2013 Cigna Medicare Rx®

By using Cigna's websites or any Cigna products, software, mobile applications, or other electronic or web-based services (collectively referred to as the "Service"), you agree to the following terms and conditions. Your continued access or use of the Service shall be deemed your acceptance of this Legal Disclaimer.

  1. Do not post or transmit any unlawful, threatening, abusive, libelous, defamatory, racist, obscene, vulgar, pornographic, profane or indecent information. This includes, without limitation, any transmissions that are or that encourage illegal conduct. This ban includes anything that would constitute a criminal offense, give rise to civil liability or otherwise violate any local, state, national or international law.
  2. Never post or transmit comments containing harassing or offensive language, using sexual references, sexual nicknames, racial slurs or rude or deliberately offensive comments.
  3. Do not engage in disruptive activity online, including excessive use of scripts, sound waves or scrolling (repeating the same message over and over).
  4. Do not post or transmit any information, software or other material that violates or infringes the rights of others. This prohibition includes material that constitutes an invasion of privacy or publicity rights permission from the owner.
  5. Never post or transmit any information, software or other material that contains a virus, worm, Trojan horse or other code that has contaminating or destructive properties.
  6. Do not post any information, software or other material for commercial purposes.
  7. Do not solicit other users to join or contribute money to any online service or other organization, or advocate or attempt to persuade users to join in legal or illegal schemes.
  8. Never pretend to be any other person or entity. Site users also may not falsely represent their professional or other affiliation with any person or entity.
  9. Do not use the Service to collect personally identifiable information in violation of the policies contained in the Cigna Privacy Information.

Web-Enabled Mobile or Handheld Devices
Certain web and smartphone applications of the Service have been designed to run on a personal computer, standard laptop or web-enabled mobile device. If you view or use the Service on a mobile or handheld device you may experience some display and functionality limitations.  You may experience varying wireless network coverage and speed, depending on your geographic location and telecommunications provider.  The Service should not be used while operating any motor vehicle, or in any other manner that might endanger yourself or others. 

If your mobile device uses Global Positioning System (GPS) technology, trackers, or other location tracking tools, your location information may be used for purposes of determining your location when using a function on the Service that uses such information. While using the Service, if you allow your location information to be obtained, we will use this information solely to return your estimated location and to provide you with more personalized results and/or services. Cigna does not monitor your GPS tracking or location information, and does not save this information.  We will not use this information to identify you or disclose this information to any third parties. 

By using the Service you expressly agree and acknowledge that Cigna shall not responsible for any of the following: (a) performance limitations and/or failures experienced in connection with any wireless or Wi-Fi service used to access the Service; (b) data transmitted through wireless access that may be intercepted by unauthorized persons; or (3) your failure to physically secure and/or monitor your personal computer, laptop or wireless device or to protect your passwords, resulting in unauthorized access to the Service and/or your Cigna account or plan information. 

While using any web-enabled mobile or handheld device to use the Service, standard mobile phone carrier and data usage charges will apply. You expressly agree and acknowledge that the use of any mobile or handheld device is at your sole risk and shall be in accordance with all applicable local, state and federal laws.
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Updates and Reverse Engineering
By using the Service, you agree to receive any applicable software updates that may be issued from time to time by Cigna. You agree to accept and install such updates as part of your use of the Service. You also agree not to reverse engineer, modify, decompile, adapt, translate, disassemble, or otherwise attempt to discover the source code of the Service and/or any Cigna application.
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1. A signature of a person authorized to act on behalf of (i) the owner of an exclusive right that is allegedly infringed or (ii) the person defamed.

2. Identification of the copyrighted work claimed to have been infringed, or, if multiple copyrighted works at a single online site are covered by a single notification, a representative list of such works at that site.

3. Identification of the material that is claimed to be infringing, or to be the subject of infringing activity, including information reasonably sufficient to permit us to locate the material.

4. Information reasonably sufficient to permit us to contact you, such as your address, telephone number, and/or electronic mail address.

5. A statement that you have a good faith belief that use of the material in the manner complained of is not authorized by the copyright or other proprietary right owner, its agent, or the law.

If you choose to access the Service from outside the United States you do so on your own initiative and are responsible for compliance with U.S. and local laws, if and to the extent that local laws are applicable. Software is subject to United States export controls. No software may be downloaded or otherwise exported or re-exported (i) into (or to a national resident of) Cuba, Iraq, Libya, North Korea, Iran, Syria, or any other country to which the U.S. has embargoed goods, or (ii) to anyone on the U.S. Treasury Department list of Specially Designated Nationals or the U.S. Commerce Department's Table of Deny Orders. You represent and warrant that you are not located in, under the control of, or a national resident of any such country or on any such list. You agree to comply with U.S. export control laws and that you will not transfer any software or other content from the Service to a foreign national or foreign country in violation of those laws.
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MRC I
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 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 for the particular 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 such excess.

MRC II
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. The 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:

  1. the health care professional or facility's normal charge for a similar service or supply; or
  2. 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:

  1. the health care professional or facility's normal charge for a similar service or supply; or
  2. 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 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: 

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

Whether the MRC I, MRC II or ACR methodology is used, the customer 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 Cigna-administered plan, you and your authorized representatives can find the MRC for a particular procedure and geographic location by calling the 800 number on your ID card.

If you use a health care professional who is not in the Cigna 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.
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