Cigna in Arizona

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Cigna Product Types and Company Names

Product Types and Company Names

Product availability may vary by location and funding type and is subject to change. The legal entity insuring or administering any group product will vary depending on the group's location, the number of employees and the types of plans or products being offered.

The following chart shows the product types available and the Cigna companies that insure or administer these products in Arizona:

Arizona Group Product Types	Cigna Company Name(s)
Health Maintenance Organization (HMO) HMO Open Access In-Network benefits of Point of Service (POS) In-Network benefits of Open Access POS	Cigna HealthCare of Arizona, Inc.
Out-of-network benefits of POS and Open Access POS Voluntary, Limited Benefit Plans	Connecticut General Life Insurance Company
Network* Network Open Access Network POS Network POS Open Access Preferred Provider Organization (PPO) Exclusive Provider Organization (EPO) Open Access Plus (OAP) OAP In-Network* Indemnity Cigna Choice Fund®	Connecticut General Life Insurance Company or Cigna Health and Life Insurance Company
Administration of all self-funded medical plans, including Cigna Consumer Advantage®	Cigna Health and Life Insurance Company
Cigna Dental Care (DHMO)	Cigna Dental Health Plan of Arizona, Inc.
Cigna Traditional (Dental Indemnity) Cigna Dental PPO** Cigna Dental Care® Value Plans CignaFlex Advantage® Cigna Vision PPO	Connecticut General Life Insurance Company or Cigna Health and Life Insurance Company
Administration of all self-funded dental plans including Dental EPO	Cigna Health and Life Insurance Company
Cigna Vision Plans (available as riders with a Cigna Health Benefit Plan)	Same company as Health Benefit Plan
Cigna Managed Pharmacy Plans (available as riders with a Cigna Health Benefit Plan)	Same company as Health Benefit Plan
Term Life Insurance	Life Insurance Company of North America
Group Universal Life Insurance	Connecticut General Life Insurance Company
Personal Accident Insurance Business Travel Accident Insurance Accidental Death and Dismemberment Insurance Accidental Injury Insurance Hospital Indemnity Insurance Critical Illness Insurance	Life Insurance Company of North America
Short-Term Disability Insurance Long-Term Disability Insurance	Life Insurance Company of North America
Stop-Loss Insurance	Connecticut General Life Insurance Company or Cigna Health and Life Insurance Company
Employee Assistance Program (EAP)	Cigna Behavioral Health, Inc.
Cigna Onsite Health®	Cigna Onsite Health, L.L.C.
Cigna Home Delivery PharmacySM	Tel-Drug, Inc. and Tel-Drug of Pennsylvania, L.L.C.
Healthy Rewards®	Connecticut General Life Insurance Company or Cigna Health and Life Insurance Company
CignaPlus Savings®	Connecticut General Life Insurance Company or Cigna Health and Life Insurance Company

*In Arizona, these lock-in products cannot be offered on an insured stand-alone basis and must be accompanied with the option to choose a plan offered by the same Cigna company that offers out-of-network benefits.

 

**In Arizona, the Cigna Dental PPO product insured by Connecticut General Life Insurance Company is referred to as the CG Dental PPO. Cigna's Dental PPO plans are underwritten or administered by Connecticut General Life Insurance Company or Cigna Health and Life Insurance Company with network management services provided by Cigna Dental Health, Inc. and Cigna Dental Health Plan of Arizona, Inc.

 

Cigna Medical Group

Cigna Medical Group

Cigna Medical Group (CMG) is one of the Valley's largest multi-specialty group practices. Operating in greater Phoenix for nearly 40 years, it is a modern medical practice with primary and specialty care providers and convenient locations. Its hallmark is quality, no hassle health care from friendly providers and many additional services—from lab and X-rays to urgent care and pharmacy—often available under one roof.

CMG provides care to Cigna customers in the Phoenix metropolitan area and operates convenience care clinics, known as CMG CareToday, for non-appointed, walk-in care serving Cigna customers and the community.

Cigna Medical Group and CMG CareToday are operating divisions of Cigna HealthCare of Arizona, Inc.

To learn more go to www.CignaMedicalGroup.com. For more information about CMG CareToday, please visit www.CareToday.com.

Group Health Benefit Plans

General Information

In Arizona, we offer a variety of health benefit plans, on an insured or self-funded (ASO) basis.

 

Examples of the types of health benefit plans available to Arizona residents include, but are not limited to:

Cigna Choice Fund Plans

Cigna's Consumer Driven Health Plans are available on both an insured and self-funded (ASO) basis. In Arizona, our Cigna Choice Fund Health Reimbursement Account (HRA) and Health Savings Account (HSA) products are currently offered to employer groups with 51 or more employees. Cigna Choice Fund Plans offers a wide variety of programs, product types (PPO, OAP, and Indemnity) and services that can help improve health and well-being while saving and planning for future costs, including HSAs, HRAs and Flexible Spending Accounts (FSA).

Health Maintenance Organization (HMO)

HMO plans are available on a guaranteed cost basis. HMO Plans offer access to quality health care from a broad network of participating health care professionals. During enrollment, customers choose a Primary Care Physician (PCP) who may provide routine care, coordinate care and provide referrals to in-network specialists and facilities.

Point of Service (POS)

POS plans are available on both an insured and a self-funded (ASO) basis. POS Plans offer customers choice on where to get care. To get the most from a POS plan, choose an in-network Primary Care Physician (PCP) to coordinate care and receive care from a provider in the Cigna HealthCare^® Network. In POS plans, customers also have the choice to see whomever they want; however, when care is received from a doctor or facility that is not in the Cigna HealthCare network, out-of-pocket costs will be higher. The in-network benefits of the insured POS plans are comparable to HMO benefits and the out-of-network benefits of the Cigna POS plans are comparable to Indemnity benefits.

Network

Network plans are available on both an insured and a self-funded (ASO) basis. Network Plans offer features similar to HMO and POS plans. Note that this lock-in product cannot be offered on an insured stand-alone basis in Arizona.

Preferred Provider Organization (PPO)

PPO plans are available on both an insured and a self-funded (ASO) basis. PPO Plans offer the freedom to visit any licensed provider. A customer does not have to choose a primary care physician (PCP) or obtain a referral to see a specialist.

Open Access Plus (OAP)

OAP plans are available on both an insured and a self-funded (ASO) basis. Although optional, customers are encouraged to choose a Primary Care Physician (PCP) to be their health advocate and integrator of care. OAP is a self-directed product with a national seamless network.

Open Access Plus In-Network (OAPIN)

OAPIN plans are available on an insured and a self-funded (ASO) basis. OAPIN is a national seamless product with competitive discounts. OAPIN plans offer features similar to the Open Access Plus plan without an out-of-network option for non-emergency care. Note that this lock-in product cannot be offered on an insured stand-alone basis in Arizona.

Indemnity Plans

Indemnity plans are available on both an insured and a self-funded (ASO) basis. Indemnity plans offer customers the flexibility to visit any doctor and choose hospitals and health care facilities. Specialists can be accessed without referrals.

Voluntary, Limited Benefit Plans (Starbridge^® and Fundamental Care)

Voluntary, Limited Benefit Plans are available on an insured basis. Cigna's Limited-Benefit Health Plans are designed to give access to affordable benefits for everyday medical care, but they are not comprehensive plans. These plans help to cover doctor visits, wellness, prescriptions, and much more.

 

If you are offered a Cigna plan through your employer and would like a better understanding of the benefit plan(s) offered to you, look for general descriptions in our Products and Services section.

Dental Plans

General Information

In Arizona, we offer a variety of dental plans, on an insured or self-funded (ASO) basis. Examples of the types of dental plans available to Arizona residents include, but are not limited to:

Dental Health Maintenance Organization (DHMO)

DHMO plans are available on a pre-paid basis only. DHMO plans offer access to quality dental care from a broad network of participating network dentists and specialists. During enrollment, customers must choose a Network General Dentist (NGD) who may provide routine care, coordinate care and provide referrals to in-network specialists. Customers must visit their network general dentist or specialist in order for the benefit amounts on their patient charge schedule to apply. A Cigna Dental Care (DHMO) network dentist is a licensed dentist who has signed an agreement with Cigna Dental to provide customers with general dentistry or specialty care services.

Dental Preferred Provider Organization (DPPO)

DPPO plans are available on both an insured and a self-funded (ASO) basis. DPPO Plans offer customers the freedom to visit any dentist or specialist. However, when customers receive dental care from a dentist or specialist who does not participate in the DPPO network, their out-of-pocket expenses will generally be higher. A customer does not need to choose a Network General Dentist (NGD) to receive care or need a referral to see a specialist.

Cigna Traditional (Dental Indemnity)

Dental Indemnity plans are available on both an insured and a self-funded (ASO) basis. Customers and their covered family customers can access dental care from any general dentist or specialist. Customers do not need to select a primary care dentist to receive care or need a referral to receive care from a specialist.

Cigna Dental Oral Health Integration Program^®

Cigna Dental customers with certain medical conditions may be eligible for full reimbursement of their out-of-pocket charges for specific dental procedures. Medical conditions that qualify for dental reimbursement include: diabetes, heart disease, stroke, maternity, head and neck cancer radiation, organ transplants, and chronic kidney disease. Please review your plan materials for a list of reimbursable dental procedures and more program details.

Health Related & Non-Insured Services

Health Related & Non-Insured Services

Cigna health benefit plans provide access to preventive care, health education and other forms of health related programs. Through our local and national wellness programs, customers can receive information and support that can help them learn how to stay fit and enjoy healthier lives. We encourage our customers to take advantage of these important wellness programs.

 

Current programs include:

• Cigna HealthCare Healthy Rewards. This program offers discounts on health and wellness programs and services. There are no added membership fees for the Healthy Rewards discount program. Cigna HealthCare customers and their covered family members are already qualified. Examples of services available through the program include discounts on products and services from health clubs, weight management systems, Lasik vision correction and magazine subscriptions. Please contact Customers Services using the number on your ID card to learn which Healthy Rewards programs are available in Arizona.
• Cigna HealthCare 24-hour Health Information Line^SM. We have a toll-free telephone line staffed with trained nurses who can answer questions, help direct members to the nearest Cigna HealthCare participating provider and help process urgent care referrals when necessary. Additionally, through this toll-free number, callers can access a Health Information Library of audio tapes on more than 1,000 various health conditions and topics.
• Cigna Well Aware for Better Health^® offers help for these chronic conditions:
  • Asthma
  • Diabetes
  • Heart disease
  • Low back pain
  • Depression
  • Weight complications
  • Chronic Obstructive Pulmonary Disease
  • Targeted conditions*
  Each program allows you to design a personalized action plan under your doctor's guidance. We'll provide your doctor with confidential updates on your progress and challenges, and we'll provide you with:
  • access to a personal, experienced registered nurse to call for guidance and support
  • educational material about your condition
  • self-care information
  • reminders of important tests and exams
  • informational newsletters
  *These conditions include acid-related stomach disorders, atrial fibrillation, decubitus ulcer, fibromyalgia, hepatitis C, inflammatory bowel disease, irritable bowel syndrome, osteoarthritis, osteoporosis and urinary incontinence. Availability of the Well Aware program depends on your benefit program. Please check with your benefit manager.
• Cigna HealthCare Healthy Babies^® program. This program encourages prenatal care and provides important information and resources for parents-to-be. We supply valuable education materials from the March of Dimes^® including Mama Magazine and other brochures about pregnancy. One of the many ways we emphasize early and regular access to proper prenatal care is by eliminating copayments for OB office visits after the initial visit.

Product Disclosures

General Information

IMPORTANT NOTICE: Please note that the products and services described on Cigna's websites may not be applicable to you or available to you under your employer's plan. Please refer to your plan documents for information that is applicable to your specific plan.

 

If you are offered a Cigna plan through your employer and are a plan member or customer, or planning to become a plan member or customer, we recommend reading any disclosure that's applicable to you so that you can become more familiar with your plan and any state-specific mandates. If you are considering becoming a plan member or customer and have questions about your plan coverage, please contact your employer.

 

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

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

Exclusions and Limitations

All plans have exclusions, limitations, reduction of benefits and terms under which the policy may be continued in force or discontinued. Rates may vary based upon the plan design selected and employee demographics. Cigna reserves the right to change the premium rates. For a complete list of both covered and not covered services under your plan or policy, including benefits required by your state, see your evidence of coverage, insurance certificate or summary plan description.

Discount Programs

CignaPlus Savings

• CignaPlus Savings is a dental discount program that provides customers access to discounted fees, pursuant to schedules negotiated by Cigna Dental with participating providers, which customers 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 customers. Customers have the right to cancel within thirty (30) calendar days of enrolling in the program. For more information, please call or write the company:
  
  Cigna Dental
  Attn: Operations
  1571 Sawgrass Corporate Parkway, Suite 140
  Sunrise, FL 33323
  Telephone: 1.877.521.0244

Healthy Rewards

• This program 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. A discount program is NOT insurance, and the customer must pay the entire discounted charge.

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 (except that contributions are required from those under COBRA continuation coverage). 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

WARNING: 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 a HSA plan, you expressed your interest in opening a Health Savings Account with JPMorgan Chase Bank (Mellon Trust of New England, N.A. for GWH-Cigna Customers), an HSA service provider, or any other successor HSA service provider (hereafter "the HSA Service Provider"). The HSA Service Provider 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.

However, if your employer has not selected JPMorgan Chase Bank (Mellon Trust of New England, N.A. for GWH-Cigna Customers) as the 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.

 

With respect to an HSA opened pursuant to this arrangement, the HSA 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, 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.

Cigna Mobile

While accessing Cigna.com or myCigna.com remotely through Cigna Mobile, standard mobile phone carrier and data usage charges will apply. Cigna’s mobile web solution is available to any current Cigna customer who has been provided user access to myCigna.com, which includes the personalized Health Care Provider (HCP) directory, contact info, and prescription drug price quote tool (if your plan includes prescription drug coverage through Cigna). Cigna’s mobile HCP directory is also available at www.Cigna.com. The listing of a HCP in the mobile directories available at myCigna.com and Cigna.com does not guarantee that the services rendered by that professional are covered under your specific medical plan. Check your official plan documents, or call the number listed on your ID card, for information about the services covered under your plan benefits. Cigna Mobile currently is not available for GWH-Cigna Customers.

Reimbursement for Out-of-Network Services

Many of the group health insurance policies and employee health benefit plans that Cigna administers cover expenses incurred for services from health care professionals or facilities who do not participate in the Cigna health care professional 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. The plan sponsor (your employer or other organization) may choose one of the following MRC provisions:

 

MRC I
Under this option, a database compiled by Ingenix, Inc., a subsidiary of United Healthcare, 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 Ingenix 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 Ingenix data) will not be considered in determining reimbursement and the patient will be fully responsible for such excess.

 

As a result of a recent settlement agreement between United Healthcare and the New York Attorney General, the database used by Ingenix to compile the billed-charge data for the health insurance industry will be turned over to an independent non-profit company, FAIR Health, Inc.

 

Cigna will begin using data compiled by FAIR Health, Inc. to calculate MRC amounts as applicable to any Cigna administered plans (a) commencing April 1, 2011 for dental procedures and services and (b) commencing July 1, 2011 for medical, surgical and anesthesia procedures and services.

 

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:

• 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.

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 facilities' 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 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 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.

Disclosure of Financial Arrangements

Compensation to Third Parties

Compensation is paid to third party brokers and insurance sales people for placing a Client's ("Client" refers to employers or other groups sponsoring a health benefit plan) insurance coverage and/or plan administration contract with Cigna. This 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-funded plans).

 

Additional compensation may be paid to brokers and insurance sales people based on persistency or other non-case-specific factors, sometimes referred to as "contingent commissions." This additional compensation is not part of the regular commissions.

 

Reports are sent to its employer policyholders and contract-holders regarding the commission and contingent commissions paid to brokers or insurance sales people 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 or sales person regarding compensation arrangements.

Primary Source of Revenue

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.

Other Revenue Sources

We negotiate for additional revenue from some third party vendors. We negotiate the additional revenue as part of the overall structure of each vendor agreement. The nature of negotiated contracts with vendors is that they are generally based on the aggregation of all business related to the contract and are not Client-specific.

 

Cigna retains this additional revenue for its sole and exclusive use, applying it in part to the overall cost of maintaining Client programs and other business expenses. The aggregate revenue generated from the third party vendors, including programs designed to generate cost savings for the Client, allows Cigna to cover the cost of client programs and other business expenses and to offer lower premiums and administrative fees to its Clients.

 

Cigna may offer programs and services where a third party vendor supplies all or part of the program or services. The claim amount charged to the Client for the program or services includes both an amount to cover the vendor fees and an amount for Cigna’s related and other expenses. The disease management program is an example of a vendor program where the Client may be charged more than the amount charged by the vendor for the program.

 

Another example can be found in the rates for pharmacy benefits negotiated with a pharmacy benefit manager (PBM). The rates charged to a Client are typically expressed as a percentage discount from average wholesale price. Cigna may offer lower discounts to the Client than the discounts that Cigna is offered by the PBM. Cigna may obtain or retain all or a portion of drug manufacturer revenue that it receives from the PBM or directly from the drug manufacturer. This revenue may be based on factors including membership volume, volume of drug usage or placement of a drug on the formulary. Cigna’s drug formulary changes occasionally based on clinical efficacy, net drug cost and market share considerations. Customer reimbursements will differ depending on where the drug falls in the formulary. Changes to the formulary can impact the revenue paid by drug manufacturers to Cigna or the PBM.

 

Cigna may also receive transition fees when it changes third party vendors. These fees are paid to Cigna by the vendor to cover implementation and related expenses such as staffing or administrative changes that Cigna incurs during the transition. Cigna may receive marketing fees or commissions 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 other compensation from its third party vendors. For example, Cigna may receive payment for the development and installation of special computer systems or programs necessary for Cigna to deliver a particular service to its Clients.

 

Cigna may receive performance guarantee payments if a vendor does not meet performance targets.

 

Cigna uses a specialized vendor to negotiate discounts for large out-of-network (OON) claims. When a large out of network claim is received, the vendor will negotiate with the provider to obtain a lower rate, or discount, to the charges. The amount for the claim charged to our Client will reflect the discounted charges and an administrative fee will be charged for providing the savings program. Similar savings programs are in place for secondary networks and to audit large, complex hospital claims.

 

When a third party should have been responsible for the claims incurred by a customer (as a result of an automobile accident, for example), after paying the claim, Cigna may try to obtain reimbursement from the third party source. Cigna currently pursues reimbursement using a specialized subrogation vendor. For successful efforts, a percentage of the recovery is retained by Cigna. Additionally, Cigna has priority right to reimbursement of any stop loss payments. Any excess is credited to the Client.

 

In most situations, Cigna processes claims directly and the claim amount collected by Cigna from the Client equals the amount paid to the provider. Where a third party manages a particular type of medical service, a portion of the claim amount paid to the third party may in turn be paid to Cigna by the third party to cover Cigna’s costs of administration and other business costs. A Customer’s coinsurance, deductible and lifetime maximum are calculated based on the entire claim amount including the portion retained by Cigna to cover costs.

 

Certain Cigna companies directly provide or arrange for the provision of covered heath care services including, but not limited to Cigna Behavioral Health, 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-funded customers. Effective December 1, 2009, the Clinical Claims Review (CCR) program will be treated as a savings initiative pursuant to the Savings Initiative provision of your administrative services agreement and we will be retaining the specified fee for the savings realized.