Skip to main navigation Skip to main content Skip to footer For Individuals & Families For Providers For Brokers For Employers Español For Medicare: For Medicare Medicare Overview Medicare Advantage (Part C) Medicare Part D Prescription Drug Plans (PDP) Medicare Supplement Insurance Choosing a Medicare Plan What is Medicare Advantage (Part C)? What is Medicare Supplement? What is Medicare Part D? See all topics Overview Customer Forms Find Your Plan Documents Health Risk Assessment Premium Payment Options Provider and Pharmacy Directories Group Plans Resources Group Plans Provider Network Log in to myCigna Overview Medicare Advantage Eligibility and Enrollment Medicare Part D Eligibility and Enrollment Medicare Supplement Eligibility and Enrollment Choosing a Medicare Plan What is Medicare Advantage (Part C)? What is Medicare Supplement? What is Medicare Part D? See all topics Find a Doctor Log in to myCigna
Home Medicare Shop for Plans Medicare Supplement Insurance PoliciesMedicare Supplement State Disclosures

Medicare Supplement State Disclosures

Look up the important features of your Medicare Supplement policy by state.

General Disclosures

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. Full terms and conditions of coverage are defined by and governed by an issued Medicare Supplement policy.

American Retirement Life Insurance Company

Medicare Supplement Policy Form Series:

  • Plan A: AR-MSD-AA-A-GN, AR-MSD-IA-A-GN, AR-MSD-CR-A-GN
  • Plan F: AR-MSD-AA-F-GN, AR-MSD-IA-F-GN; AR-MSD-CR-F-GN
  • Plan G: AR-MSD-AA-G-GN, AR-MSD-IA-G-GN, AR-MSD-CR-G-GN
  • Plan N: AR-MSD-AA-N-GN, AR-MSD-IA-N-GN, AR-MSD-CR-N-GN

Address:
American Retirement Life Insurance Company
PO Box 5700
Scranton, PA 18505-5700

Arkansas, Delaware and Nebraska

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 (not applicable in Plan F);

(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;

(7) confinement that begins or expenses incurred while your policy is not in force; or

(8) Pre-existing Conditions: We will not pay for any expenses incurred for care or treatment of a pre-existing 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 Pre-existing 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. A pre-existing condition is a condition for which medical advice was given or treatment was recommended by or received from a physician within six (6) months prior to the policy effective date.

Cigna Health And Life Insurance Company

Medicare Supplement Policy Form Series:

  • Plan A: CHLIC-MS-AA-A-GN, CHLIC-MS-IA-A-GN, CHLIC-MS-CR-A-GN
  • Plan F: CHLIC-MS-AA-F-GN, CHLIC-MS-IA-F-GN, CHLIC-MS-CR-F-GN
  • Plan High Deductible F (HDF): CHLIC-MS-AA-HDF-GN, CHLIC-MS-IA-HDF-GN, CHLIC-MS-CR-HDF-GN
  • Plan G: CHLIC-MS-AA-G-GN, CHLIC-MS-IA-G-GN, CHLIC-MS-CR-G-GN
  • Plan N: CHLIC-MS-AA-N-GN, CHLIC-MS-IA-N-GN, CHLIC-MS-CR-N-GN

Address:
Cigna Health and Life Insurance Company
PO Box 5700
Scranton, PA 18505-5700

Arizona, Connecticut, Georgia, Illinois, Iowa, Maine, Mississippi, Missouri, and Virginia

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 (not applicable in Plans F & HDF);

(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) Pre-existing Conditions:  We will not pay for any expenses incurred for care or treatment of a pre-existing 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 pre-existing 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. A pre-existing condition is a condition for which medical advice was given or treatment was recommended by or received from a Physician within six (6) months prior to the policy effective date.

California

Medicare Supplement Policy Forms: Plan A: CHLIC-MS-AA-A-CA; Plan F: CHLIC-MS-AA-F-CA; Plan HDF: CHLIC-MS-AA-HDF-CA; Plan G: CHLIC-MS-AA-G-CA; Plan N: CHLIC-MS-AA-N-CA

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 (not applicable in Plans F and HDF);

(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 Medi-Cal or 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) Pre-existing Conditions: These policies will not pay for any expenses incurred for care or treatment of a Pre-existing 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 pre-existing 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. A pre-existing condition is a condition for which medical advice was given or treatment was recommended by or received from a Physician within six (6) months prior to the policy effective date.

Florida

Medicare Supplement Policy Forms: Plan A: CHLIC-MS-IA-A-FL, CHLIC-MS-DI-A-FL; Plan F: CHLIC-MS-IA-F-FL, CHLIC-MS-DI-F-FL; Plan HDF: CHLIC-MS-IA-HDF-FL, CHLIC-MS-DI-HDF-FL; Plan G: CHLIC-MS-IA-G-FL, CHLIC-MS-DI-G-FL; Plan N: CHLIC-MS-IA-N-FL, CHLIC-MS-DI-N-FL

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 (not applicable in Plans F & HDF);

(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) Pre-existing Conditions: We will not pay for any expenses incurred for care or treatment of a pre-existing 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 pre-existing 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. A pre-existing condition is a condition for which medical advice was given or treatment was recommended by or received from a Physician within six (6) months prior to the policy effective date.

Idaho

Medicare Supplement Policy Form Series: Plan A: CHLIC-MS-IA-A.v2-ID; Plan F: CHLIC-MS-IA-F.v2-ID; Plan High Deductible F (HDF): CHLIC-MS-IA-HDF.v2-ID; Plan G: CHLIC-MS-IA-G.v2-ID and Plan N: CHLIC-MS-IA-N.v2-ID

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; (Not Applicable in Plans F & HDF)

(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) Pre-existing Conditions: We will not pay for any expenses incurred for care or treatment of a pre- existing 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 pre-existing 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. A pre-existing condition is a condition for which medical advice was given or treatment was recommended by or received from a Physician within six (6) months before the effective date of coverage.

Minnesota

Medicare Supplement Policy and Rider Form Numbers: Basic Medicare Supplement Policy: CHLIC-MS-BASIC-MN; Extended Basic Medicare Supplement Policy: CHLIC-MS-EXTENDED-MN; Medicare Supplement Policy with $20 and $50 Copayment Medicare Part B Coverage: CHLIC-MS-COPAYMENT-MN; High Deductible Coverage Medicare Supplement Policy: CHLIC-MS-HIGHD-MN; Medicare Part A Deductible Rider: CHLIC-MS-PTAD-MN; Medicare Part B Deductible Rider: CHLIC-MS-PTBD-MN; Medicare Part B Excess Charge: CHLIC-MS-PTBEXC-MN; Preventive Medical Care Benefit Rider: CHLIC-MS-PC-MN.

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:

(1a) Basic Medicare Supplement Policy: The Medicare Part A & Part B Deductibles. The Part B deductible has limited availability for individuals eligible for coverage prior to January 1, 2020.
(b) Medicare Supplement Policy with $20 and $50 Copayment Medicare Part B Coverage: the Medicare Part B Deductible;
(c) High Deductible Coverage Medicare Supplement Policy: 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);

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

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

(7) Expense resulting from a Pre-existing Condition is not covered unless it is incurred 6 months or more after the Coverage Effective Date. The Pre-Existing Condition limitation does not apply to individuals seeking coverage during their guaranteed enrollment period. A Pre-existing Condition is one: (a) for which medical advice was given or treatment was recommended by or received from a Physician within 90 days or less before Your Coverage Effective Date; and (b) which would not have caused Us to deny issuing Your policy had it been named on Your application.
This provision does not apply if, as of the date of application, You had a Continuous Period of Creditable Coverage or had prior coverage under a Medicare Supplement policy for at least six (6) months. If, as of the date of application, You had less than six (6) months prior Creditable Coverage, the Pre-existing 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. This provision does not apply if You applied for and were issued this policy under guaranteed issue status.

Montana

Medicare Supplement Policy Forms: Plan A: CHLIC-MS-AA-A-MT; Plan F: CHLIC-MS-AA-F-MT; Plan HDF: CHLIC-MS-AA-HDF-MT; Plan G: CHLIC-MS-AA-G-MT; Plan N: CHLIC-MS-AA-N-MT

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.

New Hampshire

Medicare Supplement Policy Forms: Plan A: CHLIC-MS-IA-A-NH; Plan F: CHLIC-MS-IA-F-NH; Plan HDF: CHLIC-MS-IA-HDF-NH; Plan G: CHLIC-MS-IA-G-NH; Plan N: CHLIC-MS-IA-N-NH

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 (not applicable in Plan F);

(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) Pre-existing Conditions: We will not pay for any expenses incurred for care or treatment of a Pre-existing 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 Pre-existing 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.

New Jersey

Medicare Supplement Policy Forms: Plan A: CHLIC-MS-AA-A-NJ; Plan C: CHLIC-MS-AA-C-NJ; Plan F: CHLIC-MS-AA-F-NJ; Plan High Deductible F (HDF): CHLIC-MS-AA-HDF-NJ; Plan G: CHLIC-MS-AA-G-NJ; Plan N: CHLIC-MS-AA-N-NJ.

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 (not applicable in Plans F and HDF);

(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 an additional benefit in this policy; or

(7) Pre-existing Conditions: We will not pay for any expenses incurred for care or treatment of a pre-existing 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 pre-existing 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. A pre-existing condition is a condition for which medical advice was given or treatment was recommended by or received from a Physician within six (6) months prior to the policy effective date.

New Mexico

Medicare Supplement Policy Forms: Plan A: CHLIC-MS-AA-A-NM; Plan F: CHLIC-MS-AA-F-NM; Plan HDF: CHLIC-MS-AA-HDF-NM; Plan G: CHLIC-MS-AA-G-NM; Plan N: CHLIC-MS-AA-N-NM

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 (not applicable in Plans F & HDF);

(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) Pre-existing Conditions: We will not pay for any expenses incurred for care or treatment of a pre-existing 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 pre-existing 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. A pre-existing condition is a condition for which medical advice was given or treatment was recommended by or received from a Physician within six (6) months prior to the policy effective date.

North Dakota

Medicare Supplement Policy Forms: Plan A: CHLIC-MS-AA-A-ND, CHLIC-MS-AO-A-ND; Plan F: CHLIC-MS-AA-F-ND, CHLIC-MS-AO-F-ND; Plan HDF: CHLIC-MS-AA-HDF-ND, CHLIC-MS-AO-HDF-ND; Plan G: CHLIC-MS-AA-G-ND, CHLIC-MS-AO-G-ND; Plan N: CHLIC-MS-AA-N-ND, CHLIC-MS-AO-N-ND

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.

Ohio

Medicare Supplement Policy Forms: Plan A: CHLIC-MS-AA-A-OH; Plan F: CHLIC-MS-AA-F-OH; Plan High Deductible F (HDF): CHLIC-MS-AA-HDF-OH; Plan G: CHLIC-MS-AA-G-OH; and Plan N: CHLIC-MS-AA-N-OH

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 (not applicable in Plans F & HDF);

(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) Pre-existing Conditions:  We will not pay for any expenses incurred for care or treatment of a pre-existing 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 pre-existing 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. A pre-existing condition is a condition for which medical advice was given or treatment was recommended by or received from a Physician within six (6) months prior to the policy effective date.

Rhode Island

Medicare Supplement Policy Forms: Plan A: CHLIC-MS-AA-A-RI; Plan F: CHLIC-MS-AA-F-RI; Plan High Deductible F (HDF): CHLIC-MS-AA-HDF-RI; Plan G: CHLIC-MS-AA-G-RI; and Plan N: CHLIC-MS-AA-N-RI.

Exclusions and Limitations:

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

(1) the Medicare Part B deductible (not applicable for Plans F and C);

(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 the policy;

(6) any deductible, coinsurance, or copayment not covered by Medicare, unless such coverage is listed as a benefit in the policy; or

(7) Pre-Existing Conditions: We will not pay for any expenses incurred for care or treatment of a Pre-Existing 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 a policy under guaranteed issue status; if on the date of application for a policy you had at least six (6) months of prior Creditable Coverage; or if the 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 a policy. If you had less than six (6) months prior Creditable Coverage, the Pre-Existing Conditions limitation will be reduced by the aggregate amount of Creditable Coverage. If the policy is replacing another Medicare Supplement policy, credit will be given for any portion of the waiting period that has been satisfied.

Texas

Medicare Supplement Policy Forms: Plan A: CHLIC-MS-AA-A-TX; Plan F: CHLIC-MS-AA-F-TX; Plan High Deductible F (HDF): CHLIC-MS-AA-HDF-TX; Plan G: CHLIC-MS-AA-G-TX; and Plan N: CHLIC-MS-AA-N-TX.

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 (not applicable in Plans F & HDF);

(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) Pre-existing Conditions: We will not pay for any expenses incurred for care or treatment of a pre-existing 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 pre-existing 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. A pre-existing condition is a condition for which medical advice was given or treatment was recommended by or received from a Physician within six (6) months prior to the policy effective date.

Vermont

Medicare Supplement Policy Forms: Plan A: CHLIC-MS-CR-A-VT; Plan F: CHLIC-MS-CR-F-VT; Plan HDF: CHLIC-MS-CR-HDF-VT; Plan G: CHLIC-MS-CR-G-VT; Plan N: CHLIC-MS-CR-N-VT

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 (not applicable in Plans F and HDF);

(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;

(7) Pre-existing Conditions: These policies will not pay for any expenses incurred for care or treatment of a Pre-existing 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 pre-existing 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. A pre-existing condition is a condition for which medical advice was given or treatment was recommended by or received from a Physician within six (6) months prior to the policy effective date.

Washington

Medicare Supplement Policy Forms: Plan A: CHLIC-MS-CR-A-WA, CHLIC-MS-CR-AO-A-WA; Plan F: CHLIC-MS-CR-F-WA, CHLIC-MS-CR-AO-F-WA; Plan HDF: CHLIC-MS-CR-HDF-WA, CHLIC-MS-CR-AO-HDF-WA; Plan G: CHLIC-MS-CR-G-WA, CHLIC-MS-CR-AO-G-WA; Plan N: CHLIC-MS-CR-N-WA, CHLIC-MS-CR-AO-N-WA

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

(1) the Medicare Part B deductible (not applicable for Plans F and C);

(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 the policy;

(6) any deductible, coinsurance, or copayment not covered by Medicare, unless such coverage is listed as a benefit in the policy; or

(7) Pre-Existing Conditions: We will not pay for any expenses incurred for care or treatment of a Pre-Existing Condition for the first three (3) months from the effective date of coverage. This exclusion does not apply if you applied for and were issued a policy under guaranteed issue status; if on the date of application for a policy you had at least three (3) months of prior Creditable Coverage; or if the policy is replacing another Medicare Supplement policy and a three (3) month waiting period has already been satisfied. Evidence of prior coverage or replacement must have been disclosed on the application for a policy. If you had less than three (3) months prior Creditable Coverage, the Pre-Existing Conditions limitation will be reduced by the aggregate amount of Creditable Coverage. If the policy is replacing another Medicare Supplement policy, credit will be given for any portion of the waiting period that has been satisfied.

West Virginia

Medicare Supplement Policy Forms: Plan A: CHLIC-MS-AA-A.v2-WV; Plan F: CHLIC-MS-AA-F.v2-WV; Plan HDF: CHLIC-MS-AA-HDF.v2-WV; Plan G: CHLIC-MS-AA-G.v2-WV; Plan N: CHLIC-MS-AA-N.v2-WV

Exclusions and Limitations:

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

(1) the Medicare Part B deductible (not applicable for Plans F and C);

(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 the policy;

(6) any deductible, coinsurance, or copayment not covered by Medicare, unless such coverage is listed as a benefit in the policy; or

(7) Pre-Existing Conditions: We will not pay for any expenses incurred for care or treatment of a Pre-Existing 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 a policy under guaranteed issue status; if on the date of application for a policy you had at least six (6) months of prior Creditable Coverage; or if the 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 a policy. If you had less than six (6) months prior Creditable Coverage, the Pre-Existing Conditions limitation will be reduced by the aggregate amount of Creditable Coverage. If the policy is replacing another Medicare Supplement policy, credit will be given for any portion of the waiting period that has been satisfied.

Wisconsin

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) Skilled Nursing Facility Care costs beyond what is covered by Medicare and the Wisconsin mandated 30-day skilled nursing benefit;

2) Home Health Care visits above the number of visits covered by Medicare and the Wisconsin mandated 40 visits in a twelve month period;

3) Physician charges above Medicare’s approved charge, unless the Optional Medicare Part B Excess Charges Rider is purchased;

4) Outpatient prescription drugs;

5) Most care received outside the USA, unless the Optional Foreign Travel Emergency Rider is purchased;

6) Dental care (except anesthesia charges for dental care provided in a hospital or ambulatory surgery center), dentures, checkups, routine immunizations, cosmetic surgery, routine foot care, examinations for and the cost of eyeglasses or hearing aids, unless eligible by Medicare;

7) Any expense incurred in excess of the Usual and Customary Charge or not medically necessary as determined by Us for all required Wisconsin mandated benefits;

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

9) Any services that are not medically necessary as determined by Medicare;

10) 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;

11) Any type of expense not a Medicare Eligible Expense except as provided previously in this policy

PRE-EXISTING CONDITION: We will not pay for any expenses incurred for care or treatment of a Pre-existing 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 Pre-existing 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.

DEFINITION

PRE-EXISTING CONDITION means a condition for which medical advice was given or treatment was recommended by or received from a Physician within six (6) months prior to the policy effective date.

Wyoming

Medicare Supplement Policy Forms: Plan A: CHLIC-MS-AA-A.v2-WY; Plan F: CHLIC-MS-AA-F.v2-WY; Plan G: CHLIC-MS-AA-G.v2-WY; Plan High Deductible G: CHLIC-MS-AA-HDG-WY; Plan N: CHLIC-MS-AA-N.v2-WY

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 ninety (90) days 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 ninety (90) days of prior Creditable Coverage; or, if this policy is replacing another Medicare Supplement policy and a ninety (90) day 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 ninety (90) days 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.

Cigna National Health Insurance Company

Address:
Cigna National Health Insurance Company
PO Box 5700
Scranton, PA 18505-5700

Medicare Supplement Policy Form Series:

  • CNHIC-MS-AA-A-GN
  • CNHIC-MS-AA-F-GN
  • CNHIC-MS-AA-G-GN
  • CNHIC-MS-AA-HDG-GN
  • CNHIC-MS-AA-N-GN
Alabama, Colorado, Kentucky, Louisiana, Maryland, Mississippi, Nevada, North Carolina, South Dakota, Utah

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

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

(3) 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;

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

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

6) 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.

Indiana

Medicare Supplement Policy Forms: Plan A: CNHIC-MS-AA-A-IN; Plan F: CNHIC-MS-AA-F-IN; Plan G: CNHIC-MS-AA-G-IN; Plan N: CNHIC-MS-AA-N-IN

Exclusions and Limitations:

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

(1) the Medicare Part B deductible (not applicable for Plan F);

(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 the policy;

(6) any deductible, coinsurance, or copayment not covered by Medicare, unless such coverage is listed as a benefit in the policy; or

(7) Pre-Existing Conditions: We will not pay for any expenses incurred for care or treatment of a Pre-Existing 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 a policy under guaranteed issue status; if on the date of application for a policy you had at least six (6) months of prior Creditable Coverage; or if the 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 a policy. If you had less than six (6) months prior Creditable Coverage, the Pre-Existing Conditions limitation will be reduced by the aggregate amount of Creditable Coverage. If the policy is replacing another Medicare Supplement policy, credit will be given for any portion of the waiting period that has been satisfied.

Kansas

Medicare Supplement Policy Forms: Plan A: CNHIC-MS-AA-A-KS, CNHIC-MS-AO-A-KS; Plan F: CNHIC-MS-AA-F-KS, CNHIC-MS-AO-F-KS; Plan G: CNHIC-MS-AA-G-KS, CNHIC-MS-AO-G-KS; Plan N: CNHIC-MS-AA-N-KS, CNHIC-MS-AO-N-KS

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

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

(3) 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;

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

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

(6) 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.

Michigan

Medicare Supplement Policy Forms: Plan A: CNHIC-MS-AA-A-MI; Plan F: CNHIC-MS-AA-F-MI; Plan G: CNHIC-MS-AA-G-MI; Plan N: CNHIC-MS-AA-N-MI

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

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

(3) 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;

(4) any type of expense not a Medicare eligible expense except as provided previously in this policy;

(5) any deductible, coinsurance or co-payment not covered by Medicare, unless such coverage is listed as an additional benefit in this policy; or

(6) Pre-existing Conditions: We will not pay for any expenses incurred for care or treatment of a Pre-existing 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 Pre-existing 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.

Oklahoma

Medicare Supplement Policy Forms: Plan A: CNHIC-MS-AA-A-OK; Plan F: CNHIC-MS-AA-F-OK; Plan G: CNHIC-MS-AA-G-OK; Plan High Deductible G: CNHIC-MS-AA-HDG-OK; Plan N: CNHIC-MS-AA-N-OK

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

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

3) 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;

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

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

6) 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.

Pennsylvania

Medicare Supplement Policy Forms: Plan A: CNHIC-MS-AO-A-PA; Plan B: CNHIC-MS-AO-B-PA; Plan F: CNHIC-MS-AO-F-PA; Plan G: CNHIC-MS-AO-G-PA; Plan N: CNHIC-MS-AO-N-PA

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

(1) the Medicare Part B deductible (not applicable for Plan F);

(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 the policy;

(6) any deductible, coinsurance, or copayment not covered by Medicare, unless such coverage is listed as a benefit in the policy; or

(7) Pre-Existing Conditions: We will not pay for any expenses incurred for care or treatment of a Pre-Existing 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 a policy under guaranteed issue status; if on the date of application for a policy you had at least six (6) months of prior Creditable Coverage; or if the 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 a policy. If you had less than six (6) months prior Creditable Coverage, the Pre-Existing Conditions limitation will be reduced by the aggregate amount of Creditable Coverage. If the policy is replacing another Medicare Supplement policy, credit will be given for any portion of the waiting period that has been satisfied.

South Carolina

Medicare Supplement Policy Forms: Plan A: CNHIC-MS-AA-A-SC; Plan F: CNHIC-MS-AA-F-SC; Plan G: CNHIC-MS-AA-G-SC; Plan N: CNHIC-MS-AA-N-SC

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 (not applicable for Plan F);

(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) Pre-existing Conditions: We will not pay for any expenses incurred for care or treatment of a Pre-existing 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 Pre-existing 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.

Tennessee

Medicare Supplement Policy Forms: Plan A: CNHIC-MS-AA-A-TN; Plan F: CNHIC-MS-AA-F-TN; Plan G: CNHIC-MS-AA-G-TN; Plan N: CNHIC-MS-AA-N-TN

Exclusions and Limitations:

The benefits of this policy will not duplicate any benefits paid by Medicare. With the exception of the Medicare Part B Excess Charges Benefit, 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 and no other services or organization has a legal obligation to provide or pay for;

(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 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;

(7)  or 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.

Loyal American Life Insurance Company

Medicare Supplement Policy Form Series:

  • Plan A: LY-MSD-AA-A-GN, LY-MSD-IA-A-GN, LY-MSD-CR-A-GN
  • Plan F: LY-MSD-AA-F-GN, LY-MSD-IA-F-GN, LY-MSD-CR-F-GN
  • Plan G: LY-MSD-AA-G-GN, LY-MSD-IA-G-GN, LY-MSD-CR-G-GN
  • Plan N: LY-MSD-AA-N-GN, LY-MSD-IA-N-GN, LY-MSD-CR-N-GN

Address:
Loyal American Life Insurance Company
PO Box 5700
Scranton, PA 18505-5700

Alaska, District of Columbia and Hawaii

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 (not applicable in Plan F);

(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;

(7) confinement that begins or expenses incurred while your policy is not in force; or

(8) Pre-existing Conditions:  These policies will not pay for any expenses incurred for care or treatment of a Pre-existing 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 pre-existing 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. A pre-existing condition is a condition for which medical advice was given or treatment was recommended by or received from a Physician within six (6) months prior to the policy effective date.

MS-SITE-ExclLimit2022


Page Footer

Customer Plan Links

Choosing a Medicare Plan Community Resources Disaster Policy Enrollment and Eligibility Filing a Grievance Medicare Appeals Process and Exceptions Medicare Coverage Decisions Medicare Disenrollment Organization Determination Pre-Enrollment Disclaimers

Other Cigna Websites

Leon Medical Centers Health Plans Texas Medicaid STAR+PLUS Texas Medicare-Medicaid Plan

Audiences

Individuals and Families Medicare Employers Brokers Providers About Cigna

Solutions for

Health Care Providers Pharmacists Pharmacy Residents Group Plans

Medicare Links

Medicare.gov Medicare Ombudsman Medicare Complaint Form

 Cigna. All rights reserved.

Privacy Legal Medicare Supplement State Disclosures Customer Rights Accessibility Notice of Non-Discrimination Language Assistance [PDF] Report Fraud Sitemap

Medicare Advantage Policy Disclaimers

All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation. The Cigna name, logos, and other Cigna marks are owned by Cigna Intellectual Property, Inc. All clinical products and services of the LivingWell Health Centers are either provided by or through clinicians contracted with HealthSpring Life & Health Insurance Company, Inc., HealthSpring of Florida, Inc., Bravo Health Mid-Atlantic, Inc., and Bravo Health Pennsylvania, Inc. or employees leased by HS Clinical Services, PC, Bravo Advanced Care Center, PC (PA), Bravo Advanced Care Center, PC (MD) and not by Cigna Corporation. The Cigna name, logos, and other Cigna marks are owned by Cigna Intellectual Property, Inc. All pictures are used for illustrative purposes only.

Cigna contracts 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 Cigna depends on contract renewal.

Medicare Supplement Policy Disclaimers

Medicare Supplement website content not approved for use in: Minnesota, Missouri, North Carolina, North Dakota, Oregon, Virginia.

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 Cigna National Health Insurance Company, Cigna Health and Life Insurance Company, American Retirement Life 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, 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.

American Retirement Life Insurance Company, Cigna National Health Insurance Company and Loyal American Life Insurance Company do not issue policies in New Mexico.

Kansas Disclosures, Exclusions and Limitations

Medicare Supplement Policy Forms: Plan A: CNHIC-MS-AA-A-KS, CNHIC-MS-AO-A-KS; Plan F: CNHIC-MS-AA-F-KS, CNHIC-MS-AO-F-KS; Plan G: CNHIC-MS-AA-G-KS, CNHIC-MS-AO-G-KS; Plan N: CNHIC-MS-AA-N-KS, CNHIC-MS-AO-N-KS

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 Cigna.com to another website, which may be a non-Cigna website.

Y0036_22_101121_M | Page last updated 06/01/2022 .