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Coverage and Claims
Cigna Healthcare coverage policies are tools to assist in interpreting standard health coverage plan provisions.
How to access Cigna Healthcare coverage policies
The most up to date and comprehensive information about our standard coverage policies are available on CignaforHCP, without logging in, for your convenience.
You can also refer to the Preventive Care Services – (A004) Administrative Policy [PDF] for detailed information on our coverage policy for preventive health services.
When do coverage policies apply?
The terms of an individual's particular coverage plan document (Group Service Agreement (GSA), Evidence of Coverage, Certificate of Coverage, Summary Plan Description (SPD) or similar plan document) may differ significantly from the standard coverage plans upon which these coverage policies are based. If these coverage policies are inconsistent with the terms of the individual's specific coverage plan, then the terms of the individual's specific coverage plan always control.
Coverage determinations in each specific instance require consideration of:
- the terms of the applicable coverage plan document in effect on the date of service
- any applicable laws/regulations
- any relevant collateral source materials
- the specific facts of the particular situation
Medical technology is continuously evolving; our coverage policies are subject to change without prior notice. Additional coverage policies may be developed as needed or may be withdrawn from use. Additionally, some health plans administered by Cigna HealthcareSM, such as certain self-funded employer plans or governmental plans, may not use our coverage policies. Doctors and individuals should contact their Cigna Healthcare representative for specific coverage information.
Some coverage policies require that services be pre-approved by Cigna Healthcare. Learn more about our prior authorization procedures.
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The Cigna Group Information
Individual and family medical and dental insurance plans are insured by Cigna Health and Life Insurance Company (CHLIC), Cigna HealthCare of Arizona, Inc., Cigna HealthCare of Illinois, Inc., Cigna HealthCare of Georgia, Inc., Cigna HealthCare of North Carolina, Inc., Cigna HealthCare of South Carolina, Inc., and Cigna HealthCare of Texas, Inc. Group health insurance and health benefit plans are insured or administered by CHLIC, Connecticut General Life Insurance Company (CGLIC), or their affiliates (see a listing of the legal entities that insure or administer group HMO, dental HMO, and other products or services in your state). Accidental Injury, Critical Illness, and Hospital Care plans or insurance policies are distributed exclusively by or through operating subsidiaries of The Cigna Group Corporation, are administered by Cigna Health and Life Insurance Company, and are insured by either (i) Cigna Health and Life Insurance Company (Bloomfield, CT); (ii) Life Insurance Company of North America (“LINA”) (Philadelphia, PA); or (iii) New York Life Group Insurance Company of NY (“NYLGICNY”) (New York, NY), formerly known as Cigna Life Insurance Company of New York. The Cigna Healthcare name, logo, and other Cigna Healthcare marks are owned by The Cigna Group Intellectual Property, Inc. LINA and NYLGICNY are not affiliates of Cigna Healthcare.
All insurance policies and group benefit plans contain exclusions and limitations. For availability, costs and complete details of coverage, contact a licensed agent or Cigna Healthcare sales representative. This website is not intended for residents of New Mexico.