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March 2011


Preventive Care Coverage Update

CIGNA has changed how preventive care claims are administered to better align with our preventive care policy.


Previously, services not included on CIGNA's list of covered preventive services may have been paid at the preventive care benefit level when submitted with a preventive care claim. Now, regardless of whether they are submitted separately or as part of a preventive care claim, services that are not on the list of preventive services will be considered for coverage under the patient’s available non-preventive/routine care benefits, and patient cost-sharing may apply.


CIGNA's list of covered preventive benefits includes all of the United States Preventive Services Task Force (USPSTF) recommendations rated “A” or “B,” including any new items that may not have been previously covered under our preventive care benefit but are now mandated for inclusion by the Patient Protection and Affordable Care Act. See below for examples of services not included in the list of covered preventive care benefits to which patient cost sharing may apply:


Services Not Covered as Preventive Care

Effective October 1, 2010 as plans renew

Effective May 15, 2011 for plans that renewed on or after October 1, 2010

  • Chest x-ray
  • Vitamin D testing
  • General health panels
  • Comprehensive metabolic panels
  • Basic metabolic panels
  • Electrocardiogram (EKG)
  • Urinalysis

For all other plans, coverage changes to EKG and urinalysis services will become effective on the renewal date.

 This change does not affect your fee schedule. All that is changing is the coverage category under which these non-preventive care services will be reimbursed. Patient cost-sharing will continue to be explained in the Explanation of Payment (EOP).


Additional services not covered as preventive care may be covered at a different benefit level. Information about eligibility and benefits for your patients with CIGNA coverage is available on the secure CIGNA for Health Care Professionals website, www.cignaforhcp.com > View Member Eligibility and Benefits. For patients with GWH-CIGNA ID cards, visit www.gwhcignaforhcp.com > Eligibility and Benefits Inquiry.  For additional information on preventive care, including the full list of covered preventive services in A Guide to CIGNA's Preventive Health Coverage for Health Care Professionals, visit www.cigna.com/health/provider/medical/care_guidelines.html.




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