Skip to main navigation Skip to main content Skip to footer For Individuals & Families For Medicare For Brokers For Employers Español For Providers: For Providers
Credentialing

Credentialing
Credentialing Overview Medical Credentialing Dental Credentialing Behavioral Credentialing
Coverage and Claims

Coverage and Claims
Coverage and Claims Overview Claims Prior Authorizations Coverage Policies Appeals and Disputes Payments
Pharmacy

Pharmacy
Pharmacy Overview Formulary Drug Lists Medicare Part D Pharmacy Management
Provider Resources

Provider Resources

Provider Resources Overview The Body and Mind Connection Cultural Competency and Health Equity Programs for Patients Medicare Providers
Newsletters
Cigna Network News for Providers
Credentialing Overview Medical Credentialing Dental Credentialing Behavioral Credentialing Coverage and Claims Overview Claims Prior Authorizations Coverage Policies Appeals and Disputes Payments Pharmacy Overview Formulary Drug Lists Medicare Part D Pharmacy Management Provider Resources Overview The Body and Mind Connection Cultural Competency and Health Equity Programs for Patients Medicare Providers Cigna Network News for Providers Log in to CignaforHCP
Home Providers Coverage and ClaimsAccess Coverage Policies

Coverage Policies

Cigna coverage policies are tools to assist in interpreting standard health coverage plan provisions.

How to access Cigna 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 Cigna's 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, such as certain self-funded employer plans or governmental plans, may not use Cigna's coverage policies. Doctors and individuals should contact their Cigna representative for specific coverage information.

Some coverage policies require that services be pre-approved by Cigna. Learn more about our prior authorization procedures.

Related Documents

Coverage Policies on CignaforHCP Preventive Care Services – (A004) Administrative Policy [PDF]

More in Coverage and Claims

Prior Authorizations Appeals and Disputes Claims Referrals ID Cards

Back to Coverage and Claims

Page Footer

I want to...

Get an ID card File a claim View my claims and EOBs Check coverage under my plan See prescription drug list Find an in-network doctor, dentist, or facility Find a form Find 1095-B tax form information View the Cigna Glossary Contact Cigna

Audiences

Individuals and Families Medicare Employers Brokers Providers

Secure Member Sites

myCigna member portal Health Care Provider portal Cigna for Employers Client Resource Portal Cigna for Brokers

Cigna Company Information

About Cigna Company Profile Careers Newsroom Investors Suppliers Third Party Administrators International Evernorth

 Cigna. All rights reserved.

Privacy Legal Product Disclosures Cigna Company Names Customer Rights Accessibility Report Fraud Sitemap

Disclaimer

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., and Cigna HealthCare of North Carolina, 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 Cigna 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 name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. LINA and NYLGICNY are not affiliates of Cigna.

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 sales representative. This website is not intended for residents of New Mexico.

Selecting these links will take you away from Cigna.com to another website, which may be a non-Cigna website. Cigna may not control the content or links of non-Cigna websites. Details