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  • Home Medicare Member Resources and Services Cigna Healthcare Quality Improvement Program

    Cigna Healthcare Quality Improvement Program

    Helping to improve the care we provide our customers and create a better quality of life.

    The Quality Improvement Program uses surveys and preventive screenings to track and develop the health care we provide our customers. By comparing the results of our surveys and screenings, we’re able to see how our programs help your health.

    Preventive Screenings

    Our Quality Improvement Program focuses on preventive screenings such as:

    Annual Flu Vaccine

    In 2020, the goal  at Cigna HealthcareSM was for 76% of our customers to get their annual flu vaccine. Four markets achieved this goal with 76% or more of customers getting their flu vaccine.

    Breast Cancer

    In 2020, Cigna Healthcare aimed to have 69% of women complete a mammogram. Ten markets went above that goal and reached 77% completion.

    Care for Older Adults: Medication Review and Pain Assessment

    The goal at Cigna Healthcare was for older adult customers in 2020 to have their medications reviewed was 84%. Eight markets exceeded the goal for medication review with 93% medication reviews completed.

    Our 2020 goal for pain assessment in older adults was 87%. Eight markets surpassed this goal with 95% of pain assessment completed.

    Colorectal Cancer

    Our goal was for 71% of our customers to have a colorectal cancer screening in 2020. All markets surpassed that goal and reached 78% completion.

    Diabetic Retinal Eye Exam

    In 2020, Cigna Healthcare aspired to have 71% of customers with diabetes complete a diabetic retinal eye exam. Seven markets were successful in reaching that goal with a 72% completion rate.

    Osteoporosis Management in Women who had a Fracture

    Cigna Healthcare sought a goal of 50% in 2020 for Osteoporosis Management in women who had a fracture. Two markets reached the goal of 50%.

    Statin Therapy for Patients with Cardiovascular Disease

    In 2020, our goal was for 84% of our customers with cardiovascular disease to have statin therapy. Five markets met this goal with 84% of customers receiving statin therapy.

    2021 Assessment of Customer Experience

    In 2021, your survey responses showed that we have made improvements overall. Our group will continue to focus on improvement in these areas:

    • Getting routine and urgent care appointments
    • Getting seen within 15 minutes of appointment time
    • Getting needed tests, care, or treatment
    • Getting appointments with specialists
    • Getting the help you need to manage your care
    • Giving you the facts you need when you call us
    • Addressing physical and mental health needs

    Affirmative Statement on Incentives

    Cigna Healthcare Utilization Management associates base decisions on the clinical needs of members, benefit availability, and appropriateness of care. Objective, scientifically-based clinical criteria and treatment guidelines, such as InterQual measures, along with Medicare National Coverage Guidelines in the context of provider or member-supplied clinical information, lead the decision-making process. Cigna Healthcare in no way rewards or incentivizes, either financially or otherwise, practitioners, utilization reviewers, case managers, physician advisers, or other individuals involved in conducting utilization review, for issuing denials of coverage or service, or inappropriately restricting care.

    Our Evaluation of New Technologies

    The Cigna Healthcare Pharmacy and Therapeutics Committee and Clinical Guidelines Committee review new medications, medical and behavioral methods, and devices as potential benefit additions for our customers.

    The Cigna Healthcare Pharmacy and Therapeutics Committee is made up of practicing physicians and pharmacists from many clinical specialties, along with experts on care for older adults or disabled people. They consider whether a certain drug is better than, the same as, or worse than the medical benefit and safety of other drugs within the same drug class. They also look at scientific studies and standards of care, along with clinical guidelines, up to date medical and drug studies, and Food and Drug Administration approved uses of medications.

    Based on this review, the Pharmacy and Therapeutics Committee votes on whether medications work better than, as well as, or worse than other treatments in terms of medical benefit and safety. This decision is used to help determine what drugs are listed on the formulary.

    For residents of Tennessee, TennCare is not responsible for payment for these benefits, except for appropriate cost sharing amounts. TennCare is not responsible for guaranteeing the availability or quality of these benefits.

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  • Medicare Advantage and Medicare Part D Policy Disclaimers

    Cigna Healthcare products and services are provided exclusively by or through operating subsidiaries of The Cigna Group. The Cigna Healthcare names, logos, and marks, including THE CIGNA GROUP and CIGNA HEALTHCARE are owned by The Cigna Group Intellectual Property, Inc. Subsidiaries of The Cigna Group contract with Medicare to offer Medicare Advantage HMO and PPO plans and Part D Prescription Drug Plans (PDP) in select states, and with select State Medicaid programs. Enrollment in a Cigna Healthcare product depends on contract renewal.

    To file a marketing complaint, contact Cigna Healthcare or call 1-800-MEDICARE (), 24 hours a day, 365 days a year, TTY . Please include the agent/broker name if possible.

    Medicare Supplement Policy Disclaimers

    Medicare Supplement website content not approved for use in: Oregon.

    AN OUTLINE OF COVERAGE IS AVAILABLE UPON REQUEST. We'll provide an outline of coverage to all persons at the time the application is presented.

    Our company and agents are not connected with or endorsed by the U.S. Government or the federal Medicare program. This is a solicitation for insurance. An insurance agent may contact you. Premium and benefits vary by plan selected. Plan availability varies by state. Medicare Supplement policies are underwritten by American Retirement Life Insurance Company, Cigna Health and Life Insurance Company, Cigna Insurance Company, Cigna National Health Insurance Company or Loyal American Life Insurance Company. Each insurer has sole responsibility for its own products.

    The following Medicare Supplement Plans are available to persons eligible for Medicare due to disability: Plan A in Arkansas, Connecticut, Indiana, Maryland, Oklahoma, Rhode Island, Texas, and Virginia; Plans A, F, and G in North Carolina; and Plans C and D in New Jersey for individuals aged 50-64. Medicare Supplement policies contain exclusions, limitations, and terms under which the policies may be continued in force or discontinued. For costs and complete details of coverage, contact the company.

    This website is designed as a marketing aid and is not to be construed as a contract for insurance. It provides a brief description of the important features of the policy. Please refer to the policy for the full terms and conditions of coverage.

    In Kentucky, Plans A, F, G, HDG, N are available under Cigna National Health Insurance Company, Plans A, F, G, HDF, N are available under Cigna Health and Life Insurance Company and Plans A, B, C, D, F, G, N are available under Loyal American Life Insurance Company.

    Kansas Disclosures, Exclusions and Limitations


    Exclusions and Limitations:

    The benefits of this policy will not duplicate any benefits paid by Medicare. The combined benefits of this policy and the benefits paid by Medicare may not exceed one-hundred percent (100%) of the Medicare Eligible Expenses incurred. This policy will not pay benefits for the following:

    (1) the Medicare Part B Deductible;

    (2) any expense which You are not legally obligated to pay; or services for which no charge is normally made in the absence of insurance;

    (3) any services that are not medically necessary as determined by Medicare;

    (4) any portion of any expense for which payment is made by Medicare or other government programs (except Medicaid); or for which payment would have been made by Medicare if You were enrolled in Parts A and B of Medicare;

    (5) any type of expense not a Medicare Eligible Expense except as provided previously in this policy;

    (6) any deductible, Coinsurance or Co-payment not covered by Medicare, unless such coverage is listed as a benefit in this policy; or

    (7) Preexisting Conditions: We will not pay for any expenses incurred for care or treatment of a Preexisting Condition for the first six (6) months from the effective date of coverage. This exclusion does not apply if You applied for and were issued this policy under guaranteed issue status; if on the date of application for this policy You had at least six (6) months of prior Creditable Coverage; or, if this policy is replacing another Medicare Supplement policy and a six (6) month waiting period has already been satisfied. Evidence of prior coverage or replacement must have been disclosed on the application for this policy. If You had less than six (6) months prior Creditable Coverage, the Preexisting Conditions limitation will be reduced by the aggregate amount of Creditable Coverage. If this policy is replacing another Medicare Supplement policy, credit will be given for any portion of the waiting period that has been satisfied.

    Selecting these links will take you away from to another website, which may be a non-Cigna Healthcare website.

    Y0036_24_1037312_M | Page last updated 03/28/2024