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Federal and State Compliance and Policy Disclosures, Exclusions, and Limitations

Health Insurance Plans

Rates will vary by plan design and the plan deductible, copay, coinsurance, and out-of-pocket maximums selected. Rates vary based on age, family size, geographic location (residential zip code) and tobacco use. Rates are subject to change upon notice in accordance with applicable state law.

Rates for new medical policies/service agreements with an effective date on or after 01/01/2023 are guaranteed through 12/31/2023. Medical rates are subject to change upon 30 days’ prior notice in KS, MO, TN and PA; 31 days’ prior notice in SC; 45 days’ prior notice in FL, UT; 60 days’ prior notice in IN, AZ, IL, TX, NC, GA and CO; and 75 days’ prior notice in MS and VA.

Provider networks can vary by state and market. For the plan(s) you are interested in, view the Summary of Benefits for important market-specific provider network information.

To see if your provider is in-network or to find a new in-network provider, visit www.cigna.com/ifp-providers.

Major medical insurance policies/service agreement have exclusions, limitations, reduction of benefits and terms under which the policy may be continued in force or discontinued. Medical applications are accepted during the annual Open Enrollment Period, or within 60 calendar days of a qualifying life event. Benefits are provided only for those services that are medically necessary as defined in the policy/service agreement and for which the insured person has benefits.

Form Series for Cigna Health and Life Insurance Company:

Exclusive Provider (EPO):
EPO: CO: COINDEPO052022, COINDOPTIONEPO052022; FL: FLINDEPO062022; IN:ININDEPO052022; KS: KSINDEPO052022; MO: MOINDEPO052022; MS: MSINDEPO052022; PA PAINDEPO052022; TN: TNINDEPO062022, UT: UTINDEPO062022, VA: VAINDEPO04152022 off exchange, VAINDEPO04152022-HIX on exchange

Form Series for Cigna HealthCare of Arizona, Inc., Cigna HealthCare of Georgia, Inc., Cigna HealthCare of Illinois, Inc., Cigna HealthCare of North Carolina, Inc., Cigna HealthCare of South Carolina, Inc. and Cigna HealthCare of Texas, Inc.:

HMO: AZ: INDHMOAZ01-2023; GA: INDHMOGA01-2023; IL: INDHMOIL01-2023, INDHMOILd01-2023, INDHMOILa01-2023, INDHMOILh01-2023; NC: INDHMONC01-2023, SC: INDSCHMOEOC01-2023; TX: TXINDHMO052022

The policy/service agreement may be cancelled by Cigna due to failure to pay premium, fraud (in VA, any act, practice or omission that constitutes fraud), ineligibility, when the insured no longer lives in the service area, or when Cigna ceases to offer policies/service agreements of this type or cease to offer any plans in the individual market in the state, in accordance with applicable law. You may cancel the policy/service agreement on the first of the month following our receipt of your written notice. In VA, you may cancel the policy/service agreement on the date of our receipt of your written cancellation notice, unless otherwise stated.

In Texas, we may cancel this EOC only in the event of any of the following:

  • You fail to pay Your Premiums as they become due or by the end of the last day of the 31 day grace period for plans not purchased from a Marketplace or the 90 consecutive day grace period for plans purchased from a Marketplace.
  • On the first of the month following Our receipt of Your written notice to cancel.
  • When You become ineligible for this coverage.
  • If You have committed, or allowed someone else to commit, any fraud or deception in connection with this EOC or coverage, after Cigna provides 15 days’ advance written notice.
  • When We cease to offer policies of this type to all individuals in Your class. In this event, Texas law requires that We do the following: (1) provide written notice to each Member of the discontinuation before the 90th day preceding the date of the discontinuation of the coverage; (2) offer to each Member on a guaranteed issue basis the option to purchase any other individual hospital medical or surgical insurance coverage offered by Us at the time of discontinuation; and (3) act uniformly without regard to any health status related factors of an Member.
  • When We cease offering any plans in the individual market in Texas, We will notify You of the impending termination of Your coverage at least 180 days prior to Your cancellation.
  • When the Subscriber no longer lives in the Service Area.
  • In the event of entry of a final judgment by a court declaring all or part of the Patient Protection and Affordable Care Act (P.L. 111-148) invalid, unconstitutional, or otherwise ineffective, and the state not providing alternative and sufficient means of funding advanced-premium tax credits, this EOC shall be subject to cancellation consistent with applicable federal and state law.

Cigna reserves the right to modify the policy/service agreement, including plan provisions, benefits and coverages, consistent with state or federal law. Policies/service agreements renew on a calendar year basis.

Cigna does not discriminate on the basis of race, color, national origin, disability, age, sex, gender identity, sexual orientation, or health status in the administration of the plan, including enrollment and benefit determinations.

No Cost Language Services. You can get an interpreter. You can get documents read to you and some sent to you in your language. For help, call us at 866.‍494.2111.

Servicios de idiomas sin costo. Puede obtener un intérprete. Le pueden leer documentos y que le envíen algunos en español. Para obtener ayuda, llámenos al 866.‍494.2111.

For costs, and additional details about coverage, contact Cigna at 900 Cottage Grove Rd, Hartford, CT 06152 or call 1-866-GET-Cigna. (1-866-‍438-2446).

Federal and State Compliance Disclosures and Health Insurance Plan Exclusions & Limitations (E&Ls), and State-Specific Information

Alaska

AK Guaranty Association Notice [PDF]

Arizona

Arizona Connect Exclusions and Limitations - 2022 [PDF]

Arizona Connect Exclusions and Limitations - 2023 [PDF]

Arkansas

AR Guaranty Association Notice [PDF]

California

CA Guaranty Association Notice [PDF]

Colorado

CO Life and Health Insurance Protection Association Notice [PDF]

Colorado Connect Exclusions and Limitations - 2022 [PDF]

Colorado Connect Exclusions and Limitations - 2023 [PDF]

Access Plan

Our Access Plans provide information on: (1) who participates in the provider network; (2) how we ensure that the network meets the health care needs of its members; (3) how the provider referral process works; (4) how care is continued if providers leave the network; (5) what steps are taken to ensure medical quality and customer satisfaction; (6) where you can go for information on other policy services and features. The Access Plan is designed to disclose all the policy information required under Colorado law, and is available for review.

Cigna Colorado Medical Access Plan [PDF]

Cigna Colorado Dental Access Plan [PDF]

District of Columbia

DC Guaranty Association Notice [PDF]

Florida

Florida Connect Exclusions and Limitations - 2022 [PDF]

Florida Connect Exclusions and Limitations - 2023 [PDF]

Georgia

Georgia Connect Exclusions and Limitations - 2022 [PDF]

Georgia Connect Exclusions and Limitations - 2023 [PDF]

Georgia Mammogram Notice [PDF]

Hawaii

HI Guaranty Association Notice [PDF]

Illinois

IL Guaranty Association Notice [PDF]

Illinois Maternity Elective Abortion Notice [PDF]

Illinois Direct Access to OBGYNs Notice [PDF]

Illinois Connect Exclusions and Limitations - 2022 [PDF]

Illinois Connect Exclusions and Limitations - 2023 [PDF]

Indiana

IN Guaranty Association Notice [PDF]

Indiana Connect Exclusions and Limitations - 2023 [PDF]

Iowa

IA Guaranty Association Notice [PDF]

Kansas

KS Guaranty Association Notice [PDF]

Kansas Connect Exclusions and Limitations - 2022 [PDF]

Kansas Connect Exclusions and Limitations - 2023 [PDF]

Louisiana

LA Guaranty Association Notice [PDF]

Minnesota

MN Guaranty Association Notice [PDF]

Mississippi

MS Guaranty Association Notice [PDF]

Mississippi Connect Exclusions and Limitations - 2022 [PDF]

Mississippi Connect Exclusions and Limitations - 2023 [PDF]

Missouri

MO Guaranty Association Notice [PDF]

Missouri Connect Exclusions and Limitations - 2022 [PDF]

Missouri Connect Exclusions and Limitations - 2023 [PDF]

Montana

MT Guaranty Association Notice [PDF]

Nevada

NV Guaranty Association Notice [PDF]

North Carolina

NC Guaranty Association Notice [PDF]

North Carolina Connect Exclusions and Limitations - 2022 [PDF]

North Carolina Connect Exclusions and Limitations - 2023 [PDF]

North Dakota

ND Guaranty Association Notice [PDF]

Ohio

OH Guaranty Association Notice [PDF]

Oklahoma

OK Guaranty Association Notice [PDF]

Pennsylvania

Pennsylvania Connect Exclusions and Limitations - 2022 [PDF]

Pennsylvania Connect Exclusions and Limitations - 2023 [PDF]

South Carolina

South Carolina Connect Exclusions and Limitations - 2023 [PDF]

South Dakota

SD Guaranty Association Notice [PDF]

Tennessee

TN Guaranty Association Notice [PDF]

Tennessee Connect Exclusions and Limitations - 2022 [PDF]

Tennessee Connect Exclusions and Limitations - 2023 [PDF]

Texas

TX Guaranty Association Notice [PDF]

Texas Connect Exclusions and Limitations - 2023 [PDF]

Utah

UT Guaranty Association Notice [PDF]

Utah Connect Exclusions and Limitations - 2022 [PDF]

Utah Connect Exclusions and Limitations - 2023 [PDF]

Virginia

Virginia Connect Exclusions and Limitations - 2022 [PDF]

Virginia Connect Exclusions and Limitations - 2023 [PDF]

Wyoming

WY Guaranty Association Notice [PDF]

Dental Insurance Plans

Dental Plans are insured by Cigna Health and Life Insurance Company with network management services provided by Cigna Dental Health, Inc. Rates may vary based on age, family size, geographic location (residential zip code) and plan design.

Dental Pediatric Insurance Plans

Dental Plans are insured by Cigna Health and Life Insurance Company with network management services provided by Cigna Dental Health, Inc. Rates vary based on age, number of enrolled dependents, geographic location (residential zip code), and plan design.

These dental plans offer the full range of Essential Health Benefit Pediatric Oral Care and satisfy the requirements under the Affordable Care Act. This policy does not provide any dental benefits to individuals age nineteen (19) or older. This policy is being offered so the purchaser will have pediatric dental coverage as required by the Affordable Care Act. If you want adult dental benefits, you will need to buy a plan that has adult dental benefits. This plan will not pay for any adult dental care, so you will have to pay the full price of any care you receive.

Dental Pediatric Plan Exclusions & Limitations (E&Ls) and State Specific Information

Arizona

Arizona Pediatric Dental Plan Exclusions - 2022 [PDF]

Arizona Pediatric Dental Plan Exclusions - 2023 [PDF]

Colorado

Colorado Pediatric Dental Plan Exclusions - 2022 [PDF]

Colorado Pediatric Dental Plan Exclusions - 2023 [PDF]

Florida

Florida Pediatric Dental Plan Exclusions - 2022 [PDF]

Florida Pediatric Dental Plan Exclusions - 2023 [PDF]

Illinois

Illinois Pediatric Dental Plan Exclusions - 2022 [PDF]

Illinois Pediatric Dental Plan Exclusions - 2023 [PDF]

Missouri

Missouri Pediatric Dental Plan Exclusions - 2022 [PDF]

Missouri Pediatric Dental Plan Exclusions - 2023 [PDF]

North Carolina

North Carolina Pediatric Dental Plan Exclusions - 2022 [PDF]

North Carolina Pediatric Dental Plan Exclusions - 2023 [PDF]

Tennessee

Tennessee Pediatric Dental Plan Exclusions - 2022 [PDF]

Tennessee Pediatric Dental Plan Exclusions - 2023 [PDF]

Virginia

Virginia Pediatric Dental Plan Exclusions - 2022 [PDF]

Virginia Pediatric Dental Plan Exclusions - 2023 [PDF]

Dental Family + Pediatric Insurance Plans

Dental Plans are insured by Cigna Health and Life Insurance Company with network management services provided by Cigna Dental Health, Inc. Rates vary based on age, family size, geographic location (residential zip code), and plan design.

These dental plans offer the full range of Essential Health Benefit Pediatric Oral Care and satisfy the requirements under the Affordable Care Act.

Dental Family + Pediatric Plan Exclusions & Limitations (E&Ls) and State-Specific Information

Arizona

Arizona Family + Pediatric Dental Plan Exclusions - 2022 [PDF]

Arizona Family + Pediatric Dental Plan Exclusions - 2023 [PDF]

Colorado

Colorado Family + Pediatric Dental Plan Exclusions - 2022 [PDF]

Colorado Family + Pediatric Dental Plan Exclusions - 2022 [PDF]

Florida

Florida Family + Pediatric Dental Plan Exclusions - 2022 [PDF]

Florida Family + Pediatric Dental Plan Exclusions - 2023 [PDF]

Tennessee

Tennessee Family + Pediatric Dental Plan Exclusions - 2022 [PDF]

Tennessee Family + Pediatric Dental Plan Exclusions - 2023 [PDF]


Plans are insured by Cigna Health and Life Insurance Company or its affiliates: For Arizona residents, health plans are offered by Cigna HealthCare of Arizona, Inc. For Georgia residents, health plans are offered by Cigna HealthCare of Georgia, Inc. For Illinois residents, health plans are offered by Cigna HealthCare of Illinois, Inc. For North Carolina residents, health plans are offered by Cigna HealthCare of North Carolina, Inc.  For South Carolina residents, health plans are offered by Cigna HealthCare of South Carolina, Inc. For Texas residents, health plans are offered by Cigna HealthCare of Texas, Inc.

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Disclaimer

Product availability may vary by location and plan type and is subject to change. All health insurance policies and health benefit plans contain exclusions and limitations. For costs and details of coverage, review your plan documents or contact a Cigna representative.

All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company, Cigna HealthCare of Arizona, Inc., Cigna HealthCare of Georgia, Inc., Cigna HealthCare of Illinois, Inc., Cigna HealthCare of North 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 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.

 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