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FEDERAL AND STATE COMPLIANCE AND POLICY DISCLOSURES, EXCLUSIONS, AND LIMITATIONS




HEALTH INSURANCE PLANS

Rates will vary by plan design and the plan deductible, copay, coinsurance, and
out-of-pocket maximums selected. Rates vary based on age, family size,
geographic location (residential zip code) and tobacco use. Rates are subject to
change upon notice in accordance with applicable state law.

Rates for new medical policies/service agreements with an effective date on or
after 01/01/2023 are guaranteed through 12/31/2023. Medical rates are subject to
change upon 30 days’ prior notice in KS, MO, TN and PA; 31 days’ prior notice in
SC; 45 days’ prior notice in FL, UT; 60 days’ prior notice in IN, AZ, IL, TX,
NC, GA and CO; and 75 days’ prior notice in MS and VA.

Provider networks can vary by state and market. For the plan(s) you are
interested in, view the Summary of BenefitsSummary of Benefits for important
market-specific provider network information.

To see if your provider is in-network or to find a new in-network provider,
visit www.cigna.com/ifp-providerswww.cigna.com/ifp-providers.

Major medical insurance policies/service agreement have exclusions, limitations,
reduction of benefits and terms under which the policy may be continued in force
or discontinued. Medical applications are accepted during the annual Open
Enrollment Period, or within 60 calendar days of a qualifying life event.
Benefits are provided only for those services that are medically necessary as
defined in the policy/service agreement and for which the insured person has
benefits.

Form Series for Cigna Health and Life Insurance Company:

Exclusive Provider (EPO):
EPO: CO: COINDEPO052022, COINDOPTIONEPO052022; FL: FLINDEPO062022;
IN:ININDEPO052022; KS: KSINDEPO052022; MO: MOINDEPO052022; MS: MSINDEPO052022;
PA PAINDEPO052022; TN: TNINDEPO062022, UT: UTINDEPO062022, VA: VAINDEPO04152022
off exchange, VAINDEPO04152022-HIX on exchange

Form Series for Cigna HealthCare of Arizona, Inc., Cigna HealthCare of Georgia,
Inc., Cigna HealthCare of Illinois, Inc., Cigna HealthCare of North Carolina,
Inc., Cigna HealthCare of South Carolina, Inc. and Cigna HealthCare of Texas,
Inc.:

HMO: AZ: INDHMOAZ01-2023; GA: INDHMOGA01-2023; IL: INDHMOIL01-2023,
INDHMOILd01-2023, INDHMOILa01-2023, INDHMOILh01-2023; NC: INDHMONC01-2023, SC:
INDSCHMOEOC01-2023; TX: TXINDHMO052022

The policy/service agreement may be cancelled by Cigna due to failure to pay
premium, fraud (in VA, any act, practice or omission that constitutes fraud),
ineligibility, when the insured no longer lives in the service area, or when
Cigna ceases to offer policies/service agreements of this type or cease to offer
any plans in the individual market in the state, in accordance with applicable
law. You may cancel the policy/service agreement on the first of the month
following our receipt of your written notice. In VA, you may cancel the
policy/service agreement on the date of our receipt of your written cancellation
notice, unless otherwise stated.

In Texas, we may cancel this EOC only in the event of any of the following:

 * You fail to pay Your Premiums as they become due or by the end of the last
   day of the 31 day grace period for plans not purchased from a Marketplace or
   the 90 consecutive day grace period for plans purchased from a Marketplace.
 * On the first of the month following Our receipt of Your written notice to
   cancel.
 * When You become ineligible for this coverage.
 * If You have committed, or allowed someone else to commit, any fraud or
   deception in connection with this EOC or coverage, after Cigna provides 15
   days’ advance written notice.
 * When We cease to offer policies of this type to all individuals in Your
   class. In this event, Texas law requires that We do the following: (1)
   provide written notice to each Member of the discontinuation before the 90th
   day preceding the date of the discontinuation of the coverage; (2) offer to
   each Member on a guaranteed issue basis the option to purchase any other
   individual hospital medical or surgical insurance coverage offered by Us at
   the time of discontinuation; and (3) act uniformly without regard to any
   health status related factors of an Member.
 * When We cease offering any plans in the individual market in Texas, We will
   notify You of the impending termination of Your coverage at least 180 days
   prior to Your cancellation.
 * When the Subscriber no longer lives in the Service Area.
 * In the event of entry of a final judgment by a court declaring all or part of
   the Patient Protection and Affordable Care Act (P.L. 111-148) invalid,
   unconstitutional, or otherwise ineffective, and the state not providing
   alternative and sufficient means of funding advanced-premium tax credits,
   this EOC shall be subject to cancellation consistent with applicable federal
   and state law.

Cigna reserves the right to modify the policy/service agreement, including plan
provisions, benefits and coverages, consistent with state or federal law.
Policies/service agreements renew on a calendar year basis.

Cigna does not discriminate on the basis of race, color, national origin,
disability, age, sex, gender identity, sexual orientation, or health status in
the administration of the plan, including enrollment and benefit determinations.

No Cost Language Services. You can get an interpreter. You can get documents
read to you and some sent to you in your language. For help, call us at .

Servicios de idiomas sin costo. Puede obtener un intérprete. Le pueden leer
documentos y que le envíen algunos en español. Para obtener ayuda, llámenos al .

For costs, and additional details about coverage, contact Cigna at 900 Cottage
Grove Rd, Hartford, CT 06152 or call . (1-866-‍438-2446).


FEDERAL AND STATE COMPLIANCE DISCLOSURES AND HEALTH INSURANCE PLAN EXCLUSIONS &
LIMITATIONS (E&LS), AND STATE-SPECIFIC INFORMATION

Alaska

AK Guaranty Association Notice [PDF]AK Guaranty Association Notice [PDF]

Arizona

Arizona Connect Exclusions and Limitations - 2022 [PDF] Arizona Connect
Exclusions and Limitations - 2022 [PDF]

Arizona Connect Exclusions and Limitations - 2023 [PDF]Arizona Connect
Exclusions and Limitations - 2023 [PDF]

Arkansas

AR Guaranty Association Notice [PDF]AR Guaranty Association Notice [PDF]

California

CA Guaranty Association Notice [PDF] CA Guaranty Association Notice [PDF]

Colorado

CO Life and Health Insurance Protection Association Notice [PDF]CO Life and
Health Insurance Protection Association Notice [PDF]

Colorado Connect Exclusions and Limitations - 2022 [PDF]Colorado Connect
Exclusions and Limitations - 2022 [PDF]

Colorado Connect Exclusions and Limitations - 2023 [PDF]Colorado Connect
Exclusions and Limitations - 2023 [PDF]

Access Plan

Our Access Plans provide information on: (1) who participates in the provider
network; (2) how we ensure that the network meets the health care needs of its
members; (3) how the provider referral process works; (4) how care is continued
if providers leave the network; (5) what steps are taken 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 review.

Cigna Colorado Medical Access Plan [PDF]Cigna Colorado Medical Access Plan [PDF]

Cigna Colorado Dental Access Plan [PDF]Cigna Colorado Dental Access Plan [PDF]

District of Columbia

DC Guaranty Association Notice [PDF]DC Guaranty Association Notice [PDF]

Florida

Florida Connect Exclusions and Limitations - 2022 [PDF]Florida Connect
Exclusions and Limitations - 2022 [PDF]

Florida Connect Exclusions and Limitations - 2023 [PDF]Florida Connect
Exclusions and Limitations - 2023 [PDF]

Georgia

Georgia Connect Exclusions and Limitations - 2022 [PDF]Georgia Connect
Exclusions and Limitations - 2022 [PDF]

Georgia Connect Exclusions and Limitations - 2023 [PDF]Georgia Connect
Exclusions and Limitations - 2023 [PDF]

Georgia Mammogram Notice [PDF]Georgia Mammogram Notice [PDF]

Hawaii

HI Guaranty Association Notice [PDF]HI Guaranty Association Notice [PDF]

Illinois

IL Guaranty Association Notice [PDF]IL Guaranty Association Notice [PDF]

Illinois Maternity Elective Abortion Notice [PDF]Illinois Maternity Elective
Abortion Notice [PDF]

Illinois Direct Access to OBGYNs Notice [PDF]Illinois Direct Access to OBGYNs
Notice [PDF]

Illinois Connect Exclusions and Limitations - 2022 [PDF]Illinois Connect
Exclusions and Limitations - 2022 [PDF]

Illinois Connect Exclusions and Limitations - 2023 [PDF]Illinois Connect
Exclusions and Limitations - 2023 [PDF]

Indiana

IN Guaranty Association Notice [PDF]IN Guaranty Association Notice [PDF]

Indiana Connect Exclusions and Limitations - 2023 [PDF]Indiana Connect
Exclusions and Limitations - 2023 [PDF]

Iowa

IA Guaranty Association Notice [PDF]IA Guaranty Association Notice [PDF]

Kansas

KS Guaranty Association Notice [PDF]KS Guaranty Association Notice [PDF]

Kansas Connect Exclusions and Limitations - 2022 [PDF]Kansas Connect Exclusions
and Limitations - 2022 [PDF]

Kansas Connect Exclusions and Limitations - 2023 [PDF]Kansas Connect Exclusions
and Limitations - 2023 [PDF]

Louisiana

LA Guaranty Association Notice [PDF]LA Guaranty Association Notice [PDF]

Minnesota

MN Guaranty Association Notice [PDF]MN Guaranty Association Notice [PDF]

Mississippi

MS Guaranty Association Notice [PDF]MS Guaranty Association Notice [PDF]

Mississippi Connect Exclusions and Limitations - 2022 [PDF]Mississippi Connect
Exclusions and Limitations - 2022 [PDF]

Mississippi Connect Exclusions and Limitations - 2023 [PDF]Mississippi Connect
Exclusions and Limitations - 2023 [PDF]

Missouri

MO Guaranty Association Notice [PDF]MO Guaranty Association Notice [PDF]

Missouri Connect Exclusions and Limitations - 2022 [PDF]Missouri Connect
Exclusions and Limitations - 2022 [PDF]

Missouri Connect Exclusions and Limitations - 2023 [PDF]Missouri Connect
Exclusions and Limitations - 2023 [PDF]

Montana

MT Guaranty Association Notice [PDF]MT Guaranty Association Notice [PDF]

Nevada

NV Guaranty Association Notice [PDF]NV Guaranty Association Notice [PDF]

North Carolina

NC Guaranty Association Notice [PDF]NC Guaranty Association Notice [PDF]

North Carolina Connect Exclusions and Limitations - 2022 [PDF]North Carolina
Connect Exclusions and Limitations - 2022 [PDF]

North Carolina Connect Exclusions and Limitations - 2023 [PDF]North Carolina
Connect Exclusions and Limitations - 2023 [PDF]

North Dakota

ND Guaranty Association Notice [PDF]ND Guaranty Association Notice [PDF]

Ohio

OH Guaranty Association Notice [PDF]OH Guaranty Association Notice [PDF]

Oklahoma

OK Guaranty Association Notice [PDF]OK Guaranty Association Notice [PDF]

Pennsylvania

Pennsylvania Connect Exclusions and Limitations - 2022 [PDF]Pennsylvania Connect
Exclusions and Limitations - 2022 [PDF]

Pennsylvania Connect Exclusions and Limitations - 2023 [PDF]Pennsylvania Connect
Exclusions and Limitations - 2023 [PDF]

South Carolina

South Carolina Connect Exclusions and Limitations - 2023 [PDF]South Carolina
Connect Exclusions and Limitations - 2023 [PDF]

South Dakota

SD Guaranty Association Notice [PDF]SD Guaranty Association Notice [PDF]

Tennessee

TN Guaranty Association Notice [PDF]TN Guaranty Association Notice [PDF]

Tennessee Connect Exclusions and Limitations - 2022 [PDF]Tennessee Connect
Exclusions and Limitations - 2022 [PDF]

Tennessee Connect Exclusions and Limitations - 2023 [PDF]Tennessee Connect
Exclusions and Limitations - 2023 [PDF]

Texas

TX Guaranty Association Notice [PDF]TX Guaranty Association Notice [PDF]

Texas Connect Exclusions and Limitations - 2023 [PDF]Texas Connect Exclusions
and Limitations - 2023 [PDF]

Utah

UT Guaranty Association Notice [PDF]UT Guaranty Association Notice [PDF]

Utah Connect Exclusions and Limitations - 2022 [PDF]Utah Connect Exclusions and
Limitations - 2022 [PDF]

Utah Connect Exclusions and Limitations - 2023 [PDF]Utah Connect Exclusions and
Limitations - 2023 [PDF]

Virginia

Virginia Connect Exclusions and Limitations - 2022 [PDF]Virginia Connect
Exclusions and Limitations - 2022 [PDF]

Virginia Connect Exclusions and Limitations - 2023 [PDF]Virginia Connect
Exclusions and Limitations - 2023 [PDF]

Wyoming

WY Guaranty Association Notice [PDF]WY Guaranty Association Notice [PDF]


DENTAL INSURANCE PLANS

Dental Plans are insured by Cigna Health and Life Insurance Company with network
management services provided by Cigna Dental Health, Inc. Rates may vary based
on age, family size, geographic location (residential zip code) and plan design.


DENTAL PEDIATRIC INSURANCE PLANS

Dental Plans are insured by Cigna Health and Life Insurance Company with network
management services provided by Cigna Dental Health, Inc. Rates vary based on
age, number of enrolled dependents, geographic location (residential zip code),
and plan design.

These dental plans offer the full range of Essential Health Benefit Pediatric
Oral Care and satisfy the requirements under the Affordable Care Act. This
policy does not provide any dental benefits to individuals age nineteen (19) or
older. This policy is being offered so the purchaser will have pediatric dental
coverage as required by the Affordable Care Act. If you want adult dental
benefits, you will need to buy a plan that has adult dental benefits. This plan
will not pay for any adult dental care, so you will have to pay the full price
of any care you receive.


DENTAL PEDIATRIC PLAN EXCLUSIONS & LIMITATIONS (E&LS) AND STATE SPECIFIC
INFORMATION

Arizona

Arizona Pediatric Dental Plan Exclusions - 2022 [PDF]Arizona Pediatric Dental
Plan Exclusions - 2022 [PDF]

Arizona Pediatric Dental Plan Exclusions - 2023 [PDF]Arizona Pediatric Dental
Plan Exclusions - 2023 [PDF]

Colorado

Colorado Pediatric Dental Plan Exclusions - 2022 [PDF]Colorado Pediatric Dental
Plan Exclusions - 2022 [PDF]

Colorado Pediatric Dental Plan Exclusions - 2023 [PDF]Colorado Pediatric Dental
Plan Exclusions - 2023 [PDF]

Florida

Florida Pediatric Dental Plan Exclusions - 2022 [PDF]Florida Pediatric Dental
Plan Exclusions - 2022 [PDF]

Florida Pediatric Dental Plan Exclusions - 2023 [PDF]Florida Pediatric Dental
Plan Exclusions - 2023 [PDF]

Illinois

Illinois Pediatric Dental Plan Exclusions - 2022 [PDF]Illinois Pediatric Dental
Plan Exclusions - 2022 [PDF]

Illinois Pediatric Dental Plan Exclusions - 2023 [PDF]Illinois Pediatric Dental
Plan Exclusions - 2023 [PDF]

Missouri

Missouri Pediatric Dental Plan Exclusions - 2022 [PDF]Missouri Pediatric Dental
Plan Exclusions - 2022 [PDF]

Missouri Pediatric Dental Plan Exclusions - 2023 [PDF]Missouri Pediatric Dental
Plan Exclusions - 2023 [PDF]

North Carolina

North Carolina Pediatric Dental Plan Exclusions - 2022 [PDF]North Carolina
Pediatric Dental Plan Exclusions - 2022 [PDF]

North Carolina Pediatric Dental Plan Exclusions - 2023 [PDF]North Carolina
Pediatric Dental Plan Exclusions - 2023 [PDF]

Tennessee

Tennessee Pediatric Dental Plan Exclusions - 2022 [PDF]Tennessee Pediatric
Dental Plan Exclusions - 2022 [PDF]

Tennessee Pediatric Dental Plan Exclusions - 2023 [PDF]Tennessee Pediatric
Dental Plan Exclusions - 2023 [PDF]

Virginia

Virginia Pediatric Dental Plan Exclusions - 2022 [PDF]Virginia Pediatric Dental
Plan Exclusions - 2022 [PDF]

Virginia Pediatric Dental Plan Exclusions - 2023 [PDF]Virginia Pediatric Dental
Plan Exclusions - 2023 [PDF]


DENTAL FAMILY + PEDIATRIC INSURANCE PLANS

Dental Plans are insured by Cigna Health and Life Insurance Company with network
management services provided by Cigna Dental Health, Inc. Rates vary based on
age, family size, geographic location (residential zip code), and plan design.

These dental plans offer the full range of Essential Health Benefit Pediatric
Oral Care and satisfy the requirements under the Affordable Care Act.


DENTAL FAMILY + PEDIATRIC PLAN EXCLUSIONS & LIMITATIONS (E&LS) AND
STATE-SPECIFIC INFORMATION

Arizona

Arizona Family + Pediatric Dental Plan Exclusions - 2022 [PDF]Arizona Family +
Pediatric Dental Plan Exclusions - 2022 [PDF]

Arizona Family + Pediatric Dental Plan Exclusions - 2023 [PDF]Arizona Family +
Pediatric Dental Plan Exclusions - 2023 [PDF]

Colorado

Colorado Family + Pediatric Dental Plan Exclusions - 2022 [PDF]Colorado Family +
Pediatric Dental Plan Exclusions - 2022 [PDF]

Colorado Family + Pediatric Dental Plan Exclusions - 2022 [PDF]Colorado Family +
Pediatric Dental Plan Exclusions - 2022 [PDF]

Florida

Florida Family + Pediatric Dental Plan Exclusions - 2022 [PDF]Florida Family +
Pediatric Dental Plan Exclusions - 2022 [PDF]

Florida Family + Pediatric Dental Plan Exclusions - 2023 [PDF]Florida Family +
Pediatric Dental Plan Exclusions - 2023 [PDF]

Tennessee

Tennessee Family + Pediatric Dental Plan Exclusions - 2022 [PDF]Tennessee Family
+ Pediatric Dental Plan Exclusions - 2022 [PDF]

Tennessee Family + Pediatric Dental Plan Exclusions - 2023 [PDF]Tennessee Family
+ Pediatric Dental Plan Exclusions - 2023 [PDF]





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Plans are insured by Cigna Health and Life Insurance Company or its affiliates:
For Arizona residents, health plans are offered by Cigna HealthCare of Arizona,
Inc. For Georgia residents, health plans are offered by Cigna HealthCare of
Georgia, Inc. For Illinois residents, health plans are offered by Cigna
HealthCare of Illinois, Inc. For North Carolina residents, health plans are
offered by Cigna HealthCare of North Carolina, Inc.  For South Carolina
residents, health plans are offered by Cigna HealthCare of South Carolina,
Inc. For Texas residents, health plans are offered by Cigna HealthCare of Texas,
Inc.






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THE CIGNA GROUP INFORMATION

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DISCLAIMER

Product availability may vary by location and plan type and is subject to
change. All health insurance policies and health benefit plans contain
exclusions and limitations. For costs and details of coverage, review your plan
documents or contact a Cigna representative.

All Cigna products and services are provided exclusively by or through operating
subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance
Company, Cigna HealthCare of Arizona, Inc., Cigna HealthCare of Georgia, Inc.,
Cigna HealthCare of Illinois, Inc., Cigna HealthCare of North Carolina, Inc. and
Cigna HealthCare of Texas, 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.



 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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