Overview
Coverage Positions/Criteria
CIGNA HealthCare Coverage Positions are tools to assist in interpreting standard health benefit plan provisions. Please keep the following in mind when accessing these Coverage Positions.
Select one of the links below to access CIGNA's medical or pharmacy coverage positions.
- Medical Index
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Pharmacy Index
- The terms of a participant's particular benefit plan document [Group Service Agreement (GSA), Evidence of Coverage, Certificate of Coverage, Summary Plan Description (SPD) or similar plan document] may differ significantly from the standard benefit plans upon which these Coverage Positions are based. If these Coverage Positions are inconsistent with the terms of the member's specific benefit plan, then the terms of the member's specific benefit plan always control.
- Coverage determinations in each specific instance require consideration of:
- the terms of the applicable benefit plan document in effect on the date of service
- any applicable laws/regulations
- any relevant collateral source materials including Coverage Positions
- the specific facts of the particular situation
- Medical technology is continuously evolving; our Coverage Positions are subject to change without prior notice. Additional Coverage Positions may be developed as needed or may be withdrawn from use. Additionally, some benefit plans administered by CIGNA HealthCare, such as certain self-funded employer plans or governmental plans, may not utilize CIGNA HealthCare Coverage Positions. Providers and members should contact their CIGNA HealthCare representative for specific coverage information.
- At this time, the Coverage Positions available at this site represent a portion of the coverage policies and collateral tools used by CIGNA HealthCare. We plan to make additional Coverage Positions available in the future.
- CIGNA HealthCare also uses other tools developed by third-parties to assist in interpreting health benefit plan provisions including:
- Milliman Care Guidelines, a division of Milliman, Inc., 12th edition, June 2008
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