Product Disclosures

Products and Services Provided by Cigna Corporation Subsidiaries

Cigna Corporation is a holding company and is not an insurance or an operating company. Therefore, all products and services are provided exclusively by or through operating subsidiaries and not by Cigna Corporation. "Cigna" may refer to Cigna Corporation itself or one or more of its subsidiaries, but when used in connection with the provision of a product or service, always refers to a subsidiary. For a listing of the legal entities that offer, insure or administer products and services in your state, please visit

General Disclaimer

The products and services described on Cigna's websites may not be applicable to you or available to you under your plan. Please refer to your policy or plan documents for information that is applicable to your specific plan.

We recommend reading any disclosure that's applicable to you before purchasing a Cigna insurance policy or enrolling in a Cigna plan so that you can become more familiar with your plan and any state-specific mandates. If you are considering a Cigna plan and have questions about your plan coverage, please contact your licensed insurance agent or Cigna representative.

While reviewing the information on this page, it's important to note:

  • The disclosures provided here are general and your policy or plan documents may contain additional disclosures which are required by your state and/or specific to your plan. The disclosures in your policy or plan documents take precedence.
  • Certain mandates may only apply to certain policies or plan types.
  • State mandates may not apply to employer-funded (or self-insured) group plans. Please contact your plan sponsor if you need to know whether your plan is self-insured and whether any state mandates apply to your plan.
Individual and Family Medical/Dental Insurance Plans

Product details for Cigna Individual and Family Medical and Dental insurance policies may vary by state. Before applying for insurance coverage, be sure to read the plan information and policy disclosures applicable to your specific state and policy. To find information related to your state, visit

Exclusions and Limitations

All insurance policies and group benefit plans have exclusions, limitations, reduction of benefits and terms under which the policy may be continued in force or discontinued. Rates may vary and are subject to change. Health coverage is provided subject to any deductibles, co-payment, or coinsurance provisions. For costs and a complete list of both covered and not-covered services under your plan or policy, including benefits required by your state, see your insurance policy, evidence of coverage, or your employer’s insurance certificate or summary plan description.

Product Descriptions - Not Available in all States

The product descriptions, if any, provided on or other Cigna websites are for informational purposes only and are subject to change. Product availability may vary by area and plan type and is subject to change. Product descriptions are not a contract and are not intended to constitute offers to sell or solicitations in connection with any products or services. Anyone interested in a particular product should contact their licensed insurance agent, Cigna sales representative or plan sponsor to determine whether the product is available in their area and to request a copy of the applicable policy or other plan documents for a complete description of the product.

Health Care Provider Network; Patient Satisfaction Scores, Designations, and Ratings

Patient experience, quality designations, cost-efficiency and other ratings found in Cigna's online provider directories reflect a partial assessment of quality and/or cost and should not be the sole basis for decision-making (as such measures have a risk of error). They are not a guarantee of the quality of care that will be provided to individual patients. Individuals are encouraged to consider all relevant factors and consult with their physician when selecting a health care facility. Health care professionals and facilities that participate in the Cigna network are independent contractors solely responsible for the treatment provided to their patients. They are not agents of Cigna. Actual costs will vary depending on the location and type of services received.  Your plan deductible, co-payment and coinsurance requirements apply and may vary based on the type of facility and health care professional providing care. The listing of a health care professional or facility in the network directory does not guarantee that the services rendered by that professional or facility are covered under your specific policy or medical plan. Check your policy or official plan documents for complete details about costs and the services covered under your plan benefits.

Cigna Dental Care (DHMO)

The term "DHMO" is used to refer to group dental product designs that may differ by state of residence of enrollee, including but not limited to, prepaid plans, managed care plans, and plans with open access features. The Cigna DHMO is not available in the following states: AK, HI, ME, MT, NH, NM, ND, PR, RI, SD, VI, VT, WV, and WY.

Discount Program Information

The CignaPlus Savings and Healthy Rewards programs are NOT insurance, and the member must pay the entire discounted charge.

  • CignaPlus Savings® is a dental discount program that provides members access to discounted fees, pursuant to schedules negotiated by Cigna Dental with participating providers, which members are responsible for paying in full, directly to participating providers. Although all participating providers go through a credentialing process to assure that they are appropriately licensed and qualified, Cigna Dental does not otherwise guarantee nor is it responsible for the quality of any services or products purchased by members. Members have the right to cancel within thirty (30) calendar days of enrolling in the program. For more information, please call or write Cigna Dental:

    Cigna Dental
    Attn: Operations
    1571 Sawgrass Corporate Parkway, Suite 140
    Sunrise, FL 33323
    Telephone: 1.877.521.0244

  • Cigna Healthy Rewards® offers discounts on health and wellness programs and services. If your Cigna plan includes coverage for any of these services, this program is in addition to, not instead of, your plan benefits. Healthy Rewards programs are separate from your medical benefits and customers are required to pay the entire discounted charge. Healthy Rewards programs may not be available in all states and may be discontinued at any time.
Health Reimbursement Account (HRA) Plan Option

HRAs can only be chosen together with certain plan types. Your HRA is self-funded by your employer, who is solely responsible for contributing the funds used to pay benefits under your plan using the funds in your HRA. You are not required to make any contribution to the HRA account, either pursuant to a salary deduction election or otherwise under a Section 125 cafeteria plan. You may not enroll under this option if you are considered self-employed (including partners and more-than-2% shareholders in a subchapter S corporation).

Health Savings Account (HSA) Pre-enrollment Statements

You cannot open an HSA if, in addition to coverage under an HSA-qualified High Deductible Health Plan ("HDHP"), you are also covered under a Health Flexible Spending Account (FSA) or an HRA or any other health coverage that is not a HDHP.

If you have elected to enroll in an HSA plan, you expressed your interest in opening a Health Savings Account with an HSA service provider. The HSA service provider you choose will contact you and provide you with an HSA enrollment form, a signature card, a request for information for any Customer Identification Program compliance and other related materials necessary to open an HSA account with the HSA service provider. In order to open an HSA with the HSA service provider, you must:

  1. In a timely manner, complete, sign and submit all the forms required by the HSA service provider; and
  2. Be found to meet all of the requirements prescribed by the HSA service provider.

If you are enrolled in a Cigna Individual and Family Health Savings Plan, you will need to contact the HSA service provider of your choice to set up a Health Savings Account to pair with your Cigna Health Savings Plan.

If you are offered a Cigna-administered HDHP through your employer and your employer has not selected the Cigna-preferred HSA service provider, you may open the HSA with an HSA custodian/trustee that is either arranged by your employer or that you personally select. You must agree to complete necessary forms and meet the requirements set forth by the HSA custodian/trustee pertaining to the establishment and operation of your HSA.

The HSA provider and/or trustee/custodian will be solely responsible for all HSA services, transactions and activities related thereto. Neither your employer nor Cigna is responsible for any aspects of the HSA services, administration and operation.

Prior to enrollment with an HSA provider, you must certify that you have enrolled or plan to enroll under a HDHP and are not covered under any other health coverage that is not a HDHP.

Reimbursement for Out-of-Network Services

Certain Cigna health insurance policies and Cigna-administered health benefit plans cover expenses incurred for services from health care professionals and facilities that do not participate in the Cigna provider network. Those policies and plans include Maximum Reimbursable Charge ("MRC") provisions that may limit the amount of an out-of-network charge that will be considered by Cigna in calculating reimbursement.

For Cigna Individual and Family Medical plans, refer to your policy for details on how MRC is calculated under the terms of your policy.

For group health plans, the plan sponsor (employer or other organization) may choose one of the following MRC provisions that limits the amount that will be considered in calculating benefits under the out-of-network coverage (if any) for non-emergency services:

Under this option, a data base compiled by FAIR Health, Inc. (an independent non-profit company) is used to determine the billed charges made by health care professionals or facilities in the same geographic area for the same procedure codes using data. The maximum reimbursable amount is then determined by applying a plan sponsor selected percentile (typically the 70th or 80th percentile) of billed charges, based upon the FAIR Health, Inc. data. For example, if the plan sponsor has selected the 80th percentile, then any portion of a charge that is in excess of the 80th percentile of charges billed by providers in the FAIR Health, Inc. data base for the service in the same relative geographic area (as determined using the FAIR Health, Inc. data) will not be considered in determining reimbursement and the patient will be fully responsible for charges in excess of the MRC.

This option uses a schedule of charges established using a methodology similar to that used by Medicare to determine allowable fees for services within a geographic market or at a particular facility. This schedule amount is then multiplied by a percentage (110%, 150% or 200%) selected by the plan sponsor to produce the MRC.

In the limited situations where a Medicare-based amount is not available (e.g., a certain type of health care professional or procedure is not covered by Medicare or charges relate to covered services for which Medicare has not established a reimbursement rate), the MRC is determined based on the lesser of:

  • the health care professional or facility's normal charge for a similar service or supply; or
  • the MRC I methodology based on the 80th percentile of billed charges.

There is no MRC with respect to services for which there is not enough charge data in a geographic area to determine a MRC charge.

Average Contracted Rate ("ACR")
Under this option, the MRC is determined based on the lesser of:

  • the health care professional or facility's normal charge for a similar service or supply; or
  • the Average Contracted Rate - i.e., the average percentage discount applied to all claims in a geographic area paid by Cigna during a recent 6 month period for the same or similar service/supply provided by health care professionals or facilities participating in the Cigna provider network. The ACR is updated by Cigna on a semiannual basis. The geographic area used by Cigna is either a Metropolitan Statistical Areas (MSA) or an area within governmental boundaries (e.g. state, county, zip code).

In some cases, the ACR amount will not be used and the MRC is determined based on the lesser of:

  • the health care professional or facilities' normal charge for a similar service or supply; or
  • the MRC I methodology based on the 80th percentile of billed charges.

Whether the MRC I, MRC II or ACR methodology is used, the patient is responsible for all charges over the MRC amount, as well as any applicable deductible and coinsurance amounts for charges that do not exceed the MRC. The claim is also subject to all other exclusions and limitations in the applicable benefit plan.

If you are enrolled in a plan insured or administered by Cigna, you and your authorized representatives can request the MRC for a particular procedure and geographic location by calling the number on your Cigna ID card.

If you use a health care professional who is not in the Cigna provider network, be sure to check your plan documents to make sure that your plan covers out-of-network services. If you have a Flexible Spending Account, you may be able to use that money for out-of-network services.

Cigna Secure Travel

Cigna Secure Travel® services are provided under a contract with Worldwide Assistance Services, Inc. Full terms, conditions and exclusions are contained in the Cigna Secure Travel service agreement. This program is not insurance and does not include reimbursement of expenses for financial losses.

Cigna Will Preparation Services

Will Preparation Services are independently administered by ARAG®. Cigna does not provide legal services and makes no representations or warranties as to the quality of the information on the ARAG website or the services of ARAG.


The Cignassurance® Program for beneficiaries is available to beneficiaries receiving coverage checks over $5,000 from Cigna Life and Personal Accident Programs. Phone and face-to-face counseling sessions must be used within one year of the date the claim is approved. Cignassurance accounts are not deposit account programs and are not insured by the Federal Deposit Insurance Corporation or any other federal agency. Account balances are the liability of the insurance company and the insurance company reserves the right to reduce account balances for any payment made in error. Counseling, legal or financial assistance programs are not available under policies insured by Cigna Life Insurance Company of New York.

Cigna Identity Theft Services

Cigna's Identity Theft Services are provided under a contract with Europ Assistance USA. Full terms, conditions and exclusions are contained in Cigna’s Identity Theft Program service agreement.

My Secure Advantage Financial Wellness Program

The My Secure Advantage Financial Wellness Program is independently administered by CLC Incorporated (CLC). Cigna does not provide financial services and makes no representations or warranties as to the quality of the information on the CLC website or the services of CLC.

Disclosure of Financial Arrangements

Compensation is paid to third party brokers and benefits advisors for placing an individual insured's or Client's ("Client" refers to employers or other groups sponsoring a group health plan) insurance coverage and/or self-insured plan administration contract with Cigna. In the case of individual insureds, this compensation is determined by agreement between Cigna and the third party broker. For Clients, this compensation is determined by agreement of the plan sponsor and its broker or benefits advisor. Compensation is typically in the form of a percentage of premiums collected (in the case of insurance policies), or a fixed, per-employee per-month rate in the case of self-insured plans.

Additional compensation may be paid to brokers/benefits advisors based on persistency or other non-case-specific factors. Cigna sends reports to group insurance policyholders annually regarding the commission and other compensation paid to brokers/benefit advisors during the prior calendar year for their use in preparing their Annual Return and Report (Form 5500) where required under federal law (ERISA). Upon request, we will also disclose how the Client may receive more information directly from the broker/benefits advisor regarding compensation arrangements.

The primary compensation received with respect to insurance policies is the policyholder paid insurance premium. The primary source of revenue in connection with administrative services contracts is the service fees paid by the self-insured plan sponsor and/or the plan.

Revenue Sources

In addition to the premium charged to policyholders and the administrative fees charged to sponsors of self-insured plans, Cigna negotiates for compensation from some third-party vendors with which Cigna contracts to perform services in connection with the plans we insure or administer. This compensation is to reimburse Cigna for its costs of implementing and maintaining programs offered by these third-party vendors. This allows Cigna to offer lower premiums and administrative fees.

Cigna may subcontract with a third-party vendor for the performance of a service that Cigna has agreed to provide to a plan sponsor. The amount charged to the Client for the program or services may include both the vendor’s reimbursement as well as a Cigna charge. For example, where Cigna contracts with a third-party for the administration of a disease management program, the plan sponsor may be charged both the reimbursement owed the third-party vendor and an additional amount by Cigna. Cigna may also receive compensation from vendors for placing the business with the vendor. These may be calculated on a per-member per-month (PMPM) basis, flat rate, or on a percentage basis. Cigna may receive performance guarantee payments if a vendor does not meet performance targets. Cigna may receive other compensation from its third-party vendors. These charges are typically reflected in Cigna's agreement with the plan sponsor or in related disclosure documentation.

Cigna may receive payments directly from drug manufacturers or Pharmacy Benefit managers with which it contracts. These payments may be consideration for placement of a manufacturer’s drug on the Cigna drug formulary.

Cigna uses specialized vendors to negotiate discounts for out-of-network claims. The amount charged to self-insured plans reflects the negotiated discount. An administrative fee is paid to the vendor for successfully negotiating a discount under these programs and Cigna charges a percentage of the net savings for administering these programs.

When a third party should have been responsible for the claims incurred by a covered individual (as a result of an automobile accident, for example), after paying the claim, Cigna may try to obtain reimbursement from the third party responsible for the accident, or that party’s liability insurer. Cigna currently pursues reimbursement using a specialized subrogation vendor. For successful efforts, a percentage of the recovery is retained by the vendor and Cigna. Additionally, Cigna reserves a priority right to reimbursement of any prior stop-loss insurance payments it may have made to Clients.

Certain Cigna companies directly provide or arrange for the provision of covered health care services including, but not limited to Cigna Behavioral Health, Inc. and Cigna HealthCare of Arizona, Inc. Their charges for providing or arranging for these services are reimbursed as claims.

Clinical Claims Review Program

In an effort to assure that high dollar claims are correctly billed and paid in accordance with industry and other applicable standards, we have extended our claims review program to include a review of select facility claims for billing and coding errors. This program is now available for all self-insured Clients.

State-Specific Information

Rate Review Notice
Cigna filed for a 38.5% rate increase effective January 1, 2013 for the plans covering any groups enrolled in the healthcare coverage sponsored by the Arizona Small Business Association (ASBA). The ASBA plans are comprehensive major medical plans (including prescription drug coverage) sold to small employer groups through the association. ASBA offers three plans – one HMO plan and two high deductible Open Access plans. Cigna developed the proposed rate increases for 2013 using methods consistent with Cigna's standard large group underwriting practices, and the 38.5% rate increase was applicable to all plans and all age/gender categories.

The Center for Consumer Information and Insurance Oversight (CCIIO) recently found that the 38.5% rate increase was not unreasonable for the Open Access plans but that the increase was unreasonable for the HMO plan. The experience under the HMO plan has been more favorable in recent years, which we believe to be a result of the individuals enrolled in the HMO plan being healthier on average than those enrolled in the Open Access plans. Overall, the recent experience for the entire group has been quite poor. For calendar year 2011 the actual claims exceeded premiums by 36%, and for the first half of 2012 the actual claims exceeded premiums by over 62%.

Cigna's goal with the proposed rate increase was to preserve what we believe are appropriate rate differences between the various plans. We believe those rate differences should be based primarily upon differences in anticipated cost levels related to differences in benefits between the various plans and not differences in the average health of enrollees. If rates for the various plans are set using each plan’s actual experience there is the risk that rate differences will increase to the point where certain plans will become unaffordable and may have to be discontinued altogether. By maintaining a relatively stable rate differential between plans we feel we can offer the widest variety of affordable plan options for all of the association’s member small employer groups.

For the reasons outlined above Cigna believes it is most appropriate to develop and implement a single rate increase that is applicable to all the association’s plans. As a result we have decided not to withdraw the increased rates for the HMO plan offered through Cigna HealthCare of Arizona.

More information can be found here.


Disclosure Required of Retail Sellers Under California Civil Code Sec. 1714.43
Cigna Home Delivery PharmacySM does not make efforts to identify or eradicate human trafficking from its direct supply chains for tangible goods that it offers for sale.

California Health Plan Information
For information about Cigna Individual and Family Health plans and services in your area, go to For group/employer health plan information, including Cigna companies, accessing group plan services and information about COBRA/conversion privileges, utilization review and grievances/appeals, visit


State of Colorado Notice – ACCESS PLAN
If you would like more information on: (1) who participates in our provider network; (2) how we ensure that the network meets the health care needs of our members; (3) how our provider referral process works; (4) how care is continued if providers leave our network; (5) what steps we take to ensure medical quality and customer satisfaction; (6) where you can go for information on other policy services and features. You may request a copy of our Access Plan. The Access Plan is designed to disclose all the policy information required under Colorado law, and is available for your review upon request.


Surprise Bills

Connecticut (CT) law protects health insurance and HMO customers from “surprise bills” by health care providers that do not participate in the customer’s health plan network. 

A “surprise bill” is a bill that the customer receives for an out-of-network service, when he or she did not knowingly choose an out-of-network health care provider to perform the service. Surprise bills do not include charges for planned services that the customer knows in advance will be performed by an out-network provider.

Surprise bills occur when, without the customer’s knowledge or choice, the out-of-network provider performs a service:
•    in an in-network facility, or
•    during a procedure that also involves an in-network provider, or
•    during a procedure that was authorized beforehand by the insurance carrier, but then referred or transferred to an out-of-network provider.

When a customer receives a surprise bill for a service that is covered under his or her CT health insurance or HMO plan, the insurance carrier will provide coverage as if the service was performed by an in-network health care provider. In other words, the customer will pay no more than the cost share amount he or she would pay for in-network services under the plan. The out-of-network health care provider is barred from requesting any payment from the customer, other than the cost-sharing amount the customer pays for in-network services under the plan.


Provider Performance Outcome and Financial Data Disclosures
Customers are encouraged to view Florida provider performance outcome and financial data that will be posted on the Agency for Health Care Administration’s Health Information website:

For more information, please call or write us at:

Cigna, 2701 North Rocky Point Drive, Suite 800,
Tampa, FL 33607

Office hours: 8:00 a.m. to 5:00 p.m. (EST) Monday through Friday
Telephone: 1.813.637.1200 Fax: 1. 813.637.1223

For Customer inquiries, call our Nationwide Customer Services Telephone Number: 1.800.244.6224 (Please note: If you are enrolled in an employer-sponsored plan, this number may be different for your employer group. Please check your Cigna ID card for the correct Customer Services telephone number.)


Cigna Dental Care (DHMO) Plans
In Illinois, the Cigna Dental Care plan is considered a prepaid dental plan.


Special information for policies in Maine
Your health plan may include prescription drug benefits. The following lists (also known as formularies) show which drugs Cigna may cover with your plan. Some of these drugs may need special approval to get them. Cigna calls this special approval utilization review, prior authorization or step therapy. It’s important that you know how your prescription drug benefits work. How much you pay, and what drugs are available, all depend on the health plan you have. For example:

  1. The cost of your medicine depends on the plan you have. Your plan also directs how we apply that cost to any deductible or out of pocket maximum.
  2. Whether or not there are any drugs not covered depends on your plan.
  3. Any limits or rules about the use of or how much drug you can get depends on your plan and/or drug safety considerations.
  4. The amount of coverage Cigna allows when you use an out-of-network doctor depends on your plan.
  5. The amount of coverage Cigna allows for drugs not covered also depends on your plan..
  6. Finally, if it’s medically necessary that you see an out-of-network doctor or use a non-covered drug, you may have the right to appeal. This too depends on your plan.



Cigna Dental Care (DHMO) Plans – Out-of-Network Services
If you are considering enrollment or are enrolled in a Cigna Dental Care (DHMO) plan through your employer, you must visit your selected network dentist in order for the charges on the Patient Charge Schedule to apply. You may also visit other dentists that participate in our network or you may visit dentists outside the Cigna Dental Care network. If you do, the fees listed on the Patient Charge Schedule will not apply. You will be responsible for the dentist’s usual fee. We will pay 50% of the value of your network benefit for those services. Of course, you’ll pay less if you visit your selected Cigna Dental Care network dentist. Call Customer Service for more information.

New Mexico

The product or sales information on this site is not intended for residents of New Mexico. If you would like more information about Cigna plans and services in your state, please contact your licensed broker or Cigna sales representative.

New York






If your plan provides out-of-network benefits, your cost for a covered health service depends on an estimated total payment for the service in your area. The share that you pay for the out-of-network service is a share of that estimated total payment.

How We Estimate Total Payments

Each employer or plan sponsor chooses the estimated total payment for out-of-network services.  Depending on the plan options chosen by the employer or group plan sponsor, the total payment for out-of-network services is estimated based on either:

(1)     a fixed percentile of the charges by similar providers in the same geographic area, for the same service;


(2) a fixed percentage of a fee schedule similar to Medicare, for the same service in the same geographic area.

For example, the plan may estimate the total payment as 80% of the charges by similar providers in the area, or 150% of the Medicare-like fee schedule for the services.

When the plan pays out-of-network benefits, your cost share amount is a share of the estimated total payment.  For example, if the plan estimates the total payment for a specialist procedure as 150% of the Medicare-like fee for that procedure, the plan will pay benefits based on that estimated total. (for instance, if the plan pays 70% for out-of-network benefits, the benefit will be 70% of the estimated total payment). The share you pay for out-of-network services is also based on the plan’s estimated total payment.  So, you pay less when the plan’s estimated total is lower than the provider’s billed charge.


The Provider’s Billed Charge

Out-of-network providers may bill a carrier any amount for a covered health service. For example, a specialist can often bill higher amounts than what other specialists in the area normally charge for the same service, and will often bill higher amounts than what Medicare pays. Out-of-network provider bills are also usually higher than the rates that in-network providers agree to receive for the same health service.

Get information from your provider:

  • If your provider does not participate in your health plan’s provider network, your provider must tell you the estimated amount the practice will bill you for services, if you ask. Your provider must also give you the name and practice name, address and phone number of any anesthesiology, laboratory, pathology, radiology or assistant surgeon specialists that he or she schedules for you or refers you to for services. 
  • All hospitals are required to post a list of their charges on their websites, or show on their websites how to obtain this information. Hospitals are also required to tell you about charges by doctors who’s services at the hospital are not included in the hospital's charges; these doctors may or may not participate in your health plan network and you should ask your arranging provider if any doctor scheduled to perform services is in your network.


New York State, and Benchmark Amounts

The State of New York requires a specific “usual and customary” definition, to create a benchmark cost amount for out-of-network health services. The benchmark amount is available for insurance customers to compare provider bills and plan payments. The State’s “usual and customary” benchmark cost amount is defined this way:

 “the 80th percentile of all charges for the particular health care service performed by a provider in the same or similar specialty and provided in the same geographical area, as reported in a benchmarking database maintained by a nonprofit organization”. 

The organization that provides the benchmark database for this purpose is Fair Health, Inc., as required by the New York State Department of Financial Services. The organization also provides an online benchmark cost calculator, for a fee paid by carriers. You can use their Consumer Cost Lookup page, free of charge, to look up a benchmark cost amount for common health care services in your geographic area. The website to access the Consumer Cost Lookup page is:

(for questions about navigating this site, a customer can call  1-855-566-5871, Mon-Fri  9am-6pm EST)  

Comparing the Cost of Out-of-Network Services

As you can see above, what you pay for covered out-of-network services is based on three things: (1) the provider’s billed charge; (2) the way your plan estimates total charges; and (3) the benefit share your plan pays for out-of-network services. The provider may bill a higher amount than the plan’s estimated charge, but if the provider accepts the plan’s estimated total payment the share you pay will be less.

The New York “usual and customary” benchmark amount may be higher or lower than your plan pays. Plans that estimate the total payments as the 80th percentile of provider charges in the geographic area, or 370% of the Medicare-like fee schedule in the geographic area, pay amounts that are generally alike the New York “usual and customary” benchmark amount. If the plan estimates total payments with a lower percentile of charges in the area, or a lower percentage of the Medicare-like fee schedule, the plan’s estimated total will be lower than “usual and customary” benchmark and the share you pay may be less.

You can refer to your plan documents to see the method and fixed percentile or percentage your plan uses to estimate total payments. Your plan documents also show the benefit share that the plan pays for out-of-network services, and the share that you pay.

If your plan provides both in-network and out-of-network benefits, you will always pay less if you get your health services in-network from one of our credentialed network health professionals. 

You can go to this link to look up the approximate dollar amount that your plan will pay for a specific in-network service:

 You can also call the toll-free help number on your health care plan ID card to help you find an in-network provider or to request the approximate dollar amount that your plan will pay for a specific in-network or out-of-network service, or examples of out-of-network costs for certain common services (colonoscopy, laminotomy, and breast reconstruction). 

Filing Out-of-Network Claims

If you assign claim payment for covered services to your out-of-network health care provider, your provider will normally file the claims and will receive the payments directly.

Otherwise, you may file claims on your own behalf.  You can go to this link to download the applicable claim forms for covered services:   Completed claim forms should be mailed to the Cigna address listed on your ID card.

If you have additional questions, or would like to fax or email your completed claim forms, please contact Customer Service using the toll-free number on your ID card. Completed claim forms may also be faxed to these numbers:

  • if the Cigna address listed on your ID card is PO Box 182223, you may fax to 859.410.2422
  • if the Cigna address listed on your ID card is PO Box 188061, you may fax to 859.410.2440




Customers will get in-network benefits for out-of-network ‘surprise bill’ and emergency services. The out-of-network health care provider and carrier are required to protect the customer from any additional ‘balance billing’ by the provider, after the carrier benefits are paid.

Customers will get disclosures from physicians and hospitals, describing the potential costs and benefit reductions for other kinds of services rendered or referred out-of-network. Customers can also request from carriers a benefit estimate for those services.

Health Care Providers that render out-of-network ‘surprise bill’ or emergency services will get the opportunity to negotiate carrier payments, according to usual & customary cost guidelines. In-state providers may request an Independent Dispute Resolution review, when agreement on a payment amount is not reached. 

Out-of-network providers may directly receive customer benefit payments if the customer assigns payment. When payment is assigned, the provider is prohibited from billing the customer for any charge that exceeds the carrier’s in-network benefit amount.

Carriers will pay in-network benefits for out-of-network ‘surprise bill’ and emergency services. Carriers that are billed for out-of-network ‘surprise bill’ or emergency services will get the opportunity to negotiate payments, according to usual & customary cost guidelines. When billed by an in-state provider, the carrier may request an Independent Dispute Resolution review if agreement is not reached on a payment amount.

Carriers will pay customer benefit amounts directly to the provider if the customer assigns payment. Carriers will also furnish disclosures to customers regarding benefit payment and balance billing protection for these services.



‘Surprise Bills’

An out-of-network ‘surprise bill’ is any one of the following:

(1) A bill from an out-of-network physician at a network hospital/ambulatory surgical center, in instances where:

  • a participating provider was not available; or
  • the non-participating physician rendered services without the member's knowledge; or
    • unforeseen medical services arose at the time the health care services were rendered.

(2) A bill from an out-of-network provider whose services were referred by a network physician, without explicit written consent from the customer acknowledging that he or she was aware the network physician was referring to an out-of-network provider.

This includes common surprise bill instances, such as out-of-network anesthesiologists or assistant surgeons in a network hospital/surgical center, and network PCP referrals to out-of-network specialty services in or outside the PCP’s office. A bill from an out-of-network provider that the customer chose to go to, when a network provider was available, is not a surprise bill.

Emergency Claims

The out-of-network emergency claims covered as in-network benefits, and negotiated/paid without additional balance billing to the customer, include claims screening, examining and treating to stabilize any emergency condition by the hospital’s emergency department and facility staff. 

Emergency conditions include any medical and behavioral condition that a layperson with average knowledge could reasonably expect to:

  • place the patient in serious jeopardy (or others, in the case of behavioral conditions);
  • seriously impair bodily functions, or make a body part or organ dysfunctional;
  • seriously disfigure a person; or
  • pose a threat to the health or safety of a pregnant woman in contraction or her unborn child,

in the absence of immediate medical attention by the out-of-network emergency provider.



‘Surprise Bills’

With an Assignment of Benefits

In this circumstance, the customer submits an Assignment of Benefits form to the provider and carrier before the service is provided,  or the provider submits an Assignment of Benefits form to the carrier (with customer agreement) at the time the claim is submitted or after the claim is first processed.

The carrier must try to negotiate a payment with the provider, or pay billed charges. If an attempt to negotiate fails, the carrier may pay a ‘reasonable amount’ within the usual and customary range. The provider or carrier may request an Independent Dispute Resolution review of the carrier’s payment amount or the provider’s billed amount, with the understanding that the review arbitrator will require both parties to accept either one or the other of those amounts (no compromises). 

In any case, the customer pays only the plan’s normal in-network cost share of the amount paid.  The Assignment of Benefits form prohibits the provider from balance billing the customer any amount beyond that cost share.

With no Assignment of Benefits

If a carrier receives an out-of-network provider claim for a surprise bill with no Assignment of Benefits form, the carrier may process the claim according to normal plan payment guidelines for out-of-network services (for example, denying the claim if the plan covers in-network benefits only, or paying the usual out-of-network rate if the plan provides PPO or POS coverage). 

In this circumstance, a carrier claim notice to the customer or the explanation of benefits (“EOB”) for the claim must include an explanation that the claim could be a ‘surprise bill’ and that the customer should contact the carrier or visit the carrier’s website for additional information about surprise bills. The customer may request an Independent Dispute Resolution review of the provider’s billed amount or the carrier’s payment amount, with the understanding that the arbitrator will require both parties to accept either one or the other of those amounts (no compromises).

Emergency Services

Carrier payment to an out-of-network emergency service may be ‘reasonable amount’ within the usual and customary range, or a negotiated amount or billed charge. 

If the carrier pays a ‘reasonable amount’, the amount must be consistent with the carrier’s benefit policy description of payment methods for out-of-network emergency claims. If the policy describes a range of payment methods or amounts, the payment must be the greater of the amounts described.  New York regulators now require carriers to use state-modeled language for these policy descriptions, and so the payment method and amounts will fall within consistent ranges.

Like for ‘Surprise Bills’, the provider or carrier may request an Independent Dispute Resolution review of the carrier’s payment or the provider’s billed amount, with the understanding that the arbitrator will require both parties to accept either one or the other of those amounts (no compromises). Carriers that request a review will notify the customer not to pay any balance bill.

For “low cost” emergency services (certain procedures billed for $600 or less, at 120% or less of the usual and customary rate), slightly different rules apply. Here, carriers pay a negotiated amount or billed charge, and no Independent Dispute Resolution is available.      



Carriers will provide the following information to customers, in a claim notice or in the explanation of benefits (EOB) for the claim:

  • explanation that the customer’s out-of-pocket cost will be no greater than the in-network benefit cost share;
  • explanation that the customer’s final cost share may increase, if the Independent Dispute Resolution process requires carrier payment of a provider’s higher billed charge ;
  • direction to contact the carrier if the provider balance-bills the customer for the out-of-network service; and
  • direction to the carrier’s website for additional information about surprise bills (if a surprise bill claim).



Customers can get protection from ‘surprise bills’ by assigning benefits to the out-of-network provider that renders the surprise bill service. Customers pay only their plan’s in-network cost share for these services, and providers that receive the assignment are prohibited from balance billing the customer any amount beyond that cost share.

To assign benefits, the customer must

  • sign the Assignment of Benefits Form available from the New York Department of Financial Services, which permits the provider to seek payment directly from the customer’s health plan; and
  • send the Form to their health carrier and provider, and include a copy of the ‘surprise’ bill or bills they do not think they should pay.

New York Assignment of Benefits Form:




Customers can request an Independent Dispute Resolution review of a New York out-of-network provider ‘surprise bill’ only if they do not assign their benefits to the provider that bills them. To request the review, the customer must:

  • complete the Application available from the New York Department of Financial Services; and
  • send the Form to NYS Department of Financial Services, Consumer Assistance Unit/IDR Process,

One Commerce Plaza, Albany,  NY 12257.


Out of Network Health Care Providers

Providers in New York can request an independent arbitration review of carrier payment amounts for a ‘surprise bill’ or emergency service bill. To submit a dispute, health care providers must:

  • visit the Department of Financial Services (DFS) website to receive a file number;
  • complete the Application available from the New York Department of Financial Services; and
  • send the application to the assigned independent dispute resolution entity.


Independent Dispute Resolution Decisions

The Independent Dispute Resolution arbitrator will make a binding decision on all parties to accept either:

(a) the provider’s charge as originally billed; or (b) the carrier’s payment amount as originally determined for the bill (no compromises).  In some cases, if settlement looks likely or if the carrier payment and provider fee are unreasonably far apart, the arbitrator may direct the provider and carrier to negotiate a settlement directly.

Independent Dispute Resolution decisions are made within 30 calendar days after the application is received. The decision is based on these factors:

  • whether there’s a gross disparity between the provider’s charge and (1) charges paid for the same services to other patients for other carriers out-of-network, and (2) the fees paid by the carrier to similarly qualified out-of-network providers for the same services in the same region;
  • the provider's training, education, experience, and usual charge for comparable services when the provider does not participate with the patient's health plan;
  • the circumstances and complexity of the case, and patient characteristics; and
  • the usual and customary cost of the service.

New York Independent Dispute Resolution Application Form:

Customers or providers with questions on the Independent Dispute Resolution process may call (800) 342-3736,

or e-mail


Cigna Dental Care (DHMO) Plans – Out-of-Network Services
DHMO for Oklahoma is an Employer Group Pre-Paid Dental Plan. You may also visit dentists outside the Cigna Dental Care network. If you do, the fees listed on the Patient Charge Schedule will not apply. You will be responsible for the dentist’s usual fee. We pay non-network dentists the same amount we’d pay network dentists for covered services. You’ll pay less if you visit a network dentist in the Cigna Dental Care network. Call Customer Service for more information.

Oklahoma: Oklahoma Policy Numbers
Medical - GM6000 C1 et al (Connecticut General Life Insurance Company, "CGLIC"); HP-APP-1 et al (Cigna Health and Life Insurance Company, "CHLIC"). Dental - Indemnity/PPO: GM6000 ELI288 et al (CGLIC), Cigna Dental Care (DHMO): GM6000 DEN201V1 (CGLIC), Cigna Dental Care Specialty Access: GM6000 DEN200V1 (CGLIC); Indemnity/Dental PPO: HP-POL99 (CHLIC), Cigna Dental Care (DHMO) & Specialty Access: HP-POL115 (CHLIC). Group Universal Life (GUL 2): XX-603404 et al (CGLIC). Disability & Life (other than GUL) - TL-004700 et al, Disability Reserve Buy Out: TL-008610.37. Blanket Accident: BA-01-1000.00 et al, Group Accident: GA-00-1000.00 et al (Life Insurance Company of North America).


Product Information and Frequently Asked Questions
For information about Cigna Individual and Family Health plans and services available in Texas, visit, For a list of Cigna companies, information about group/employer health plan products, and answers to frequently asked questions, visit