
Inlay – Metallic – 1 surface 
$435.00 
D2520 
Inlay – Metallic – 2 surfaces 
$435.00 
D2530 
Inlay – Metallic – 3 or more surfaces 
$435.00 
D2542 
Onlay – Metallic – 2 surfaces 
$505.00 
D2543 
Onlay – Metallic – 3 surfaces 
$505.00 
D2544 
Onlay – Metallic – 4 or more surfaces 
$505.00 
D2710 
Crown – Resin-based composite, indirect 
$265.00 
D2712 
Crown – 3/4 resin-based composite, indirect 
$380.00 
D2720 
Crown – Resin with high noble metal 
$260.00 
D2721 
Crown – Resin with predominantly base metal 
$345.00 
D2722 
Crown – Resin with noble metal 
$285.00 
D2740 
Crown – Porcelain/ceramic 
$520.00 
D2750 
Crown – Porcelain fused to high noble metal 
$350.00 
D2751 
Crown – Porcelain fused to predominantly base metal 
$425.00 
D2752 
Crown – Porcelain fused to noble metal 
$370.00 
D2753 
Crown - Porcelain fused to titanium and titanium alloys 
$350.00 
D2780 
Crown – 3/4 cast high noble metal 
$360.00 
D2781 
Crown – 3/4 cast predominantly base metal 
$435.00 
D2782 
Crown – 3/4 cast noble metal 
$380.00 
D2783 
Crown – 3/4 porcelain/ceramic 
$520.00 
D2790 
Crown – Full cast high noble metal 
$360.00 
D2791 
Crown – Full cast predominantly base metal 
$435.00 
D2792 
Crown – Full cast noble metal 
$380.00 
D2794 
Crown – Titanium and titanium alloys 
$360.00 
D2799 
Interim crown (not to be used as a temporary crown for a 
$140.00 
  
routine prosthetic restoration) 
  
D2910 
Re-cement or re-bond inlay, onlay, veneer or partial 
$43.00 
  
coverage restoration 
  
D2915 
Re-cement or re-bond indirectly fabricated or 
$43.00 
  
prefabricated post and core 
  
D2920 
Re-cement or re-bond crown 
$43.00 
D2928 
Prefabricated porcelain/ceramic crown – Permanent 
$155.00 
  
tooth 
  
D2929 
Prefabricated porcelain/ceramic crown - Primary tooth 
$155.00 
D2930 
Prefabricated stainless steel crown – Primary tooth 
$110.00 
D2931 
Prefabricated stainless steel crown – Permanent tooth 
$110.00 
D2932 
Prefabricated resin crown 
$135.00 
D2933 
Prefabricated stainless steel crown with resin window 
$155.00 
D2934 
Prefabricated esthetic coated stainless steel crown – 
$155.00 
  
Primary tooth

SERIAL 250052-RFP 
 
D2940 
Protective restoration 
$24.00 
D2941 
Interim therapeutic restoration - Primary dentition 
$24.00 
D2950 
Core buildup – Including any pins 
$125.00 
D2951 
Pin retention – Per tooth – In addition to restoration 
$29.00 
D2952 
Post and core – In addition to crown, indirectly fabricated 
$170.00 
D2954 
Prefabricated post and core – In addition to crown 
$140.00 
D2960 
Labial veneer (resin laminate) – Direct 
$130.00 
D2976 
Band stabilization – Per tooth 
$0.00 
D2980 
Crown repair necessitated by restorative material failure 
$24.00 
D2983 
Veneer repair necessitated by restorative material failure 
$24.00 
D2989 
Excavation of a tooth resulting in the determination of 
$185.00 
  
non-restorability 
  
D2991 
Application of hydroxyapatite regeneration medicament 
$17.00 
  
- Per tooth 
  
D6210 
Pontic – Cast high noble metal 
$350.00 
D6211 
Pontic – Cast predominantly base metal 
$435.00 
D6212 
Pontic – Cast noble metal 
$380.00 
D6214 
Pontic – Titanium and titanium alloys 
$360.00 
D6240 
Pontic – Porcelain fused to high noble metal 
$350.00 
D6241 
Pontic – Porcelain fused to predominantly base metal 
$435.00 
D6242 
Pontic – Porcelain fused to noble metal 
$380.00 
D6243 
Pontic – Porcelain fused to titanium and titanium alloys 
$350.00 
D6245 
Pontic – Porcelain/ceramic 
$480.00 
D6602 
Retainer inlay – Cast high noble metal, 2 surfaces 
$340.00 
D6603 
Retainer inlay – Cast high noble metal, 3 or more surfaces 
$360.00 
D6604 
Retainer inlay – Cast predominantly base metal, 2 
$415.00 
  
surfaces 
  
D6605 
Retainer inlay – Cast predominantly base metal, 3 or 
$425.00 
  
more surfaces 
  
D6606 
Retainer inlay – Cast noble metal, 2 surfaces 
$360.00 
D6607 
Retainer inlay – Cast noble metal, 3 or more surfaces 
$360.00 
D6610 
Retainer onlay – Cast high noble metal, 2 surfaces 
$340.00 
D6611 
Retainer onlay – Cast high noble metal, 3 or more 
$360.00 
  
surfaces 
  
D6612 
Retainer onlay – Cast predominantly base metal, 2 
$415.00 
  
surfaces 
  
D6613 
Retainer onlay – Cast predominantly base metal, 3 or 
$425.00 
  
more surfaces 
  
D6614 
Retainer onlay – Cast noble metal, 2 surfaces 
$360.00 
D6615 
Retainer onlay – Cast noble metal, 3 or more surfaces 
$370.00 
D6624 
Retainer inlay – Titanium 
$350.00 
D6634 
Retainer onlay – Titanium 
$350.00 
D6740 
Retainer crown – Porcelain/ceramic 
$530.00 
D6750 
Retainer crown – Porcelain fused to high noble metal 
$360.00 
D6751 
Retainer crown – Porcelain fused to predominantly base 
$435.00 
  
metal 
  
D6752 
Retainer crown – Porcelain fused to noble metal 
$380.00 
D6753 
Retainer crown – Porcelain fused to titanium and 
$360.00 
  
titanium alloys 
  
D6780 
Retainer crown – 3/4 cast high noble metal 
$360.00 
D6781 
Retainer crown – 3/4 cast predominantly base metal 
$435.00 
D6782 
Retainer crown – 3/4 cast noble metal 
$380.00 
D6784 
Retainer crown - 3/4 titanium and titanium alloys 
$360.00 
D6790 
Retainer crown – Full cast high noble metal 
$360.00 
D6791 
Retainer crown – Full cast predominantly base metal 
$435.00

SERIAL 250052-RFP 
 
D6792 
Retainer crown – Full cast noble metal 
$380.00 
D6794 
Retainer crown – Titanium and titanium alloys 
$360.00 
D6930 
Re-cement or re-bond fixed partial denture 
$65.00 
  
Complex rehabilitation – An additional charge per 
$135.00 
  
crown/bridge unit when there are 6 or more units of 
  
  
crown and/or bridge in the same treatment plan – ask patient’s 
  
  
dentist for the guidelines 
  
Endodontics (root canal treatment, excluding final restorations) 
Gingival and/or osseous regenerative procedures (ie. grafting of gum tissue and/or bone) are limited to one 
regenerative procedure per site (or per tooth, if applicable). 
D3110 
Pulp cap – Direct (excluding final restoration) 
$38.00 
D3120 
Pulp cap – Indirect (excluding final restoration) 
$38.00 
D3220 
Pulpotomy – Removal of pulp, not part of a root canal 
$97.00 
D3221 
Pulpal debridement (not to be used when root canal is 
$110.00 
  
done on the same day) 
  
D3222 
Partial pulpotomy for apexogenesis – Permanent tooth 
$110.00 
  
with incomplete root development 
  
D3310 
Anterior root canal – Permanent tooth (excluding final 
$375.00 
  
restoration) 
  
D3320 
Premolar root canal – Permanent tooth (excluding final 
$445.00 
  
restoration) 
  
D3330 
Molar root canal – Permanent tooth (excluding final 
$595.00 
  
restoration) 
  
D3331 
Treatment of root canal obstruction – Nonsurgical access 
$170.00 
D3332 
Incomplete endodontic therapy – Inoperable, 
$185.00 
  
unrestorable or fractured tooth 
  
D3333 
Internal root repair of perforation defects 
$175.00 
D3346 
Retreatment of previous root canal therapy – Anterior 
$535.00 
D3347 
Retreatment of previous root canal therapy – Premolar 
$605.00 
D3348 
Retreatment of previous root canal therapy – Molar 
$710.00 
D3410 
Apicoectomy/periradicular surgery – Anterior 
$440.00 
D3421 
Apicoectomy/periradicular surgery – Premolar (first root) 
$470.00 
D3425 
Apicoectomy/periradicular surgery – Molar (first root) 
$540.00 
D3426 
Apicoectomy/periradicular surgery (each additional root) 
$180.00 
D3430 
Retrograde filling per root 
$130.00 
D3471 
Surgical repair of root resorption – Anterior 
$440.00 
D3472 
Surgical repair of root resorption – Premolar 
$440.00 
D3473 
Surgical repair of root resorption – Molar 
$440.00 
D3501 
Surgical exposure of root surface without apicoectomy 
$440.00 
  
or repair of root resorption – Anterior 
  
D3502 
Surgical exposure of root surface without apicoectomy 
$440.00 
  
or repair of root resorption – Premolar 
  
D3503 
Surgical exposure of root surface without apicoectomy 
$440.00 
  
or repair of root resorption – Molar 
  
D3911 
Intraorifice barrier 
$0.00 
D3921 
Decoronation or submergence of an erupted tooth 
$440.00 
Periodontics (treatment of supporting tissues (gum and bone) of the teeth) - Gingival and/or osseous 
regenerative procedures (gum tissue and/or bone) are limited to 1 regenerative procedure per site (or per 
tooth, if applicable). Localized delivery of antimicrobial agents is limited to 8 teeth (or 8 sites, if applicable) 
and coverage is restricted to one per tooth per 12 consecutive months. The use of any tools or equipment, 
including but not limited to handpieces, lasers, scalers, etc., is considered inclusive to the overall covered 
procedure listed on the Patient Charge Schedule, and cannot be separately charged. 
D4210 
Gingivectomy or gingivoplasty – 4 or more teeth per 
$320.00 
  
quadrant 
  
D4211 
Gingivectomy or gingivoplasty – 1 to 3 teeth per 
$160.00

SERIAL 250052-RFP 
 
  
quadrant 
  
D4212 
Gingivectomy or gingivoplasty to allow access for 
$160.00 
  
restorative procedure, per tooth 
  
D4240 
Gingival flap (including root planing) – 4 or more teeth 
$365.00 
  
per quadrant 
  
D4241 
Gingival flap (including root planing) – 1 to 3 teeth per 
$220.00 
  
quadrant 
  
D4245 
Apically positioned flap 
$365.00 
D4249 
Clinical crown lengthening – Hard tissue 
$405.00 
D4260 
Osseous surgery – 4 or more teeth per quadrant 
$640.00 
D4261 
Osseous surgery – 1 to 3 teeth per quadrant 
$385.00 
D4263 
Bone replacement graft – Retained natural tooth - First 
$290.00 
  
site in quadrant 
  
D4264 
Bone replacement graft – Retained natural tooth - Each 
$225.00 
  
additional site in quadrant 
  
D4266 
Guided tissue regeneration, natural teeth – Resorbable 
$380.00 
  
barrier per site 
  
D4267 
Guided tissue regeneration, natural teeth – 
$430.00 
  
Nonresorbable barrier per site (includes membrane 
  
  
removal) 
  
D4270 
Pedicle soft tissue graft procedure 
$495.00 
D4275 
Non-autogenous connective tissue graft (including 
$495.00 
  
recipient site and donor material) first tooth, implant, or 
  
  
edentulous tooth position in graft 
  
D4277 
Free soft tissue graft procedure (including recipient and 
$495.00 
  
donor surgical sites), first tooth, implant or edentulous 
  
  
(missing) tooth position in graft 
  
D4278 
Free soft tissue graft procedure (including recipient and 
$250.00 
  
donor surgical sites), each additional contiguous tooth, 
  
  
implant or edentulous (missing) tooth position in same 
  
  
graft site 
  
D4285 
Non-autogenous connective tissue graft procedure 
$248.00 
  
(including recipient surgical site and donor materials) – 
  
  
Each additional contiguous tooth, implant or edentulous 
  
  
tooth position in same graft site 
  
D4286 
Removal of non-resorbable barrier 
$86.00 
D4341 
Periodontal scaling and root planing – 4 or more teeth 
$135.00 
  
per quadrant (limited to once per quadrant per consecutive 
  
  
12 months) 
  
D4342 
Periodontal scaling and root planing – 1 to 3 teeth per 
$75.00 
  
quadrant (limited to once per quadrant per consecutive 12 
  
  
months) 
  
D4346 
Scaling in presence of generalized moderate or severe 
$0.00 
  
gingival inflammation – Full mouth, after oral evaluation 
  
  
(limit 1 per calendar year) 
  
  
Additional scaling in presence of generalized moderate 
$45.00 
  
or severe gingival inflammation – Full mouth, after oral 
  
  
evaluation (limit 2 per calendar year) 
  
D4355 
Full mouth debridement to enable a comprehensive 
$110.00 
  
periodontal evaluation and diagnosis on a subsequent 
  
  
visit (1 per lifetime, unless medically necessary) 
  
D4381 
Localized delivery of antimicrobial agents per tooth 
$45.00 
D4910 
Periodontal maintenance (limit 4 per calendar year (only 
$93.00 
  
covered after active periodontal therapy) 
  
  
Additional periodontal maintenance procedures (beyond 
$93.00 
  
4 per calendar year)

SERIAL 250052-RFP 
 
  
Periodontal charting for planning treatment of 
$0.00 
  
periodontal disease 
  
  
Periodontal hygiene instruction 
$0.00 
D4921 
Gingival irrigation with a medicinal agent - Per quadrant 
$0.00 
Prosthetics (removable tooth replacement – dentures) - Includes up to 4 adjustments within first 6 months 
after insertion – Replacement limit 1 every 5 years. Characterization is considered an upgrade with 
maximum additional charge to the member of $225.00 per denture. 
D5110 
Full upper denture 
$450.00 
D5120 
Full lower denture 
$450.00 
D5130 
Immediate full upper denture 
$480.00 
D5140 
Immediate full lower denture 
$480.00 
D5211 
Upper partial denture – Resin base (including retentive/ 
$285.00 
  
clasping materials, rests, and teeth) 
  
D5212 
Lower partial denture – Resin base (including retentive/ 
$285.00 
  
clasping materials, rests, and teeth) 
  
D5213 
Upper partial denture – Cast metal framework with resin 
$555.00 
  
denture bases (including retentive/clasping materials, 
  
  
rests and teeth) 
  
D5214 
Lower partial denture – Cast metal framework with resin 
$555.00 
  
denture bases (including retentive/clasping materials, 
  
  
rests and teeth) 
  
D5221 
Immediate upper partial denture – Resin base (including 
$285.00 
  
retentive/clasping materials, rests and teeth) 
  
D5222 
Immediate lower partial denture – Resin base (including 
$285.00 
  
retentive/clasping materials, rests and teeth) 
  
D5223 
Immediate upper partial denture – Cast metal framework 
$555.00 
  
with resin denture bases (including retentive/clasping 
  
  
materials, rests and teeth) 
  
D5224 
Immediate lower partial denture – Cast metal framework 
$555.00 
  
with resin denture bases (including retentive/clasping 
  
  
materials, rests and teeth) 
  
D5225 
Upper partial denture – Flexible base (including 
$355.00 
  
retentive/clasping materials, rests and teeth) 
  
D5226 
Lower partial denture – Flexible base (including 
$355.00 
  
retentive/clasping materials, rests and teeth) 
  
D5227 
Immediate upper partial denture - Flexible base 
$285.00 
  
(including any clasps, rests and teeth) 
  
D5228 
Immediate lower partial denture - Flexible base 
$285.00 
  
(including any clasps, rests and teeth) 
  
D5410 
Adjust complete denture – Upper 
$43.00 
D5411 
Adjust complete denture – Lower 
$43.00 
D5421 
Adjust partial denture – Upper 
$45.00 
D5422 
Adjust partial denture – Lower 
$45.00 
Repairs to prosthetics 
D5511 
Repair broken complete denture base - Lower 
$92.00 
D5512 
Repair broken complete denture base - Upper 
$92.00 
D5520 
Replace missing or broken teeth – Complete denture 
$81.00 
  
(each tooth) 
  
D5611 
Repair resin partial denture base - Lower 
$92.00 
D5612 
Repair resin partial denture base - Upper 
$92.00 
D5630 
Repair or replace broken retentive/clasping materials - 
$115.00 
  
Per tooth 
  
D5640 
Replace broken teeth – Per tooth 
$81.00 
D5650 
Add tooth to existing partial denture 
$92.00 
D5660 
Add clasp to existing partial denture - Per tooth 
$115.00 
Denture relining (limit 1 every 24 months)

SERIAL 250052-RFP 
 
D5710 
Rebase complete upper denture 
$260.00 
D5711 
Rebase complete lower denture 
$260.00 
D5720 
Rebase upper partial denture 
$260.00 
D5721 
Rebase lower partial denture 
$260.00 
D5725 
Rebase hybrid prosthesis 
$520.00 
D5730 
Reline complete upper denture – Direct 
$160.00 
D5731 
Reline complete lower denture – Direct 
$160.00 
D5740 
Reline upper partial denture – Direct 
$160.00 
D5741 
Reline lower partial denture – Direct 
$160.00 
D5750 
Reline complete upper denture – Indirect 
$220.00 
D5751 
Reline complete lower denture – Indirect 
$220.00 
D5760 
Reline upper partial denture – Indirect 
$220.00 
D5761 
Reline lower partial denture – Indirect 
$220.00 
D5765 
Soft liner for complete or partial removable denture – 
$220.00 
  
Indirect 
  
Interim dentures (limit 1 every 5 years) 
D5810 
Interim complete denture – Upper 
$405.00 
D5811 
Interim complete denture – Lower 
$405.00 
D5820 
Interim partial denture (including retentive/clasping 
$305.00 
  
materials, rests and teeth), upper 
  
D5821 
Interim partial denture (including retentive/clasping 
$305.00 
  
materials, rests and teeth), lower 
  
D5875 
Modification of removable prosthesis following implant 
$195.00 
  
surgery 
  
D5876 
Add metal substructure to acrylic full denture (per arch) 
$185.00 
Implant/abutment supported prosthetics – All charges for crowns and bridges (fixed partial dentures) are per 
unit (each replacement on a supporting implant(s) equals 1 unit). Coverage for replacement of crowns and 
bridges and implant supported dentures is limited to 1 every 5 years. 
For single crowns, retainer (“abutment”) crowns, and pontics: The charges below include the cost of 
predominantly base metal alloy. Patient may be charged an additional amount, based on the type of material 
the dentist uses for patient’s restoration. Patient may be charged: 
• No more than $80.00 per tooth for any noble metal alloys 
• No more than $130.00 per tooth for any high noble metal alloys, titanium or titanium alloys 
• No more than $100.00 per tooth for any porcelain fused to metal (only on molar teeth) 
• No more than $100.00 per tooth if an indirectly fabricated (“cast”) post and core is made of high noble 
metal alloy 
• Porcelain/ceramic substrate crowns on molar teeth are not covered. 
If patient’s dentist offers same day in-office CAD/CAM (ceramic) services, the dentist may charge an 
additional fee of no more than $150.00 per tooth/unit for crowns, bridges, inlays, onlays, post and cores, and 
veneers. Same day in-office CAD/ CAM (ceramic) services refer to dental restorations that are created and 
delivered in the dental office the same day using a digital impression and an in-office CAD/CAM milling 
machine. 
D6058 
Abutment supported porcelain/ceramic crown 
$820.00 
D6059 
Abutment supported porcelain fused to metal crown 
$650.00 
  
(high noble metal) 
  
D6060 
Abutment supported porcelain fused to metal crown 
$725.00 
  
(predominantly base metal) 
  
D6061 
Abutment supported porcelain fused to metal crown 
$670.00 
  
(noble metal) 
  
D6062 
Abutment supported cast metal crown (high noble 
$650.00 
  
metal) 
  
D6063 
Abutment supported cast metal crown (predominantly 
$725.00 
  
base metal) 
  
D6064 
Abutment supported cast metal crown (noble metal) 
$670.00 
D6065 
Implant supported porcelain/ceramic crown 
$820.00 
D6066 
Implant supported crown - Porcelain fused to high noble 
$650.00

SERIAL 250052-RFP 
 
  
alloys 
  
D6067 
Implant supported crown - High noble alloys 
$650.00 
D6068 
Abutment supported retainer for porcelain/ceramic fixed 
$820.00 
  
partial denture 
  
D6069 
Abutment supported retainer for porcelain fused to 
$650.00 
  
metal fixed partial denture (high noble metal) 
  
D6070 
Abutment supported retainer for porcelain fused to 
$725.00 
  
metal fixed partial denture (predominantly base metal) 
  
D6071 
Abutment supported retainer for porcelain fused to 
$670.00 
  
metal fixed partial denture (noble metal) 
  
D6072 
Abutment supported retainer for cast metal fixed partial 
$650.00 
  
denture (high noble metal) 
  
D6073 
Abutment supported retainer for cast metal fixed partial 
$725.00 
  
denture (predominantly base metal) 
  
D6074 
Abutment supported retainer for cast metal fixed partial 
$670.00 
  
denture (noble metal) 
  
D6075 
Implant supported retainer for ceramic fixed partial 
$820.00 
  
denture 
  
D6076 
Implant supported retainer for fixed partial denture - 
$650.00 
  
Porcelain fused to high noble alloys 
  
D6077 
Implant supported retainer for metal fixed partial denture 
$650.00 
  
- High noble alloys 
  
D6082 
Implant supported crown – Porcelain fused to 
$725.00 
  
predominantly base alloys 
  
D6083 
Implant supported crown – Porcelain fused to noble alloys 
$670.00 
D6084 
Implant supported crown – Porcelain fused to titanium 
$650.00 
  
and titanium alloys 
  
D6085 
Interim implant crown 
$140.00 
D6086 
Implant supported crown – Predominantly base alloys 
$725.00 
D6087 
Implant supported crown – Noble alloys 
$670.00 
D6088 
Implant supported crown – Titanium and titanium alloys 
$650.00 
D6089 
Accessing and retorquing loose implant screw – Per 
$82.00 
  
screw 
  
D6092 
Re-cement implant/abutment supported crown 
$82.00 
D6093 
Re-cement implant/abutment supported fixed partial 
$103.00 
  
denture 
  
D6094 
Abutment supported crown - Titanium and titanium alloys 
$650.00 
D6096 
Remove broken implant retaining screw 
$82.00 
D6097 
Abutment supported crown – Porcelain fused to 
$650.00 
  
titanium and titanium alloys 
  
D6098 
Implant supported retainer – Porcelain fused to 
$725.00 
  
predominantly base alloys 
  
D6099 
Implant supported retainer for fixed partial denture – 
$670.00 
  
Porcelain fused to noble alloys 
  
D6106 
Guided tissue regeneration – Resorbable barrier, per 
$380.00 
  
implant 
  
D6107 
Guided tissue regeneration – Non-resorbable barrier, 
$430.00 
  
per implant 
  
D6110 
Implant /abutment supported removable denture for 
$975.00 
  
edentulous arch – Upper 
  
D6111 
Implant /abutment supported removable denture for 
$975.00 
  
edentulous arch – Lower 
  
D6112 
Implant /abutment supported removable denture for 
$1,080.00 
  
partially edentulous arch – Upper 
  
D6113 
Implant /abutment supported removable denture for 
$1,080.00 
  
partially edentulous arch – Lower

SERIAL 250052-RFP 
 
D6114 
Implant /abutment supported fixed denture for 
$975.00 
  
edentulous arch – Upper 
  
D6115 
Implant /abutment supported fixed denture for 
$975.00 
  
edentulous arch – Lower 
  
D6116 
Implant /abutment supported fixed denture for partially 
$1,080.00 
  
edentulous arch – Upper 
  
D6117 
Implant /abutment supported fixed denture for partially 
$1,080.00 
  
edentulous arch – Lower 
  
D6118 
Implant/abutment supported interim fixed denture for 
$585.00 
  
edentulous arch – Lower 
  
D6119 
Implant/abutment supported interim fixed denture for 
$585.00 
  
edentulous arch – Upper 
  
D6120 
Implant supported retainer – Porcelain fused to titanium 
$650.00 
  
and titanium alloys 
  
D6121 
Implant supported retainer for metal fixed partial denture 
$725.00 
  
– Predominantly base alloys 
  
D6122 
Implant supported retainer for metal fixed partial denture 
$670.00 
  
– Noble alloys 
  
D6123 
Implant supported retainer for metal fixed partial denture 
$650.00 
  
– Titanium and titanium alloys 
  
D6194 
Abutment supported retainer crown for fixed partial 
$650.00 
  
denture - Titanium and titanium alloys 
  
D6195 
Abutment supported retainer – Porcelain fused to 
$650.00 
  
titanium and titanium alloys 
  
D6197 
Replacement of restorative material used to close an 
$47.00 
  
access opening of a screw-retained implant supported 
  
  
prosthesis, per implant 
  
D6198 
Remove interim implant component 
$0.00 
  
Complex rehabilitation on implant/abutment supported 
$135.00 
  
prosthetic procedures – An additional charge per crown/ 
  
  
bridge unit when there are 6 or more units of crown and/ 
  
  
or bridge in the same treatment – ask patient’s dentist for the 
  
  
guidelines 
  
Oral surgery (includes routine postoperative treatment) 
Surgical removal of impacted teeth are covered for ages below 15 when medically necessary. 
D7111 
Extraction of coronal remnants – Primary tooth 
$60.00 
D7140 
Extraction, erupted tooth or exposed root – Elevation 
$64.00 
  
and/or forceps removal 
  
D7210 
Extraction, erupted tooth – Removal of bone and/or 
$155.00 
  
section of tooth 
  
D7220 
Removal of impacted tooth – Soft tissue 
$165.00 
D7230 
Removal of impacted tooth – Partially bony 
$225.00 
D7240 
Removal of impacted tooth – Completely bony 
$300.00 
D7241 
Removal of impacted tooth – Completely bony, unusual 
$315.00 
  
complications (narrative required) 
  
D7250 
Removal of residual tooth roots – Cutting procedure 
$155.00 
D7251 
Coronectomy – Intentional partial tooth removal, 
$225.00 
  
impacted teeth only 
  
D7260 
Oroantral fistula closure 
$470.00 
D7261 
Primary closure of a sinus perforation 
$415.00 
D7270 
Tooth stabilization of accidentally evulsed or displaced tooth 
$210.00 
D7280 
Exposure of an unerupted tooth (excluding wisdom teeth) 
$270.00 
D7283 
Placement of device to facilitate eruption of impacted tooth 
$68.00 
D7285 
Incisional biopsy of oral tissue – Hard (bone, tooth) (tooth 
$225.00 
  
related – not allowed when in conjunction with another

SERIAL 250052-RFP 
 
  
surgical procedure) 
  
D7286 
Incisional biopsy of oral tissue – Soft (all others) (tooth 
$190.00 
  
related – not allowed when in conjunction with another 
  
  
surgical procedure) 
  
D7287 
Exfoliative cytological sample collection 
$78.00 
D7288 
Brush biopsy – Transepithelial sample collection 
$78.00 
D7310 
Alveoloplasty in conjunction with extractions – 4 or more 
$130.00 
  
teeth or tooth spaces per quadrant 
  
D7311 
Alveoloplasty in conjunction with extractions – 1 to 3 
$68.00 
  
teeth or tooth spaces per quadrant 
  
D7320 
Alveoloplasty not in conjunction with extractions – 4 or 
$165.00 
  
more teeth or tooth spaces per quadrant 
  
D7321 
Alveoloplasty not in conjunction with extractions – 1 to 
$81.00 
  
3 teeth or tooth spaces per quadrant 
  
D7450 
Removal of benign odontogenic cyst or tumor – Up to 
$260.00 
  
1.25 cm 
  
D7451 
Removal of benign odontogenic cyst or tumor – Greater 
$260.00 
  
than 1.25 cm 
  
D7471 
Removal of lateral exostosis – Maxilla or mandible 
$275.00 
D7472 
Removal of torus palatinus 
$275.00 
D7473 
Removal of torus mandibularis 
$275.00 
D7485 
Reduction of osseous tuberosity 
$165.00 
D7510 
Incision and drainage of abscess – Intraoral soft tissue 
$110.00 
D7511 
Incision and drainage of abscess – Intraoral soft tissue 
$165.00 
  
complicated 
  
D7880 
Occlusal orthotic device, by report - (limit 1 per 24 months; 
$575.00 
  
only covered in conjunction with Temporomandibular Joint 
  
  
(TMJ) treatment) 
  
D7881 
Occlusal orthotic device adjustment 
$43.00 
D7922 
Placement of intra-socket biological dressing to aid in 
$0.00 
  
hemostasis or clot stabilization, per site 
  
D7961 
Buccal/labial frenectomy (frenulectomy) 
$180.00 
D7963 
Frenuloplasty 
$220.00 
Orthodontics (tooth movement) - The Patient Charge for patient’s entire orthodontic case, including 
retention, will be based upon the applicable charge in effect on the date patient’s orthodontic treatment 
begins (banding/ appliance insertion). Coverage is provided for twenty-four (24) months of active treatment. 
Cases beyond 24 months require an additional payment by the patient. 
D8010 
Limited orthodontic treatment of the primary dentition 
$480.00 
  
- Banding 
  
D8020 
Limited orthodontic treatment of the transitional 
$480.00 
  
dentition – Banding 
  
D8030 
Limited orthodontic treatment of the adolescent 
$230.00 
  
dentition – Banding 
  
D8040 
Limited orthodontic treatment of the adult dentition – 
$260.00 
  
Banding 
  
D8070 
Comprehensive orthodontic treatment of the transitional 
$500.00 
  
dentition – Banding 
  
D8080 
Comprehensive orthodontic treatment of the adolescent 
$515.00 
  
dentition – Banding 
  
D8090 
Comprehensive orthodontic treatment of the adult 
$515.00 
  
dentition – Banding 
  
D8660 
Pre-orthodontic treatment examination to monitor 
$66.00 
  
growth and development 
  
D8670 
Periodic orthodontic treatment visit 
  
  
Children – Up to 19th birthday: 
  
  
24-month treatment fee 
$2,472.00

SERIAL 250052-RFP 
 
  
Charge per month for 24 months 
$103.00 
  
Adults: 
  
  
24-month treatment fee 
$3,384.00 
  
Charge per month for 24 months 
$141.00 
D8680 
Orthodontic retention – Removal of appliances, 
$345.00 
  
construction and placement of retainer(s) 
  
D8681 
Removable orthodontic retainer adjustment 
$0.00 
D8695 
Removal of fixed orthodontic appliances for reasons 
$175.00 
  
other than completion of treatment 
  
D8999 
Unspecified orthodontic procedure – By report (orthodontic 
treatment plan and records including all necessary images) 
$195.00 
General anesthesia/IV sedation: coverage is provided when medically necessary for covered surgical 
procedures listed on the Patient Charge Schedule. Clinical guidelines related to the use of general 
anesthesia/IV sedation should be discussed with patient’s treating network specialist. 
D9215 
Local anesthesia 
$0.00 
D9222 
Deep sedation/general anesthesia – First 15 minutes 
$95.00 
D9223 
Deep sedation/general anesthesia – Each subsequent 
$95.00 
  
15 minute increment 
  
D9230 
Inhalation of nitrous oxide / analgesia, anxiolysis 
$60.00 
D9239 
Intravenous moderate (conscious) sedation/anesthesia 
$95.00 
  
– First 15 minutes 
  
D9243 
Intravenous moderate (conscious) sedation/analgesia - 
$95.00 
  
Each subsequent 15 minute increment 
  
D9613 
Infiltration of sustained release therapeutic drug, per 
$50.00 
  
quadrant (patient charge is per quadrant) 
  
D9910 
Application of desensitizing medicament 
$15.00 
D9911 
Application of desensitizing resin for cervical and/or root 
$0.00 
  
surface, per tooth 
  
Emergency services 
D9110 
Palliative treatment of dental pain – Per visit 
$65.00 
D9440 
Office visit – After regularly scheduled hours 
$77.00 
Miscellaneous services 
D9912 
Pre-visit patient screening 
$0.00 
D9938 
Fabrication of a custom removable clear plastic 
$101.00 
  
temporary aesthetic appliance 
  
D9939 
Placement of a custom removable clear plastic 
$31.00 
  
temporary aesthetic appliance 
  
D9941 
Fabrication of athletic mouthguard (limit 1 per 12 months) 
$110.00 
D9943 
Occlusal guard adjustment 
$0.00 
D9944 
Occlusal guard – Hard appliance, full arch (limited to 1 
$360.00 
  
D9944, D9945 or D9946 per 24 months) 
  
D9945 
Occlusal guard – Soft appliance, full arch (limited to 1 
$180.00 
  
D9944, D9945 or D9946 per 24 months) 
  
D9946 
Occlusal guard – Hard appliance, partial arch (limited to 
$215.00 
  
1 D9944, D9945 or D9946 per 24 months) 
  
D9951 
Occlusal adjustment – Limited 
$71.00 
D9952 
Occlusal adjustment – Complete 
$330.00 
D9961 
Duplicate/copy patient's records 
$0.00 
D9975 
External bleaching for home application, per arch; 
$165.00 
  
includes materials and fabrication of custom trays (all 
  
  
other methods of bleaching are not covered) 
  
D9990 
Certified translation or sign language services, per visit 
$0.00 
D9995 
Teledentistry – Synchronous; real-time encounter 
$0.00 
D9996 
Teledentistry – Asynchronous; information stored and 
$0.00 
  
forwarded to dentist for subsequent review

SERIAL 250052-RFP 
This may contain CDT Dental Procedure Codes and/or portions of, or excerpts from the Code on Dental 
Procedures and Nomenclature (CDT Code) contained within the current version of the “Dental Procedure 
Codes”, a copyrighted publication provided by the American Dental Association. The American Dental 
Association does not endorse any codes which are not included in its current publication. 
After member enrollment is effective: 
Call the dental office identified in the member Welcome Kit.  If member wishes to change dental offices, a transfer 
can be arranged at no charge by calling the toll free number listed on the member ID card or plan materials. 
Multiple ways to locate a Network General Dentist: 
- On-line provider directory at Cigna.com® 
- On-line provider directory on myCigna.com® 
- Call the number located on the member ID card to:
- Use the Dental Office Locator via Speech Recognition Speak to a Customer Service Representative
EMERGENCY: If member has a dental emergency as defined in the member’s  group’s plan documents, contact the 
member Network General Dentist as soon as possible. If the member is out of member’s service area or unable to 
contact the member’s Network Office, emergency care can be rendered by any dental office, dental clinic, or other 
comparable facility. Emergency dental care is limited to services to evaluate, diagnose, and relieve pain or stabilize 
the member’s emergent oral condition. The memer should then return to the member’s Network General Dentist for 
evaluation and determination of any follow up care that the member may require. Consult the member’s group’s plan 
documents for a complete definition of dental emergency, member’s emergency benefit and a listing of Exclusions 
and Limitations. 
Product availability may vary by location and plan type and is subject to change. All group health insurance policies 
and health benefit plans contain exclusions and limitations. For costs and details of coverage, review the member’s 
plan documents or contact a Cigna Healthcare representative. Cigna Healthcare products and services are provided 
exclusively by or through operating subsidiaries of The Cigna Group, including Cigna Health and Life Insurance 
Company (Bloomfield, CT.) (CHLIC), Cigna HealthCare of Connecticut, Inc., and Cigna Dental Health, Inc. and its 
subsidiaries, including Cigna Dental Health Plan of Arizona, Inc., Cigna Dental Health of California, Inc., Cigna Dental 
Health of Colorado, Inc., Cigna Dental Health of Delaware, Inc., Cigna Dental Health of Florida, Inc., a Prepaid 
Limited Health Services Organization licensed under Chapter 636, Florida Statutes, Cigna Dental Health of 
Kansas, Inc. (KS & NE), Cigna Dental Health of Kentucky, Inc. (KY & IL), Cigna Dental Health of Maryland, Inc., Cigna 
Dental Health of Missouri, Inc., Cigna Dental Health of New Jersey, Inc., Cigna Dental Health of North Carolina, Inc., 
Cigna Dental Health of Ohio, Inc., Cigna Dental Health of Pennsylvania, Inc., Cigna Dental Health of Texas, Inc., and 
Cigna Dental Health of Virginia, Inc. In Utah, all products and services are provided by Cigna Health and Life Insurance 
Company 
(Bloomfield, 
CT). 
HC-PCSAZ5V0 
 36 
 864117 d revised 1/1/25 © 2023 Cigna. Some content provided under 
license.

SERIAL# 250052-RFP 
 
 
EXHIBIT D – IMPLEMENTATION PLAN 
 
The dates included in this Implementation Project Plan are subject to change. If a change is necessary, Cigna will work with the County to reach a new 
agreement  
that reflects the changes in circumstances. (Note: This document is a sample of the working document.) 
 
Responsibility 
Task 
Cigna Maricopa 
County 
Target 
Completio
n Date 
Actual 
Completion 
Date 
Comments 
Overall Implementation 
 
 
Notification of Sale 
 
X 
5/30/25 
Hold Customer Interface Session (CIS)/Implementation 
Meeting 
(Discuss benefits, HIPAA elections, reporting, structure, billing, 
eligibility, pre- and post-enrollment materials, ID cards, 
schedule ongoing weekly implementation status calls ) 
X 
X 
 
 
 
6/16/2025 
Provide updated documents with changes from the 
Implementation Meeting 
X 
 
 
6/18/2025 
First Weekly Implementation Call 
X 
X 
6/27/2025 
Client Approval: Administrative Summary 
 
X 
6/27/2025 
Go Live Date 
X 
X 
1/1/2026 
Celebrate Implementation Success & discuss ongoing 
reporting/administrative procedures 
X 
X 
1/30/2026 
Complete Post Implementation Survey received from Cigna 
 
X 
3/13/2026 
Dental Benefits 
 
 
 
Cigna provides Benefit Summaries to Client for Approval 
X 
 
6/18/2025  
 
Client Approval: Benefit Summaries 
 
X 
6/25/2025  
 
Dental Claim Readiness Complete 
X 
 
1/1/2026 
 
 
Communications/One Guide/Phone Numbers/IVR updates/OE 
 
 
Plan enrollment meetings - Discuss Communication Needs, 
Enrollment Support 
X 
X 
7/1/2025 
 
 
Client to share copy of annual enrollment materials & timeline 
of distribution to review Order/Deliver Enrollment Kits Finalize 
open enrollment communication materials 
X 
X 
See 
comment 
 
The County will share a copy of its enrollment 
guide upon request no earlier than 9/30/2025.

SERIAL 250052-RFP 
Set up the Pre-Enrollment Line. Cigna will test line to ensure 
appropriate handling of questions. 
(cannot initiate set up request until employer benefits are 
approved.) 
X 
8/15/2025 
Pre-Enrollment Line Set Up Complete 
X 
8/29/2025 
Support/Attend Open Enrollment Meetings 
X 
X 
10/14/25 
10/16/25 
10/22/25 
Conduct Enrollment meetings 
Open Enrollment Period* 
X 
X 
TBD 
Structure 
Provide Structure document to client for approval 
X 
6/16/2025 
Client Approval: Structure 
X 
6/27/2025 
Account structure in production, Cigna can now accept live 
eligibility 
X 
9/26/2025 
Eligibility 
Conduct Call with Eligibility Vendor to discuss file layout, testing 
& production file timing 
X 
X 
8/15/2025 
First eligibility test file sent 
X 
9/26/2025 
Eligibility test file results returned (#1) 
X 
10/3/2025 
Second eligibility test file sent 
X 
10/8/2025 
Eligibility test file results returned (#2) 
X 
10/15/2025 
Submit open enrollment production file to Cigna 
X 
12/4/2025 
Load open enrollment eligibility into Cigna's eligibility system 
X 
12/11/2025 
Track weekly eligibility files from OE file date to the end of 
Month 
X 
TBD 
For accounts that continue to send automated 
eligibility files after we received OE File.

SERIAL 250052-RFP 
 
Dental ID Cards 
DHMO ID Cards placed into US Mail IF no dental office passed 
for residents in the following states - AZ, MD, CA, IL, TX - there 
cards will not go into the mail until after the next upcoming 
Thursday's global assignment process runs) 
X 
 
12/26/2025  
 
Dental PPO/Vision ID Card (Proof of Converge) viewable 
X 
 
1/1/2026 
 
> Will be viewed on mycigna by 1/1/26 (Go Live 
Date) 
Call & Claim Readiness 
 
 
Benefits Loaded & Tested in Cigna's Customer Service/Call 
System 
X 
 
11/14/2025 
Call ready 
X 
 
1/1/2026 
Benefits Loaded & Tested in Cigna's Claim System 
X 
 
11/14/2025 
Claim system released (dependent upon funding of bank 
account & history load, if applicable) 
X 
 
1/1/2026 
Summary Plan Descriptions 
 
 
Review & approve benefit description certificate draft(s) 
X 
X 
11/21/2025

SERIAL# 250052-RFP 
EXHIBIT E - SERVICE LEVEL AGREEMENT WITH PERFORMANCE 
GUARANTEES INCLUDING FEES AT RISK 
Cigna Performance Guarantees 
Effective Start Date: January 1, 2026 
CIGNA DENTAL CARE 
Average Speed of Answer 
PSPY 
Cigna Dental Care ASA.  Measured for the Term of the Agreement, results will 
not exceed: 30 seconds to answer a Call. Results measured at Special Account 
Queue Level. 
$500.00 
Call Abandonment Rate 
PSPY 
Cigna Dental Care Call Abandonment Rate.  Measured for the Term of the 
Agreement, results will not exceed: 2% of Calls received terminated. Results 
measured at Special Account Queue Level. 
$500.00 
Member Satisfaction 
At Risk $ 
Cigna Dental Care Member Satisfaction. Measured for the Term of the 
Agreement, results will meet or exceed: A member satisfaction level of 75% or 
greater with Cigna Dental overall. Results measured at Book of Business Level. 
$500.00 
Account Management Scorecard 
PSPY 
Cigna Dental Care - Account Management. Composite Score (all categories) of 
3.0 or better on the Account Management Report Card based on four (4) quarterly 
scorecards. Results measured at Account Level. 
$500.00 
Auto Eligibility  
PSPY 
Cigna Dental Care - Auto Eligibility 100% in 2 business days 
$500.00 
Time to Process - Specialty Referral Claims Rate 
PSPY 
Cigna Dental Care Time to Process.  Measured for the Term of the Agreement, 
result will meet or exceed: 95% within 10 Business Days. Results measured at 
Book of Business Level. 
$500.00 
Time to Process - Specialty Referral Claims Rate 
PSPY 
Cigna Dental Care Time to Process.  Measured for the Term of the Agreement, 
result will meet or exceed: 98% within 15 Business Days. Results measured at 
Book of Business Level. 
$500.00 
Financial Accuracy 
PSPY 
Cigna Dental Care Financial Accuracy.  Measured for the Term of the Agreement, 
results will meet or exceed: 99% of total audited claim dollars are correctly paid.  
Results measured at Platform Level. 
$500.00 
Processing Accuracy 
PSPY 
Cigna Dental Care - 95% Processing Accuracy/PL. 
$500.00 
Eligibility Reporting 
PSPY 
Cigna Dental Care- Eligibility Discrepancy Reporting - Reports will be available to 
view online 48 hours after we have updated a clean and accurate eligibility file 
$500.00 
Total Amount at Risk Per Enrolled Subscriber 
$5,000.00 
Total $ Maximum Amount at Risk

SERIAL# 250052-RFP 
EXHIBIT F - MARICOPA COUNTY BUSINESS ASSOCIATES AGREEMENT 
MARICOPA COUNTY 
BUSINESS ASSOCIATE AGREEMENT 
This BUSINESS ASSOCIATE AGREEMENT (“Agreement”) is effective April 9, 2025 (“Effective Date”) and 
is entered into by MARICOPA COUNTY, by and through its HIPAA-covered component, COUNTY, and 
Cigna Health and Life Insurance Company dba Cigna Healthcare (“Business Associate” or “Associate”). 
This Agreement sets out the responsibilities and obligations of Business Associate, as a Business 
Associate of Maricopa County, a hybrid entity with covered components governed by the Health Insurance 
Portability and Accountability Act (“HIPAA”) and the Health Information Technology for Economic and 
Clinical Health (“HITECH”) Act. 
RECITALS 
This Agreement is made a part of the parties’ contract or engagement letter for services (the “Contract”), 
pursuant to which Business Associate provides services to Maricopa County that involve the use or 
disclosure of Protected Health Information (“PHI”) that Maricopa County may transfer to Business 
Associate.   
AGREEMENT 
Business Associate and Maricopa County agree to the terms and conditions of this Agreement in order to 
comply with the rules on handling of PHI under the HIPAA Regulations for Privacy of Individually Identifiable 
Health Information, 45 C.F.R. Part 160 and Part 164, Subpart E (“Privacy Rule”), the HIPAA Security Rule, 
45 C.F.R. Part 160 and Part 164, Subpart C (“Security Rule”), and the HIPAA Breach Notification 
Regulations, 45 C.F.R. Part 164, Subpart D (“Breach Notification Rule”), all as amended from time to time. 
Business Associate and Maricopa County will comply with the terms of this Agreement for the duration of 
the Contract and for such other continuing periods as provided in this Agreement. 
1.
Definitions
a.
Unless otherwise provided in this Agreement, all capitalized terms in this Agreement will have the
same meaning as provided under the Privacy Rule, Security Rule, and the Breach Notification Rule.
b.
“Protected Health Information” or “PHI” means PHI as defined in 45 C.F.R. Part 160 and 164, that
is received from Maricopa County, or created, maintained, or transmitted on behalf of Maricopa
County, by Business Associate.
2.
Uses and Disclosure of PHI
a.
Except as otherwise provided in this Agreement or by law, Business Associate may use or disclose
PHI only for those purposes necessary to perform the services described in the Contract.
b.
Business Associate may use PHI for the proper management and administration of Business
Associate’s business, or to carry out its legal responsibilities. Business Associate may disclose PHI
to a third party for such purposes only if:
i.
the disclosure is required by law; or
ii.
Business Associate obtains written assurances, prior to making any disclosure to a third party
that the third party will (a) hold the PHI confidentially; (b) used or disclose the PHI only as
required by law or for the purpose for which it was disclosed to the third party; and (c) notify
Business Associate of any other use or disclosure of PHI.

SERIAL 250052-RFP 
 
c. In accordance with 45 C.F.R. § 164.502(e)(1), if Business Associate’s subcontractor creates, 
receives, maintains, or transmits PHI on behalf of Business Associate, Business Associate will 
enter into a written agreement with such subcontractor that contains the same restrictions and 
conditions on the use and disclosure of PHI as contained in this Agreement. 
d. Business Associate may use and disclose de-identified health information, if (i) the use is disclosed 
to Maricopa County and permitted by Maricopa County in its sole discretion, (ii) that the de-
identification is in compliance with 45 C.F.R. § 164.502(d), and (iii) the de-identified health 
information meets the standard and implementation specifications for de-identification under 45 
C.F.R. § 164.514(a) and (b). Business Associate may perform data aggregation services as 
permitted by 45 C.F.R. § 164.504(e)(2)(i)(B). 
e. To the extent Business Associate is to carry out Maricopa County’s obligations under the Privacy 
Rule, Business Associate will comply with the requirements of the Privacy Rule that apply to 
Maricopa County’s compliance with such obligations. 
3. Safeguards  
a. Business Associate will implement and maintain appropriate safeguards to prevent the use or 
disclosure of PHI other than as provided by this Agreement including administrative, physical, and 
technical safeguards to protect the confidentiality, integrity, and availability of the electronic PHI 
that Business Associate creates, receives, maintains, and transmits on behalf of Maricopa County.  
b. Business Associate agrees to take reasonable steps, including providing adequate training to its 
employees to ensure compliance with this Agreement and to ensure that the actions or omissions 
of its employees or agents do not cause Business Associate to breach the terms of this Agreement.  
c. Upon request of Maricopa County, Business Associate will provide evidence to Maricopa County 
that these safeguards are in place and are properly managed. 
d. Business Associate will comply with the HIPAA Security Rule. 
4. Reporting Improper Use or Disclosure of PHI, Security Incidents, and Breaches 
a. Business Associate will report to Maricopa County in writing any use or disclosure of PHI not 
provided for by this Agreement within 48 hours of when it becomes aware of such.  
b. Business Associate will report to Maricopa County in writing any Security Incident involving 
unsecured PHI of which Business Associate becomes aware. Specifically, Business Associate will 
report to Maricopa County any successful unauthorized access, use, disclosure, modification, or 
destruction of electronic PHI, or interference with system operations in an information system 
containing electronic PHI, of which Business Associate becomes aware within 48 hours of Business 
Associate learning of such Security Incident. Business Associate will also report the aggregate 
number of unsuccessful, unauthorized attempts to access, use, disclose, modify, or destroy 
electronic PHI or interfere with system operations in an information system containing electronic 
PHI, of which Business Associate becomes aware, provided that: 
i. such reports will be provided only as frequently as the parties mutually agree, but no more than 
once per month; and  
ii. if the definition of “Security Incident” under the Security Standards is amended to remove the 
requirement for reporting “unsuccessful” attempts to use, disclose, modify, or destroy e-PHI, 
the portion of this Section 4 addressing the reporting of unsuccessful, unauthorized attempts 
will no longer apply as of the effective date of such amendment. 
c. Business Associate will report in writing to Maricopa County any Breach of unsecured PHI, as 
defined in the Breach Notification Rule, within 48 hours of Business Associate’s learning of such 
Breach. Business Associate will provide such information to Maricopa County as required in the 
Breach Notification Rule. Business Associate will reimburse Maricopa County for all reasonable 
expenses incurred in notifying individuals of a Breach caused by Business Associate or Business 
Associate’s subcontractors or agents, and for reasonable expenses incurred in mitigating harm to 
those individuals. Business Associate will also defend, hold harmless, and indemnify Maricopa 
County and its employees, agents, officers, directors, and affiliated entities, from and against any 
claims, losses, damages, liabilities, costs, expenses, penalties, or obligations (including attorneys’ 
fees), which Maricopa County may incur due to a Breach caused by Business Associate or 
Business Associate’s subcontractors or agents.   
d. Business Associate will report in writing to Maricopa County within 48 hours of learning of any 
potential unauthorized use or disclosure, Security Incident, or Breach that may contain PHI and 
that would take more than 48 hours to determine whether PHI was actually involved.

SERIAL 250052-RFP 
5.
Mitigation of Disclosures of PHI
Business Associate will take reasonable measures to mitigate, to the extent practicable, any harmful
effect that is known to Business Associate of any use or disclosure of PHI by Business Associate or its
agents or subcontractors in violation of the requirements of this Agreement.
6.
Obligations Regarding Business Associate Personnel
Business Associate will inform all of its employees, agents, and subcontractors (“Business Associate
Personnel”) who will be involved in providing services related to the Contract, of the Business
Associate’s obligations under this Agreement. Business Associate represents and warrants that the
Business Associate Personnel are under legal obligation to Business Associate, by contract or
otherwise, sufficient to enable Business Associate to fully comply with the provisions of this Agreement.
Business Associate will maintain a system of sanctions for any Business Associate Personnel who
violates this Agreement.
7.
Audit Report
a.
Upon request, Business Associate will provide Maricopa County, with a copy of its most recent
independent HIPAA compliance report (AT-C 315), HITRUST certification, or other mutually agreed
upon independent standards based third party audit report.
b.
Maricopa County agrees not to re-disclose Business Associate’s audit report.
8.
Access to PHI
a.
Within five business days of a request by Maricopa County for access to PHI, Business Associate
will make the requested PHI available to Maricopa County and will provide copies upon request.
b.
If an individual requests access to an individual’s PHI directly to Business Associate, Business
Associate will within five business days forward that request in writing to Maricopa County.
Maricopa County will be responsible for making all determinations regarding the grant or denial of
an individual’s request for PHI and Business Associate will make no such determinations. Maricopa
County will release PHI to an individual pursuant to such a request, or direct Business Associate
in writing to make the disclosure.
9.
Amendment of PHI
a.
Within five business days of a request and instruction from Maricopa County, Business Associate
will amend PHI or a record about an individual that is maintained by, or otherwise within the
possession of, Business Associate in accordance with procedures established by 45 C.F.R. §
164.526.
b.
If an individual requests that Business Associate amend an individual’s PHI, Business Associate
within five business days will forward this request to Maricopa County. Any decision to amend PHI
will be the sole responsibility of Maricopa County.
10. Accounting of Disclosures of PHI
a.
Business Associate will document any disclosures of PHI made by it to account for such disclosures
as required by 45 C.F.R. § 164.528. Business Associate also will make available information related
to such disclosures as would be required for Maricopa County to respond to a request for an
accounting of disclosures in accordance with 45 C.F.R. § 164.528. Business Associate will maintain
its record of disclosures for six years from the termination of this Agreement.
b.
At a minimum, Business Associate will record the following information:
i.
the date of disclosure of PHI;
ii.
the name of the entity or person who received PHI, and, if known, the address of such entity or
person;
iii.
a description of the PHI disclosed; and
iv.
a brief statement of the purpose of the disclosure that includes the basis for such disclosure.
c.
Within five business days of receiving a written request from Maricopa County, Business Associate
will provide Maricopa County its records of disclosures.
d.
If an individual requests an accounting of disclosures directly from Business Associate, Business
Associate will within five business days forward the request and its records of disclosures to
Maricopa County. Maricopa County will be responsible for preparing and delivering the accounting
to the individual, and Business Associate will not provide an accounting of its disclosures directly
to any individual.

SERIAL 250052-RFP 
11. Availability of Books and Records
a.
Business Associate will within five business days of Maricopa County’s written request, make
available during normal business hours at Business Associate’s offices, or otherwise mutually
agreed upon location, all its internal practices, books, agreements, records, and policies and
procedures relating to the use and disclosure of PHI for purposes of allowing Maricopa County or
its agents or auditors to determine Business Associate’s compliance with HIPAA and this
Agreement.
b.
Business Associate will make its internal practices, books, and records relating to the use and
disclosure of PHI available to the Secretary of the Department of Health and Human Services to
the extent required for determining compliance with the Privacy Rule, or the Breach Notification
Rule.
c.
No attorney-client, accountant-client, or other legal privilege will be deemed waived by Business
Associate or Maricopa County because of this Section.
12. Restrictions on Use of Disclosure of PHI
If Maricopa County advises Business Associate of any changes in, or restrictions to, the permitted use
or disclosure of PHI, Business Associate will restrict the use or disclosure of PHI consistent with
Maricopa County’s instructions.
13. Data Return or Destruction of PHI
a.
Business Associate’s data stewardship does not confer data ownership rights on Business
Associate with respect to any data shared with it under this Agreement, including all forms thereof.
b.
Within 30 days of termination of the Contract or this Agreement, Business Associate will return to
Maricopa County all PHI that Business Associate and its subcontractors and agents maintain in
any form or format. Alternatively, Business Associate may, upon Maricopa County’s consent,
destroy all such PHI and provide Maricopa County with written documentation of such destruction.
Business Associate will be responsible for recovering any PHI from its subcontractors and agents,
or documenting their destruction of such PHI, consistent with this section.
c.
If Business Associate believes that returning or destroying PHI at the termination of this Agreement
is infeasible, it will provide written notice to Maricopa County within 30 days from the termination of
this Agreement explaining its circumstances. Maricopa County will promptly respond wither it
agrees. If Maricopa County agrees, then Business Associate may keep the PHI and will extend all
protections, limitations, and restrictions of this Agreement to the PHI, and will limit the use and
disclosure of the PHI to only those circumstances that make return or destruction infeasible.
Business Associate will ensure the same protections and limitations are followed by its agents and
subcontractors. If Maricopa County does not agree that that return or destruction of PHI is
infeasible, Maricopa County will notify Business Associate, and Business Associate and its agents
and subcontractors will return or destroy the PHI within 30 days.
d.
The obligations of Business Associate and contractors or agents of Business Associate under this
Section shall survive the termination of this Agreement.
14. Term and Termination
a.
This Agreement will become effective on the date first written above and will continue in effect until
all obligations of the Parties have been met under the Contract and under this Agreement.
b.
Maricopa County may terminate immediately this Agreement, the Contract, and any other related
agreements if Maricopa County makes a determination that Business Associate has breached this
Agreement and Business Associate has failed to cure that breach to Maricopa County’s reasonable
satisfaction within 30 days after written notice from Maricopa County. Maricopa County may report
the problem to the Secretary of HHS if termination is not feasible.
15. General Provisions
a.
Amendments. The parties agree to take such action as is necessary to amend this Agreement
from time to time as is necessary for Maricopa County and Business Associate to comply with the
requirements of applicable federal and state law.  All amendments to this Agreement shall be in
writing and signed by both parties.
b.
Construction of Terms. The terms of this Agreement will be construed considering any applicable
interpretation or guidance on the Privacy Standards and Security Standards issued by the
Department of Health and Human Services and other applicable state or federal laws, rules, and
regulations as amended from time to time.

SERIAL 250052-RFP 
c.
No Third-Party Beneficiaries. Nothing in this Agreement will confer upon any person other than
the parties and their respective successors or assigns, any rights, remedies, obligations, or
liabilities, whatsoever.
d.
Assignment of Rights and Delegation of Duties. This Agreement is binding upon and inures to
the benefit of the parties and their respective successors and permitted assigns. However, neither
party may assign any of its rights or delegate any of its obligations under this Agreement without
prior written consent of the other party, which consent shall not be unreasonable withheld or
delayed.
e.
No Waiver. Failure or delay on the part of either party to exercise any right, power, privilege, or
remedy shall not constitute a waiver. No provision of this Agreement may be waived by either party
except by a writing signed by an authorized representative of the party making the waiver.
f.
Severability. The provisions of this Agreement shall be severable, and if any provision of this
Agreement shall be held or declared to be illegal, invalid, or unenforceable, the remainder of this
Agreement shall continue in full force and effect.
g.
Entire Agreement. This Agreement constitutes the entire agreement between the parties with
regard to the Privacy Rule, Security Rule, and the Breach Notification Rule. There are no
understandings or agreements relating to this Agreement that are not fully expressed in this
Agreement and no change, waiver, or discharge of obligations arising under this Agreement will be
valid unless in writing and executed by the party against whom such change, waiver, or discharge
is sought to be enforced.
h.
Written Agreement. This Agreement is considered as an integral part of the underlying Contract
and is incorporated as though fully set forth within the Contract. This Agreement will govern in the
event of conflict or inconsistency with any provision of Contract.
i.
Venue and Choice of Law. Any suit, action, or other legal proceeding arising out of, or relating to,
this Agreement shall be brought in the venue designated in the Contract or, if no designation is
made, either in Maricopa County Superior Court or in the United States District Court for the District
of Arizona, sitting in Phoenix, Arizona. This Agreement and the rights and obligations of the parties
shall be governed by the laws of the State of Arizona, without regard to applicable conflict of law
principles.
j.
Counterparts. This Agreement may be executed in two or more counterparts, each of which shall
be deemed an original and when taken together shall constitute one agreement.
k.
Facsimile and Electronic Signatures. Facsimile and electronic signatures shall be deemed to be
original signatures for all purposes of this Agreement.
l.
Notices. For purposes of this Agreement and complying with all of its provisions, including all
reporting, notification, and disclosures required in this Agreement or in accordance with applicable
law, all notices shall be sent in accordance with the notice provisions under the Contract.
m. Relationship of the Parties. In the performance of the Contract and the duties and obligations
described in this Agreement, each party is at all times an independent contractor and at no time
shall the relationship between the parties be construed as a partnership, joint venture, employment,
or agency relationship.
Agreed to by Business Associate and Maricopa County: 
Cigna Health and Life Insurance Company dba Cigna Healthcare (Business Associate) 
Signature 
Date 
Print Name 
Title 
Maricopa County 
Signature 
Date 
Print Name 
Title 
Pete Chuchro
6/3/2025
Market Growth Leader of Arizona