QUICK GUIDE TO
CIGNA ID CARDS
960220 12/21
We pack a lot of important information on
our ID cards.
This brochure can help define and clarify information that
appears on Cigna’s most common customer ID cards. It
can also help you understand the requirements associated
with our various plans, allowing you to quickly and
eciently serve your patients.
We may occasionally update this brochure during the year.
Download the most current version at Cigna.com > Health
Care Providers > Coverage and Claims > ID Cards.
Important information about this guide
Please note: Some Cigna ID cards include a “G” in the
upper-right corner,and may have dierent service
channels,including customer service phone numbers
andclaim appeal addresses.
Sample standard Cigna ID card images are shown in this
guide. However, the actual content may vary to conform
toa state’s legislative and regulatory requirements. An
IDcard is not a guarantee of coverage, and benefits should
be verified.
Always be sure to check the back of your patient’s ID card
for the correct contact information. Youcan also refer to
the Important contact information page in the back of this
guide, or referto the Cigna Reference Guide forphysicians,
hospitals, ancillaries, and other health care professionals by
logging in to the Cigna for Health Care Professionals
website (CignaforHCP.com) >Resources >Reference
Guides >Medical Reference Guides >Health Care
Professional Reference Guides.
Table of contents
Managed care plans. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Networks:
Network Open Access . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2
Open Access Plus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2
HMO Open Access or POS Open Access . . . . . . . . . . . . . . .2
LocalPlus
or LocalPlusIN. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
HMO, POS, or HMO POS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Network or Network POS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
PPO or EPO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Cigna SureFit
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Individual & Family Plans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Networks:
Connect. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10
Cigna Plus. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10
Medicare plans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12
Networks:
Prescription Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Medicare Advantage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12
PPO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12
Cigna Global Health Benefits
®
plans. . . . . . . . . . . . . . . . . . . . . . 14
Networks:
Networks in the U.S.: PPO or OAP . . . . . . . . . . . . . . . . . .14
Networks outside the U.S.: Vary by location . . . . . . . . .14
Cigna Choice Fund
®
plans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Networks:
Vary by plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16
Shared Administration Repricing plans. . . . . . . . . . . . . . . . . . . 16
Networks:
Shared Administration Open Access Plus. . . . . . . . . . . .16
Shared Administration PPO . . . . . . . . . . . . . . . . . . . . . . . .16
Shared Administration Local Plus . . . . . . . . . . . . . . . . . . .16
Strategic Alliance plans. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18
Networks:
Vary by plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18
Cigna + Oscar . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Networks:
LocalPlus and Open Access Plus . . . . . . . . . . . . . . . . . . . . . . 20
Indemnity plans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Networks:
No network requirements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
The myCigna
®
App. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Important contact information. . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
1
Networks: HMO Open Access or POS Open Access
SAR
Legal entity name
Coverage effective date: MM/DD/CCYY
Group: 1234567
Issuer (80840)
ID: U23456789 01
Name: John Public
PCP: James Smith
PCP Name Ln2
PCP Phone: XXX.XXX.XXXX
ID card acct name
RxBIN XXXXXX RxPCN XXXXXXXX
DOI
POS (or HMO) Open Access
No referral required
PCP Visit $15/$25
Specialist $15/$25
Hospital ER $50
Urgent Care $25
Vision Yes
Rx $10/20%/40%/100%
Rx Indiv Deduct $50
Coinsurance applies
Client
logo
TPV logo
CSN logo
Tiered Benefits
NSP
logo
Network Savings Program
WWW.CIGNA.COM
You may be asked to present this card when you receive care. The card does not guarantee coverage.
You must comply with all terms and conditions of the plan. Willful misuse of this card is considered fraud.
INPATIENT ADMISSION or INPATIENT ADMISSION AND OUTPATIENT PROCEDURES:
Your network provider must call the toll-free number listed below to pre-certify the above services. Refer to your plan documents
for your pre-certif ication requirements. Failure to do so may af fect benef its. In an emergency, seek care immediately, then call your
primary care doctor as soon as possible for further assistance and directions on follow-up care within ### hours.
For information about mental health services and coverage, call 1-XXX-XXX-XXXX
Med Group: Sunset Med Group
Send Claims to: 123 Main Street, Suite 999, Anytown, USA 12345-6789
For Dental call ABC Company 1-XXX-XXX-XXXX (not a Cigna Company)
For Vision call ABC Company 1-XXX-XXX-XXXX (not a Cigna Company)
Cigna Vision PO Box 385018, Birmingham, AL 35238-5018
Cigna Claims: PO Box XXXXX, Anytown, USA 12345-6789
TPV Name, PO Box XXXXX, Anytown, USA 12345-6789
CSN Name, PO Box XXXXX, Anytown, USA 12345-6789
Customer Service: 1-XXX-XXX-XXXX
MH/SA: 1-XXX-XXX-XXXX
MANAGED CARE PLANS
WWW.CIGNA.COM
You may be asked to present this card when you receive care. The card does not guarantee coverage.
You must comply with all terms and conditions of the plan. Willful misuse of this card is considered fraud.
INPATIENT ADMISSION or INPATIENT ADMISSION AND OUTPATIENT PROCEDURES:
Your network provider must call the toll-free number listed below to pre-certify the above services. Refer to your plan documents
for your pre-certif ication requirements. Failure to do so may af fect benef its. In an emergency, seek care immediately, then call your
primary care doctor as soon as possible for further assistance and directions on follow-up care within ### hours.
For information about mental health services and coverage, call 1-XXX-XXX-XXXX
Med Group: Sunset Med Group
Send Claims to: 123 Main Street, Suite 999, Anytown, USA 12345-6789
For Dental call ABC Company 1-XXX-XXX-XXXX (not a Cigna Company)
For Vision call ABC Company 1-XXX-XXX-XXXX (not a Cigna Company)
Cigna Vision PO Box 385018, Birmingham, AL 35238-5018
Cigna Claims: PO Box XXXXX, Anytown, USA 12345-6789
TPV Name, PO Box XXXXX, Anytown, USA 12345-6789
CSN Name, PO Box XXXXX, Anytown, USA 12345-6789
Customer Service: 1-XXX-XXX-XXXX
MH/SA: 1-XXX-XXX-XXXX
Cat#
Legal entity name
Coverage effective date: MM/DD/CCYY
Group: 1234567
Issuer (80840)
ID: U23456789 01
Name: John Public
PCP: James Smith
PCP Name Ln2
PCP phone: XXX.XXX.XXXX
ID card acct name
RxBIN XXXXXX RxPCN XXXXXXXX
DOI
Open Access Plus
No referral required
PCP visit $10/$25
Specialist $10/$25
Hospital ER $50
Urgent care $25
Vision Yes
Rx $10/20/30
Network Coinsurance:
In 90%/10%
Out 70%/30%
Med/Rx deductible applies
TPV logo
CSN logo
Tiered Benefits
Client
logo
Network: Open Access Plus
Network: Network Open Access
WWW.CIGNA.COM
You may be asked to present this card when you receive care. The card does not guarantee coverage.
You must comply with all terms and conditions of the plan. Willful misuse of this card is considered fraud.
INPATIENT ADMISSION or INPATIENT ADMISSION AND OUTPATIENT PROCEDURES:
Your network provider must call the toll-free number listed below to pre-certify the above services. Refer to your plan documents
for your pre-certif ication requirements. Failure to do so may af fect benef its. In an emergency, seek care immediately, then call your
primary care doctor as soon as possible for further assistance and directions on follow-up care within ### hours.
For information about mental health services and coverage, call 1-XXX-XXX-XXXX
Med Group: Sunset Med Group
Send Claims to: 123 Main Street, Suite 999, Anytown, USA 12345-6789
For Dental call ABC Company 1-XXX-XXX-XXXX (not a Cigna Company)
For Vision call ABC Company 1-XXX-XXX-XXXX (not a Cigna Company)
Cigna Vision PO Box 385018, Birmingham, AL 35238-5018
Cigna Claims: PO Box XXXXX, Anytown, USA 12345-6789
TPV Name, PO Box XXXXX, Anytown, USA 12345-6789
CSN Name, PO Box XXXXX, Anytown, USA 12345-6789
Customer Service: 1-XXX-XXX-XXXX
MH/SA: 1-XXX-XXX-XXXX
AWAY FROM HOME CARE
5
SAR
Legal entity name
Coverage effective date: MM/DD/CCYY
Group: 1234567
Issuer (80840)
ID: U23456789 01
Name: John Public
PCP: James Smith
PCP Name Ln2
PCP Phone: XXX.XXX.XXXX
ID card acct name
RxBIN XXXXXX RxPCN XXXXXXXX
DOI
Network Open Access
No referral required
PCP Visit $10/$25
Specialist $10/$25
Hospital ER $50
Urgent Care $25
Vision Yes
Rx $10/20%/40%/100%
Rx Indiv Deduct $50
Coinsurance applies
Client
logo
TPV logo
CSN logo
Tiered Benefits
NSP
logo
Network Savings Program
11
12
13
14
10
11
13
14
15
10
10
13
12
12
14
18
18
5
5
1
8
9
3
4
7
6
6
7
8
3
4
1
9
2
5
7
1
8
4
3
9
2
PCP required Referral required Away from Home Care Out-of-network benefits
Encouraged No No No
PCP required Referral required Away from Home Care Out-of-network benefits
Encouraged No Yes Yes
PCP required Referral required Away from Home Care Out-of-network benefits
Encouraged No No No
Encouraged No No Yes
For more information, see the next page.
For more information, see the next page.
For more information, see the next page.
HMO
POS
4
Managed care plans
Managed care plans are designed to manage cost, utilization,
and quality. Depending on the plan, customers may have
coverage for participating providers only, or have both
in-network and out-of-network benefits. Some plans require
referrals for specialty care and the selection of a primary care
provider (PCP).
Network: Network Open Access
Plans that use this network oer customers access to participating
providers, with no referrals required.
›
Flexible plan designs allow for an array of cost-sharing options,
including copayments, coinsurance, anddeductibles.
›
Customers can select a PCP to helpcoordinate care;
it’srecommended, but not required.
›
Referrals are not required to see participating specialists.
›
Precertification may still be required for certain services
andprocedures.
›
No out-of-network coverage, except for emergencies.*
For a directory of providers who participate in this network,
visitCigna.com >Find a Doctor.
Network: Open Access Plus
Plans that use this network oer customers access to a large,
national network of providers. The plans include health advocacy
programs to help customers engage in wellness initiatives and
manage chronicconditions.
›
Customers can select a PCP to help coordinate care;
it’srecommended, but not required.
›
Referrals are not required to see specialists.
›
Precertification may still be required for certain services
andprocedures.
For a directory of providers who participate inthis network,
visitCigna.com >Find a Doctor.
Networks: Health Maintenance Organization (HMO)
OpenAccess orPoint of Service (POS) Open Access
Plans that use these networks oer customers access to local
providers and a variety of dierent benefitoptions. The plans
include negotiated network-specific discounts and fee schedules,
along with robust medical management, to help reduce use of
nonessential procedures.
›
Customers can select a PCP to help coordinate care;
it’srecommended, but not required.
›
Referrals are not required to see specialists.
›
Precertification may still be required for certain services
andprocedures.
For a directory of providers who participate inthese networks,
visitCigna.com >Find a Doctor.
* Emergency services as defined in their plan.
3
*PCP selection and referrals are encouraged in Missouri.
Key
Refer to this key for explanations of the
information found on the sample Cigna ID cards
featured in this brochure.
1
Use this ID number for all claims and inquiries.
2
Indicates a seamless network where a patient
can receive in-network care on a regional or
statewide basis.
3
For patients with coinsurance, submit claims
toCigna or its designee, and receive an
explanation of payment (EOP), which will show
any remaining amount due from the patient.
4
Collect any copayment at the time of service.
5
May read as: “Cigna Health and Life Insurance
Company” or “Connecticut General Life
Insurance Co.” or “Cigna HealthCare of
XXXX, Inc.”
6
ID cards with the Cigna Care Network
logo
indicate the patient’s liability varies based
onthe provider’s Cigna Care designation
status. Refer to the online provider directory
atCigna.com >Find a Doctor to determine a
physician’s CignaCare designation status.
7
Eective date of coverage.
8
Name of patient‘s primary care provider(PCP).
9
Network Savings Program (NSP) logo indicates
that out-of-network discounts may be available
to the customer.
10
Employer name.
11
If a third party administers services in
conjunction with Cigna, the ID card may
include multiple logos, and show a dierent
claim address or telephone number on the
back of the card.
12
Precertification requirements may be shown
aseither “Inpatient Admission” or “Inpatient
Admission and Outpatient Procedures.’’
13
Submit claims to the claim submission address
shown on the card.
14
Call the customer service number(s) indicated
on the card. Some plans have dedicated
numbers for accessing information. Always
check the card for the correct number or refer
to the Important contact information page in
this guide.
15
“Away From Home Care” indicates the patient
has access to the Cigna national Away From
Home Care feature.
16
Indicates shared administration repricing.
17
Union identifier.
18
Client-specific network (CSN) logo.
Networks: HMO, POS, or HMO POS
Cat#
Legal Entity Name
Coverage Effective Date MM/DD/CCYY
Group: 1234567
Issuer (80840)
ID:
U
23456789 01
Name: John Public
PCP: James Smith
PCP Name Ln2
PCP Phone: XXX-XXX-XXXX
ID Card Acct Name
RxBIN
017010
RxPCN
0215
COMM
RxGroup: 1234567
DOI Label
HMO
No Referred Required
PCP Visit $15
Specialist $15
Hospital ER $50
Urgent Care $25
Vision Yes
Rx $10/20/40
Rx Indiv Deduct $50
Coinsurance Applies
Client
logo
NSP
logo
Network Savings Program
Preferred Hospital
Select
WWW.CIGNA.COM
You may be asked to present this card when you receive care. The card does not guarantee coverage.
You must comply with all terms and conditions of the plan. Willful misuse of this card is considered fraud.
INPATIENT ADMISSION or INPATIENT ADMISSION AND OUTPATIENT SERVICES
Your network provider must call the toll-free number listed below to pre-certify the above services.
Refer to your plan documents for your pre-certication requirements. Failure to do so may aect
benets. In an emergency, seek care immediately, then call your primary care doctor as soon as
possible for further assistance and directions on follow-up care within ### hours.
For information about mental health services and coverage, call XXX.XXX.XXXX
MedGroup: Sunset Med Group
Send claims to: 123 Main Street, Suite 999, Anytown, USA 12345-678
For Pharmacy call ABC Company 1-XXX-XXX-XXXX (not a Cigna Company)
For Vision call ABC Company 1-XXX-XXX-XXXX (not a Cigna Company)
Cigna Vision P.O. Box 385018, Birmingham, AL 32538/5018
Cigna: PO Box XXXXX, Anytown, USA 12345-6789
Member Services: 1-XXX-XXX-XXXX
MH/SA: 1-XXX-XXX-XXXX C
WWW.CIGNA.COM
You may be asked to present this card when you receive care. The card does not guarantee coverage.
You must comply with all terms and conditions of the plan. Willful misuse of this card is considered fraud.
INPATIENT ADMISSION or INPATIENT ADMISSION AND OUTPATIENT PRECEDURES:
Your Network provider must call the toll-free number listed below to pre-certify the above services. Refer to your plan documents
for your pre-certication requirements. Failure to do so may aect benets. In an emergency, seek care immediately, then call your
primary care doctor as soon as possible for further assistance and directions on follow-up care within ## hours.
Carve out 1 Prt Line
Carve out 2 Prt Line
Send claims to:
CAD Name, PO Box XXXX, Anytown, USA 12345-6789
TPV Name, PO Box XXXX, Anytown, USA 12345-6789
All Other: PO Box XXXX, Anytown, USA 12345-6789
Customer Service: 800.XXX.XXXX MH/SA: 800.XXX.XXXX
We encourage you to use a PCP as a valuable resource and personal health advocate.
AWAY FROM HOME CARE
Open Access Plus
Legal entity name
Coverage effective date: MM/DD/CCYY
Group: 1234567
Issuer (80840)
ID: U23456789 01
Name: John Public
PCP: James Smith
Jane Smith
PCP Phone: 860.123.4567
ABC12 & Sons Company
RxBIN XXXXXX RxPCN XXXXXXXX
DOI Label
LocalPlus (or LocalPlusIN)
No referral required
PCP Visit $10
Specialist $15
Hospital ER $50
Urgent Care $25
Vision Yes
Rx $10/20/30
Network coinsurance:
In 90%/10%
Out 70%/30%
Med/Rx deductible applies
TPV logo
CAD logo
Client
logo
Cat #
NSP
logo
Network Savings Program
11
10
12
12
13
13
14
15
18
1
1
5
7
2
4
3
9
8
9
4
MANAGED CARE PLANS (CONTINUED)
For more information, see the next page.
PCP required Referral required Away from Home Care Out-of-network benefits
Yes Yes No No
Yes Yes No Yes
Yes Yes No Yes
For more information, see the next page.
HMO
POS
HMO POS
Networks: LocalPlus
®
or LocalPlusIN
PCP required Referral required Away from Home Care Out-of-network benefits
Encouraged No Yes Yes
Encouraged No Yes No
LocalPlus
LocalPlusIN
4
Networks: LocalPlus
®
or LocalPlusIN
Plans that use these networks oer customers access
to participating providers in their local area, or in any
area in the country where one exists, for coverage at the
in-network cost.
›
In areas where these networks are not available,
customers can access care through our Away From
Home Care feature for coverage at the in-network cost.
›
If customers choose to access care from providers
outside the LocalPlus network (or outside the Away
From Home Care feature when the LocalPlus network
isn’t available), they will likely pay more. (Customers
with the LocalPlusIN plan will pay the full cost of
theircare.*)
›
Referrals are not required to see specialists.
›
Precertification may still be required for certain services
and procedures.
For a directory of providers who participate in these
networks, visitCigna.com >Find a Doctor.
Networks: HMO, POS, or HMO POS
Plans that use these networks oer customers cost savings
and access to a local network of providers.
›
Customers must select a network-participating PCP to
coordinate care for coverage at the in-network cost.
›
Referrals are required to see specialists except
OB/GYNs.
›
HMO POS plans include benefits and features similar to
HMO plans, plus out-of-network coverage at reduced
benefitlevels.
For a directory of providers who participate inthese
networks, visitCigna.com >Find a Doctor.
Key
Refer to this key for explanations of the
information found on the sample Cigna ID cards
featured in this brochure.
1
Use this ID number for all claims and inquiries.
2
Indicates a seamless network where a patient
can receive in-network care on a regional or
statewide basis.
3
For patients with coinsurance, submit claims
toCigna or its designee, and receive an
explanation of payment (EOP), which will show
any remaining amount due from the patient.
4
Collect any copayment at the time of service.
5
May read as: “Cigna Health and Life Insurance
Company” or “Connecticut General Life
Insurance Co.” or “Cigna HealthCare of
XXXX, Inc.”
6
ID cards with the Cigna Care Network
logo
indicate the patient’s liability varies based
onthe provider’s Cigna Care designation
status. Refer to the online provider directory
atCigna.com >Find a Doctor to determine a
physician’s CignaCare designation status.
7
Eective date of coverage.
8
Name of patient‘s primary care provider(PCP).
9
Network Savings Program (NSP) logo indicates
that out-of-network discounts may be available
to the customer.
10
Employer name.
11
If a third party administers services in
conjunction with Cigna, the ID card may
include multiple logos, and show a dierent
claim address or telephone number on the
back of the card.
12
Precertification requirements may be shown
aseither “Inpatient Admission” or “Inpatient
Admission and Outpatient Procedures.’’
13
Submit claims to the claim submission address
shown on the card.
14
Call the customer service number(s) indicated
on the card. Some plans have dedicated
numbers for accessing information. Always
check the card for the correct number or refer
to the Important contact information page in
this guide.
15
“Away From Home Care” indicates the patient
has access to the Cigna national Away From
Home Care feature.
16
Indicates shared administration repricing.
17
Union identifier.
18
Client Arranged Deal (CAD) network logo.
* Except for emergency services as defined by their plan.
5
MANAGED CARE PLANS (CONTINUED)
Networks: PPO or EPO
Cat #
Legal Entity Name
Coverage Effective Date: MM/DD/CCYY
Group: 1234567
Issuer (80840)
ID: U23456789 01
Name: John Public
ID Card Acct Name
RxBIN 017010 RxPCN 0215COMM
RxGroup: 1234567
DOI Label
PPO
Dr. Visit $15
Specialist $10/$25
Hospital ER $50
Urgent Care $25
Vision Yes
Rx $10/20/30
Network Coinsurance:
In 90%/10%
Out 70%/30%
Med/Rx Deductible Applies
Client
logo
CAD or NBN logo
NSP
logo
Network Savings Program
SELF FUNDED NJ Arbitrations: YES
as of: MM/DD/CCYY
TPV LOGO
Tiered Benef its
AWAY FROM HOME CARE
WWW.CIGNA.COM
You may be asked to present this card when you receive care. The card does not guarantee coverage.
You must comply with all terms and conditions of the plan. Willful misuse of this card is considered fraud.
INPATIENT ADMISSION: or INPATIENT ADMISSION AND OUTPATIENT PROCEDURES:
Your Network provider must call the toll-free number listed below to pre-certify the above services. Refer
to your plan documents for your pre-certification requirements. Failure to do so may affect benefits. In an
emergency, seek care immediately, then call your primary care doctor as soon as possible for further
assistance and directions on follow up care within ## hours.
Coinsurance/deductible is paid directly to the doctor/facility by Cigna using individual’s available health funds.
For Dental call ABC Company 1-XXX-XXX-XXXX (not a Cigna Company)
For Vision call ABC Company 1-XXX-XXX-XXXX (not a Cigna Company)
Cigna Vision P.O. Box 385018, Birmingham, AL 35238-5018
Send Claims to:
CAD Name, P.O. BOX XXXX, ANYTOWN, USA 12345-6789
TPV Name, P.O. BOX XXXX, ANYTOWN, USA 12345-6789
All Others: P.O. BOX XXXXX, ANYTOWN, USA 12345-6789
Customer Service: 1-800-XXX-XXXX MH/SA: 1-800-XXX-XXXX
11
10
12
13
14
15
18
5
7
1
9
3
4
6
PCP required Referral required Away from Home Care Out-of-network benefits
No No Yes Yes
Encouraged No Yes No
PPO
EPO
For more information, see the next page.
bo
Networks: Network or Network POS
You may be asked to present this card when you receive care. The card does not guarantee coverage. You must comply with all
terms and conditions of the plan. Willful misuse of this card is considered fraud.
INPATIENT ADMISSION:
Your provider must call the toll-free number listed below to pre-certify the above services. Refer to your plan documents for your
pre-certication requirements. Failure to do so may aect benets. In an emergency, seek care immediately, then call your primary
care doctor as soon as possible for further assistance and directions on follow-up care within ### hours.
For information about mental health services and coverage, call MHSA Stmt Tel
Med Group: Sunset Med Group
Send claims to: 123 Main Street, Suite 999, Anytown, USA 12345-6789
For Pharmacy, call ABC Company 800.XXX.XXXX (Not a Cigna Company)
For Vision, call ABC Company 800.XXX.XXXX (Not a Cigna Company)
Cigna Claims: PO Box XXXX, Anytown, USA 12345-6789
TPV Name, PO Box XXXX, Anytown, USA 12345-6789
CSN Name, PO Box XXXX, Anytown, USA 12345-6789
Customer Service: 800.XXX.XXXX MH/SA: 800.XXX.XXXX
WWW.CIGNA.COM
bl
OAP#
Legal entity name
Coverage effective date: MM/DD/CCYY
Group: 1234567
Issuer (80840)
ID: U23456789 01
Name: John Public
PCP: James Smith
PCP Name Ln2
PCP Phone: XXX.XXX.XXXX
ID card acct name
RxBIN XXXXXX RxPCN XXXXXXXX
DOI
Network
PCP Visit $15/$20
Specialist $15/$20
Hospital ER $50
Urgent Care $25
Vision Yes
Rx $10/20%/40%/100%
Rx Indiv Deduct $50
Coinsurance applies
Client
logo
TPV logo
CSN logo
Tiered Benefits
10
18
11
12
13
14
2
8
1
5
6
7
4
3
9
PCP required Referral required Away from Home Care Out-of-network benefits
Yes Yes No No
Yes Yes No Yes
For more information, see the next page.
Network
Network
POS
6
Networks: Network or Network POS
Plans that use these networks oer customers cost
savings, local convenience, and choice.
›
Customers must select a network-participating PCP to
coordinate care for coverage at thein-network cost.
›
Referrals are required to see specialists except
OB/GYNs.
›
Network POS plans include benefits and features similar
to Network plans, plus out-of-network coverage at
reduced benefit levels.
For a directory of providers who participate in these
networks, visitCigna.com >Find a Doctor.
Networks: PPO or Exclusive Provider Organization (EPO)
Plans that use these networks oer customers access to
participating providers across the country.
PPO:
›
Both in- and out-of-network benefits are available.
›
Customers can access services from providers who
do not participate in the network, butwill assume
additional costs andbe reimbursed at alower
coinsurance level.
EPO:
›
No out-of-network coverage, except in emergencies.*
›
Referrals are not required to see network-participating
specialists.
For a directory of providers who participate in these
networks, visitCigna.com >Find a Doctor.
Key
Refer to this key for explanations of the
information found on the sample Cigna ID cards
featured in this brochure.
1
Use this ID number for all claims and inquiries.
2
Indicates a seamless network where a patient
can receive in-network care on a regional or
statewide basis.
3
For patients with coinsurance, submit claims
toCigna or its designee, and receive an
explanation of payment (EOP), which will show
any remaining amount due from the patient.
4
Collect any copayment at the time of service.
5
May read as: “Cigna Health and Life Insurance
Company” or “Connecticut General Life
Insurance Co.” or “Cigna HealthCare of
XXXX, Inc.”
6
ID cards with the Cigna Care Network
logo
indicate the patient’s liability varies based
onthe provider’s Cigna Care designation
status. Refer to the online provider directory
atCigna.com >Find a Doctor to determine a
physician’s CignaCare designation status.
7
Eective date of coverage.
8
Name of patient‘s primary care provider(PCP).
9
Network Savings Program (NSP) logo indicates
that out-of-network discounts may be available
to the customer.
10
Employer name.
11
If a third party administers services in
conjunction with Cigna, the ID card may
include multiple logos, and show a dierent
claim address or telephone number on the
back of the card.
12
Precertification requirements may be shown
aseither “Inpatient Admission” or “Inpatient
Admission and Outpatient Procedures.’’
13
Submit claims to the claim submission address
shown on the card.
14
Call the customer service number(s) indicated
on the card. Some plans have dedicated
numbers for accessing information. Always
check the card for the correct number or refer
to the Important contact information page in
this guide.
15
“Away From Home Care” indicates the patient
has access to the Cigna national Away From
Home Care feature.
16
Indicates shared administration repricing.
17
Union identifier.
18
Client-specific network (CSN) or Client
Arranged Deal (CAD) network logo.
* Emergency services as defined in their plan.
7
Group: 00699999
Issuer (80840)
ID:
666666666 A
Name:
John Doe
PCP: Jeremiah B Johnson MD
G
Referral Required
Cigna SureFit HCA of the FrontRange
RxBIN 017010 RxPCN 05180000
RxGrp 00699999
RxID 222222222 00
Primary Care
Specialist
Urgent Care
ER
Hospital
$25/0%
$50/0%
$15/0%
Ded/20%
Ded/10%
Administered by Cigna Health and Life Insurance Company
In Network Only
Administered by Cigna Health and Life Insurance Company
MANAGED CARE PLANS (CONTINUED)
Network: Cigna SureFit
®
You may have to show this card when you receive care. This doesn’t guarantee coverage. Not
using this card correctly is fraud. For emergencies, call 911 or get immediate care. Contact your
doctor after you get emergency services. If you don’t know if your situation is an emergency,
call your doctor or our 24/7 Health Information Line. Customers: Check your plan documents
for out-of-network (OON) precertication requirements. This may aect your OON benets.
Health Care Professionals: Check your provider contract for precertication requirements.
Customers: myCigna.com
Health Care Professionals: CignaforHCP.com
Medical Claims PO Box 188061 Chattanooga, TN 37422-8061 Payer ID #62308
Rx Claims: Pharmacy Service Center, PO Box 188053, Chattanooga TN 37422-8053
Customers & Health Care Professionals call 866-494-2111
For Pharmacists Only 800-351-9170
Mask 606 Issue Date: 10/25/17
You may be asked to present this card when you receive care. The card does not guarantee coverage. You
must comply with all terms and conditions of the plan. Willful misuse of this card is considered fraud.
INPATIENT ADMISSION or INPATIENT ADMISSION AND OUTPATIENT PROCEDURES:
Your network provider mst call the toll-free number listed below to pre-certify the above services. Refer
to your plan documents for your pre-certication requirements Failure to do so may aect benets. In
an emergency, seek care immediately, then call your primary care doctor as soon as possible for further
assistance and directions on follow-up care within ###hours.
For pharmacy, call ABC Company 800.XXX.XXXX (Not a Cigna Company)
For vision, call ABC Company 800.XXX.XXXX (Not a Cigna Company)
Send claims to:
CAD name, PO Box XXXX, Anytown, USA 12345-6789
TPV name, PO Box XXXX, Anytown, USA 12345-6789
All others: PO Box XXXX, Anytown, USA 12345-6789
Customer service: 1-XXX.XXX.XXXX MH/SA: 1-XXX.XXX.XXXX
WWW.CIGNA.COM
13
14
13
14
1
8
1
8
3
Market-specific
network name
Market-specific
network name
To find the market-specific network name that will appear on the IDcard, refer to the table below. In the first
column, identifyyour market area. In the second column, you will see the corresponding market-specific
network name that should appear onthe Cigna SureFit ID card.
For more information, see the next page.
Market Market-specific network name
Arizona (Phoenix)
California (Southern California)
Central Florida (Orlando)
Colorado (Boulder, Denver, and Colorado Springs)
of the Front Range
Kansas and Missouri (Kansas City)
Mid-Atlantic (Northern Virgina, Richmond and
Washington, DC)
Missouri (St. Louis)
South Florida
South Florida
PCP required Referral required Away from Home Care Out-of-network benefits
Yes Yes No No
with
and
aliates
Southern California
Kansas City
8
Key
Refer to this key for explanations of the
information found on the sample Cigna ID cards
featured in this brochure.
1
Use this ID number for all claims and inquiries.
2
Indicates a seamless network where a patient
can receive in-network care on a regional or
statewide basis.
3
For patients with coinsurance, submit claims
toCigna or its designee, and receive an
explanation of payment (EOP), which will show
any remaining amount due from the patient.
4
Collect any copayment at the time of service.
5
May read as: “Cigna Health and Life Insurance
Company” or “Connecticut General Life
Insurance Co.” or “Cigna HealthCare of
XXXX, Inc.”
6
ID cards with the Cigna Care Network
logo
indicate the patient’s liability varies based
onthe provider’s Cigna Care designation
status. Refer to the online provider directory
atCigna.com >Find a Doctor to determine a
physician’s CignaCare designation status.
7
Eective date of coverage.
8
Name of patient‘s primary care provider(PCP).
9
Network Savings Program (NSP) logo indicates
that out-of-network discounts may be available
to the customer.
10
Employer name.
11
If a third party administers services in
conjunction with Cigna, the ID card may
include multiple logos, and show a dierent
claim address or telephone number on the
back of the card.
12
Precertification requirements may be shown
aseither “Inpatient Admission” or “Inpatient
Admission and Outpatient Procedures.’’
13
Submit claims to the claim submission address
shown on the card.
14
Call the customer service number(s) indicated
on the card. Some plans have dedicated
numbers for accessing information. Always
check the card for the correct number or refer
to the Important contact information page in
this guide.
15
“Away From Home Care” indicates the patient
has access to the Cigna national Away From
Home Care feature.
16
Indicates shared administration repricing.
17
Union identifier.
18
Client-specific network (CSN) logo.
Network: Cigna SureFit
®
Plans that use this network oer customers access
tolocalphysician and hospital groups for personal,
patient-centeredcare.
›
Customers must select a network-participating PCP
tocoordinate their care.
›
Referrals are required to see specialists.
›
No out-of-network coverage or Away From Home Care,
except in emergencies.*
For a directory of providers who participate in these
networks, visitCigna.com >Find a Doctor.
* Emergency services as defined in their plan.
9



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• Present this ID card each time you visit a health care professional.
• If you have questions or to elect or change your PCP, please visit
our website or call the toll-free customer service number located
on your ID card.
Group: 00881700
Issuer (80840)
ID:
234567891
Name:
JOHN M DOE
PCP: Jessica A. Doright DO
GCigna HealthCare of Illinois, Inc.
Medical/Rx
Referral Required
Cigna Plus
RxBIN 017010 RxPCN 0518GWH
RxGrp 00881700
RxID 234567891 00
Primary Care
Specialist
Urgent Care
ER
Hospital
Ded-50%
Ded-50%
Ded-50%
Ded-50%
Ded-50%
03040 9090436 0000 0000002 0000002 251 116
>000002 9090436 003040




1 00500-0005-L
RUN_DATE 20200907 12:45:50DATA_SEQ_NO 0000002CLIENT_NUMBER 003040UHG_TYPE DIG1CARDDOC_ID 9090436/000002-00DOC_ID 9090436/000002-01DOC_ID 9090436/000002-02DOC_SEQ_ID 0000002NAME DOE ,JOHNMAILSET_NUMBER 0000002CUST_KEY1 00881700CUST_KEY2 234567891CUST_KEY3 00CUST_KEY4 JOHNCUST_KEY5 MCUST_KEY6 DOECUST_KEY7 234567891CUST_KEY8 09/02/2020CUST_KEY9 M
What does it mean?
Ded/Coin - Subject to the plan deductible and/or coinsurance
Ded - Subject to the plan deductible amount
Coin - Subject to the plan coinsurance amount
Copay - Subject to the copayment amount
PCP - Primary Care Physician
Urgent Care - After hours/urgent care
ER - Emergency Room
Hospital or Hospital Stay - Inpatient hospital
Rx- Pharmacy
THE FOLLOWING NOTICE APPLIES TO CUSTOMERS COVERED UNDER LOUISIANA PLANS
NOTICE: YOUR SHARE OF THE PAYMENT FOR HEATHCARE SERVICE MAY BE BASED ON
THE AGREEMENT BETWEEN YOUR HEALTH PLAN AND YOUR PROVIDER. UNDER CERTAIN
CIRCUMSTANCES, THIS AGREEMENT MAY ALLOW YOUR PROVIDER TO BILL YOU FOR
AMOUNTS UP TO THE PROVIDER'S REGULAR BILLED CHARGES.
'Cigna' and the 'Tree of Life' logo are registered service marks of
Cigna Intellectual Property, Inc., licensed for use by Cigna Corporation
and its operating subsidiaries. All products and services are provided by or through
such operating subsidiaries and not by Cigna Corporation. Such operating
subsidiaries include Connecticut General Life Insurance Company (CGLIC)
Cigna Health and Life Insurance (CHLIC), Cigna Health Management, Inc.
and Cigna Dental Health, Inc. The Cigna Dental PPO is underwritten or administered
by CGLIC or CHLIC with network management services provided by Cigna
Dental Health, Inc., and certain of its operating subsidiaries. In Arizona and
Louisiana, the insured Dental PPO product is referred to as the 'CG Dental PPO'
(CGLIC) or 'CH Dental PPO' (CHLIC). In Texas, the insured dental product offered
by CGLIC and CHLIC is referred to as the 'Cigna Dental Choice Plan'.
The Cigna Dental PPO Network(s) is a national reference to our network; in Texas
this network(s) will be utilized with the Cigna Dental Choice Plan
Medical Claims
PO Box 188061 Chattanooga, TN 37422-8061 Payer ID #62308
Rx Claims
Pharmacy Service Center, PO Box 188053, Chattanooga TN 37422-8053
For Premium, Billing and Enrollment
Questions please call: 1-877-900-1237
For Benefit and Claim questions please
call: 1-866-494-2111
For Pharmacists Only: 800-351-9170
Mask 606 Issue Date: 09/07/20
*116*
 00000000  
 DIRECT  
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  
JOHN DOE
 
9999 W FARWELL AVE
 
APT 999
CHICAGO, IL 60626
 20200907
 Mon Sep 07, 2020 @ 12:45:50
 N
  606
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• Present this ID card each time you visit a health care professional.
• If you have questions or to elect or change your PCP, please visit
our website or call the toll-free customer service number located
on your ID card.
Group: 00881200
Issuer (80840)
ID:
456789123
Name:
JOHN E DOE
GCigna Health and Life Insurance Company
Medical/Rx
No Referral Required
Florida Connect
RxBIN 017010 RxPCN 0518GWH
RxGrp 00881200
RxID 456789123 00
Primary Care
Specialist
Urgent Care
ER
Hospital
$25-0%
$60-0%
$50-0%
Ded-$600-0%
Ded-20%
03040 9091187 0000 0000001 0000001 252 117
>000001 9091187 003040


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1 00500-0005-L
RUN_DATE 20200908 11:30:45DATA_SEQ_NO 0000001CLIENT_NUMBER 003040UHG_TYPE DIG1CARDDOC_ID 9091187/000001-00DOC_ID 9091187/000001-01DOC_ID 9091187/000001-02DOC_SEQ_ID 0000001NAME DOE ,JOHNMAILSET_NUMBER 0000001CUST_KEY1 00881200CUST_KEY2 456789123CUST_KEY3 00CUST_KEY4 JOHNCUST_KEY5 ECUST_KEY6 DOECUST_KEY7 456789123CUST_KEY8 11/01/2020CUST_KEY9 M
What does it mean?
Ded/Coin - Subject to the plan deductible and/or coinsurance
Ded - Subject to the plan deductible amount
Coin - Subject to the plan coinsurance amount
Copay - Subject to the copayment amount
PCP - Primary Care Physician
Urgent Care - After hours/urgent care
ER - Emergency Room
Hospital or Hospital Stay - Inpatient hospital
Rx- Pharmacy
THE FOLLOWING NOTICE APPLIES TO CUSTOMERS COVERED UNDER LOUISIANA PLANS
NOTICE: YOUR SHARE OF THE PAYMENT FOR HEATHCARE SERVICE MAY BE BASED ON
THE AGREEMENT BETWEEN YOUR HEALTH PLAN AND YOUR PROVIDER. UNDER CERTAIN
CIRCUMSTANCES, THIS AGREEMENT MAY ALLOW YOUR PROVIDER TO BILL YOU FOR
AMOUNTS UP TO THE PROVIDER'S REGULAR BILLED CHARGES.
'Cigna' and the 'Tree of Life' logo are registered service marks of
Cigna Intellectual Property, Inc., licensed for use by Cigna Corporation
and its operating subsidiaries. All products and services are provided by or through
such operating subsidiaries and not by Cigna Corporation. Such operating
subsidiaries include Connecticut General Life Insurance Company (CGLIC)
Cigna Health and Life Insurance (CHLIC), Cigna Health Management, Inc.
and Cigna Dental Health, Inc. The Cigna Dental PPO is underwritten or administered
by CGLIC or CHLIC with network management services provided by Cigna
Dental Health, Inc., and certain of its operating subsidiaries. In Arizona and
Louisiana, the insured Dental PPO product is referred to as the 'CG Dental PPO'
(CGLIC) or 'CH Dental PPO' (CHLIC). In Texas, the insured dental product offered
by CGLIC and CHLIC is referred to as the 'Cigna Dental Choice Plan'.
The Cigna Dental PPO Network(s) is a national reference to our network; in Texas
this network(s) will be utilized with the Cigna Dental Choice Plan
Medical Claims
PO Box 188061 Chattanooga, TN 37422-8061 Payer ID #62308
Rx Claims
Pharmacy Service Center, PO Box 188053, Chattanooga TN 37422-8053
For Premium, Billing and Enrollment
Questions please call: 1-877-484-5967
For Benefit and Claim questions please
call: 1-866-494-2111
For Pharmacists Only: 800-351-9170
Mask 606 Issue Date: 09/08/20
*117*
 00000000  
 DIRECT  
 USPS  
  
JOHN DOE
 
9999 SPINDLETOP DR
 
ORLANDO, FL 32819
 20200908
 Tue Sep 08, 2020 @ 11:30:45
 N
  606


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• Present this ID card each time you visit a health care professional.
• If you have questions or to elect or change your PCP, please visit
our website or call the toll-free customer service number located
on your ID card.
Group: 00881200
Issuer (80840)
ID:
456789123
Name:
JOHN E DOE
GCigna Health and Life Insurance Company
Medical/Rx
No Referral Required
Florida Connect
RxBIN 017010 RxPCN 0518GWH
RxGrp 00881200
RxID 456789123 00
Primary Care
Specialist
Urgent Care
ER
Hospital
$25-0%
$60-0%
$50-0%
Ded-$600-0%
Ded-20%
03040 9091187 0000 0000001 0000001 252 117
>000001 9091187 003040



1 00500-0005-L
RUN_DATE 20200908 11:30:45DATA_SEQ_NO 0000001CLIENT_NUMBER 003040UHG_TYPE DIG1CARDDOC_ID 9091187/000001-00DOC_ID 9091187/000001-01DOC_ID 9091187/000001-02DOC_SEQ_ID 0000001NAME DOE ,JOHNMAILSET_NUMBER 0000001CUST_KEY1 00881200CUST_KEY2 456789123CUST_KEY3 00CUST_KEY4 JOHNCUST_KEY5 ECUST_KEY6 DOECUST_KEY7 456789123CUST_KEY8 11/01/2020CUST_KEY9 M
What does it mean?
Ded/Coin - Subject to the plan deductible and/or coinsurance
Ded - Subject to the plan deductible amount
Coin - Subject to the plan coinsurance amount
Copay - Subject to the copayment amount
PCP - Primary Care Physician
Urgent Care - After hours/urgent care
ER - Emergency Room
Hospital or Hospital Stay - Inpatient hospital
Rx- Pharmacy
THE FOLLOWING NOTICE APPLIES TO CUSTOMERS COVERED UNDER LOUISIANA PLANS
NOTICE: YOUR SHARE OF THE PAYMENT FOR HEATHCARE SERVICE MAY BE BASED ON
THE AGREEMENT BETWEEN YOUR HEALTH PLAN AND YOUR PROVIDER. UNDER CERTAIN
CIRCUMSTANCES, THIS AGREEMENT MAY ALLOW YOUR PROVIDER TO BILL YOU FOR
AMOUNTS UP TO THE PROVIDER'S REGULAR BILLED CHARGES.
'Cigna' and the 'Tree of Life' logo are registered service marks of
Cigna Intellectual Property, Inc., licensed for use by Cigna Corporation
and its operating subsidiaries. All products and services are provided by or through
such operating subsidiaries and not by Cigna Corporation. Such operating
subsidiaries include Connecticut General Life Insurance Company (CGLIC)
Cigna Health and Life Insurance (CHLIC), Cigna Health Management, Inc.
and Cigna Dental Health, Inc. The Cigna Dental PPO is underwritten or administered
by CGLIC or CHLIC with network management services provided by Cigna
Dental Health, Inc., and certain of its operating subsidiaries. In Arizona and
Louisiana, the insured Dental PPO product is referred to as the 'CG Dental PPO'
(CGLIC) or 'CH Dental PPO' (CHLIC). In Texas, the insured dental product offered
by CGLIC and CHLIC is referred to as the 'Cigna Dental Choice Plan'.
The Cigna Dental PPO Network(s) is a national reference to our network; in Texas
this network(s) will be utilized with the Cigna Dental Choice Plan
Medical Claims
PO Box 188061 Chattanooga, TN 37422-8061 Payer ID #62308
Rx Claims
Pharmacy Service Center, PO Box 188053, Chattanooga TN 37422-8053
For Premium, Billing and Enrollment
Questions please call: 1-877-484-5967
For Benefit and Claim questions please
call: 1-866-494-2111
For Pharmacists Only: 800-351-9170
Mask 606 Issue Date: 09/08/20
*117*
 00000000  
 DIRECT  
 USPS  
  
JOHN DOE
 
9999 SPINDLETOP DR
 
ORLANDO, FL 32819
 20200908
 Tue Sep 08, 2020 @ 11:30:45
 N
  606




• Present this ID card each time you visit a health care professional.
• If you have questions or to elect or change your PCP, please visit
our website or call the toll-free customer service number located
on your ID card.
Group: 00881700
Issuer (80840)
ID:
234567891
Name:
JOHN M DOE
PCP: Jessica A. Doright DO
GCigna HealthCare of Illinois, Inc.
Medical/Rx
Referral Required
Cigna Plus
RxBIN 017010 RxPCN 0518GWH
RxGrp 00881700
RxID 234567891 00
Primary Care
Specialist
Urgent Care
ER
Hospital
Ded-50%
Ded-50%
Ded-50%
Ded-50%
Ded-50%
03040 9090436 0000 0000002 0000002 251 116
>000002 9090436 003040




1 00500-0005-L
RUN_DATE 20200907 12:45:50DATA_SEQ_NO 0000002CLIENT_NUMBER 003040UHG_TYPE DIG1CARDDOC_ID 9090436/000002-00DOC_ID 9090436/000002-01DOC_ID 9090436/000002-02DOC_SEQ_ID 0000002NAME DOE ,JOHNMAILSET_NUMBER 0000002CUST_KEY1 00881700CUST_KEY2 234567891CUST_KEY3 00CUST_KEY4 JOHNCUST_KEY5 MCUST_KEY6 DOECUST_KEY7 234567891CUST_KEY8 09/02/2020CUST_KEY9 M
What does it mean?
Ded/Coin - Subject to the plan deductible and/or coinsurance
Ded - Subject to the plan deductible amount
Coin - Subject to the plan coinsurance amount
Copay - Subject to the copayment amount
PCP - Primary Care Physician
Urgent Care - After hours/urgent care
ER - Emergency Room
Hospital or Hospital Stay - Inpatient hospital
Rx- Pharmacy
THE FOLLOWING NOTICE APPLIES TO CUSTOMERS COVERED UNDER LOUISIANA PLANS
NOTICE: YOUR SHARE OF THE PAYMENT FOR HEATHCARE SERVICE MAY BE BASED ON
THE AGREEMENT BETWEEN YOUR HEALTH PLAN AND YOUR PROVIDER. UNDER CERTAIN
CIRCUMSTANCES, THIS AGREEMENT MAY ALLOW YOUR PROVIDER TO BILL YOU FOR
AMOUNTS UP TO THE PROVIDER'S REGULAR BILLED CHARGES.
'Cigna' and the 'Tree of Life' logo are registered service marks of
Cigna Intellectual Property, Inc., licensed for use by Cigna Corporation
and its operating subsidiaries. All products and services are provided by or through
such operating subsidiaries and not by Cigna Corporation. Such operating
subsidiaries include Connecticut General Life Insurance Company (CGLIC)
Cigna Health and Life Insurance (CHLIC), Cigna Health Management, Inc.
and Cigna Dental Health, Inc. The Cigna Dental PPO is underwritten or administered
by CGLIC or CHLIC with network management services provided by Cigna
Dental Health, Inc., and certain of its operating subsidiaries. In Arizona and
Louisiana, the insured Dental PPO product is referred to as the 'CG Dental PPO'
(CGLIC) or 'CH Dental PPO' (CHLIC). In Texas, the insured dental product offered
by CGLIC and CHLIC is referred to as the 'Cigna Dental Choice Plan'.
The Cigna Dental PPO Network(s) is a national reference to our network; in Texas
this network(s) will be utilized with the Cigna Dental Choice Plan
Medical Claims
PO Box 188061 Chattanooga, TN 37422-8061 Payer ID #62308
Rx Claims
Pharmacy Service Center, PO Box 188053, Chattanooga TN 37422-8053
For Premium, Billing and Enrollment
Questions please call: 1-877-900-1237
For Benefit and Claim questions please
call: 1-866-494-2111
For Pharmacists Only: 800-351-9170
Mask 606 Issue Date: 09/07/20
*116*
 00000000  
 DIRECT  
 USPS  
  
JOHN DOE
 
9999 W FARWELL AVE
 
APT 999
CHICAGO, IL 60626
 20200907
 Mon Sep 07, 2020 @ 12:45:50
 N
  606
Lorem ipsum
INDIVIDUAL & FAMILY PLANS
Network: Connect
PCP required Referral required Away from Home Care Out-of-network benefits
No* No* No No
PCP required Referral required Away from Home Care Out-of-network benefits
No* No* No No
For more information, see the next page.
*PCP selection and referrals are required only in Illinois.
*PCP selection and referrals are required only in Illinois.
14
14
13
13
1
1
3
3
4
4
8
8
Connect (Market Name)
(Market Name)
Network: Cigna Plus
10
Individual & Family Plans
Cigna oers Individual & Family Plans with medical, pharmacy,
and (when applicable) pediatric dental benefits in Arizona,
Colorado, Florida, Illinois, Kansas, Missouri, North Carolina,
Tennessee, Utah, and Virginia. Depending on the plan,
customers will have access to providers who participate in our
Connect network. The network name will appear on the top
right of the ID card.
Network: Connect
Plans that use this network oer customers access to providers in
their local area.
›
Customers do not have to select a PCP but are encouraged to
coordinate their care with a network-participating PCP.
›
Referrals are encouraged but not required to see specialists.
›
No out-of-network coverage or Away From Home Care, except
in emergencies.**
For a directory of providers who participate in this network,
visit Cigna.com/IFP-Providers.
Network: Cigna Plus
Plans that use this network oer customers access to providers in
their local area.
›
Customers must select a network-participating PCP
tocoordinate their care.*
›
Referrals are required to see specialists.*
›
No out-of-network coverage or Away From Home Care, except
in emergencies.**
For a directory of providers who participate in this network,
visitCigna.com/IFP-Providers. These listings will be available and
labeled as “Cigna Plus” within the network selection options.
Key
Refer to this key for explanations of the
information found on the sample Cigna ID cards
featured in this brochure.
1
Use this ID number for all claims and inquiries.
2
Indicates a seamless network where a patient
can receive in-network care on a regional or
statewide basis.
3
For patients with coinsurance, submit claims
toCigna or its designee, and receive an
explanation of payment (EOP), which will show
any remaining amount due from the patient.
4
Collect any copayment at the time of service.
5
May read as: “Cigna Health and Life Insurance
Company” or “Connecticut General Life
Insurance Co.” or “Cigna HealthCare of
XXXX, Inc.”
6
ID cards with the Cigna Care Network
logo
indicate the patient’s liability varies based
onthe provider’s Cigna Care designation
status. Refer to the online provider directory
atCigna.com >Find a Doctor to determine a
physician’s CignaCare designation status.
7
Eective date of coverage.
8
Name of patient‘s primary care provider(PCP).
9
Network Savings Program (NSP) logo indicates
that out-of-network discounts may be available
to the customer.
10
Employer name.
11
If a third party administers services in
conjunction with Cigna, the ID card may
include multiple logos, and show a dierent
claim address or telephone number on the
back of the card.
12
Precertification requirements may be shown
aseither “Inpatient Admission” or “Inpatient
Admission and Outpatient Procedures.’’
13
Submit claims to the claim submission address
shown on the card.
14
Call the customer service number(s) indicated
on the card. Some plans have dedicated
numbers for accessing information. Always
check the card for the correct number or refer
to the Important contact information page in
this guide.
15
“Away From Home Care” indicates the patient
has access to the Cigna national Away From
Home Care feature.
16
Indicates shared administration repricing.
17
Union identifier.
18
Client-specific network (CSN) logo.
* PCP selection and referrals are required in Illinois.
** Emergency services as defined in their plan.
11
MEDICARE PLANS
<barcode>
<URL>
Name
ID
Health Plan
[Effective Date
<Customer Full Name>
<Customer ID>
(80840)
<Effective Date>]
[Services may require [a referral or] [an] authorization by the Health Plan.]
Medicare limiting charges apply.
Customer Service
<--Toll Free Number ---> (TTY 711)
<Plan Name>
<Plan Type>
<Contract/PBP/[segment]>
[No Referral Required] COPAYS
RxBIN
RxPCN
RxGRP
<XXXXXXX>
<XXXXXXX>
<XXXXXXX>
PCP
Emergency
<$xx>
<$xx>
This card does not guarantee coverage or payment.
[Provider Services
[Authorization[/Referral]
[Provider Medical Claims
[Pharmacy Help Desk
[Pharmacy Claims
[Dental Services
[Provider Dental Claims
<Phone Number>]
<Phone Number>]
<Address>]
<Phone Number>]
<Address>]
<Phone Number>]
<Address>]
INT_21_89795_C
This card is used for all True Choice plans.
[No PC
P Required]
Specialist
Urgent care
<$xx>
<$xx>
947178
<barcode>
<URL>
Name
ID
Health Plan
[Effective Date
<Customer Full Name>
<Customer ID>
(80840)
<Effective Date>]
[Services may require [a referral or] [an] authorization by the Health Plan.]
Medicare limiting charges apply.
Customer Service
<--Toll Free Number ---> (TTY 711)
<Plan Name>
<Plan Type>
<Contract/PBP/[segment]>
[No Referral Required] COPAYS
RxBIN
RxPCN
RxGRP
<XXXXXXX>
<XXXXXXX>
<XXXXXXX>
PCP
Emergency
<$xx>
<$xx>
This card does not guarantee coverage or payment.
[Provider Services
[Authorization[/Referral]
[Provider Medical Claims
[Pharmacy Help Desk
[Pharmacy Claims
[Dental Services
[Provider Dental Claims
<Phone Number>]
<Phone Number>]
<Address>]
<Phone Number>]
<Address>]
<Phone Number>]
<Address>]
INT_21_89795_C
This card is used for all True Choice plans.
[No PC
P Required]
Specialist
Urgent care
<$xx>
<$xx>
947178
<barcode>
[<URL>]
[ ]
Name
ID
Health Plan
[
Effective Date
PCP
PCP Phone
PCP Network
<Customer Full Name>
<Customer ID>
(80840)
<Effective Date>]
<PCP Name>
<Phone Number>
<Network>
<Plan Name>
<Plan Type>
<Contract/PBP[/segment]>
[No Referral Required] COPAYS
RxBIN
RxPCN
RxGRP
<XXXXXXX>
<XXXXXXX>
<XXXXXXX>
PCP
Emergency
<$xx>
<$xx>
This card does not guarantee coverage or payment.
[Provider Services
[Authorization[
/Referral]
[Provider Medical Claims
[Pharmacy Help Desk
[Pharmacy Claims
[Dental Services
[Provider Dental Claims
<Phone Number>]
<Phone Number>]
<Address>]
<Phone Number>]
<Address>]
<Phone Number>]
<Address>]
This card is used for all plans except True Choice, EGWP, Leon and Arizona plans.
Specialist
Urgent C
are
<$xx>
<$xx>
[Services may require [a referral or] [an] authorization by the Health Plan.]
[Medicare limiting charges apply.]
[Customer Service
<--Toll Free Number ---> (TTY 711)]
947176
INT_21_89712_C
<barcode>
[<URL>]
[ ]
Name
ID
Health Plan
[
Effective Date
PCP
PCP Phone
PCP Network
<Customer Full Name>
<Customer ID>
(80840)
<Effective Date>]
<PCP Name>
<Phone Number>
<Network>
<Plan Name>
<Plan Type>
<Contract/PBP[/segment]>
[No Referral Required] COPAYS
RxBIN
RxPCN
RxGRP
<XXXXXXX>
<XXXXXXX>
<XXXXXXX>
PCP
Emergency
<$xx>
<$xx>
This card does not guarantee coverage or payment.
[Provider Services
[Authorization[
/Referral]
[Provider Medical Claims
[Pharmacy Help Desk
[Pharmacy Claims
[Dental Services
[Provider Dental Claims
<Phone Number>]
<Phone Number>]
<Address>]
<Phone Number>]
<Address>]
<Phone Number>]
<Address>]
This card is used for all plans except True Choice, EGWP, Leon and Arizona plans.
Specialist
Urgent C
are
<$xx>
<$xx>
[Services may require [a referral or] [an] authorization by the Health Plan.]
[Medicare limiting charges apply.]
[Customer Service
<--Toll Free Number ---> (TTY 711)]
947176
INT_21_89712_C
<barcode>
[<URL>]
Name
ID
Health Plan
[Effective Date
PCP
PCP Phone
PCP Network
<Customer Full Name>
<Customer ID>
(80840)
<Effective Date>]
<PCP Name>
<Phone Number>
<Network>
<Plan Name>
<Plan Type>
<Contract/PBP[/segment]>
[No Referral Required] COPAYS
Part B Drugs
[RxBIN
[RxPCN
[RxGRP
<XXXXXXX>]
<XXXXXXX>]
<XXXXXXX>]
PCP
Emergency
<$xx>
<$xx>
This card does not guarantee coverage or payment.
[Provider Services
[Authorization[
/Referral]
[Provider Medical Claims
[Dental Services
[Provider Dental Claims
[Pharmacy Help Desk
<Phone Number>]
<Phone Number>]
<Address>]
<Phone Number>]
<Address>]
<Phone Number>]
This card is used for non-TrueChoice MA Only plans.
Specialist
Urgent C
are
<$xx>
<$xx>
[Services may require [a referral or] [an] authorization by the Health Plan.]
[Medicare limiting charges apply.]
[Customer Service
<--Toll Free Number ---> (TTY 711)]
947177
INT_21_89709_C
<barcode>
[<URL>]
Name
ID
Health Plan
[Effective Date
PCP
PCP Phone
PCP Network
<Customer Full Name>
<Customer ID>
(80840)
<Effective Date>]
<PCP Name>
<Phone Number>
<Network>
<Plan Name>
<Plan Type>
<Contract/PBP[/segment]>
[No Referral Required] COPAYS
Part B Drugs
[RxBIN
[RxPCN
[RxGRP
<XXXXXXX>]
<XXXXXXX>]
<XXXXXXX>]
PCP
Emergency
<$xx>
<$xx>
This card does not guarantee coverage or payment.
[Provider Services
[Authorization[
/Referral]
[Provider Medical Claims
[Dental Services
[Provider Dental Claims
[Pharmacy Help Desk
<Phone Number>]
<Phone Number>]
<Address>]
<Phone Number>]
<Address>]
<Phone Number>]
This card is used for non-TrueChoice MA Only plans.
Specialist
Urgent C
are
<$xx>
<$xx>
[Services may require [a referral or] [an] authorization by the Health Plan.]
[Medicare limiting charges apply.]
[Customer Service
<--Toll Free Number ---> (TTY 711)]
947177
INT_21_89709_C
Network: Prescription Drugs
Network: Medicare Advantage
Network: PPO
12
PCP required Referral required Prescription Drug Plan
MAPD Yes Yes* Part D
MA    Yes Yes* Part B
PPO   No No
For more information, see the next page.
*Referral requirements are indicated on the customer’s Cigna ID Card.
*Select service areas do not require the use of referrals.
2
5
7
3
1
4
3
6
2
7
3
1
4
3
6
2
5
7
3
1
4
6
13
Key
Refer to this key for explanations of the
information found on the sample Cigna ID cards
featured in this brochure.
1
Use this ID number for all claims and inquiries.
2
Eective date of coverage.
3
Name of patient‘s primary care provider(PCP).
4
Collect any copayment at the time of service.
5
Prescription Drug Coverage.
6
Submit claims to the claim submission address
shown on the card.
7
Call the customer service number(s) indicated
on the card. Some plans have dedicated
numbers for accessing information. Always
check the card for the correct number.
Medicare Plans
Cigna contracts with the Centers for Medicare & Medicaid
Services (CMS) to oer Medicare Advantage (MA) plans.
Customers are able to select one of several plans oered
based on their location, budget and health care needs.
For more information and to access the directory of
participating providers, visit Medicareproviders.cigna.com.
Medical Benefits Abroad
Policy No:
Employer:
To verify benefits, please see the contact information on the back of this card.
www.CignaEnvoy.com
Network Savings Program
Preferred care network in the U.S.: Cigna HealthCare PPO
All benefits are subject to verification of eligibility, definitions, exclusions,
and contract limitation. Card possession does not certify eligibility
for benefits. For U.S.-inpatient services pre-authorization required.
Members and Providers
US Provider: Payor ID# Cigna – 62308
Fax Claims: 800.243.6998 (toll-free) or 001.302.797.3150 (direct fax)
Contact: 800.243.1348 (toll-free) or 001.302.797.3535 (outside the U.S.)
302.797.3535 (inside the U.S.)
Mail Claims: Cigna PO Box 15111, Wilmington, DE 19850-5111
Courier: Cigna 300 Bellevue Parkway, Wilmington DE 19809-3718
Website: www.CignaEnvoy.com
AWAY FROM HOME CARE
112094 11/15
Medical Benefits Abroad
Policy No:
Employer:
To verify benefits, please see the contact information on the back of this card.
www.CignaEnvoy.com
Network Savings Program
Preferred care network in the U.S.: Cigna HealthCare PPO
All benefits are subject to verification of eligibility, definitions, exclusions,
and contract limitation. Card possession does not certify eligibility
for benefits. For U.S.-inpatient services pre-authorization required.
Members and Providers
US Provider: Payor ID# Cigna – 62308
Fax Claims: 1.800.243.6998 (toll-free) or 001.302.797.3150 (direct fax)
Contact: 1.800.243.1348 (toll-free) or 001.302.797.3535 (outside the U.S.)
302.797.3535 (inside the U.S.)
Mail Claims: Cigna PO Box 15111, Wilmington, DE 19850-5111
Courier: Cigna 300 Bellevue Parkway, Wilmington DE 19809-3718
Website: www.CignaEnvoy.com
AWAY FROM HOME CARE
112094 11/15
CIGNA GLOBAL HEALTH BENEFITS
®
PLANS
Networks in the U.S.: PPO or OAP
Cigna Global Health Benefits plans that use these networks oer medical coverage to individuals, for unexpected illness
and injuries that occur while traveling in the U.S. on international business outside of their home or permanent
assignment country.
Cigna Global Health Benefits plans that use these networks oer medical coverage outside the U.S. for globally mobile
customers, including U.S. expatriates and inpatriates to the U.S., and their dependents.
10
12
14
13
15
9
1
PCP required Referral required Away from Home Care Out-of-network benefits
Encouraged No Yes Yes
For more information, see the next page.
Networks outside the U.S.: Vary by location
14
Cigna Global Health Benefits
®
plans
We oer Cigna Global Health Benefits plans for globally
mobile employees, including U.S. expatriates and inpatriatesto
the U.S. There are multiple coverage options encompassing
medical, business travel medical, dental, life, accidental death
and dismemberment, and a range of ancillary coverage. The
network name will appear on the IDcard.
For more information and to access the directory of participating
providers, visit CignaEnvoy.com.
Key
Refer to this key for explanations of the
information found on the sample Cigna ID cards
featured in this brochure.
1
Use this ID number for all claims and inquiries.
2
Indicates a seamless network where a patient
can receive in-network care on a regional or
statewide basis.
3
For patients with coinsurance, submit claims
toCigna or its designee, and receive an
explanation of payment (EOP), which will show
any remaining amount due from the patient.
4
Collect any copayment at the time of service.
5
May read as: “Cigna Health and Life Insurance
Company” or “Connecticut General Life
Insurance Co.” or “Cigna HealthCare of
XXXX, Inc.”
6
ID cards with the Cigna Care Network
logo
indicate the patient’s liability varies based
onthe provider’s Cigna Care designation
status. Refer to the online provider directory
atCigna.com >Find a Doctor to determine a
physician’s CignaCare designation status.
7
Eective date of coverage.
8
Name of patient‘s primary care provider(PCP).
9
Network Savings Program (NSP) logo indicates
that out-of-network discounts may be available
to the customer.
10
Employer name.
11
If a third party administers services in
conjunction with Cigna, the ID card may
include multiple logos, and show a dierent
claim address or telephone number on the
back of the card.
12
Precertification requirements may be shown
aseither “Inpatient Admission” or “Inpatient
Admission and Outpatient Procedures.’’
13
Submit claims to the claim submission address
shown on the card.
14
Call the customer service number(s) indicated
on the card. Some plans have dedicated
numbers for accessing information. Always
check the card for the correct number or refer
to the Important contact information page in
this guide.
15
“Away From Home Care” indicates the patient
has access to the Cigna national Away From
Home Care feature.
16
Indicates shared administration repricing.
17
Union identifier.
18
Client-specific network (CSN) logo.
15
Network: Shared Administration Open Access Plus, Shared Administration PPO, or LocalPlus
AWAY FROM HOME CARE
You may be asked to present this card when you receive care. The card does not guarantee coverage.
You must comply with all terms and conditions of the plan. Willful misuse of this card is considered fraud.
INPATIENT ADMISSION
Your provider must call the toll-free number below to precertify your medical benets or benets may be aected.
Refer to your plan documents for your plan's precertication requirements. In an emergency, seek care immediately,
then notify Cigna within ## hours.
Mail all non-medical claims and correspondence to: ID Card Account Name
SAR Fund Address
Submit/Mail claims to: Cigna Payor 62308, P.O. Box 188004, Chattanooga, TN 37422-8004
All other:
TPV Name PO Box XXXXX, Anytown, USA 12345-6789
Pre-certification: 1-XXX-XXX-XXXX Pharmacy Questions: 1-XXX-XXX-XXXX
Eligibility, Benefit and Claim Questions: 1-XXX-XXX-XXXX
To access the online provider directory go to www.cignasharedadministration.com
To access member pharmacy tools go to www.cigna.com
We encourage you to use a PCP as a valuable resource and personal health advocate.
Cat#
Legal entity name
Coverage effective date: MM/DD/CCYY
Group: 1234567
Issuer (80840)
ID: U23456789 01
Name: John Public
S
PCP: James Smith
PCP name Ln2
PCP phone: 860-555-1212
Fund Name
Fund #: Fund number
RxBIN XXXXXX RxPCN XXXXXXXX
DOI
Open Access Plus
No referral required
PCP visit $15
Specialist $20
Rx 30% / 40% / 50%
Network coinsurance:
In 90% / 10%
Out 70% / 30%
Deductible applies
Client
logo
TPV logo
12
13
14
15 17
16
11
5
7
4
3
1
SHARED ADMINISTRATION REPRICING PLANS
For more information, see the next page.
PCP required Referral required Away from Home Care Out-of-network benefits
Encouraged No Yes Yes
WWW.CIGNA.COM
You may be asked to present this card when you receive care. The card does not guarantee coverage.
You must comply with all terms and conditions of the plan. Willful misuse of this card is considered fraud.
INPATIENT ADMISSION:
Your provider must call the toll-free number listed below to pre-certify the above services. Refer to your plan documents for your
pre-certication requirements. Failure to do so may aect benets. In an emergency, seek care immediately, then call your primary
care doctor as soon as possible for further assistance and directions on follow-up care within ### hours.
Coinsurance/deductible is paid directly to the doctor/facility by Cigna using individual’s available health funds.
For Pharmacy, call ABC Company 800.XXX.XXXX (Not a Cigna Company)
For Vision, call ABC Company 800.XXX.XXXX (Not a Cigna Company)
Send claims to:
CAD Name, PO Box XXXX, Anytown, USA 12345-6789
TPV Name, PO Box XXXX, Anytown, USA 12345-6789
All Others: PO Box XXXX, Anytown, USA 12345-6789
Customer Service: 800.XXX.XXXX MH/SA: 800.XXX.XXXX
We encourage you to use a PCP as a valuable resource and personal health advocate.
AWAY FROM HOME CARE
Cat#
Legal entity name
Coverage effective date: MM/DD/CCYY
Group: 1234567
Issuer (80840)
ID: U23456789 01
Name: John Public
PCP: John Smith
PCP Name Ln2
PCP Phone: XXX.XXX.XXXX
ID card acct name
RxBIN XXXXXX RxPCN XXXXXXXX
DOI
Choice Fund OA Plus
No referral required
PCP Visit 15%/20%
Specialist 15%/20%
Hospital ER 20%
Vision Yes
Rx 30%/40%/50%
Network Coinsurance:
In 90%/10%
Out 70%/30%
Med/Rx deductible applies
TPV logo
CAD logo
Tiered Benefits
Client
logo
Networks: Vary by plan
11
10
12
13
14
15
18
6
5
7
3
1
8
9
CIGNA CHOICE FUND
®
PLANS
For more information, see the next page.
PCP required Referral required Away from Home Care Out-of-network benefits
PPO No No Yes Yes
EPO Encouraged No Yes No
OAP Encouraged No Yes Yes
LocalPlus Encouraged No Yes Yes
Indemnity No No N/A Yes
16
Cigna Choice Fund
®
plans
These plans combine an employer-funded health reimbursement
account (HRA) or employer/employee-funded tax-advantaged
health savings account (HSA) with PPO, EPO, Open Access
Plus, LocalPlus, or indemnity plans. Customers will have
access to providers who participate in the network aligned
totheirplan.
Networks: Vary by plan
Plans that use these networks oer customers access to a suite of
providers, and allow them to be in charge of how and when they
spend their health fund dollars.
›
Referrals are not required to see specialists.
›
Typically, no copayments are required.
›
Providers should bill Cigna directly.
›
Precertification may still be required for certain services and
procedures.
For a directory of providers who participate in these networks,
visitCigna.com >Find a Doctor.
Shared Administration Repricing plans
Shared Administration Repricing plans are oered by
theCigna Taft-Hartley and Federal Business Segment. They
are designed for Taft-Hartley and federal plan employers that
want to continue processing and paying their own claims, and
retain customer and provider services, or use a third-party
administrator to perform these functions.
Networks: Shared Administration Open Access Plus,
SharedAdministration PPO, or LocalPlus
Plans that use these networks oer customers access to a national
network of providers.
›
Referrals are not required to see specialists.
›
Both in- and out-of-network benefits are available. Customers
can access providers that participate in a national network,
which includes Away From Home Care.
For a directory of providers who participate in these networks,
visitCignaSharedAdministration.com.
Key
Refer to this key for explanations of the
information found on the sample Cigna ID cards
featured in this brochure.
1
Use this ID number for all claims and inquiries.
2
Indicates a seamless network where a patient
can receive in-network care on a regional or
statewide basis.
3
For patients with coinsurance, submit claims
toCigna or its designee, and receive an
explanation of payment (EOP), which will show
any remaining amount due from the patient.
4
Collect any copayment at the time of service.
5
May read as: “Cigna Health and Life Insurance
Company” or “Connecticut General Life
Insurance Co.” or “Cigna HealthCare of
XXXX, Inc.”
6
ID cards with the Tiered Benefits
®
logo indicate
the patient’s liability varies based onthe
provider’s Cigna Care designation status.
Referto the online provider directory at
Cigna.com >Find a Doctor to determine a
physician’s CignaCare designation status.
7
Eective date of coverage.
8
Name of patient‘s primary care provider(PCP).
9
Network Savings Program (NSP) logo indicates
that out-of-network discounts may be available
to the customer.
10
Employer name.
11
If a third party administers services in
conjunction with Cigna, the ID card may
include multiple logos, and show a dierent
claim address or telephone number on the
back of the card.
12
Precertification requirements may be shown
aseither “Inpatient Admission” or “Inpatient
Admission and Outpatient Procedures.’’
13
Submit claims to the claim submission address
shown on the card.
14
Call the customer service number(s) indicated
on the card. Some plans have dedicated
numbers for accessing information. Always
check the card for the correct number or refer
to the Important contact information page in
this guide.
15
“Away From Home Care” indicates the patient
has access to the Cigna national Away From
Home Care feature.
16
Indicates shared administration repricing.
17
Union identifier.
18
Client Arranged Deal (CAD) network logo.
17
18
AWAY FROM HOME CARE
WWW.CIGNA.COM
You may be asked to present this card when you receive care. The card does not guarantee coverage.
You must comply with all terms and conditions of the plan. Willful misuse of this card is considered fraud.
INPATIENT ADMISSION:
Your network provider must call the toll-free number listed below to pre-certify the above services. Refer to your plan documents
for your pre-certication requirements. Failure to do so may aect benets. In an emergency, seek care immediately, then call your
primary care doctor as soon as possible for further assistance and directions on follow-up care within 48 hours.
Coinsurance/deductible is paid directly to the doctor/facility by Cigna using individual’s available health funds.
For pharmacy: Call ABC Company 1.800.XXX.XXXX (Not a Cigna Company)
For vision: Call ABC Company 1.800.XXX.XXXX (Not a Cigna Company)
Send claims to: CSN name, PO Box XXXXX, Anytown, USA 12345-6789
All other: PO Box XXXXX, Anytown, USA 12345-6789
Customer service: 1.800.XXX.XXXX MH/SA: 1.800.XXX.XXXX
We encourage you to use a PCP as a valuable resource and personal health advocate.
Cat#
Legal entity name
Coverage effective date: MM/DD/CCYY
Group: 1234567
Issuer (80840)
ID: U23456789 01
Name: John Public
PCP: John Smith
PCP name Ln2
PCP phone: 860.555.1212
ID card acct name
RxBIN XXXXXX RxPCN XXXXXXXX
DOI
Open Access Plus
No referral required
PCP visit $15
Specialist $30
Hospital ER $50
Urgent care $25
Vision Yes
Rx $10/$20/$40/90%
Rx indiv deduct $50
Network coinsurance:
In 90%/10%
Client
logo
TPV / Alliance
logo
CareLink
logo
11
12
13
14
15
10
5
7
1
9
3
4
STRATEGIC ALLIANCE PLANS
PCP required Referral required Away from Home Care Out-of-network benefits
Encouraged No Yes Yes
For more information, see the next page.
Networks: Vary by plan
Sample ID cards for Cigna's Strategic Alliances
These samples show ID cards for people whose health plans are administered by one of our Strategic Alliances with Allegiance,
HealthPartners, MVP, PriorityHealth, or Tufts. The Cigna logo on the card indicates they may visit a Cigna-participating provider
when in the Cigna service area.
The sample below shows an ID card for a customer with a Cigna-administered plan. If it displays a Strategic Alliance logo,* the
customer may use that Strategic Alliance’s network when outside the service area for Cigna network-participating providers.
* Logos include Allegiance, HealthPartners, MVP,
PriorityHealth, and Tufts.
Member Medical Network
Pharmacy Plan
Customer Service: 1-800-XXX-XXXX
Pharmacist Use Only: 1-800-XXX-XXXX
xxxxxxxxxxxxxx
Covered Person: JOHN SAMPLE
EMPLOYER
Group ID No.: 000000
Participant ID#: SMPL0001
Dependent(s)
JANE SAMPLE
JIMMY SAMPLE
Type of Coverage Effective Date
Medical
No Referral Required Plan Opt: Basic
Questions?Questions?Questions?Questions?
1-800-877-XXXX
www.askallegiance.com
Medical Benefits In-Network Non-NetworkMedical Benefits In-Network Non-NetworkMedical Benefits In-Network Non-NetworkMedical Benefits In-Network Non-Network
Ind Deductible $XXXX $XXXX
Ind Out of Pocket $XXXX $XXXX
Open Access Plus
RxBin: 004336
PCN: ADV
RxGrp: XXXXX
1166-AL 5352 000000-MOCK-MED-BASIC---- M()D()V()
20211005T01 Sh: 0 Bin 1
J0EF Env [1] CSets 1 of 1
Strategic alliance plans
Cigna has entered into strategic alliances with several nationally
recognized health care companies. These plans give our
customers access to an alliance’s network of providers and
discounts in specific geographic areas. They also provide the
alliance’s customers with access to Cigna’s national provider
network and discounts outside their specific geographic area.
Networks: Vary by plan
›
Referrals are not required to see specialists.
›
Precertification may still be required for certain services
andprocedures.
›
Claims should be submitted to the payer ID on the customer’s
ID card.
Key
Refer to this key for explanations of the
information found on the sample Cigna ID cards
featured in this brochure.
1
Use this ID number for all claims and inquiries.
2
Indicates a seamless network where a patient
can receive in-network care on a regional or
statewide basis.
3
For patients with coinsurance, submit claims
toCigna or its designee, and receive an
explanation of payment (EOP), which will show
any remaining amount due from the patient.
4
Collect any copayment at the time of service.
5
May read as: “Cigna Health and Life Insurance
Company” or “Connecticut General Life
Insurance Co.” or “Cigna HealthCare of
XXXX, Inc.”
6
ID cards with the Cigna Care Network
logo
indicate the patient’s liability varies based
onthe provider’s Cigna Care designation
status. Referto the online provider directory
atCigna.com >Find a Doctor to determine a
physician’s CignaCare designation status.
7
Eective date of coverage.
8
Name of patient‘s primary care provider(PCP).
9
Network Savings Program (NSP) logo indicates
that out-of-network discounts may be available
to the customer.
10
Employer name.
11
If a third party administers services in
conjunction with Cigna, the ID card may
include multiple logos, and show a dierent
claim address or telephone number on the
back of the card.
12
Precertification requirements may be shown
aseither “Inpatient Admission” or “Inpatient
Admission and Outpatient Procedures.’’
13
Submit claims to the claim submission address
shown on the card.
14
Call the customer service number(s) indicated
on the card. Some plans have dedicated
numbers for accessing information. Always
check the card for the correct number or refer
to the Important contact information page in
this guide.
15
“Away From Home Care” indicates the patient
has access to the Cigna national Away From
Home Care feature.
16
Indicates shared administration repricing.
17
Union identifier.
18
Client-specific network (CSN) logo.
19
20
CIGNA + OSCAR
Networks: LocalPlus and Open Access Plus
Sample ID Cards
Member ID cards will include details about the network the plan aligns with and will look like the samples below:
Open Access Plus Plans LocalPlus Plans
PCP required Referral required Away from Home Care Out-of-network benefits
Encouraged No Yes Yes
Cigna + Oscar
Cigna has entered into a strategic partnership with Oscar
Health to jointly provide commercial health solutions to small
businesses. These plans are available in select markets. They
provide aordable, seamless, fully insured health benefits under
the Cigna + Oscar brand to the small group market.
For a directory of providers who participate in this network, visit
www.hioscar.com/providers.
Networks: Vary by plan
›
Referrals are not required to see specialists.
›
Precertification may still be required for certain services
andprocedures.
›
Claims should be submitted to the payer ID on the customer’s
ID card.
21
1
5
bk
You may be asked to present this card when you receive care. The card does not guarantee coverage. You must comply with all
terms and conditions of the plan. Willful misuse of this card is considered fraud.
INPATIENT ADMISSION:
Your provider must call the toll-free number listed below to pre-certify the above services. Refer to your plan documents for your
pre-certication requirements. Failure to do so may aect benets. In an emergency, seek care immediately, then call your primary
care doctor as soon as possible for further assistance and directions on follow-up care within ### hours.
Coinsurance/deductible is paid directly to the doctor/facility by Cigna using individual’s available health funds.
Note: You can reduce your out-of-pocket expenses if you use a Network Savings Program provider. Use of a Network Savings
Program provider does not aect your benet coverage. For help nding a participating provider, please visit our website, or call
the toll-free number listed on this card.
For Pharmacy, call ABC Company 800.XXX.XXXX (Not a Cigna Company)
For Vision, call ABC Company 800.XXX.XXXX (Not a Cigna Company)
Send Claims to: PO Box XXXX, Anytown, USA 12345-6789
Customer Service: 800.XXX.XXXX MH/SA: 800.XXX.XXXX
WWW.CIGNA.COM
NSP
logo
Network Savings Program
Cat#
Legal entity name
Coverage effective date: MM/DD/CCYY
Group: 1234567
Issuer (80840)
ID: U23456789 01
Name: John Public
ID card acct name
RxBIN XXXXXX RxPCN XXXXXXXX
DOI
Indemnity
Rx $10/20%/40%/100%
Rx indiv deduct $50
Indiv deduct $300
Family deduct $500
Hospital deduct $200
ER deduct $50
Coinsurance:
Medical 80%/20%
Med/Rx deductible applies
Client
logo
10
12
13
14
5
7
3
1
9
INDEMNITY PLANS
PCP required Referral required Away from Home Care Out-of-network benefits
No* No N/A Yes
For more information, see the next page.
Network: No network requirements
* This ID card will not display the name of a PCP if one is chosen.
22
Key
Refer to this key for explanations of the
information found on the sample Cigna ID cards
featured in this brochure.
1
Use this ID number for all claims and inquiries.
2
Indicates a seamless network where a patient
can receive in-network care on a regional or
statewide basis.
3
For patients with coinsurance, submit claims
toCigna or its designee, and receive an
explanation of payment (EOP), which will show
any remaining amount due from the patient.
4
Collect any copayment at the time of service.
5
May read as: “Cigna Health and Life Insurance
Company” or “Connecticut General Life
Insurance Co.” or “Cigna HealthCare of
XXXX, Inc.”
6
ID cards with the Cigna Care Network
logo
indicate the patient’s liability varies based
onthe provider’s Cigna Care designation
status. Refer to the online provider directory
atCigna.com >Find a Doctor to determine a
physician’s CignaCare designation status.
7
Eective date of coverage.
8
Name of patient‘s primary care provider(PCP).
9
Network Savings Program (NSP) logo indicates
that out-of-network discounts may be available
to the customer.
10
Employer name.
11
If a third party administers services in
conjunction with Cigna, the ID card may
include multiple logos, and show a dierent
claim address or telephone number on the
back of the card.
12
Precertification requirements may be shown
aseither “Inpatient Admission” or “Inpatient
Admission and Outpatient Procedures.’’
13
Submit claims to the claim submission address
shown on the card.
14
Call the customer service number(s) indicated
on the card. Some plans have dedicated
numbers for accessing information. Always
check the card for the correct number or refer
to the Important contact information page in
this guide.
15
“Away From Home Care” indicates the patient
has access to the Cigna national Away From
Home Care feature.
16
Indicates shared administration repricing.
17
Union identifier.
18
Tiered Benefits logo.
Indemnity plans
These plans give customers the freedom to choose
anyprovider.
›
No network requirements.
›
Referrals are not required to see specialists.
23
The myCigna
®
App
The myCigna
App gives Cigna customers a simple way to personalize, organize, and access their important health
and coverage information – on the go. Your patients may present their Cigna ID card claims information and
coverage eligibility to you via the app on their smartphone or tablet.
Sample ID card information you might see on your patients’ myCigna App
Provider directory
›
Locate network-participating doctors and health
care facilities
›
Access maps for instant driving directions
Health wallet
›
Store and organize all contact information for
doctors, hospitals, and pharmacies
›
Add providers to contact list right from a claim or
directory search
Claims
›
View and search recent and past medical, dental,
andpharmacy claims
›
Bookmark and group claims for easy reference
Trackers
›
View in-network and out-of-network medical
anddental year-to-date deductibles, as well as
out-of-pocket and annual maximums
Coverage
›
See plan coverage and benefit information for
medical, dental, pharmacy, behavioral health,
substance abuse, and disability
›
Access and view health fund balances
›
Review plan deductibles, coinsurance,
andcopayments
Nov Eleven
ID:100654369
PREFERRED
PROVIDER
ORGANIZATION
Group Number:
00617573
Coverage Effective Date:
01/01/2014
Issuer: 80840
For coverage info:
Review your coverage on the
myCigna website or mobile app,
or
call 1.866.494.2111.
Issue Date: 07/21/2015
Customers and Health
Care Professionals:
1.866.494.2111
(24 hours a day, 365 days
a year)
Send Medical Claims To:
Cigna
1000 Great-West Drive
Kennett, MO 63857
Payer ID: #62308
You may be asked to present this card when you access
care. This card doesn't guarantee coverage. You must
comply with all items and conditions of the plan. Willful
misuse of this card is considered fraud.
Hospital Admission: Prior to any non-emergency hospital
admission, you or your doctor must call the toll-free
Customers and Health Care Professionals number shown
below to request "precertification." In the case of an
emergency, you, your family, or your doctor must call within
48 hours of hospital admission. Failure to contact Cigna will
affect your coverage.
In an Emergency: Seek care immediately. Go directly to the
nearest emergency facility or call 911.
Health Care Professionals:. Visit www.CignaforHCP.com or
call 800-882-4462.
ID Cards - Print or Request
Click the "Print" button below to print your card.
Please note: Temporary cards are not an exact copy of your permanent ID card and do not contain all the same information as
your permanent ID card. Your temporary card will expire in ten days or on your coverage end date, whichever is first. To request
a permanent ID card, go to ID Cards--Print or Request.
PRINT CANCEL
© 2015 Cigna. All rights reserved.
Selecting these links will take you away from myCigna.com. Cigna does not control the linked sites' content or links. Details
Page 1 of 1myCigna - ID Cards - Print or Request
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ID card features
›
Quickly view ID card information (front and back)
for family members
›
Easily print, email, or scan right from a smartphone
or tablet
Additional app features:
The myCigna App includes features that help your patients – and you – have an easier
health care experience.
Nov Eleven
ID:100654369
PREFERRED
PROVIDER
ORGANIZATION
Group Number:
00617573
Coverage Effective Date:
01/01/2014
Issuer: 80840
For coverage info:
Review your coverage on the
myCigna website or mobile app,
or
call 1.866.494.2111.
Issue Date: 07/21/2015
Customers and Health
Care Professionals:
1.866.494.2111
(24 hours a day, 365 days
a year)
Send Medical Claims To:
Cigna
1000 Great-West Drive
Kennett, MO 63857
Payer ID: #62308
You may be asked to present this card when you access
care. This card doesn't guarantee coverage. You must
comply with all items and conditions of the plan. Willful
misuse of this card is considered fraud.
Hospital Admission: Prior to any non-emergency hospital
admission, you or your doctor must call the toll-free
Customers and Health Care Professionals number shown
below to request "precertification." In the case of an
emergency, you, your family, or your doctor must call within
48 hours of hospital admission. Failure to contact Cigna will
affect your coverage.
In an Emergency: Seek care immediately. Go directly to the
nearest emergency facility or call 911.
Health Care Professionals:. Visit www.CignaforHCP.com or
call 800-882-4462.
ID Cards - Print or Request
Click the "Print" button below to print your card.
Please note: Temporary cards are not an exact copy of your permanent ID card and do not contain all the same information as
your permanent ID card. Your temporary card will expire in ten days or on your coverage end date, whichever is first. To request
a permanent ID card, go to ID Cards--Print or Request.
PRINT CANCEL
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866.494.2111.
866.494.2111
24
Use our electronic tools
›
Log in to the Cigna for Health Care Professionals
website (CignaforHCP.com)
›
Connect with us through electronic data interchange
(EDI): Visit Cigna.com/EDIVendors to learn more
›
Call our automated phone system: 800.88Cigna
(882.4462)
Conduct administrative
transactions electronically
Cigna’s convenient eServices tools help you manage
theadministrative details of health care.
›
Access patient eligibility and benefits
›
Estimate patient out-of-pocket costs
›
View and submit precertification requests
›
Check claim status
›
Enroll online for electronic funds transfer (EFT),
then view, print, and share online remittance reports
the same day you receive electronic payments
›
Receive electronic remittance advices and
automatically load them to your accounts
receivable system
›
Submit questions about fee schedules and
specific patient benefits
Learn more
To access our educational resources, log in to
CignaforHCP.com > Resources > eCourses. Select
courses about EDI, eligibility and benefits, estimating
patient out-of-pocket costs, precertification, electronic
claim submission, claim status inquiry, enrolling in and
managing EFT, online remittance reports, and more.
More ways to access patient information when you need it
Additional app features (continued)
Drug search
›
View medication costs based on their plan and see
lower-cost alternatives*
›
Find closest network-participating pharmacy
location using GPS
›
Research medicine and dosages
›
Speed dial Cigna Home Delivery Pharmacy
SM
* Prices are not guaranteed, nor is the display of a price a guarantee of coverage.
Medication costs and coverage may vary at the time prescriptions are filled at the
pharmacy, and pricing at individual pharmacies may vary. Coverage and pricing terms
are subject to change.
** The myCigna App is available to Cigna health plan customers. Actual features may vary
depending on their plan.
Customers can download the free
myCigna App**
The Apple logo is a trademark of Apple Inc., registered in the U.S. and other countries. App
Store is a registered service mark of Apple Inc. Android and Google Play are trademarks of
Google Inc. Amazon, Kindle, Fire and all related logos are trademarks of Amazon.com, Inc.
or its affiliates. The downloading and use of the myCigna App is subject to the terms and
conditions of the app, and the online store from which it is downloaded. Standard mobile
phone carrier and data usage charges apply.
25
Important contact information
Find the contacts you need to get in touch with us for information about your patients with Cigna coverage.*
Please note that call, claim, and service channels may dier based on the Cigna participant’s identification (ID) card.
If you want to: Use the following:
Update your contact or demographic information, or notify
us of errors/changes to the way you are currently listed in our
provider directories, including:**
›
Name
›
Type/Degree
›
Specialty
›
Product and network tier
›
National Provider Identifier (NPI) number
›
Medical group or hospital affiliation
›
Office email address
›
Address
›
Office phone number
›
Whether you are accepting new patients
Submit demographic changes to Cigna electronically by logging in to
CignaforHCP.com > Working With Cigna > Update Directory Information.
If you have not registered, please go to the registration page to begin
theprocess.
Or
Practitioner & Group Changes:
Fax: 877.358.4301
Email: [email protected]
Hospital & Ancillary Changes:
Fax: 646.459.2180
Exceptions
If you are located in the following markets, submit updates electronically on
CignaforHCP.com or as directed below.
U.S. Virgin Islands
Email: [email protected] Fax: 340.774.7175
Mail: V.I. Equicare, Inc.
V.I. Medical Foundation Bldg, Ste 209A
PO Box 9620
St. Thomas, VI 00801
California
Email: CA_Direct[email protected]
Perform online transactions:***
›
Verify patient eligibility
›
Inquire about patient coverage and covered services
›
Predict the total cost of service and patient liability for
specific medical procedures
›
Request precertification for services
›
Inquire about precertification for services
›
View claim-coding policies and payment guidelines
›
Review medical or pharmacy coverage positions
›
View the prescription drug list
›
View sample ID cards
›
Obtain a Reference Guide
›
Request a copy of your contract
›
Request fee schedule information
Cigna for Health Care Professionals website: CignaforHCP.com
Perform transactions using a multipayer website or vendor via
electronic data interchange (EDI):***
›
Verify patient eligibility and coverage
›
Inquire about patient coverage and covered services
›
Check the status of a claim
›
Request precertification for services
›
Submit claims electronically
›
Receive electronic remittance advice
›
View list of EDI vendors
Refer to Cigna.com/EDIvendors for a list of directly connected Cigna vendors.
26
If you want to: Use the following:
Enroll to receive electronic funds transfer (EFT) or directdeposit Log in to CignaforHCP.com > Working with Cigna > Electronic Funds
Transfer> Enroll in Electronic Funds Transfer (EFT) Options.
Perform telephone transactions:***
›
Learn about electronic services
›
Verify patient eligibility and coverage
›
Check the status of a claim
›
Request precertification for services
›
Request an exception to the prescription drug list
›
In the Texas market, request the Texas SB 418 Written
Verification; a representative is available Monday to
Friday, from 6 a.m. to 6 p.m. and from 9 a.m. to 12 p.m.
onweekends and holidays
Phone: 800.88Cigna (882.4462)
For patients with “G” ID cards:
Phone: 866.494.2111
Customer Service numbers are also included on the patient’s ID card.
Submit a paper claim Refer to patient’s ID card
Submit or inquire about an appeal or dispute Phone: 800.88Cigna (882.4462)
Website: CignaforHCP.com
Fax: 877.815.4827
Mail: Cigna National Appeals
PO Box 188011
Chattanooga, TN 37422
For patients with “G” ID cards:
Fax: 877.804.1679
Mail: Cigna National Appeals
PO Box 188062
Chattanooga, TN 37422-8062
Submit or inquire about provider credentialing** Phone: 800.88Cigna (882.4462)
Obtain information about organ and tissue transplant network Cigna LifeSOURCE Transplant Network®
Phone: 800.668.9682
Website: CignaLifeSOURCE.com
Contact a dental network Phone: 800.Cigna24 (244.6224)
Website: CignaforHCP.com
For patients with “G” ID cards:
Phone: 866.494.2111
Obtain other telephone numbers and addresses Refer to the patient’s ID card
Other important contacts: Use the following:
Evernorth Behavioral Health Phone: 800.926.2273
Website: CignaforHCP.com
Home delivery pharmacy Cigna Home Delivery Pharmacy: 800.285.4812
Express Scripts Pharmacy, a Cigna company: 800.211.1456
Accredo, a Cigna specialty pharmacy Accredo Physician Service Center: 844.516.3319
Website: Accredo.com > Prescribers
27
Other important contacts: Use the following:
Medical management (including precertification) Phone: 800.88Cigna (882.4462)
Website: CignaforHCP.com
For patients with “G” ID cards:
Phone: 866.494.2111
Customer service numbers are also included on the patient’s ID card.
eviCore healthcare
(diagnostic cardiology, gastroenterology, high-tech radiology,
integrated oncology, musculoskeletal, and radiation therapy
services)
Effective February 1, 2021, eviCore will begin managing home
health, durable medical equipment (DME), home infusion, and
sleep services for Cigna customers.
Diagnostic cardiology, high-tech radiology, musculoskeletal, and
gastroenterology
Phone: 888.693.3297
Website: eviCore.com
Radiation therapy and integrated oncology
Phone: 866.668.9250
Website: eviCore.com
Home health, DME & Sleep Management Services (effective 02.01.21)
Phone: 800.298.4806
Website: evicore.com/ep360
Exceptions
For CareLink customers in MA and RI and Cigna customers in Hawaii and
Puerto Rico, use the following contact information:
Phone: 800.88Cigna (882.4462)
Website: CignaforHCP.com
Pharmacy prior authorizations Electronic medical record or electronic health record: CoverMyMeds®
orSurescripts®
Website: CoverMyMeds.com/epa/Cigna
Phone: 800.244.6224
Specialty pharmacy condition counseling Accredo Therapeutic Resource Centers: 844.516.3319
Cigna specialty condition counseling: 800.633.6521
28
* Excluding customers with third party administrator plans.
** Excluding providers contracted through a Cigna Strategic Alliance.
*** Not all transactions are available for all Cigna plans.
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company, Connecticut General Life
Insurance Company, Evernorth Care Solutions, Inc., Evernorth Behavioral Health, Inc., Cigna Health Management, Inc., Tel-Drug, Inc., Tel-Drug of Pennsylvania, L.L.C., and HMO or service company
subsidiaries of Cigna Health Corporation and Cigna Dental Health, Inc. “Cigna Specialty Pharmacy Services” refers to the specialty drug division of Tel-Drug, Inc. and Tel-Drug of Pennsylvania, L.L.C.,
doing business as Cigna Home Delivery Pharmacy. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc.
960220 12/21 PCOMM-2021-1766 © 2021 Cigna. Some content provided under license.