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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 01/01/2024 are guaranteed through 12/31/2024. Medical rates are subject to change upon 30 days’ prior notice in 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: COINDEPO052023, COINDOPTIONEPO052023;   FL: FLINDEPO052023;  IN:ININDEPO052023;  MS: MSINDEPO052023; PA PAINDEPO052023; TN: TNINDEPO062023; UT: UTINDEPO062023; VA:  VAINDEPO042023 off exchange, VAINDEPO042023-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: INDHMOAZ01-2024;  GA: INDHMOGA01-2024;  IL: INDHMOIL01-2024, INDHMOILc01-2024; NC: INDHMONC01-2024;  SC: INDSCHMOEOC01-2024; INDHMOTX01-2024 - Consumer Choice, INDHMOTXSM01-2024 – State Mandate Plans

The policy/service agreement may be cancelled by Cigna Healthcare due to:

  • failure to pay premium
  • fraud (in SC and VA, any act or practice that constitutes fraud)
  • ineligibility
  • when the insured no longer lives in the service area (in AZ, not applicable to a dependent child living outside the Service Area; in VA, no longer resides, lives, or works in the Service Area). Or,
  • when Cigna Healthcare ceases to offer policies/service agreements of this type or ceases to offer any plans in the individual market in the state, in accordance with applicable law.  We will notify you of the impending termination of your coverage at least 180 days prior to your cancellation.

Any cancellation shall be without prejudice for any claim for Covered Expenses incurred before cancellation.

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.

Cigna Healthcare 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 Healthcare 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 Healthcare 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 - 2023 [PDF]

Arizona Connect Exclusions and Limitations - 2024 [PDF]

Arkansas

AR Guaranty Association Notice [PDF]

California

CA Guaranty Association Notice [PDF]

Colorado

Colorado Covered Persons Demographic Data Notice [PDF]

CO Life and Health Insurance Protection Association Notice [PDF]

Colorado Connect Exclusions and Limitations - 2023 [PDF]

Colorado Connect Exclusions and Limitations - 2024 [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 - 2023 [PDF]

Cigna Colorado Medical Access Plan - 2024 [PDF]

Cigna Colorado Dental Access Plan - 2023 [PDF]

Cigna Colorado Dental Access Plan - 2024 [PDF]

District of Columbia

DC Guaranty Association Notice [PDF]

Florida

Florida Connect Exclusions and Limitations - 2023 [PDF]

Florida Connect Exclusions and Limitations - 2024 [PDF]

Georgia

Georgia Connect Exclusions and Limitations - 2023 [PDF]

Georgia Connect Exclusions and Limitations - 2024 [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 - 2023 [PDF]

Illinois Connect Exclusions and Limitations - 2024 [PDF]

Indiana

IN Guaranty Association Notice [PDF]

Indiana Connect Exclusions and Limitations - 2023 [PDF]

Indiana Connect Exclusions and Limitations - 2024 [PDF]

Iowa

IA Guaranty Association Notice [PDF]

Kansas

KS Guaranty Association Notice [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 - 2023 [PDF]

Mississippi Connect Exclusions and Limitations - 2024 [PDF]

Missouri

MO Guaranty Association Notice [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 - 2023 [PDF]

North Carolina Connect Exclusions and Limitations - 2024 [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 - 2023 [PDF]

Pennsylvania Connect Exclusions and Limitations - 2024 [PDF]

South Carolina

South Carolina Connect Exclusions and Limitations - 2023 [PDF]

South Carolina Connect Exclusions and Limitations - 2024 [PDF]

South Dakota

SD Guaranty Association Notice [PDF]

Tennessee

TN Guaranty Association Notice [PDF]

Tennessee Connect Exclusions and Limitations - 2023 [PDF]

Tennessee Connect Exclusions and Limitations - 2024 [PDF]

Texas

TX Guaranty Association Notice [PDF]

Texas Connect Exclusions and Limitations - 2023 [PDF]

Texas Connect Exclusions and Limitations - 2024 [PDF]

Utah

UT Guaranty Association Notice [PDF]

Utah Connect Exclusions and Limitations - 2023 [PDF]

Utah Connect Exclusions and Limitations - 2024 [PDF]

Virginia

Virginia Connect Exclusions and Limitations - 2023 [PDF]

Virginia Connect Exclusions and Limitations - 2024 [PDF]

West Virginia

Network Access Plan

West Virginia Dental PPO Network Access Plan [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.

Rates are subject to change upon 30 days’ prior notice in AK, AL, AR, AZ, CO, CT, DC, DE, HI, IA, ID, IL, IN, KS, KY, MA, ME, MI, MN, MO, MT, ND, NE, NH, NJ, NM, NY, OH, OK, OR, PA, RI, SD, TN, UT, VT, WI and WY, 31 days’ prior notice in SC, 40 days’ prior notice in MD, 45 days’ prior notice in FL, 75 days’ prior notice in MS, and 60 days’ prior notice in CA, GA, NV, TX, VA and WV. In LA rates are guaranteed for the initial 12-months of coverage, except if due to addition of a newly covered person, a change in age or geographic location, or a change in policy coverage. Thereafter, rates are subject to change upon 45 days’ prior notice. In NC, dental rates are guaranteed for a 12-month period.

Dental plans apply waiting periods to covered basic (6-months), major (12-months) and orthodontic (12-months) dental care services. In ME, waiting periods are waived for Class II and Class III if under the age of 19. Waiting periods may vary by state. Refer to the policy or outline of coverage for details. Class IV Orthodontia waiting period cannot be waived. Dental plans do not apply waiting periods to covered preventive/diagnostic services and temporomandibular joint services in AR, NM, NV, MN and VT. Some covered services are determined by age: topical application of fluoride or sealant, space maintainers, and materials for crowns and bridges. If the plan covers replacement of teeth, there is no payment for replacement of teeth that are missing prior to coverage. In FL, LA, OH, VA and VT, payment limitation no longer applies after 12 months of continuous coverage. In NM, payment limitation no longer applies after 6 months of continuous coverage. In MD and NY, payment limitation no longer applies after 12 months of continuous coverage. In NY, Temporomandibular Joint Dysfunction will be included to the extent that it is determined that such treatment is dental in nature and such treatment is regularly covered under the listed covered services.

Dental preferred provider insurance policies have exclusions, limitations, reduction of benefits and terms under which a policy may be continued in force or discontinued.

Form Series for Cigna Health and Life Insurance Company:

Cigna Dental Preventive, 1000 and 1500 plans: AL, CO, CT, DE, HI, IA, IL, MI, ND, WV and WY: HC-NOT11 et al., AK: HC-NOT53, AR: HC-NOT36 et al., AZ: INDDENTPOLAZ032017, CA: INDDENTPOLCA0713 et al., DC: HC-NOT42, et al., FL: HC-NOT15 et al., GA: INDDENPOLGA0317, ID: HC-NOT51 et al., IN: HC-NOT23, et al., KS: HC-NOT49 et al., KY: HC-NOT44, et al., LA: INDDENTPOLLA0713, MA: HC-NOT11, HC-NOT32 et al., ME: HC-NOT58, et al., MD:INDDENTPOLMD.PREV, INDDENTPOLMD.1000, INDDENTPOLMD.1500 and MDINDSADOHIPAMND10-20, MI: INDSADPOLMI.1000, INDENTPOLAMI042021.1500, INDENTPOLAMI042021.Prev, MO: INDDENTPOLMO0713, MN: INDDENTPOLMN0713, MS: HC-NOT48 et al., MT: INDDENTPOLMT0713, NC: HC-NOT18, NE HC-NOT47 et al., NH INDDENTPOLNH.1000, INDDENTPOLNH.1500, INDDENTPOLNH.PREV, NJ: HC-NOT46, et al., NM: INDDENPOLNM0322.1000 and INDDENPOLNM0322.1500, NY: INDDENTPOLNY.PREV, INDDENTPOLNY.1000, INDDENTPOLNY.1500, NV: HC-NOT39 et al., OH: INDDENTPOLOH0317, OK: HC-NOT26 et al., OR: INDDENTPOLOR0713, PA:INDDENPOLPA0917, RI: INDDENPOLRI0918., SC: HC-NOT19 et al., SD HC-NOT59 et al., TN: HC-NOT20 et al., TX: HC-NOT21 et al., UT: HC-NOT50 et al., VA: INDDENTPOLVA0317, VT HC-NOT56 et al., WA: INDDENTPOLWA0317, WI HC- NOT54 et al.)

Cigna Dental 5000/200, 3000/150, and 3000/100 plans: AL, CO, CT, DE, HI, IA, IL, ND, PA, WV and WY: HC-NOT11 et al., AK: HC-NOT53, et al., AR: HC-NOT36 et al., AZ: INDDENPOLAZ, CA: INDDENPOLCA, DC: HC-NOT42, et al., FL: HC-NOT15 et al., GA: INDDENPOLGAv1, ID: HC-NOT51 et al., IN: HC-NOT23, et al., KS: HC-NOT49 et al., KY: HC-NOT44, et al., LA: INDDENPOLLA, MA: HC-NOT11 et al., ME: INDDENPOLME, MI: INDDENPOLMI, MO: INDDENPOLMO, MS: HC-NOT48 et al., MT: INDDENPOLMT, NC: HC-NOT18, et al., NE HC-NOT47 et al., NH: INDDENPOLNH, NM: INDDENPOLNM, NJ: HC-NOT46, et al., NV: HC-NOT39 et al., OH: INDDENPOLOH, OK: HC-NOT26 et al., RI: INDDENPOLRI, SC: INDDENPOLSC1022, SD: HC-NOT59 et al., TN: HC-NOT20 et al., TX: HC-NOT21 et al., UT: HC-NOT50 et al., VA: INDDENPOLVA, VT: HC-NOT56 et al., WI: HC-NOT54 et al.

Cigna Dental Vision/Dental Vision Hearing: INDDVPOL[State]1021.1000, INDDVHPOL[State], 1021.2000, INDDVPOL[State]1021.2500R, INDDVHPOL[State], 1021.3500 (AK, AL, AR, AZ, CA, CO, CT, DC, DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, NC, ND, NE, NH, NJ, NV, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, VT, WI, WV and WY).

The policy 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 if we cease to offer policies of this type or any individual dental plans in this state, in accordance with applicable law. You may cancel the policy, on the first of the month following our receipt of your written notice. In VA, you may cancel the policy on the date of our receipt of your written cancelation notice, unless otherwise stated. We reserve the right to modify this policy, including policy provisions, benefits and coverages, consistent with state or federal law. This individual plan is renewable monthly or quarterly.

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 - 2023 [PDF]

Arizona Pediatric Dental Plan Exclusions - 2024 [PDF]

Colorado

Colorado Pediatric Dental Plan Exclusions - 2023 [PDF]

Colorado Pediatric Dental Plan Exclusions - 2024 [PDF]

Florida

Florida Pediatric Dental Plan Exclusions - 2023 [PDF]

Florida Pediatric Dental Plan Exclusions - 2024 [PDF]

Illinois

Illinois Pediatric Dental Plan Exclusions - 2023 [PDF]

Illinois Pediatric Dental Plan Exclusions - 2024 [PDF]

Missouri

Missouri Pediatric Dental Plan Exclusions - 2023 [PDF]

Missouri Pediatric Dental Plan Exclusions - 2024 [PDF]

North Carolina

North Carolina Pediatric Dental Plan Exclusions - 2023 [PDF]

North Carolina Pediatric Dental Plan Exclusions - 2024 [PDF]

Tennessee

Tennessee Pediatric Dental Plan Exclusions - 2023 [PDF]

Tennessee Pediatric Dental Plan Exclusions - 2024 [PDF]

Virginia

Virginia Pediatric Dental Plan Exclusions - 2023 [PDF]

Virginia Pediatric Dental Plan Exclusions - 2024 [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 - 2023 [PDF]

Arizona Family + Pediatric Dental Plan Exclusions - 2024 [PDF]

Colorado

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

Colorado Family + Pediatric Dental Plan Exclusions - 2024 [PDF]

Florida

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

Florida Family + Pediatric Dental Plan Exclusions - 2024 [PDF]

Tennessee

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

Tennessee Family + Pediatric Dental Plan Exclusions - 2024 [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.

In Utah, products and services provided by Cigna Health and Life Insurance Company (CHLIC), (Bloomfield, CT).

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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