CIGNA Medicare Select Plus Rx^® Enrollment Disclaimer

CIGNA HealthCare of Arizona, Inc. is a Medicare Advantage organization with a Medicare contract that offers various individual plans (including the CIGNA Medicare Select Plus Rx - Dual (HMO SNP) plan, which is a Coordinated Care plan offered without a contract with the Arizonamedicaid program.)

Eligibility and Enrollment Information

To enroll in CIGNA Medicare Select Plus Rx (HMO) or CIGNA Medicare Select Plus Rx - Dual (HMO SNP), you must:

• Live in our service area of Maricopa County or Apache Junction or Queen Creek, Arizona (zip codes: 85117, 85118, 85119, 85120, 85178, 18140 and 85143)
• Be entitled to Medicare Part A and enrolled in Medicare Part B.
• Continue to pay your Medicare Part B premium.

To enroll in the CIGNA Medicare Select Plus Rx - Dual plan, you must also be eligible for Medicaid through the Arizona Health Care Cost Containment System (AHCCCS).

You can only enroll in a plan during specific times of the year. For more information, about enrollment periods, please call 1-800-592-9231 (TTY/TDD users call 1-800-987-8816). Representatives are available 8 am - 8 pm, 7 days a week.

As a CIGNA Medicare Select Plus Rx customer, you'll receive all primary and most specialty care through the Cigna Medical Group network, with more than 30 locations throughout the Valley. You must use plan providers except in emergent or urgent care situations or for out-of-area renal dialysis. If you obtain routine care from out-of-network providers, neither Medicare nor CIGNA Medicare Select Plus Rx will be responsible for the costs. You may be enrolled in only one Medicare Advantage Plan at a time and as a customer of CIGNA Medicare Select Plus Rx, you must receive your prescription drug benefit through CIGNA. Limitations, copayments and restrictions may apply.

Benefits, formulary, pharmacy network, premium and/or copayments/coinsurance may change on January 1, 2012. Please contact CIGNA Medicare Select Plus Rx for details.

Extra Help

You may be able to get extra help to pay for your prescription drug premiums and costs. To see if you qualify for getting extra help, call:

• 1-800-MEDICARE (1-800-633-4227). TTY/TDD users should call 1-877-486-2048, 24 hours a day/7days a week
• The Social Security Office at 1-800-772-1213 between 7 am and 7 pm, Monday through Friday. TTY/TDD users should call 1-800-325-0778
• Your State Medical Assistance (Medicaid) Office.

People with limited incomes may qualify for Extra Help to pay for their prescription drug costs. If you qualify, Medicare could pay for up to seventy-five (75) percent or more of your drug costs including monthly prescription drug premiums, annual deductibles and coinsurance. Additionally, those that qualify will not be subject to the coverage gap or a late enrollment penalty. Many people are eligible for these savings and don't even know it. For more information about this Extra Help, contact your local Social Security office or call 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days per week. TTY users should call 1-877-486-2048.

Contract Termination

The CIGNA HealthCare of Arizona contract with CMS is renewed annually and the availability of coverage beyond the end of the current contract year is not guaranteed. CIGNA HealthCare of Arizona is authorized by law to refuse to renew our contract with CMS, and CMS also may refuse to renew our contract. These events may result in termination of a beneficiary's enrollment in the plan. In addition, CIGNA HealthCare of Arizonamay reduce our service area. If this happens, you will be notified at least 90 days prior to the change, and your options for coverage will be explained to you.

Pharmacy Benefits

CIGNA Medicare Select Plus Rx customers may receive prescription drugs at any of the Cigna Medical Group (CMG) pharmacies in the Valley. Customers in the Wickenburg areamay fill prescriptions at a CMG Pharmacy or at a select number of retail pharmacies in the Wickenburg area. For a list of those pharmacies, please call Customer Service.

Enrollees must use the network pharmacies to receive plan benefits except under non-routine circumstances when they cannot reasonably use network pharmacies.

Under limited circumstances such as emergencies, customers may receive prescription drugs from an out-of-network pharmacy for a limited supply basis only.

Mail Order Prescription Drug Service

Mail order prescription drug service is available. CIGNA Home Delivery Pharmacy is the preferred mail order pharmacy. You can obtain up to a 90-day supply of medication for reduced copays.

For more information, please call Customer Service at 1-800-627-7534. TTY/TDD users call 1-800-987-8816, 8 am - 8 pm, local time, 7 days a week. (From February 15^th through October 14^th, 8 am - 8 pm Monday - Friday.)

CIGNA Medicare Select Plus Rx Disenrollment Information

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