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Skip to main navigation Skip to main content Skip to footer For Individuals &
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PRODUCT DISCLOSURES



Products and Services Provided by Cigna Corporation Subsidiaries

Cigna Corporation is a holding company and is not an insurance or an operating
company. Therefore, all products and services are provided exclusively by or
through operating subsidiaries and not by Cigna Corporation. For Cigna company
name information, click hereclick here.

General Disclaimer

The products and services described on Cigna's websites may not be applicable to
you or available to you under your plan. Please refer to your policy or plan
documents for information that is applicable to your specific plan.

We recommend reading any disclosure that's applicable to you before purchasing a
Cigna insurance policy or enrolling in a Cigna-administered plan so that you can
become more familiar with your plan and any state-specific mandates. If you are
considering a plan through Cigna or have questions about your plan coverage,
please contact your licensed insurance agent or a Cigna representative.

While reviewing the information on this page, it's important to note:

 * The disclosures provided here are general and your policy, service agreement
   or plan documents may contain additional disclosures which are required by
   your state and/or specific to your plan. The disclosures in your policy,
   service agreement or plan documents take precedence.
 * Certain mandates may only apply to certain policies or plan types.
 * State mandates may not apply to employer-funded (or self-insured) group
   plans. Please contact your plan sponsor if you need to know whether your plan
   is self-insured and whether any state mandates apply to your plan.

Individual and Family Medical/Dental Insurance

Product details for Cigna Individual and Family Medical and Dental plans may
vary by state. Before applying for insurance coverage, be sure to read the
policy/service agreement information and disclosures applicable to your specific
state and policy/service agreement. To find information related to your state,
visit
https://www.cigna.com/individuals-families/shop-plans/health-insurance-planshttps://www.cigna.com/individuals-families/shop-plans/health-insurance-plans.

Exclusions and Limitations

All insurance policies, service agreements and group benefit plans may have
exclusions, limitations, reduction of benefits and terms under which the policy
may be continued in force or discontinued. Rates may vary and are subject to
change. Health coverage is provided subject to any deductibles, co-payment, or
coinsurance provisions. For costs and a complete list of both covered and
not-covered services under your plan, policy or service agreement, including
benefits required by your state, see your insurance policy, service agreement,
evidence of coverage, or your employer’s insurance certificate or summary plan
description.

Product Descriptions - Not Available in all States

The product descriptions, if any, provided on Cigna websites are for
informational purposes only and are subject to change. Product availability may
vary by area and plan type and is subject to change. Product descriptions are
not a contract and are not intended to constitute offers to sell or
solicitations in connection with any products or services. Anyone interested in
a particular product should contact their licensed insurance agent, Cigna sales
representative or plan sponsor to determine whether the product is available in
their area and to request a copy of the applicable policy, service agreement, or
other plan documents for a complete description of the product.

Sample Group Policy Forms

Cigna makes available sample group policy forms to help our current and
prospective customers understand the services which may or may not be covered
under the different health plans we insure and/or administer. These forms are
for illustrative purposes only and the terms of your specific group policy or
plan may vary. No benefits are guaranteed. These forms are not legal documents
or contracts and no coverage representation is considered to be actual medical
benefits provided to you by Cigna. If there are any differences between the
information in these sample forms and the terms of your official plan documents,
the terms of your official plan documents will apply. View Sample FormsSample
Forms

Health Care Provider Network; Patient Satisfaction Scores, Designations, and
Ratings

Patient experience, quality designations, cost-efficiency and other ratings
found in Cigna's online provider directories reflect a partial assessment of
quality and/or cost and should not be the sole basis for decision-making (as
such measures have a risk of error). They are not a guarantee of the quality of
care that will be provided to individual patients. Individuals are encouraged to
consider all relevant factors and consult with their physician when selecting a
health care provider. Health care providers that participate in the Cigna
network are independent contractors solely responsible for the treatment
provided to their patients. They are not agents of Cigna. Actual costs will vary
depending on the location and type of services received. Your plan deductible,
co-payment and coinsurance requirements apply and may vary based on the type of
facility and health care professional providing care. The listing of a health
care professional or facility in the network directory does not guarantee that
the services rendered by that professional or facility are covered under your
specific policy or medical plan. Check your policy or official plan documents
for complete details about costs and the services covered under your plan
benefits.

Cigna Dental Care (DHMO)

The term "DHMO" is used to refer to group dental 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.

Discount Program Information

The CignaPlus Savings program is NOT insurance, and the member must pay the
entire discounted charge.

 * The CignaPlus Savings® dental discount program provides customers access to
   discounted fees, pursuant to schedules negotiated by Cigna Dental with
   participating providers, which customers are responsible for paying in full,
   directly to participating providers. Although all participating providers go
   through a credentialing process to assure that they are appropriately
   licensed and qualified, Cigna Dental does not otherwise guarantee nor is it
   responsible for the quality of any services or products purchased by
   customers. Customers have the right to cancel within thirty (30) calendar
   days of enrolling in the program. For more information, please call or write
   Cigna Dental:
   
   Cigna Dental
   Attn: Operations
   1571 Sawgrass Corporate
   Parkway, Suite 140
   Sunrise, FL 33323
   Telephone: 

Health Reimbursement Accounts (HRAs)

HRAs can only be chosen together with certain plan types. Your HRA is
self-funded by your employer, who is solely responsible for contributing the
funds used to pay benefits under your plan using the funds in your HRA. You are
not required to make any contribution to the HRA account, either pursuant to a
salary deduction election or otherwise under a Section 125 cafeteria plan. You
may not enroll under this option if you are considered self-employed (including
partners and more-than-2% shareholders in a subchapter S corporation).

Health Savings Account (HSA) Pre-enrollment Statements

You cannot open an HSA if, in addition to coverage under an HSA-qualified High
Deductible Health Plan ("HDHP"), you are also covered under a Health Flexible
Spending Account (FSA) or an HRA or any other health coverage that is not a
HDHP.

If you have elected to enroll in an HSA plan, you expressed your interest in
opening a Health Savings Account with an HSA service provider. The HSA service
provider you choose will contact you and provide you with an HSA enrollment
form, a signature card, a request for information for any Customer
Identification Program compliance and other related materials necessary to open
an HSA account with the HSA service provider. In order to open an HSA with the
HSA service provider, you must:

 1. In a timely manner, complete, sign and submit all the forms required by the
    HSA service provider; and
 2. Be found to meet all of the requirements prescribed by the HSA service
    provider.

If you are enrolled in a Cigna Individual and Family Health Savings Plan, you
will need to contact the HSA service provider of your choice to set up a Health
Savings Account to pair with your Cigna Health Savings Plan.

If you are offered a Cigna-administered HDHP through your employer and your
employer has not selected the Cigna-preferred HSA service provider, you may open
the HSA with an HSA custodian/trustee that is either arranged by your employer
or that you personally select. You must agree to complete necessary forms and
meet the requirements set forth by the HSA custodian/trustee pertaining to the
establishment and operation of your HSA.

The HSA provider and/or trustee/custodian will be solely responsible for all HSA
services, transactions and activities related thereto. Cigna is not responsible
for any aspects of the HSA services, administration and operation.

Prior to enrollment with an HSA provider, you must certify that you have
enrolled or plan to enroll under a HDHP and are not covered under any other
health coverage that is not a HDHP.

Reimbursement for Out-of-Network Services

Certain Cigna medical insurance policies/service agreements and
Cigna-administered health benefit plans cover expenses incurred for services
from health care providers and facilities that do not participate in the Cigna
provider network. Those policies, service agreements, and plans include Maximum
Reimbursable Charge ("MRC") provisions that may limit the amount of an
out-of-network charge that will be considered by Cigna in calculating
reimbursement.

For Cigna Individual and Family Medical plans, refer to your policy/service
agreement for details on how MRC is calculated under the terms of your policy.

For group health plans, the plan sponsor (employer or other organization) may
choose one of the following MRC provisions that limits the amount that will be
considered in calculating benefits under the out-of-network coverage (if any)
for non-emergency services unless the billed charge is less:

MRC I
Under this option, a data base compiled by FAIR Health, Inc. (an independent
non-profit company) is used to determine the billed charges made by health care
professionals or facilities in the same geographic area for the same procedure
codes using data. The maximum reimbursable amount is then determined by applying
a plan sponsor selected percentile (typically the 70th or 80th percentile) of
billed charges, based upon the FAIR Health, Inc. data. For example, if the plan
sponsor has selected the 80th percentile, then any portion of a charge that is
in excess of the 80th percentile of charges billed by providers in the FAIR
Health, Inc. data base for the service in the same relative geographic area (as
determined using the FAIR Health, Inc. data) will not be considered in
determining reimbursement and the patient will be fully responsible for charges
in excess of the MRC.

If there is not enough FAIR Health charge data  in a geographic area to
determine a MRC charge, there is no MRC; the providers billed charges will be
used to calculate benefits.

MRC II
This option uses a schedule of charges established using a methodology similar
to that used by Medicare to determine allowable fees for services within a
geographic market. This schedule amount is then multiplied by a percentage
(110%, 150% or 200%) selected by the plan sponsor to produce the MRC.

In the limited situations where a Medicare-based amount is not available (e.g.,
a certain type of health care professional or procedure is not covered by
Medicare or charges relate to covered services for which Medicare has not
established a reimbursement rate), the MRC is determined based on the lesser of:

 * the health care professional or facility's normal charge for a similar
   service or supply; or
 * the MRC I methodology based on the 80th percentile of billed charges.

Average Contracted Rate ("ACR")
Under this option, the MRC is determined based on the lesser of:

 * the health care professional or facility's normal charge for a similar
   service or supply; or
 * the Average Contracted Rate - i.e., the average percentage discount applied
   to all claims in a geographic area paid by Cigna during a recent 6 month
   period for the same or similar service/supply provided by health care
   professionals or facilities participating in the Cigna provider network. The
   ACR is updated by Cigna on a semiannual basis. The geographic area used by
   Cigna is either a Metropolitan Statistical Areas (MSA) or an area within
   governmental boundaries (e.g. state, county, zip code).

In some cases, the ACR amount will not be used and the MRC is determined based
on the lesser of:

 * the health care professional or facilities' normal charge for a similar
   service or supply; or
 * the MRC I methodology based on the 80th percentile of billed charges.

Whether the MRC I, MRC II or ACR methodology is used, the patient is responsible
for all charges over the MRC amount, as well as any applicable deductible and
coinsurance amounts for charges that do not exceed the MRC. The claim is also
subject to all other exclusions and limitations in the applicable benefit plan.

If you are enrolled in a plan insured or administered by Cigna, you and your
authorized representatives can request the MRC for a particular procedure and
geographic location by calling the number on your Cigna ID card.

If you use a health care professional who is not in the Cigna provider network,
be sure to check your plan documents to make sure that your plan covers
out-of-network services. If you have a Flexible Spending Account (FSA), Health
Savings Account (HSA), or Health Reimbursement Account (HRA), you may be able to
use that money for out-of-network services.

Cigna Secure Travel

Cigna Secure Travel is provided under a contract with Generali Global Assistance
(GGA). GGA and Cigna do not guarantee the quality of any medical services
provider or medical facility. The final selection of a local medical provider or
facility is the covered person’s right and responsibility. The medical
professionals or attorneys suggested or designated by GGA are solely responsible
for their services. They are not employees or agents of GGA or Cigna. Emergency
Assistance services may be insured under a group or blanket insurance policy
issued by Life Insurance Company of North America or Cigna Life Insurance
Company of New York. All other Cigna Secure Travel services are NOT insurance
and do not provide reimbursement of expenses or financial losses. Expenses for
medical care are not covered. In any case where benefits are provided through
insurance, the terms of the insurance policy control. All other services are
provided by GGA and are subject to the terms of the service agreement with GGA.

Cignassurance

The Cignassurance® Program for beneficiaries is available to beneficiaries
receiving coverage checks over $5,000 from Cigna Group Life and Personal
Accident Programs. Phone and face-to-face counseling sessions must be used
within one year of the date the claim is approved. Cignassurance accounts are
not deposit account programs and are not insured by the Federal Deposit
Insurance Corporation or any other federal agency. Account balances are the
liability of the insurance company and the insurance company reserves the right
to reduce account balances for any payment made in error. Counseling, legal or
financial assistance programs are not available under policies insured by Cigna
Life Insurance Company of New York.

Cigna Identity Theft Services

Cigna's Identity Theft Services are provided under a contract with Generali
Global Assistance. Full terms, conditions and exclusions are contained in
Cigna’s Identity Theft Program service agreement.

My Secure Advantage Financial Wellness Program

The My Secure Advantage Financial Wellness Program is independently administered
by CLC Incorporated (CLC). Cigna does not provide financial services and makes
no representations or warranties as to the quality of the information on the CLC
website or the services of CLC.

Disclosure of Third-Party Financial Arrangements

Compensation is paid by Cigna to third-party “brokers,” “benefits advisors” and
consultants. In the case of individual insurance, this compensation is
determined by agreement between Cigna and the third party broker. In the case of
insured or self-funded group plans, this compensation is determined by agreement
of the plan sponsor and its broker or benefits advisor. Cigna may bill the
client and collect the compensation on behalf of the broker/benefits consultant.
This compensation is typically in the form of a percentage of premiums collected
(in the case of insurance policies), or a fixed, per-employee per-month rate in
the case of self-insured plans.

Additional compensation may be paid by Cigna to brokers/benefits advisors based
on persistency or other non-case-specific factors. Cigna sends reports to group
insurance policyholders annually regarding the commission and other compensation
paid to brokers/benefit advisors during the prior calendar year for their use in
preparing their Annual Return and Report (Form 5500) where required under
federal law (ERISA). Upon request, we will also disclose how the Client may
receive more information directly from the broker/benefits advisor regarding
compensation arrangements.

The primary compensation received with respect to insurance policies is the
policyholder paid insurance premium. The primary source of revenue in connection
with administrative services contracts is the service fees paid by the
self-insured plan sponsor and/or the plan.

Revenue Sources

In addition to the premium charged to policyholders and the administrative fees
charged to sponsors of self-insured group plans, Cigna negotiates for
compensation from some third-party vendors with which Cigna contracts to perform
services in connection with the plans we insure or administer. This compensation
is to reimburse Cigna for its costs of implementing and maintaining programs
offered by these third-party vendors. This allows Cigna to offer lower premiums
and administrative fees.

Cigna may subcontract with a third-party vendor for the performance of a service
that Cigna has agreed to provide to a plan sponsor. The amount charged to the
Client for the program or services may include both the vendor’s reimbursement
as well as a Cigna charge. For example, where Cigna contracts with a third-party
for the administration of a disease management program, the plan sponsor may be
charged both the reimbursement owed the third-party vendor and an additional
amount by Cigna. Cigna may also receive compensation from vendors for placing
the business with the vendor. These may be calculated on a per-member per-month
(PMPM) basis, flat rate, or on a percentage basis. Cigna may receive performance
guarantee payments if a vendor does not meet performance targets. Cigna may
receive other compensation from its third-party vendors. These charges are
typically reflected in Cigna's agreement with the plan sponsor or in related
disclosure documentation.

Cigna may receive payments directly from drug manufacturers or Pharmacy Benefit
managers with which it contracts. These payments may be consideration for
placement of a manufacturer’s drug on the Cigna drug formulary.

Cigna uses specialized vendors to negotiate discounts for out-of-network claims.
The amount charged to self-insured plans reflects the negotiated discount. An
administrative fee is paid to the vendor for successfully negotiating a discount
under these programs and Cigna charges a percentage of the net savings for
administering these programs.

When a third party should have been responsible for the claims incurred by a
covered individual (as a result of an automobile accident, for example), after
paying the claim, Cigna may try to obtain reimbursement from the third party
responsible for the accident, or that party’s liability insurer. Cigna currently
pursues reimbursement using a specialized subrogation vendor. For successful
efforts, a percentage of the recovery is retained by the vendor and Cigna.
Additionally, Cigna reserves a priority right to reimbursement of any prior
stop-loss insurance payments it may have made to Clients.

Certain Cigna companies directly provide or arrange for the provision of covered
health care services including, but not limited to Evernorth Behavioral Health,
Inc. and Cigna HealthCare of Arizona, Inc. Their charges for providing or
arranging for these services are reimbursed as claims.

Clinical Claims Review Program

In an effort to assure that high dollar claims are correctly billed and paid in
accordance with industry and other applicable standards, we have extended our
claims review program to include a review of select facility claims for billing
and coding errors. This program is now available for all self-insured Clients.


FEDERAL AND STATE-SPECIFIC NOTICES AND DISCLOSURES

Federal

Your Rights and Protections Against Surprise Medical Bills under the No
Surprises Act
When you get emergency care or get treated by an out-of-network provider at an
in-network hospital or ambulatory surgical center in the United States, you are
protected from surprise billing or balance billing. This protection will begin
on or after 1/1/2022, depending on when your health plan coverage year begins.

What is “balance billing” (sometimes called “surprise billing”)?

When you see a doctor or other health care provider in the United States, you
may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a
deductible. You may have other costs or have to pay the entire bill if you see a
provider or visit a health care facility that isn’t in your health plan’s
network.

“Out-of-network” providers are doctors, facilities, and other health care
providers that haven’t signed a contract with your health plan. Out-of-network
providers may be able to bill you for the difference between what your plan
agreed to pay for a service and what they want to charge. This is called
“balance billing.” This bill may be more expensive than an in-network provider
and might not count toward your annual out-of-pocket limit.

“Surprise billing” is an unexpected balance bill. This can happen when you can’t
control who is involved in your care—like when you have an emergency.  This can
also happen when you schedule a visit at an in-network facility but are
unexpectedly treated by an out-of-network provider.  For example, you may go to
an in-network hospital but then an out-of-network provider treats you. This
could happen when you need anesthesia during a surgery.  The surgeon may be
in-network, but the anesthesiologist may be out-of-network.  Both providers can
bill you for the care they give.

You are protected from balance billing for:

Emergency services

If you have an emergency and you get care from an out-of-network provider or
facility in the United States, the most they can bill you is your plan’s
in-network cost-sharing amount (such as a copay and coinsurance). This means
you’ll pay what you would have if you got care from an in-network provider.
You can’t be balance billed for these emergency services. This includes services
you may get after you’re in stable condition, unless you give written consent
and give up your protections not to be balanced billed for these
post-stabilization services.

Certain non-emergency services at an in-network hospital or ambulatory surgical
center

You’re also protected when you get services from an in-network hospital or
ambulatory surgical center in the United States.  Certain providers there may be
out-of-network. You may not know which providers are in- or out-of-network. 
It’s always good to ask whether a provider participates in your health plan’s
network if you can.  If the provider is out-of-network, the most they may bill
you is your plan’s in-network cost-sharing amount (such as a copay or
coinsurance). This applies to emergency medicine, anesthesia, pathology,
radiology, laboratory, neonatology, assistant surgeon, hospitalist, or
intensivist services. These providers can’t balance bill you and may not ask you
to give up your protections against being balance billed.

If you get other services at these in-network facilities, out-of-network
providers can’t balance bill you, unless you give written consent and give up
your protections.

You’re never required to give up your protections from balance billing. You also
aren’t required to get care out-of-network. You have the right to choose a
provider or facility in your plan’s network.

A state balance billing law may also apply to your health plan.  For more
information about these protections, please refer to your state specific
information on this page.

When balance billing isn’t allowed, you also have the following protections in
the United States:

 * You are only responsible for paying your share of the cost (like the
   copayments, coinsurance, and deductibles that you would pay if the provider
   or facility was in-network). Your health plan will pay out-of-network
   providers and facilities directly.
 * Your health plan generally must:
   * Cover emergency services without requiring you to get approval for services
     in advance (prior authorization).
   * Cover emergency services by out-of-network providers.
   * Base what you owe the provider or facility (cost-sharing) on what it would
     pay an in-network provider or facility and show that amount in your
     explanation of benefits (EOB).
   * Count any amount you pay for emergency services or out-of-network services
     toward your deductible and out-of-pocket limit.

If you believe you’ve been wrongly billed 

Please call Cigna if you get a balance bill.  Use the phone number on your ID
card. You can also contact No Surprises Help Desk at or
http://www.cms.gov/nosurpriseshttp://www.cms.gov/nosurprises for more
information about your rights under federal law.  A state balance billing law
may also apply to your health plan.  For more information about these
protections, please refer to your state specific information on this page.

For Cigna Global Health Benefits® customers, the federal requirements only apply
to plans underwritten by Cigna Health and Life Insurance Company. For all other
plans underwritten outside the United States, the federal requirements specified
above do not apply. If you are unsure if the federal requirements apply to your
plan, please call Cigna. Use the phone number on your ID card.

Arizona

Surprise Billing

If you have coverage under an Arizona sitused plan and you receive a bill for
out-of-network services rendered during an emergency or from an out-of-network
provider at an in-network setting, state consumer protections may apply. Please
contact Cigna or AZ DOIAZ DOI for more information or if you believe you are
being balanced billed.

Arkansas

 * Arkansas Quarterly Prior Authorization statistics: Q1 2022 [PDF]Q1 2022 [PDF]

 * Arkansas Quarterly Prior Authorization statistics: Q4 2021 [PDF]Q4 2021 [PDF]

 * Arkansas Quarterly Prior Authorization statistics: Q3 2021 [PDF]Q3 2021 [PDF]

 * Arkansas Quarterly Prior Authorization statistics: Q2 2021 [PDF]Q2 2021 [PDF]

 * Arkansas Quarterly Prior Authorization statistics: Q1 2021 [PDF]Q1 2021 [PDF]

 * Arkansas Quarterly Prior Authorization statistics: Q4 2020 [PDF]Q4 2020 [PDF]

 * Arkansas Quarterly Prior Authorization statistics: Q3 2020 [PDF]Q3 2020 [PDF]

 * Arkansas Quarterly Prior Authorization statistics: Q2 2020 [PDF]Q2 2020 [PDF]

 * Arkansas Quarterly Prior Authorization statistics: Q1 2020 [PDF]Q1 2020 [PDF]

 * Arkansas Quarterly Prior Authorization statistics: Q4 2019 [PDF]Q4 2019 [PDF]

 * Arkansas Quarterly Prior Authorization statistics: Q3 2019 [PDF]Q3 2019 [PDF]

 * Arkansas Quarterly Prior Authorization statistics: Q2 2019 [PDF]Q2 2019 [PDF]

 * Arkansas Quarterly Prior Authorization statistics: Q1 2019 [PDF]Q1 2019 [PDF]

 * Arkansas Quarterly Prior Authorization statistics: Q4 2018 [PDF]Q4 2018 [PDF]

 * Arkansas Quarterly Prior Authorization statistics: Q3 2018 [PDF]Q3 2018 [PDF]

 * Arkansas Quarterly Prior Authorization statistics: Q2 2018 [PDF]Q2 2018 [PDF]

 * Arkansas Quarterly Prior Authorization statistics: Q1 2018 [PDF]Q1 2018 [PDF]

 * Arkansas Quarterly Prior Authorization statistics: Q4 2017 [PDF]Q4 2017 [PDF]

 * Arkansas Quarterly Prior Authorization statistics: Q3 2017 [PDF]Q3 2017 [PDF]

 * Arkansas Quarterly Prior Authorization statistics: Q2 2017 [PDF]Q2 2017 [PDF]

 * Arkansas Quarterly Prior Authorization statistics: Q1 2017 [PDF]Q1 2017 [PDF]

Surprise Billing

If you have coverage under an Arkansas sitused plan and you receive a bill from
an out-of-network provider at an in-network setting, state consumer protections
may apply. Please contact Cigna or AR DOIAR DOI for more information or if you
believe you are being balanced billed.

California

California Health Plan Information
For information about Cigna Individual and Family Health plans and services in
your area, go to
https://www.cigna.com/individuals-families/shop-plans/health-insurance-planshttps://www.cigna.com/individuals-families/shop-plans/health-insurance-plans.
For group/employer health plan information, including Cigna companies, accessing
group plan services and information about COBRA/conversion privileges,
utilization review and grievances/appeals,
visit https://www.cigna.com/legal/members/health-care-forms/cigna-in-california.htmlhttps://www.cigna.com/legal/members/health-care-forms/cigna-in-california.html.

Disclosure Required of Retail Sellers Under California Civil Code Sec. 1714.43
Cigna Home Delivery Pharmacy does not make efforts to identify or eradicate
human trafficking from its direct supply chains for tangible goods that it
offers for sale.

Surprise Billing

If you have coverage under a California sitused plan and you receive a bill for
out-of-network services rendered during an emergency or from an out-of-network
provider at an in-network setting, state consumer protections may apply. Please
contact Cigna or CA DOICA DOI for more information or if you believe you are
being balanced billed.

Colorado

Colorado Annual Prior Authorization statistics: 2021 [PDF]Colorado Annual Prior
Authorization statistics: 2021 [PDF]

State of Colorado Notice – ACCESS PLAN
Our Access Plans provide information on: (1) who participates in our provider
network; (2) how we ensure that the network meets the health care needs of our
members; (3) how our provider referral process works; (4) how care is continued
if providers leave our network; (5) what steps we take to ensure medical quality
and customer satisfaction; (6) where you can go for information on other policy
services and features. The Access Plan is designed to disclose all the policy
information required under Colorado law, and is available for your review.

 * Cigna Health and Life Insurance Company Medical Network Access
   Plan [PDF]Cigna Health and Life Insurance Company Medical Network Access
   Plan [PDF]
 * Cigna Health Care of Colorado, Inc., HMO Network Access Plan [PDF]Cigna
   Health Care of Colorado, Inc., HMO Network Access Plan [PDF]
 * Cigna Dental Health of Colorado, Inc., Dental HMO Network Access
   Plan [PDF]Cigna Dental Health of Colorado, Inc., Dental HMO Network Access
   Plan [PDF]
 * Cigna Health and Life Insurance Company Dental PPO Network Access
   Plan [PDF]Cigna Health and Life Insurance Company Dental PPO Network Access
   Plan [PDF]

Colorado Surprise Billing Disclosure [PDF]Colorado Surprise Billing
Disclosure [PDF]

Colorado Annual Prior Authorization statistics: 2019 [PDF]Colorado Annual Prior
Authorization statistics: 2019 [PDF]

Colorado Exposure Notification Application [PDF]Colorado Exposure Notification
Application [PDF]

Colorado Annual Prior Authorization statistics: 2020 [PDF]Colorado Annual Prior
Authorization statistics: 2020 [PDF]

Surprise Billing

If you have coverage under a Colorado sitused plan and you receive a bill for
out-of-network services rendered during an emergency or from an out-of-network
provider at an in-network setting or from an out -of-network Air Ambulance
provider, state consumer protections may apply. Please contact Cigna
or CO DOICO DOI for more information or if you believe you are being balanced
billed.

Connecticut

Surprise Bills

If you have coverage under a Connecticut sitused plan and you receive a bill for
out-of-network services rendered during an emergency or from an out-of-network
provider at an in-network setting, state consumer protections may apply. Please
contact Cigna or CT DOICT DOI for more information or if you believe you are
being balanced billed.

Connecticut (CT) law protects health insurance and HMO customers from “surprise
bills” by health care providers that do not participate in the customer’s health
plan network. 

A “surprise bill” is a bill that the customer receives for an out-of-network
service, when he or she did not knowingly choose an out-of-network health care
provider to perform the service. Surprise bills do not include charges for
planned services that the customer knows in advance will be performed by an
out-network provider.

Surprise bills occur when, without the customer’s knowledge or choice, the
out-of-network provider performs a service:

 * In an in-network facility, or
 * During a procedure that also involves an in-network provider, or
 * During a procedure that was authorized beforehand by the insurance carrier,
   but then referred or transferred to an out-of-network provider.

When a customer receives a surprise bill for a service that is covered under his
or her CT health insurance or HMO plan, the insurance carrier will provide
coverage as if the service was performed by an in-network health care provider.
In other words, the customer will pay no more than the cost share amount he or
she would pay for in-network services under the plan. The out-of-network health
care provider is barred from requesting any payment from the customer, other
than the cost-sharing amount the customer pays for in-network services under the
plan.

Delaware

Surprise Billing

If you have coverage under a Delaware sitused plan and you receive a bill for
out-of-network services rendered during an emergency or from an out-of-network
provider at an in-network setting or from an out -of-network Air Ambulance
provider, state consumer protections may apply. Please contact Cigna
or DE DOIDE DOI for more information or if you believe you are being balanced
billed.

District of Columbia

Family Planning and Birth Control Coverage [PDF]Family Planning and Birth
Control Coverage [PDF]

Florida

Mental Health and Substance Use Disorder Benefits

Insurance coverage and benefits for mental health and substance use disorder
services can vary depending on the type of health insurance policy or contract a
person is covered under, including if it is an individual, small group or large
group health plan and when the policy was originally issued. Coverage
requirements are dictated by state and/or federal law based on these and other
factors.

State Law:

Florida law requires insurers of group health plans to make available to the
policyholder (i.e. employer) coverage for mental health and substance use
disorder services.  If the policyholder elects to have mental health and
substance use disorder coverage it must comply with the federal Mental Health
Parity and Addiction Equity Act (MHPAEA) unless the policyholder is exempt.
Coverage under Florida law cannot apply any financial requirement or
quantitative treatment limitation on mental health or substance use disorder
benefits that is more restrictive than the predominant financial requirement or
quantitative treatment limitation that is applied to substantially all
medical/surgical benefits.

Federal Law:

The federal Paul Wellstone and Pete Domenici Mental Health Parity and Addiction
Equity Act (MHPAEA) aims to eliminate coverage discrimination between
policyholders or members who are seeking mental health or substance use disorder
(MH/SUD) benefits and those seeking medical and surgical care. A lack of parity
can prevent a person from pursuing needed care due to cost or limited access, or
otherwise make it more expensive or more time intensive than medical visits.

The MHPAEA was passed by Congress in 2008 with the purpose of providing added
protections to the Mental Health Parity Act (MHPA) that was passed in 1996.
Combined, these federal laws require parity with medical and surgical benefits
for annual and aggregate lifetime limits, financial requirements, treatment
limitations, and in- and out-of-network coverage, if a plan provides coverage
for mental health and substance use disorder services. Quantitative treatment
limitations (QTL) refer to the financial limitations such as coverage limits or
out-of-pocket expenses (copayment, deductible, or coinsurance, and out of pocket
maximums). Example: If most copayments under a plan for medical or surgical
office visits are not usually more than $30, the copayments for office visits to
mental health and substance use disorder professionals should be around the same
amount.

Non-quantitative treatment limitations (NQTL) refer to non-numerical standards,
such as medical-management standards, pre-authorization, formularies for
prescriptions, and fail-first policies or step-therapy protocols. Standards for
medical necessity determinations and reasons for any denial of benefits relating
to MH/SUD must be disclosed by the insurer upon request.

The requirements of the MHPA and MHPAEA applied primarily to large group health
plans until the passage and implementation of the Affordable Care Act (ACA).
Small group and individual qualified health plans effective on or after January
1, 2014, are required to provide ten essential health benefits, with one of the
benefits being coverage for mental health and substance use disorders. Federal
guidelines require individual and small group plans subject to the ACA to meet
the requirements of the MHPAEA to satisfy the essential health benefit mandate.
Grandfathered and transitional individual and small group health plans are not
required to include mental health and substance use disorder benefits and are
not subject to requirements of the ACA as it relates to mental health and
substance use disorder benefits. However, if a grandfathered or transitional
individual health plan includes mental health and substance use disorder
benefits, it must comply with the requirements of the MHPAEA.

Individuals needing assistance with mental health or substance use disorder
benefits can call the Cigna number on their ID card or they can contact the
Florida Consumer helpline by:

 * Florida Insurance Consumer Helpline
   Statewide/Toll-free: Out of State:
 * Fax: 
 * Email: Consumer.Services@myfloridacfo.comConsumer.Services@myfloridacfo.com
 * Online: Online Insurance AssistanceOnline Insurance Assistance

Provider Performance Outcome and Financial Data Disclosures
Customers are encouraged to view Florida provider performance outcome and
financial data that will be posted on the Agency for Health Care
Administration’s Health Information
website:  http://www.floridahealthfinder.gov/index.htmlhttp://www.floridahealthfinder.gov/index.html.

For more information, please call or write us at:

Cigna, 2701 North Rocky Point Drive, Suite 800,
Tampa, FL 33607

Office hours: 8 am to 5 pm (EST) Monday through Friday
Telephone:  Fax:
For Customer inquiries, call our Nationwide Customer Services Telephone Number:
(Please note: If you are enrolled in an employer-sponsored plan, this number may
be different for your employer group. Please check your Cigna ID card for the
correct Customer Services telephone number.)

If you’re a current Cigna customer, you can also login
to myCigna.commyCigna.com or use the myCigna® app to request ID cards, check
claim status, verify coverage and change your Primary Care Provider (PCP).

Employer, Broker and Provider Inquiries – please telephone  and follow the phone
prompts.

Surprise Billing

If you have coverage under a Florida sitused plan and you receive a bill for
out-of-network services rendered during an emergency or from an out-of-network
provider at an in-network setting or from an out -of-network Air Ambulance
provider, state consumer protections may apply. Please contact Cigna
or FL DOIFL DOI for more information or if you believe you are being balanced
billed.

Georgia

Surprise Billing

If you have coverage under a Georgia sitused plan and you receive a bill for
out-of-network services rendered during an emergency or from an out-of-network
provider at an in-network setting or from an out -of-network Air Ambulance
provider, state consumer protections may apply. Please contact Cigna
or GA DOIGA DOI for more information or if you believe you are being balanced
billed.

GA National Average Drug Acquisition Cost (NADAC) Report

2022-Period 1 [PDF]2022-Period 1 [PDF]

Hawaii

The following disclosure information is available to Hawaii customers:

 * A list of participating providers which must be updated on a regular basis
   indicating at least their specialty and whether the provider is accepting new
   patients;

Cigna's provider directory can be located at
http://www.cigna.com/hcpdirectory/http://www.cigna.com/hcpdirectory /

 * A complete description of benefits, services, and copayments;

For existing customers, this description is available by registering with
myCigna.commyCigna.com. For prospective customers, please contact Cigna at

 * A statement on enrollee's rights, responsibilities, and obligations;

Please see the "General Disclaimer" and "Exclusions and Limitations" sections on
the top of this page.

 * An explanation of the referral process, if one exists;

Referral procedures, which include the procedures to be followed for consulting
a provider other than the primary care provider, utilization review procedures
for obtaining precertification, information on Cigna's formulary and other
policies can be located at
http://www.cigna.com/legal/members/member-rights-and-responsibilities/cigna-health-care-policieshttp://www.cigna.com/legal/members/member-rights-and-responsibilities/cigna-health-care-policies

 * Where services or benefits may be obtained;

Cigna's provider directory can be located at
http://www.cigna.com/hcpdirectory/http://www.cigna.com/hcpdirectory /

 * Information on complaints and appeals procedures; and
 * A copy of the grievance process for claim or service denial and for
   dissatisfaction with care can be located at
   https://www.cigna.com/individuals-families/member-guide/appeals-grievanceshttps://www.cigna.com/individuals-families/member-guide/appeals-grievances
 * The telephone number of the insurance division;

Department of Commerce and Consumer Affairs:
or

Illinois

Illinois Annual Prior Authorization statistics: 2021 [PDF]Illinois Annual Prior
Authorization statistics: 2021 [PDF]

Cigna Dental Care (DHMO) Plans
In Illinois, the Cigna Dental Care plan is considered a prepaid dental plan.

Surprise Billing

If you have coverage under an Illinois sitused plan and you receive a bill for
out-of-network services rendered during an emergency or from an out-of-network
provider at an in-network setting or from an out -of-network Air Ambulance
provider, state consumer protections may apply. Please contact Cigna
or IL DOIIL DOI for more information or if you believe you are being balanced
billed.

Indiana

Surprise Billing

If you have coverage under a Indiana sitused plan and you receive a bill for
out-of-network services rendered during an emergency or from an out-of-network
provider at an in-network setting or from an out -of-network Air Ambulance
provider, state consumer protections may apply. Please contact Cigna
or IN DOIIN DOI for more information or if you believe you are being balanced
billed.

Maine

Special information for policies in Maine
Your health plan may include prescription drug benefits. The following listsThe
following lists (also known as formularies) show which drugs Cigna may cover
with your plan. Some of these drugs may need special approval to get them. Cigna
calls this special approval utilization review, prior authorization or step
therapy. It’s important that you know how your prescription drug benefits work.
How much you pay, and what drugs are available, all depend on the health plan
you have. For example:

 1. The cost of your medicine depends on the plan you have. Your plan also
    directs how we apply that cost to any deductible or out of pocket maximum.
 2. Whether or not there are any drugs not covered depends on your plan.
 3. Any limits or rules about the use of or how much drug you can get depends on
    your plan and/or drug safety considerations.
 4. The amount of coverage Cigna allows when you use an out-of-network doctor
    depends on your plan.
 5. The amount of coverage Cigna allows for drugs not covered also depends on
    your plan.
 6. Finally, if it’s medically necessary that you see an out-of-network doctor
    or use a non-covered drug, you may have the right to appeal. This too
    depends on your plan.

Surprise Billing

If you have coverage under a Maine sitused plan and you receive a bill for
out-of-network services rendered during an emergency or from an out-of-network
provider at an in-network setting or from an out -of-network Air Ambulance
provider, state consumer protections may apply. Please contact Cigna
or ME DOIME DOI for more information or if you believe you are being balanced
billed.

Maryland

Maryland Mental Health Parity Reports 2021

Indemnity-PRIND Puerto Rico Indemnity Plan [PDF]Indemnity-PRIND Puerto Rico
Indemnity Plan [PDF]

PPO-MOAP0001 Open Access Plus Plan [PDF]PPO-MOAP0001 Open Access Plus Plan [PDF]

PPO-HSAF Health Savings Account - Family Plan [PDF]PPO-HSAF Health Savings
Account - Family Plan [PDF]

PPO-OAP Traditional Open Access Plan [PDF]PPO-OAP Traditional Open Access Plan
[PDF]

PPO-OAP1 Open Access Plus Plan- Non CA [PDF]PPO-OAP1 Open Access Plus Plan- Non
CA [PDF]

PPO-NPOS1 Network Place of Service Plan 1 [PDF]PPO-NPOS1 Network Place of
Service Plan 1 [PDF]

EPO-MOAP0100 Open Access Plus Network Only Plan [PDF]EPO-MOAP0100 Open Access
Plus Network Only Plan [PDF]

EPO-MHDP0100 HDHP Open Access Plus Network Only Plan [PDF]EPO-MHDP0100 HDHP Open
Access Plus Network Only Plan [PDF]

EPO-OAPIN Open Access Plus In-Network Plan (Excluding CA) [PDF]EPO-OAPIN Open
Access Plus In-Network Plan (Excluding CA) [PDF]

EPO-OAPN1 Open Access Plus In-Network Plan [PDF]EPO-OAPN1 Open Access Plus
In-Network Plan [PDF]

EPO-OAI Essential Open Access In- Network Plan [PDF]EPO-OAI Essential Open
Access In- Network Plan [PDF]

Surprise Billing

If you have coverage under a Maryland sitused plan and you receive a bill for
out-of-network services rendered during an emergency or from an out-of-network
provider at an in-network setting, state consumer protections may apply. Please
contact Cigna or MD DOIMD DOI for more information or if you believe you are
being balanced billed.

Massachusetts

LocalPlus® Plans
This plan provides access to a network that is smaller than Cigna’s national
Open Access Plus (OAP) and Preferred Provider Organization (PPO) Networks. In
this plan customers have access to in-network benefits only from the health care
providers in the LocalPlus Network when in a LocalPlus Network service area.
Please consult the limited network directory or visit our online directory to
determine which providers are included in the LocalPlus Network. For a paper
copy, ask your employer or contact Cigna.

Surprise Billing

If you have coverage under a Massachusetts sitused plan and you receive a bill
from an out-of-network provider at an in-network setting, state consumer
protections may apply. Please contact Cigna or MA DOIMA DOI for more information
or if you believe you are being balanced billed.

Michigan

Surprise Billing

If you have coverage under a Michigan sitused plan and you receive a bill for
out-of-network services rendered during an emergency or from an out-of-network
provider at an in-network setting or from an out -of-network Air Ambulance
provider, state consumer protections may apply. Please contact Cigna
or MI DOIMI DOI for more information or if you believe you are being balanced
billed.

Minnesota

Minnesota Annual Prior Authorization statistics: 2021 [PDF]Minnesota Annual
Prior Authorization statistics: 2021 [PDF]

Cigna Dental Care (DHMO) Plans – Out-of-Network Services
If you are considering enrollment or are enrolled in a Cigna Dental Care (DHMO)
plan through your employer, you must visit your selected network dentist in
order for the charges on the Patient Charge Schedule to apply. You may also
visit other dentists that participate in our network or you may visit dentists
outside the Cigna Dental Care network. If you do, the fees listed on the Patient
Charge Schedule will not apply. You will be responsible for the dentist’s usual
fee. We will pay 50% of the value of your network benefit for those services. Of
course, you’ll pay less if you visit your selected Cigna Dental Care network
dentist. Call Customer Service for more information.

Surprise Billing

If you have coverage under a Minnesota sitused plan and you receive a bill from
an out-of-network provider at an in-network setting, state consumer protections
may apply. Please contact Cigna or MN DOIMN DOI for more information or if you
believe you are being balanced billed.

Mississippi

If you have coverage under a Mississippi sitused plan and you receive a bill
from an out-of-network provider at an in-network setting, state consumer
protections may apply. Please contact Cigna or MS DOIMS DOI for more information
or if you believe you are being balanced billed.

Missouri

Surprise Billing

If you have coverage under a Missouri sitused plan and you receive a bill for
out-of-network services rendered during an emergency or from an out-of-network
provider at an in-network setting, state consumer protections may apply. Please
contact Cigna or MO DOIMO DOI for more information or if you believe you are
being balanced billed.

Montana

Surprise Billing

If you have coverage under a Montana sitused plan and you receive a bill for
out-of-network services rendered during an emergency or from an out -of-network
Air Ambulance provider, state consumer protections may apply. Please contact
Cigna or MT DOIMT DOI for more information or if you believe you are being
balanced billed.

Nebraska

Surprise Billing

If you have coverage under a Nebraska sitused plan and you receive a bill for
out-of-network services rendered during an emergency or from an out-of-network
provider at an in-network setting or from an out -of-network Air Ambulance
provider, state consumer protections may apply. Please contact Cigna
or NE DOINE DOI for more information or if you believe you are being balanced
billed.

Nevada

Surprise Billing

If you have coverage under a Nevada sitused plan and you receive a bill for
out-of-network services rendered during an emergency or from an out -of-network
Air Ambulance provider, state consumer protections may apply. Please contact
Cigna or NV DOINV DOI for more information or if you believe you are being
balanced billed.

New Hampshire

Surprise Billing

If you have coverage under a New Hampshire sitused plan and you receive a bill
for out-of-network services rendered during an emergency or from an
out-of-network provider at an in-network setting, state consumer protections may
apply. Please contact Cigna or NH DOI [PDF]NH DOI [PDF] for more information or
if you believe you are being balanced billed.

New Jersey

New Jersey State Department of Banking and Insurance Notice for Extensions to
Grace Periods

The New Jersey State Department of Banking and Insurance requires us to share
information about extensions to grace periods and other rights under your life
insurance policy if you can demonstrate financial hardship as a result of the
COVID-19 pandemic. This notice only applies to New Jersey policy/certificate
holders with the following insurance policy/plan type with Cigna:

 * Group Term Life Insurance underwritten by Life Insurance Company of North
   America (LINA)
 * Group Universal Life Insurance underwritten by Connecticut General Life
   Insurance Company (CGLIC)
 * Individual Whole Life policies underwritten by LINA and CGLIC

Please click here [PDF]click here [PDF] to access the notice.

NEW JERSEY OUT-OF NETWORK CONSUMER PROTECTION, TRANSPARENCY, COST CONTAINMENT
AND ACCOUNTABILITY ACT [PDF]NEW JERSEY OUT-OF NETWORK CONSUMER PROTECTION,
TRANSPARENCY, COST CONTAINMENT AND ACCOUNTABILITY ACT [PDF]

NEW JERSEY OUT-OF-NETWORK CONSUMER PROTECTION, TRANSPARENCY, COST CONTAINMENT
AND ACCOUNTABILITY ACT: ESTIMATED REIMBURSEMENT FOR FREQUENTLY BILLED
OUT-OF-NETWORK SERVICES [PDF]NEW JERSEY OUT-OF-NETWORK CONSUMER PROTECTION,
TRANSPARENCY, COST CONTAINMENT AND ACCOUNTABILITY ACT: ESTIMATED REIMBURSEMENT
FOR FREQUENTLY BILLED OUT-OF-NETWORK SERVICES [PDF]

Surprise Billing

If you have coverage under a New Jersey sitused plan and you receive a bill for
out-of-network services rendered during an emergency or from an out-of-network
provider at an in-network setting, state consumer protections may apply. Please
contact Cigna or NJ DOINJ DOI for more information or if you believe you are
being balanced billed.

New Mexico

The advertising, sales and other marketing information on this site is not
intended for residents of New Mexico. If you would like more information about
Cigna plans and services in your state, please contact your licensed agent or
Cigna sales representative.

Surprise Billing

If you have coverage under a New Mexico sitused plan and you receive a bill for
out-of-network services rendered during an emergency or from an out-of-network
provider at an in-network setting or from an out -of-network Air Ambulance
provider, state consumer protections may apply. Please contact Cigna
or NM DOINM DOI for more information or if you believe you are being balanced
billed

New York

COVID-19 specific PPE disclosures

NOTICE REGARDING CHARGES FOR PERSONAL PROTECTIVE EQUIPMENT ("PPE"). Please be
advised that you are not responsible for any charges received from a
participating provider beyond your applicable deductible, copayment, or
coinsurance, include any fees charged for PPE. If you have paid PPE charges to a
participating provider, you should contact the provider and obtain a refund.  If
you would like to submit a complaint to us about charges for PPE from a
participating provider, please contact us at .

New York State Department of Financial Services Notice for Extensions to Grace
Periods

The New York State Department of Financial Services requires us to share
information about extensions to grace periods and other rights under your life
insurance policy if you can demonstrate financial hardship as a result of the
COVID-19 pandemic. This information pertains only to certain Cigna insurance
policies they may have, that are known as:

 * Group Term Life Insurance underwritten by Cigna Life Insurance Company of New
   York (CLICNY) issued to New York employers.
 * Life Insurance Port and Conversions (individual policies) underwritten by
   Connecticut General Life Insurance Company (CGLIC) issued to insureds
   residing in New York.

Please click here [PDF]click here [PDF] to access the notice.

OUT-OF-NETWORK COVERAGE

NEW YORK INSURANCE POLICIES

Out-of-network Benefits - What's my Cost?
If your plan provides out-of-network benefits, your cost for a covered health
service depends on an estimated total payment for the service in your area. The
share that you pay for the out-of-network service is a share of that estimated
total payment.

How We Estimate Total Payments

Each employer or plan sponsor chooses the estimated total payment for
out-of-network services.  Depending on the plan options chosen by the employer
or group plan sponsor, the total payment for out-of-network services is
estimated based on either:

(1)     a fixed percentile of the charges by similar providers in the same
geographic area, for the same service;

 or

(2) a fixed percentage of a fee schedule similar to Medicare, for the same
service in the same geographic area.

For example, the plan may estimate the total payment as 80% of the charges by
similar providers in the area, or 150% of the Medicare-like fee schedule for the
services.

When the plan pays out-of-network benefits, your cost share amount is a share of
the estimated total payment.  For example, if the plan estimates the total
payment for a specialist procedure as 150% of the Medicare-like fee for that
procedure, the plan will pay benefits based on that estimated total. (for
instance, if the plan pays 70% for out-of-network benefits, the benefit will be
70% of the estimated total payment). The share you pay for out-of-network
services is also based on the plan’s estimated total payment.  So, you pay less
when the plan’s estimated total is lower than the provider’s billed charge.

The Provider’s Billed Charge

Out-of-network providers may bill a carrier any amount for a covered health
service. For example, a specialist can often bill higher amounts than what other
specialists in the area normally charge for the same service, and will often
bill higher amounts than what Medicare pays. Out-of-network provider bills are
also usually higher than the rates that in-network providers agree to receive
for the same health service.

Get information from your provider:

 * If your provider does not participate in your health plan’s provider network,
   your provider must tell you the estimated amount the practice will bill you
   for services, if you ask. Your provider must also give you the name and
   practice name, address and phone number of any anesthesiology, laboratory,
   pathology, radiology or assistant surgeon specialists that he or she
   schedules for you or refers you to for services. 
 * All hospitals are required to post a list of their charges on their websites,
   or show on their websites how to obtain this information. Hospitals are also
   required to tell you about charges by doctors whose services at the
   hospital are not included in the hospital's charges; these doctors may or may
   not participate in your health plan network and you should ask your arranging
   provider if any doctor scheduled to perform services is in your network.

New York State, and Benchmark Amounts

The State of New York requires a specific “usual and customary” definition, to
create a benchmark cost amount for out-of-network health services. The benchmark
amount is available for insurance customers to compare provider bills and plan
payments. The State’s “usual and customary” benchmark cost amount is defined
this way:

 “the 80th percentile of all charges for the particular health care service
performed by a provider in the same or similar specialty and provided in the
same geographical area, as reported in a benchmarking database maintained by a
nonprofit organization”. 

The organization that provides the benchmark database for this purpose is Fair
Health, Inc., as required by the New York State Department of Financial
Services. The organization also provides an online benchmark cost calculator,
for a fee paid by carriers. You can use their Consumer Cost Lookup page, free of
charge, to look up a benchmark cost amount for common health care services in
your geographic area. The website to access the Consumer Cost Lookup page
is:  http://www.fairhealthconsumer.org/ http://www.fairhealthconsumer.org /

(for questions about navigating this site, a customer can call , Mon-Fri  9 am
-6 pm EST  

Comparing the Cost of Out-of-Network Services

As you can see above, what you pay for covered out-of-network services is based
on three things: (1) the provider’s billed charge; (2) the way your plan
estimates total charges; and (3) the benefit share your plan pays for
out-of-network services. The provider may bill a higher amount than the plan’s
estimated charge, but if the provider accepts the plan’s estimated total payment
the share you pay will be less.

The New York “usual and customary” benchmark amount may be higher or lower than
your plan pays. Plans that estimate the total payments as the 80th percentile of
provider charges in the geographic area, or 370% of the Medicare-like fee
schedule in the geographic area, pay amounts that are generally alike the New
York “usual and customary” benchmark amount. If the plan estimates total
payments with a lower percentile of charges in the area, or a lower percentage
of the Medicare-like fee schedule, the plan’s estimated total will be lower than
“usual and customary” benchmark and the share you pay may be less.

You can refer to your plan documents to see the method and fixed percentile or
percentage your plan uses to estimate total payments. Your plan documents also
show the benefit share that the plan pays for out-of-network services, and the
share that you pay.

If your plan provides both in-network and out-of-network benefits, you will
always pay less if you get your health services in-network from one of our
credentialed network health professionals. 

You can go to this link to look up the approximate dollar amount that your plan
will pay for a specific in-network
service:  http://hcpdirectory.cigna.com/web/public/providershttp://hcpdirectory.cigna.com/web/public/providers.

 You can also call the toll-free help number on your health care plan ID card to
help you find an in-network provider or to request the approximate dollar amount
that your plan will pay for a specific in-network or out-of-network service, or
examples of out-of-network costs for certain common services (colonoscopy,
laminotomy, and breast reconstruction). 

Filing Out-of-Network Claims

If you assign claim payment for covered services to your out-of-network health
care provider, your provider will normally file the claims and will receive the
payments directly.

Otherwise, you may file claims on your own behalf.  You can go to this link to
download the applicable claim forms for covered
services: https://my.cigna.com/web/secure/my/formshttps://my.cigna.com/web/secure/my/forms.
Completed claim forms should be mailed to the Cigna address listed on your ID
card.

If you have additional questions, or would like to fax or email your completed
claim forms, please contact Customer Service using the toll-free number on your
ID card. Completed claim forms may also be faxed to these numbers:

 * If the Cigna address listed on your ID card is PO Box 182223, you may fax to
   859.410.2422
 * If the Cigna address listed on your ID card is PO Box 188061, you may fax to
   859.410.2440

Out-of-network "Surprise Bill" and Emergency Service Claims 

At a Glance

Customers will get in-network benefits for out-of-network ‘surprise bill’ and
emergency services. The out-of-network health care provider and carrier are
required to protect the customer from any additional ‘balance billing’ by the
provider, after the carrier benefits are paid.

Customers will get disclosures from physicians and hospitals, describing the
potential costs and benefit reductions for other kinds of services rendered or
referred out-of-network. Customers can also request from carriers a benefit
estimate for those services.

Health Care Providers that render out-of-network ‘surprise bill’ or emergency
services will get the opportunity to negotiate carrier payments, according to
usual & customary cost guidelines. In-state providers may request an Independent
Dispute Resolution review, when agreement on a payment amount is not reached. 

Out-of-network providers may directly receive customer benefit payments if the
customer assigns payment. When payment is assigned, the provider is prohibited
from billing the customer for any charge that exceeds the carrier’s in-network
benefit amount.

Carriers will pay in-network benefits for out-of-network ‘surprise bill’ and
emergency services. Carriers that are billed for out-of-network ‘surprise bill’
or emergency services will get the opportunity to negotiate payments, according
to usual & customary cost guidelines. When billed by an in-state provider, the
carrier may request an Independent Dispute Resolution review if agreement is not
reached on a payment amount.

Carriers will pay customer benefit amounts directly to the provider if the
customer assigns payment. Carriers will also furnish disclosures to customers
regarding benefit payment and balance billing protection for these services.

Affected Claims

‘Surprise Bills’

An out-of-network ‘surprise bill’ is any one of the following:

(1) A bill from an out-of-network physician at a network hospital/ambulatory
surgical center, in instances where:

 * a participating provider was not available; or
 * the non-participating physician rendered services without the member's
   knowledge; or
 * unforeseen medical services arose at the time the health care services were
   rendered.

(2) A bill from an out-of-network provider whose services were referred by a
network physician, without explicit written consent from the customer
acknowledging that he or she was aware the network physician was referring to an
out-of-network provider.

This includes common surprise bill instances, such as out-of-network
anesthesiologists or assistant surgeons in a network hospital/surgical center,
and network PCP referrals to out-of-network specialty services in or outside the
PCP’s office. A bill from an out-of-network provider that the customer chose to
go to, when a network provider was available, is not a surprise bill.

Emergency Claims

The out-of-network emergency claims covered as in-network benefits, and
negotiated/paid without additional balance billing to the customer, include
claims screening, examining and treating to stabilize any emergency condition by
the hospital’s emergency department and facility staff. 

Emergency conditions include any medical and behavioral condition that a
layperson with average knowledge could reasonably expect to:

 * place the patient in serious jeopardy (or others, in the case of behavioral
   conditions);
 * seriously impair bodily functions, or make a body part or organ
   dysfunctional;
 * seriously disfigure a person; or
 * pose a threat to the health or safety of a pregnant woman in contraction or
   her unborn child,

in the absence of immediate medical attention by the out-of-network emergency
provider.

Carrier Payments to Out-of-network Providers

‘Surprise Bills’

With an Assignment of Benefits

In this circumstance, the customer submits an Assignment of Benefits form to the
provider and carrier before the service is provided,  or the provider submits an
Assignment of Benefits form to the carrier (with customer agreement) at the time
the claim is submitted or after the claim is first processed.

The carrier must try to negotiate a payment with the provider, or pay billed
charges. If an attempt to negotiate fails, the carrier may pay a ‘reasonable
amount’ within the usual and customary range. The provider or carrier may
request an Independent Dispute Resolution review of the carrier’s payment amount
or the provider’s billed amount, with the understanding that the review
arbitrator will require both parties to accept either one or the other of those
amounts (no compromises). 

In any case, the customer pays only the plan’s normal in-network cost share of
the amount paid.  The Assignment of Benefits form prohibits the provider from
balance billing the customer any amount beyond that cost share.

With no Assignment of Benefits

If a carrier receives an out-of-network provider claim for a surprise bill with
no Assignment of Benefits form, the carrier may process the claim according to
normal plan payment guidelines for out-of-network services (for example, denying
the claim if the plan covers in-network benefits only, or paying the usual
out-of-network rate if the plan provides PPO or POS coverage). 

In this circumstance, a carrier claim notice to the customer or the explanation
of benefits (“EOB”) for the claim must include an explanation that the claim
could be a ‘surprise bill’ and that the customer should contact the carrier or
visit the carrier’s website for additional information about surprise bills. The
customer may request an Independent Dispute Resolution review of the provider’s
billed amount or the carrier’s payment amount, with the understanding that the
arbitrator will require both parties to accept either one or the other of those
amounts (no compromises).

Emergency Services

Carrier payment to an out-of-network emergency service may be ‘reasonable
amount’ within the usual and customary range, or a negotiated amount or billed
charge. 

If the carrier pays a ‘reasonable amount’, the amount must be consistent with
the carrier’s benefit policy description of payment methods for out-of-network
emergency claims. If the policy describes a range of payment methods or amounts,
the payment must be the greater of the amounts described.  New York regulators
now require carriers to use state-modeled language for these policy
descriptions, and so the payment method and amounts will fall within consistent
ranges.

Like for ‘Surprise Bills’, the provider or carrier may request an Independent
Dispute Resolution review of the carrier’s payment or the provider’s billed
amount, with the understanding that the arbitrator will require both parties to
accept either one or the other of those amounts (no compromises). Carriers that
request a review will notify the customer not to pay any balance bill.

For “low cost” emergency services (certain procedures billed for $600 or less,
at 120% or less of the usual and customary rate), slightly different rules
apply. Here, carriers pay a negotiated amount or billed charge, and no
Independent Dispute Resolution is available.      

Claim Notices for 'Surprise Bill' and Emergency Claims

Carriers will provide the following information to customers, in a claim notice
or in the explanation of benefits (EOB) for the claim:

 * Explanation that the customer’s out-of-pocket cost will be no greater than
   the in-network benefit cost share;
 * Explanation that the customer’s final cost share may increase, if the
   Independent Dispute Resolution process requires carrier payment of a
   provider’s higher billed charge ;
 * Direction to contact the carrier if the provider balance-bills the customer
   for the out-of-network service; and
 * Direction to the carrier’s website for additional information about surprise
   bills (if a surprise bill claim).

Assignment of Benefits to an Out-of-network Health Care Provider

Customers can get protection from ‘surprise bills’ by assigning benefits to the
out-of-network provider that renders the surprise bill service. Customers pay
only their plan’s in-network cost share for these services, and providers that
receive the assignment are prohibited from balance billing the customer any
amount beyond that cost share.

To assign benefits, the customer must

 * Sign the Assignment of Benefits Form available from the New York Department
   of Financial Services, which permits the provider to seek payment directly
   from the customer’s health plan; and
 * Send the Form to their health carrier and provider, and include a copy of the
   ‘surprise’ bill or bills they do not think they should pay.

New York Assignment of Benefits
Form:  https://www.dfs.ny.gov/consumers/health_insurance/surprise_medical_bills https://www.dfs.ny.gov/consumers/health_insurance/surprise_medical_bills.

Independent Dispute Resolution for Surprise Bills & Emergency Claims

Customers

Customers can request an Independent Dispute Resolution review of a New York
out-of-network provider ‘surprise bill’ only if they do not assign their
benefits to the provider that bills them. To request the review, the customer
must:

 * Complete the Application available from the New York Department of Financial
   Services; and
 * Send the Form to NYS Department of Financial Services, Consumer Assistance
   Unit/IDR Process,

One Commerce Plaza, Albany,  NY 12257.

Out of Network Health Care Providers

Providers in New York can request an independent arbitration review of carrier
payment amounts for a ‘surprise bill’ or emergency service bill. To submit a
dispute, health care providers must:

 * visit the Department of Financial Services (DFS) website to receive a file
   number;
 * complete the Application available from the New York Department of Financial
   Services; and
 * send the application to the assigned independent dispute resolution entity.

Independent Dispute Resolution Decisions

The Independent Dispute Resolution arbitrator will make a binding decision on
all parties to accept either:

(a) the provider’s charge as originally billed; or (b) the carrier’s payment
amount as originally determined for the bill (no compromises).  In some cases,
if settlement looks likely or if the carrier payment and provider fee are
unreasonably far apart, the arbitrator may direct the provider and carrier to
negotiate a settlement directly.

Independent Dispute Resolution decisions are made within 30 calendar days after
the application is received. The decision is based on these factors:

 * Whether there’s a gross disparity between the provider’s charge and (1)
   charges paid for the same services to other patients for other carriers
   out-of-network, and (2) the fees paid by the carrier to similarly qualified
   out-of-network providers for the same services in the same region;
 * The provider's training, education, experience, and usual charge for
   comparable services when the provider does not participate with the patient's
   health plan;
 * The circumstances and complexity of the case, and patient characteristics;
   and
 * The usual and customary cost of the service.

New York Independent Dispute Resolution Application
Form:  https://www.dfs.ny.gov/consumers/health_insurance/surprise_medical_bills https://www.dfs.ny.gov/consumers/health_insurance/surprise_medical_bills

Customers or providers with questions on the Independent Dispute Resolution
process may call ,

or email IDRquestions@dfs.ny.govIDRquestions@dfs.ny.gov.

North Carolina

Surprise Billing

If you have coverage under a North Carolina sitused plan and you receive a bill
for out-of-network services rendered during an emergency or from an
out-of-network provider at an in-network setting or from an out -of-network Air
Ambulance provider, state consumer protections may apply. Please contact Cigna
or NC DOINC DOI for more information or if you believe you are being balanced
billed.

North Dakota

Surprise Billing

If you have coverage under a North Dakota sitused plan and you receive a bill
for out-of-network services rendered during an emergency or from an
out-of-network provider at an in-network setting or from an out -of-network Air
Ambulance provider, state consumer protections may apply. Please contact Cigna
or ND DOIND DOI for more information or if you believe you are being balanced
billed.

Ohio

Surprise Billing

If you have coverage under an Ohio sitused plan and you receive a bill for
out-of-network services rendered during an emergency or from an out-of-network
provider at an in-network setting, state consumer protections may apply. Please
contact Cigna or OH DOIOH DOI for more information or if you believe you are
being balanced billed.

Oklahoma

Cigna Dental Care (DHMO) Plans – Out-of-Network Services

In Oklahoma, Cigna Dental Care (DHMO) is an Employer Group Pre-Paid Dental Plan.
You may also visit dentists outside the Cigna Dental Care network. If you do,
the fees listed on the Patient Charge Schedule will not apply. You will be
responsible for the dentist’s usual fee. We pay non-network dentists the same
amount we’d pay network dentists for covered services. You’ll pay less if you
visit a network dentist in the Cigna Dental Care network. Call Customer Service
for more information.

Oklahoma Group Policy Form Numbers

Medical: HP-APP-1 et al (Cigna Health and Life Insurance Company, "CHLIC").
Indemnity/Dental PPO: HP-POL99/HP-POL-388 (CHLIC), Cigna Dental Care (DHMO) &
Specialty Access: HP-POL115 (CHLIC). Group Universal Life (GUL 2): XX-603404 et
al (Connecticut General Life Insurance Company). Disability & Term Life:
TL-004700 et al, Disability Reserve Buy Out: TL-008610.37, Blanket Accident:
BA-01-1000.00 et al, Group Accident: GA-00-1000.00 et al, Accidental Injury:
GAI-00-1000; Critical Illness: GCI-00-1000, GCI-02-1000; Hospital Care
(Indemnity): GHIP-00-1000 (Life Insurance Company of North America).

Oregon
 * Family Planning and Birth Control Coverage [PDF]Family Planning and Birth
   Control Coverage [PDF]

Oregon Group Policy Form Numbers

Medical: HP-POL38 02-13 et al (Cigna Health and Life Insurance Company,
“CHLIC”). Dental: Indemnity/PPO: HP-POL68/HP-POL352, DHMO - HP-POL121 04-10
(CHLIC). Group Universal Life (GUL 2): XX-603404 et al (Connecticut General Life
Insurance Company). Disability & Term Life: TL-004700 et al, Blanket Accident:
BA-01-1000.00 et al, Group Accident: GA-00-1000.00 et al, Accidental Injury:
GAI-00-1000.OR et al, Critical Illness: GCI-00-0000.OR & GCI-02-0000.OR et al,
Hospital Care (Indemnity): GHIP-00-1000.ORa et al (Life Insurance Company of
North America).

Surprise Billing

If you have coverage under an Oregon sitused plan and you receive a bill for
out-of-network services rendered during an emergency or from an out-of-network
provider at an in-network setting, state consumer protections may apply. Please
contact Cigna or OR DOIOR DOI for more information or if you believe you are
being balanced billed.

Pennsylvania

Surprise Billing

If you have coverage under a Pennsyvania sitused plan and you receive a bill for
out-of-network services rendered during an emergency or from an out-of-network
provider at an in-network setting or from an out -of-network Air Ambulance
provider, state consumer protections may apply. Please contact Cigna
or PA DOIPA DOI for more information or if you believe you are being balanced
billed.

South Dakota

Surprise Billing

If you have coverage under a South Dakota sitused plan and you receive a bill
from an out-of-network provider at an in-network setting, state consumer
protections may apply. Please contact Cigna or SD DOISD DOI for more information
or if you believe you are being balanced billed.

Tennessee

Tennessee Group Policy Form Numbers

Medical: HP-POL43/HC-CER1V1 et al (Cigna Health and Life Insurance Company,
“CHLIC”), GSA-COVER, et al (Cigna HealthCare of Tennessee, Inc.). Dental:
Indemnity/PPO: HP-POL69/HC-CER2V1/HP-POL389, et al., DHMO - HP-POL134/HC-CER17V1
et al. (CHLIC). Group Universal Life (GUL 2): XX-603404 et al (Connecticut
General Life Insurance Company). Disability & Term Life: TL-004700 et al,
Blanket Accident: BA-01-1000.00 et al, Group Accident: GA-00-1000.00 et al,
Accidental Injury: GAI-00-1000; Critical Illness: GCI-00-1000, GCI-02-1000;
Hospital Care (Indemnity): GHIP-00-1000 (Life Insurance Company of North
America).

Tennessee Local Contact Information

General Offices:Cigna HealthCare 1111 Market Street, BR6A Chattanooga, TN 37402

Office hours: 8 am to 5 pm (EST) Monday through Friday

Customer Inquiries: 
Nationwide Customer Service Telephone Number: (Please note: this number may be
different for your employer group. Please check your Cigna ID card for the
correct Customer Service telephone number.) Customers can also login
to myCigna.commyCigna.com or use the myCigna® app to order ID cards, check claim
status, verify coverage or change your Primary Care Provider (PCP).

Benefits Manager Inquiries:

Telephone:

Fax:

Employer Inquiries:

Telephone:

Fax:

Provider Inquiries:

Telephone:

Fax:

Broker Inquiries:

Telephone: Ext. 65549 

Fax:

Surprise Billing

If you have coverage under a Tennessee sitused plan and you receive a bill for
out-of-network services rendered during an emergency or from an out-of-network
provider at an in-network setting, state consumer protections may apply. Please
contact Cigna or TN DOITN DOI for more information or if you believe you are
being balanced billed.

Texas

Texas Annual Prior Authorization statistics: 2021 [PDF]Texas Annual Prior
Authorization statistics: 2021 [PDF]

Product Information
For a list of group/employer health plan products that may be available in
Texas, visit
https://www.cigna.com/individuals-families/shop-plans/plans-through-employer.

Health Related and Non-Insured Services
Cigna health benefit plans provide access to preventive care, health education
and other forms of health related programs. Through our local and national
wellness programs, customers can receive information and support that can help
them learn how to stay fit and enjoy healthier lives. We encourage our customers
to take advantage of these important wellness programs. Current programs may
include:

 * Cigna Healthy Rewards®. This program offers discounts on health and wellness
   programs and services. There are no added membership fees for the Healthy
   Rewards discount program. Cigna customers and their covered family members
   are already qualified. Examples of services available through the program
   include discounts on products and services from health clubs, weight
   management systems, Lasik vision correction and magazine subscriptions.
   Please log on to myCigna.commyCigna.com or use the myCigna® app to learn
   which Healthy Rewards programs are available to you.
 * Cigna 24-hour Health Information LineSM. We have a toll-free telephone line
   staffed with trained nurses who can answer questions, provide information
   about treatment options, and help customers find an appropriate level of care
   based on their symptoms and location. Additionally, customers can access a
   Health Information Library of audio tapes on more than 1,000 health
   conditions and topics.
 * Cigna Healthy Babies program. This program encourages prenatal care and
   provides important information and resources for parents-to-be. We supply
   valuable education materials from the March of Dimes including Mama Magazine
   and other brochures about pregnancy. Customers can also speak to a maternity
   coach with nursing experience and for help finding answers to any questions
   about their pregnancy.
 * Cigna Chronic Condition Management programs offer help for these chronic
   conditions:
   1. Asthma
   2. Diabetes
   3. Heart disease
   4. Low back pain
   5. Depression
   6. Weight complications
   7. Chronic Obstructive Pulmonary Disease
   8. Targeted conditions*

Each program allows you to design a personalized action plan under your doctor's
guidance. We'll provide your doctor with confidential updates on your progress
and challenges, and we'll provide you with:

 * Access to a personal, experienced registered nurse to call for guidance and
   support
 * Educational material about your condition
 * Self-care information
 * Reminders of important tests and exams
 * Informational newsletters

*These conditions include acid-related stomach disorders, atrial fibrillation,
decubitus ulcer, fibromyalgia, hepatitis C, inflammatory bowel disease,
irritable bowel syndrome, osteoarthritis, osteoporosis and urinary incontinence.
Availability of programs may depend on your plan or employee benefit program.
Please check your plan documents for details.

Frequently Asked Questions

How can I be sure that health plans in Texas match quality standards to those in
other states?

Cigna is committed to quality and to making information about health care
quality, including our own performance, available to consumers and customers.
For more information, contact us. 

We are pleased that Cigna HealthCare of Texas, Inc. has ranked among the top 200
of "America's Best Health Plans", in U.S. News and World Report for three
consecutive years (2006, 2007 and 2008) demonstrating our commitment to quality
care and service is yielding strong results. This ranking recognizes our strong
performance on clinical quality measures and NCQA accreditation record. 

NCQA Accreditation is viewed in the health care industry as a highly rigorous
and regarded health plan accreditation program in the health care industry. For
an organization to become accredited by NCQA, it must undergo a detailed survey
and meet certain standards designed to evaluate the health plan's clinical and
administrative systems. NCQA pays special attention to the areas of patient
safety, confidentiality, consumer protection, access, service and continuous
improvement.

Cigna HealthCare of Texas, Inc. which is currently accredited by NCQA, holds the
highest designation rating offered of "Excellent" for its commercial HMO/POS
products through February 2010). Cigna HealthCare of Texas also earned
"Distinction" status from NCQA for its consumer decision support tools through
its Quality Plus Member Connections Program for that same time period. 

Cigna has been publicly reporting our HEDIS®* quality results for more than a
decade. We believe consumers should have access to this type of
publicly-available information. Cigna HealthCare of Texas Effectiveness of Care
results have consistently year over year exceeded the Quality Compass National
average and/or demonstrated significant/meaningful improvements in several
measures. 

The Consumer Assessment of Health Providers and Systems (CAHPS®*) annually
evaluates health plan performance in areas such as customer service, access to
care and claims processing. Cigna HealthCare of Texas results also continue to
show year over year positive trends in several measures 2005 through 2008.

*Healthcare Effectiveness Data and Information Set (HEDIS®) is a registered
trademark of NCQA. CAHPS® is a registered trademark of the Agency for Healthcare
Research and Quality (AHRQ)

Who is eligible for the Texas Health Insurance Risk Pool? The following is a
list of criteria that may deem a terminated member eligible for the Risk Pool:

 1. The member must be a resident of Texas and apply for health coverage.
 2. The member must have a written refusal or rejection, based on health
    reasons, by a health carrier, for substantially similar individual hospital,
    medical, or surgical coverage.
 3. The member must have a certification from an agent or salaried
    representative of a health carrier on the Health Insurance Risk Pool's
    certification form, stating that the agent or salaried representative is
    unable to obtain substantially similar individual hospital, medical, or
    surgical coverage for the member from a health carrier the agent or salaried
    representative represents because, based on that health carrier's
    underwriting guidelines, the member will be declined for coverage as a
    result of a medical condition.
 4. The member must have an offer of substantially similar individual hospital,
    medical, or surgical coverage with riders excluding certain health
    conditions the member has (for example, a health carrier will provide
    coverage to the member with an exclusion of coverage for member's diabetes,
    heart disease, cancer, etc.).
 5. The member must have a diagnosis of one of the medical conditions specified
    by the Texas Health Pool Board of Directors.6. The member must have proof
    that health coverage has been maintained for the previous 18 months with no
    gap in coverage greater than 63 days, with the most recent coverage with an
    employer-sponsored plan, government plan or church plan.For additional
    information concerning eligibility, coverage, cost, limitations, exclusions,
    and termination provisions call or write:

Texas Health Insurance Risk Pool

P. O. Box 6089

Abilene, TX 79608-6089



Visit the Texas Health Insurance Risk Pool web
site: www.txhealthpool.comwww.txhealthpool.com

Are hospital based providers (radiologist; anesthesiologist; pathologist;
emergency department physician; or neonatologist) considered to be in-network
providers?

Some hospital based providers are contracted with Cigna and are considered to be
in-network providers. However, not all hospital based providers contract with
Cigna. Although health care services may be or have been provided to you at a
health care facility that is a member of the provider network used by your
health benefit plan, other professional services may be or have been provided at
or through the facility by physicians and other health care practitioners who
are not members of that network. You may be responsible for payment of all or
part of the fees for those professional services that are not paid or covered by
your health benefit plan.

Does Cigna provide coverage for acquired brain injuries?

Most Cigna insured health benefit plans include coverage for an acquired brain
injury, including the following services:

 1. Cognitive rehabilitation therapy;
 2. Cognitive communication therapy;
 3. Neurocognitive therapy and rehabilitation;
 4. Neurobehavioral, neurophysiological, neuropsychological and
    psychophysiological testing and treatment;
 5. Neurofeedback therapy and remediation;
 6. Post acute transition services and community reintegration services,
    including outpatient day treatment services or other post acute care
    treatment services; and
 7. Reasonable expenses related to periodic reevaluation of the care of an
    individual covered under the plan who has incurred an acquired brain injury,
    has been unresponsive to treatment, and becomes responsive to treatment at a
    later date, at which time the cognitive rehabilitation services would be a
    covered benefit.

The fact that acquired brain injury does not result in hospitalization or acute
care treatment does not affect the right of the insured or the enrollee to
receive the preceding treatments or services commensurate with their condition.
Post acute care treatment or services may be obtained in any facility where such
services may be legally provided, including acute or post acute rehabilitation
hospitals and assisted living facilities regulated under the Texas Health and
Safety code.
You should refer to your insurance certificate or Group Service Agreement for
detailed coverage information.

Does Cigna provide coverage for prostate cancer screening?

Most Cigna insured health benefit plans include coverage for each covered male
for an annual medically recognized diagnostic examination for the detection of
prostate cancer. Benefits include:

 1. A physical examination for the detection of prostate cancer; and
 2. A prostate-specific antigen test for each covered male who is 1. at least 50
    years of age; or 2. at least 40 years of age with a family history of
    prostate cancer or other prostate cancer risk factor. You should refer to
    your insurance certificate or Group Service Agreement for detailed coverage
    information.

Does Cigna provide coverage for tests for detection of colorectal cancer?

Most Cigna insured health benefit plans include coverage for each person
enrolled in the plan who is 50 years of age or older and at normal risk for
developing colon cancer. Covered expenses incurred in conducting a medically
recognized screening examination for the detection of colorectal cancer include
the covered person's choice of:

 1. A fecal occult blood test performed annually and a flexible sigmoidoscopy
    performed every five years, or
 2. A colonoscopy performed every 10 years. You should refer to your insurance
    certificate or Group Service Agreement for detailed coverage information.

Does Cigna provide coverage for tests for detection of human papillomavirus and
cervical cancer?

Most Cigna insured health benefit plans include coverage for each woman enrolled
in the plan who is 18 years of age or older, for expenses incurred for an annual
medically recognized diagnostic examination for the early detection of cervical
cancer. Coverage includes, at a minimum, a conventional Pap smear screening or a
screening using liquid-based cytology methods, as approved by the United States
Food and Drug Administration, alone or in combination with a test approved by
the United States Food and Drug Administration for the detection of the human
papillomavirus. You should refer to your insurance certificate or GSA for
detailed coverage information

Isn't Cigna a March of Dimes Sponsor?

Yes. We proudly support the nationwide affiliation and long-time involvement
Cigna HealthCare has with the March of Dimes®. Since 1995, Cigna HealthCare has
been the exclusive National Health Care Sponsor of the March of Dimes March for
Babies. www.marchofdimes.comwww.marchofdimes.com

Texas Annual Prior Authorization statistics: 2019 [PDF]Texas Annual Prior
Authorization statistics: 2019 [PDF]

Texas Annual Prior Authorization statistics: 2020 [PDF]Texas Annual Prior
Authorization statistics: 2020 [PDF]

Surprise Billing

If you have coverage under a Texas sitused plan and you receive a bill for
out-of-network services rendered during an emergency or from an out-of-network
provider at an in-network setting or from an out -of-network Air Ambulance
provider, state consumer protections may apply. Please contact Cigna
or TX DOITX DOI for more information or if you believe you are being balanced
billed.

Vermont

Surprise Billing

If you have coverage under a Vermont sitused plan and you receive a bill for
out-of-network services rendered during an emergency or from an out-of-network
provider at an in-network setting or from an out -of-network Air Ambulance
provider, state consumer protections may apply. Please contact Cigna
or VT DOIVT DOI for more information or if you believe you are being balanced
billed.

Virginia

If you have coverage under a Virginia sitused plan and you receive a bill for
out-of-network services rendered during an emergency or from an out-of-network
provider at an in-network setting, state consumer protections may apply. Please
contact Cigna or VA DOIVA DOI for more information or if you believe you are
being balanced billed.

Washington

Provider Network Exception

If you cannot locate an in-network provider for a specific service within a
reasonable distance and timeframe, you can contact Cigna's customer service at
the phone number on your ID card or call , and Cigna will help you locate an
appropriate provider for these services. In this situation, where medically
necessary covered services are provided out of network because there was no
in-network provider within a reasonable distance and timeframe, the out of
network services will generally be subject to an in-network level of
cost-sharing.

 * Important Mental Health and Substance Use Disorder Treatment
   InformationImportant Mental Health and Substance Use Disorder Treatment
   Information
 * Family Planning and Birth Control Coverage [PDF]Family Planning and Birth
   Control Coverage [PDF]

The following disclosure information is available to Washington customers:

 * A listing of covered benefits, including prescription drug benefits if any,
   and how consumers may be involved in decisions about benefits, can be found
   in the Benefit Summary [PDF]Benefit Summary [PDF]

You can also view additional information about how consumers may be involved in
decisions about benefits in the grievance processes outlined below.

 * A listing of exclusions, reductions, and limitations to covered benefits,
   definitions of terms such as formulary, generic versus brand name, medical
   necessity or other coverage criteria and policies regarding coverage of
   drugs, including how drugs are added or removed from the formulary and how
   consumers may be involved in decisions about benefits can be found in the
   Benefit Summary listed above. You can also view additional information about
   how consumers may be involved in decisions about benefits in the grievance
   processes outlined below and formulary information in the drug formulary
   listed below.
 * A statement of the policies for protecting the confidentiality of health
   information can be located
   at https://www.cigna.com/legal/compliance/privacy-noticeshttps://www.cigna.com/legal/compliance/privacy-notices
 * For information on the cost of premiums and any cost-sharing requirements,
   please contact your employer. Cost-sharing requirements for current customers
   can also be located by registering on myCigna.commyCigna.com or contacting
   Customer Service on the number on the back of your identification card or .
 * View a summary explanation of the grievance process [PDF]grievance
   process [PDF].
 * A copy of the grievance process for claim or service denial and for
   dissatisfaction with care can be located
   at https://www.cigna.com/individuals-families/member-guide/appeals-grievanceshttps://www.cigna.com/individuals-families/member-guide/appeals-grievances
 * Cigna does not operate a point-of-service option in Washington.
 * To obtain a complete and detailed list of covered benefits including a copy
   of the current formulary, a list of participating primary care and specialty
   care providers, including disclosure of network arrangements that restrict
   access to providers within any plan network, please contact Customer Service
   at the number on the back of your identification card or . You can also view
   participating providers and the formulary on the applicable links on this
   page.
 * The documents referred to in the medical coverage agreement can be obtained
   by contacting Customer Service at the number on the back of your
   identification number or . You can also view the formulary and grievance
   policy by accessing the links on this page.
 * A full description of the procedures to be followed for consulting a provider
   other than the primary care provider and whether the primary care provider,
   Cigna's medical director, or another entity must authorize the referral can
   be obtained by contacting Customer Service at the number on the back of your
   identification number or . You can also view authorization and referral
   information in your certificate.
 * General procedures that you must first follow for obtaining prior
   authorization for health care services can be located in the Benefit Summary
   above. You also obtain the full list of requirements by contacting Customer
   Service at the number on the back of your identification number or .
 * Cigna's reimbursement arrangements and provider compensation programs can be
   located at Cigna's provider directory
   at http://www.cigna.com/hcpdirectory/http://www.cigna.com/hcpdirectory /
 * If you want to request an annual accounting of all payments made by Cigna
   which have been counted against any payment limitations, visit limitations,
   or other overall limitations on a person's coverage under a plan, please
   contact Customer Service at the number on the back of your identification
   card.
 * Accreditation status can be located
   at http://www.cigna.com/about-us/company-profile/accreditationhttp://www.cigna.com/about-us/company-profile/accreditation
 * Referral procedures which include the procedures to be followed for
   consulting a provider other than the primary care provider, utilization
   review procedures for obtaining prior authorization, information on Cigna's
   formulary and other policies can be located
   at https://www.cigna.com/legal/members/member-rights-and-responsibilities/cigna-health-care-policieshttps://www.cigna.com/legal/members/member-rights-and-responsibilities/cigna-health-care-policies
 * Cigna's drug list formulary can be located at
   https://www.cigna.com/individuals-families/member-guide/prescription-drug-lists/https://www.cigna.com/individuals-families/member-guide/prescription-drug-lists /
 * Clinical preventive health care information can be located at
   https://www.cigna.com/knowledge-center/preventive-carehttps://www.cigna.com/knowledge-center/preventive-care
 * View Cigna's commitment to quality [PDF]commitment to quality [PDF],
   including information on standardized measures of health care.
 * Cigna's integrated plan to identify and manage the most prevalent diseases
   within its enrolled population, including cancer, heart disease, and stroke
   are included in its Case Management and Staying Healthy information are
   available at:
   https://www.cigna.com/health-care-providers/resources/case-managementhttps://www.cigna.com/health-care-providers/resources/case-management
 * Under Washington state law, a health care benefit manager (“HCBM”) is a
   person or entity providing services to, or acting on behalf of, a health
   carrier or employee benefits programs, that directly or indirectly impacts
   the determination or utilization of benefits for, or patient access to,
   health care services, drugs, and supplies including, but not limited to:
   * (i) Prior authorization or preauthorization of benefits or care;
   * (ii) Certification of benefits or care;
   * (iii) Medical necessity determinations;
   * (iv) Utilization review;
   * (v) Benefit determinations;
   * (vi) Claims processing and repricing for services and procedures;
   * (vii) Outcome management;
   * (viii) Provider credentialing and recredentialing;
   * (ix) Payment or authorization of payment to providers and facilities for
     services or procedures;
   * (x) Dispute resolution, grievances, or appeals relating to determinations
     or utilization of benefits;
   * (xi) Provider network management; or
   * (xii) Disease management.

An HCBM includes, but is not limited to, entities that specialize in specific
types of health care benefit management such as pharmacy benefit managers,
radiology benefit managers, laboratory benefit managers, and mental health
benefit managers.

A list of HCBMs that are contracted with Cigna is located at
https://www.cigna.com/assets/docs/washington/washington-state-health-care-benefit-manager-v1a.pdfhttps://www.cigna.com/assets/docs/washington/washington-state-health-care-benefit-manager-v1a.pdf

Pharmacy Disclosure Requirements

"Does this plan limit or exclude certain drugs my health care provider may
prescribe, or encourage substitutions for some drugs?"

 * Depending on a member's plan, generics may be used when filling the member's
   prescription for a brand drug, where available and appropriate, at the
   generic copay amount.
 * If a member's plan allows for doctor override, the member does not have to
   pay extra when receiving a brand name drug for which the doctor has specified
   "Dispense as Written" (DAW) on the prescription. The pharmacist dispenses the
   brand name drug specified in the prescription, not the generic alternative,
   and the member pays his or her cost share or copay for the brand name drug.
   If the doctor does not write DAW on the prescription for a brand name drug
   when a generic is available, and the member desires and requests the brand
   name drug, he or she will then have to pay the brand or generic copay plus
   the difference in cost between the brand and generic (up to the cost of the
   brand name drug).
 * Please contact Cigna at the number on the back of your ID card for specific
   details or refer to your plan booklet for additional details.

"When can my plan change the approved drug list (formulary)? If a change occurs,
will I have to pay more to use a drug I had been using?"

 * Maintaining our prescription drug list for the safety and health care needs
   of our members is the responsibility of the Pharmacy and Therapeutics
   Committee (P&T Committee). The P&T Committee reviews the drug lists at least
   annually and re-reviews existing drugs and drug classes when clinically
   significant data on safety and efficacy become available.
 * As circumstances warrant, we may add or remove medications from the
   prescription drug list from time to time. Generally, Cigna limits its changes
   to the prescription drug list to a maximum of twice a year, unless safety
   issues warrant removal. Members using any medication targeted for removal
   from the preferred tier will receive written notification in advance of this
   change.
 * When a medication changes status from preferred to non-preferred or becomes
   non-formulary on our prescription drug list, we send targeted mailings to
   notify impacted members at least 90-days in advance of the scheduled
   prescription drug list status change. This allows members time to talk with
   their doctor and see if a lower-cost option might be right for them.

"What should I do if I want a change from limitations, exclusions, substitutions
or cost increases for drugs specified in this plan?"

 * Please contact Cigna at the number on the back of your ID card with any
   questions about your pharmacy plan.

 * "How much do I have to pay to get a prescription filled?"
   
   * Cigna's member website, myCigna.commyCigna.com, provides personalized
     pharmacy plan information and helpful tools including our Prescription Drug
     Price Quote Tool. The Prescription Drug Price Quote Tool shows members drug
     prices specific to their coverage plan and lets them search for pharmacies.
     The easy-to-use drug pricing tool enables members to quickly see their
     medication options and make smart health spending decisions. Members can:
   * search for a drug and compare the cost of the brand-name medication and its
     generic equivalents
   * view drug pricing at retail pharmacies and Cigna Home Delivery Pharmacy in
     an easy-to-understand side-by-side format, including savings opportunities
     based on their coverage plan
   * use the pharmacy search feature for in-network pharmacies
   * get real-time drug price information and lower-cost drug options
   * view pricing based on their specific pharmacy coverage, including
     deductibles, copays/coinsurance, and out-of-pocket limits

 * Prescription drug price quotes are also available by contacting Cigna at the
   number on the back of your ID card.
   
   "Do I have to use certain pharmacies to pay the least out of my own pocket
   under this health plan?"
   
   * Cigna provides a well-managed, quality network with national accessibility
     so our members can get prescription drugs at a convenient location near
     their home or work and while on vacation in the U.S. This network is
     actively monitored to determine optimal access through zip code analysis
     and member/client feedback. Our retail pharmacy network is composed of more
     than 68,000 pharmacies including:
   * Major pharmacy chains
   * Smaller regional chains
   * Mass merchandiser pharmacies
   * Grocery store pharmacies
   * Veteran administration pharmacies
   * Indian Tribal Unit pharmacies
   * Independent pharmacies

 * Our network is large enough to provide members with convenient access to
   local participating pharmacies while providing competitive generic and brand
   drug discounts. Eighty percent of retail pharmacies are in Cigna's national
   pharmacy network.
 * Additionally, Cigna owns and operates its own home delivery pharmacy—Cigna
   Home Delivery Pharmacy.
 * Cigna's member website, myCigna.commyCigna.com, provides personalized
   pharmacy plan information and helpful tools including our Prescription Drug
   Price Quote Tool. The Prescription Drug Price Quote Tool shows members drug
   prices specific to their coverage plan and lets them search for in-network
   pharmacies.
 * You can also obtain pharmacy information by contacting Cigna at the number on
   the back of your ID card.

"How many days' supply of most medications can I get without paying another
co-pay or other repeating charge?"

 * Depending on your pharmacy plan, you may be able fill your maintenance
   medication in a 90-day or 30-day supply at any pharmacy in your network.
   Maintenance medications are taken regularly, over time, to treat an ongoing
   health condition, such as diabetes, high blood pressure, cholesterol or
   asthma.
 * You may also have the opportunity to save money on copays by filling your
   prescriptions 90-days at a time.
 * Please contact Cigna at the number on the back of your ID card with any
   questions about your pharmacy plan.

"What other pharmacy services does my health plan cover?"

 * Cigna ensures members have 24-hour access to registered pharmacists for
   emergencies. As an added service to our members, most participating chain
   pharmacies provide 24-hour-store locations with a pharmacist available 24
   hours each day. Members may call customer service toll-free or use
   myCigna.commyCigna.com to find the location of the nearest participating
   24-hour pharmacy. Additionally, most pharmacies list emergency numbers on
   their doors and voice mail systems.
 * Depending on your pharmacy plan, we may also provide coaching teams and
   web/app services that offer members one view into their coverage and one
   research tool into their conditions.
 * Please contact Cigna at the number on the back of your ID card with any
   questions about your pharmacy plan.

The Prescription Drug coverage provided by your plan uses the following
provisions in the administration of coverage:

 * Exclusion of certain Prescription Drug Products from the Prescription Drug
   List;
 * Therapeutic drug substitution;
 * Incentives for use of generic drugs; such as step-therapy requirements and
   cost share incentives;
 * Precertification requirements;
 * Prescription Drug List changes;
 * Supply limit requirements; and
 * Specialty Prescription Drug Product requirements

Your certificate explains the process that you and your provider must use to
seek coverage of a Prescription Drug Product that is not on the Prescription
Drug List or is not the preferred Prescription Drug Product for a covered
medical condition.

You may be eligible to receive an emergency fill for a Prescription Drug Product
at a non-Network Pharmacy if Cigna determines that the Prescription Order could
not reasonably be filled at a Network Pharmacy. Your payment will be based on
the Usual and Customary Charge submitted by the non-Network Pharmacy. You also
may be eligible to receive an emergency fill for a Prescription Drug Product
while a precertification request is being processed. The process for requesting
this emergency fill and the cost share requirements for this emergency fill are
described in your certificate.

Your certificate explains the process Cigna uses for developing coverage
standards and the Prescription Drug Lists.

Your certificate explains the process for changing coverage standards and the
Prescription Drug Lists. Additionally, your certificate explains the process
that you and your provider must use to seek coverage of a Prescription Drug
Product that is not on the Prescription Drug List or is not the preferred
Prescription Drug Product for a covered medical condition. The length of the
authorization will depend on the diagnosis and Prescription Drug Product. There
are instances when an approved Prescription Drug Product coverage exception may
be grandfathered to allow ongoing coverage.

Coverage status of a Prescription Drug Product may change periodically. As a
result of coverage changes the plan may require you to pay more or less for that
Prescription Drug Product or try another covered Prescription Drug Product.

The Prescription Drug Product dispensing fee is considered to be a
pharmacy-related service which is reimbursed by the plan.

Your certificate lists the categories of excluded Prescription Drug Products.

The above provisions are explained in your certificate, or you can contact Cigna
at for more information.

YOUR RIGHT TO SAFE AND EFFECTIVE PHARMACY SERVICES

 * State and federal laws establish standards to assure safe and effective
   pharmacy services, and to guarantee your right to know what drugs are covered
   under this plan and what coverage limitations are in your contract. If you
   would like more information about the drug coverage policies under this plan,
   or if you have a question or a concern about your pharmacy benefit, please
   contact us (the health carrier) at (1 (800) ‍244-6224)
 * If you would like to know more about your rights under the law, or if you
   think anything you received from this plan may not conform to the terms of
   your contract, you may contact the Washington State Office of Insurance
   Commissioner at . If you have a concern about the pharmacists or pharmacies
   serving you, please call the State Department of Health at .

Surprise Billing

If you have coverage under a Washington sitused plan and you receive a bill for
out-of-network services rendered during an emergency or from an out-of-network
provider at an in-network setting, state consumer protections may apply. Please
contact Cigna or the Washington state OICthe Washington state OIC for more
information or if you believe you are being balanced billed.

Washington Balance Billing Protection Act/Federal No Surprises Act Consumer
Notice [PDF]Washington Balance Billing Protection Act/Federal No Surprises Act
Consumer Notice [PDF]

West Virginia

Surprise Billing

If you have coverage under a West Virginia sitused plan and you receive a bill
from an out-of-network provider at an in-network setting, state consumer
protections may apply. Please contact Cigna or WV DOIWV DOI for more information
or if you believe you are being balanced billed.

Network Access Plan
Cigna Health and Life Insurance Company-West Virginia Medical Network Access
Plan [PDF]Cigna Health and Life Insurance Company-West Virginia Medical Network
Access Plan [PDF]

Quarterly WV NADAC Report
Q12022 [PDF]Q12022 [PDF]














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CIGNA COMPANY INFORMATION

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DISCLAIMER

Individual and family medical and dental insurance plans are insured by Cigna
Health and Life Insurance Company (CHLIC), Cigna HealthCare of Arizona, Inc.,
Cigna HealthCare of Illinois, Inc., and Cigna HealthCare of North Carolina, Inc.
Group health insurance and health benefit plans are insured or administered by
CHLIC, Connecticut General Life Insurance Company (CGLIC), or their affiliates
(see a listing of the legal entities a listing of the legal entities that insure
or administer group HMO, dental HMO, and other products or services in your
state). Accidental Injury, Critical Illness, and Hospital Care plans or
insurance policies are distributed exclusively by or through operating
subsidiaries of Cigna Corporation, are administered by Cigna Health and Life
Insurance Company, and are insured by either (i) Cigna Health and Life Insurance
Company (Bloomfield, CT); (ii) Life Insurance Company of North America (“LINA”)
(Philadelphia, PA); or (iii) New York Life Group Insurance Company of NY
(“NYLGICNY”) (New York, NY), formerly known as Cigna Life Insurance Company of
New York. The Cigna name, logo, and other Cigna marks are owned by Cigna
Intellectual Property, Inc. LINA and NYLGICNY are not affiliates of Cigna.

All insurance policies and group benefit plans contain exclusions and
limitations. For availability, costs and complete details of coverage, contact a
licensed agent or Cigna sales representative. This website is not intended for
residents of New Mexico.

Selecting these links will take you away from Cigna.com to another website,
which may be a non-Cigna website. Cigna may not control the content or links of
non-Cigna websites. Details Details


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