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CIGNA HealthCare Claim Center indicates where your claim was processed.
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Reference Number is the unique number we assign to each claim. If you have questions about your claim or EOB, be sure to have this number handy when you call CIGNA HealthCare Member Services.
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Date refers to the date your claim was processed, not the date care was received.
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Subscriber ID is the Social Security Number of the employee covered by the plan. This information should match what's printed on your CIGNA HealthCare ID card.
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Group Number is the employer's unique account number. This information should match the information printed on your CIGNA HealthCare ID card.
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How to Contact Us tells you where to call, write or visit on the Internet if you have questions.
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Summary of Medical Benefits lists the name of the person who received the health care services (either you or a covered family member) and the benefit co-payment amount owed to the health care provider. Please note: The EOB is not a bill. The co-payment amount was due at the time of service
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Rights of Review and Appeal explains what to do if you disagree with the way your claim was processed and would like to request a formal review.
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Definitions of Terms offers a handy explanation of the most important headings used on the reverse of your EOB.
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Subscriber Name refers to the name of the employee covered by the plan.
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Member or Patient ID is the CIGNA Health Care ID card number of the person who received health care service(s).
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Member or Patient Name is the name of the person who received the health care service(s).
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Provider/Type of Service is the name of the health care provider who submitted the claim and the type of health care service that was provided. The provider may be a doctor, specialist, hospital, lab, clinic, or other medical facility.
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Service Date(s) is the actual date(s) the patient received health care services from the provider.
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Charge(s) Submitted: refers to the provider's fee for service.
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Amount Not Covered is any portion of the submitted charges not covered under your benefit plan, including denied charges or services that exceed the maximum allowable reimbursement. Your provider may bill you for these charges.
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Amount Covered is the portion of the submitted charges that is eligible for coverage under your benefit plan.
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Patient Deductible is the portion of the submitted charges that is not payable because it's being applied to your annual deductible. After you have met your annual deductible, your plan covers a percentage of eligible charges.
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Patient Copay is the amount the patient is responsible for paying the provider for services received.
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Covered Balance is the amount covered minus the patient deductible and patient copay.
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Coinsurance is the amount the patient must pay after the plan has paid its share. For example: Your plan may pay 80% for covered services and require you to pay the remaining 20% as coinsurance.
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Total Plan Benefit is the total amount covered by your benefit plan for the charges submitted.
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Remark Code(s) provides any special information about how this claim was processed. A definition of a code number can be found below in the Explanation of Remarks section.
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Medical Accumulation Information is a year–to–date summary of any deductibles, plan maximums and out–of–pocket costs, as well as information specific to this claim. Patient Responsibility is the amount you must pay the provider for care if you didn't pay that amount at the time the service was rendered. If you receive a bill for more than that amount, ask the provider for a detailed explanation. Remember that the EOB is not a bill.
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Explanation of Remarks contains the definition of a remark code and tells you how your claim payment was adjusted.
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