QUICK GUIDE TO CIGNA ID CARDS - Center Care · 2 GWH-Cigna Plans • PCP selection encouraged • No referrals required • GWH-Cigna ID cards represent all products XYZ Company RXBIN

591795 q 05/14 THN-2014-256

QUICK GUIDE TO CIGNA ID CARDS

2014-2015

WE PACK A LOT OF IMPORTANT INFORMATION ON OUR ID CARDS. ThisbrochurecanhelpdefineandclarifyinformationthatappearsonCigna’smostcommoncustomerIDcards.Itcanalsohelpyouunderstandtherequirementsassociatedwithourvariousplans,allowingyoutoquicklyandefficientlyserveyourpatients.

Wemayoccasionallyupdatethisbrochureduringtheyear.DownloadthemostcurrentversionatCigna.com>HealthCareProfessionals>Resources>DoingBusinesswithCigna.

PLEASE NOTE: TherearevariousstandardCignaIDcardsshowninthisbrochurethataresubjecttoregulatoryoversight.Asaresult,theactualIDcardcontentmayvaryinordertoconformtolegislativeandregulatoryrequirements.TheIDcardsshownaresamplesandmayvaryfromtheactualcards.

QUICK GUIDE TO CIGNA ID CARDS

Refer to this key for explanations of the information found on the sample Cigna ID cards featured in this brochure.

1 UsethisIDnumberforallclaimsandinquiries.

2 Indicatesaseamlessnetworkwhereapatientcanreceivein-networkcareonaregionalorstatewidebasis.

3 Forpatientswithcoinsurance,submitclaimstoCignaoritsdesignee,andreceiveanExplanationofPayment(EOP),whichwillshowanyremainingamountduefrompatient.

4 Collectanycopaymentatthetimeofservice.

5 Mayreadas“ConnecticutGeneralLifeInsuranceCo.,”“CignaHealthandLifeInsuranceCompany”or“CignaHealthCareofXXXX,Inc.”

6 IDcardswiththeCignaCareNetwork®logoindicatethepatient’sliabilityvariesbasedonthehealthcareprofessional’sCignaCaredesignationstatus.Refertotheonlinehealthcareprofessionaldirectorytodetermineaphysician’sCignaCaredesignationstatus.

7 Effectivedateofcoverage.

8 Nameofpatient‘sprimarycarephysician(PCP).

9 NetworkSavingsProgram(NSP)logoindicatesthatout-of-networkdiscountsmaybeavailabletothecustomer.

10 Clientname.

11 IfathirdpartyadministersservicesinconjunctionwithCigna,theIDcardmayincludemultiplelogosandmayshowadifferentclaimaddressortelephonenumberonthebackofthecard.

12 Precertificationrequirementsmaybeshownaseither“InpatientAdmission”or“InpatientAdmissionandOutpatientProcedures.’’

13 Submitclaimstotheclaimsubmissionaddressshownonthecard.

14 CalltheCustomerServicenumber(s)indicatedonthecard.Someplanshavededicatednumbersforaccessinginformation–besuretocheckthecardforthecorrectnumber.

15 “AwayFromHomeCare”indicatesthepatienthasaccesstotheCignanationalnetwork.

16 IndicatesSharedAdministration.

17 Unionidentifier.

18 Client-specificnetwork(CSN)logo.

KEY

1

ID cards

• QuicklyviewIDcardinformation(frontandback)fortheentirefamily

• Easilyprint,emailorscanrightfromsmartphoneHealthcareprofessionaldirectory

• Locatedoctorsandhealthcarefacilities

• Accessmapsforinstantdrivingdirections

Health wallet

• Storeandorganizeallcontactinfofordoctors,hospitalsandpharmacies

• Addhealthcareprofessionalstocontactlistrightfromaclaimordirectorysearch

Claims

• Viewandsearchrecentandpastclaims

• Bookmarkandorganizeclaimsforeasyreference

Trackers

• Viewin-networkandout-of-networkmedicalanddentalyear-to-datedeductibles,aswellasout-of-pocketandannualmaximums

Coverage

• Seeplancoverageandbenefitinformationformedical,dental,pharmacy

• Accessandviewhealthfundbalances

• Reviewplandeductiblesandcoinsurance

Drug search

• Compareprescriptiondrugcostsatmorethan60,000pharmaciesnationwide

• FindclosestpharmacylocationusingGPS

THE MYCIGNA MOBILE APP: APP-SOLUTELY CONVENIENT

ThemyCignaMobileAppgivescustomersasimplewaytopersonalize,organizeandaccesstheirimportanthealthandbenefitsinformation–onthego.CignacustomersmaypresenttheirIDcardinformation,claimsinformationandcoverageeligibilitytoyouviatheappwiththeircellphoneortablet.

FEATURES:

Customers can get the free myCigna Mobile App from the App StoreSMor Google Play

iOSAppleversion5.1orhigherAndroidOSversion2.3orhigher

The Apple logo is a trademark of Apple Inc., registered in the U.S. and other countries. App Store is a service mark of Apple Inc. | Android and Google Play are trademarks of Google Inc.

*The myCigna Mobile App is only available to Cigna health plan customers. Actual features may vary depending on your plan. The downloading and use of the App is subject to the terms and conditions of the App and the online stores from which it is downloaded. Standard mobile phone carrier and data usage charges apply.

2

GW

H-C

ign

a P

lan

s

• PCP selection encouraged• No referrals required• GWH-Cigna ID cards represent all products

XYZ CompanyRXBIN 600428RXPCN 05180000Issuer 80840

Group Plan 123456789John Public

ID 123456789 01COPAY:Primary Care $30 Specialist $40Urgent Care $65 PCP: None SelectedNo Referral Required

For plan & benefit details, please visit myCIGNAforhealth.com

Submit All Claims To1000 Great-West DriveKennett, MO 63857-3749Payer ID #62308

Members and Providers Call1-866-494-2111

GWH-CIGNAOpen Access

Plus

ER $200

PlanType

XYZ CompanyIIN 600428Control 05180000

Issuer 80840

Group Plan 00654321Member Five

ID 100000005COPAY:Primary Care $30 Specialist $40Urgent Care $65 Preventive Care $20PCP: None SelectedNo Referral RequiredFor plan & benefit details, please visit myCIGNAforhealth.comPlan Contractor: Connecticut General Life Insurance Company

Submit All Claims To1000 Great-West DriveKennett, MO 63857-3749Payer ID #80705

Members and Providers Call1-866-494-2111

GWH-CIGNAOpen Access

Plus

Members: Carry this card at all times. Pretreatment authorization must be obtained for hospital admissions, outpatient surgeries performed outside a physician’s office and for the other services specified in the benefit plan. Member is responsible for obtaining authorization for non-network services. Failure to follow pretreatment authorization procedures may result in a reduction of benefits. In an emergency, seek care immediately, then call your primary care doctor as soon as possible for further assistance. We encourage you to use a primary care physician as a valuable resource and personal health advocate. CIGNA has multiple networks. Your plan is paired with the GWH-CIGNA network. To find a GWH-CIGNA provider, please visit your member website at myCIGNAforhealth.com.

For Pharmacists Only 1-800-XXX-XXXX

R318 (5/10) Mask 401

For providers not in your primary network, visit multiplan.com

Providers: Pretreatment authorization must be received for all services listed above and as specified in the member’s benefit plan by calling the number on the front of this card or online at CignaforHCP. com. Emergency hospital admissions must be reported within 48 hours.

Notice: Possession of this card does not guarantee coverage or payment for the service or procedure reviewed. Please call the Member and Providers number on the front of this card for eligibility information.

Issue Date: 01/01/12

GWH-CignaPlanType

• PCP selection encouraged• No referrals required• GWH-Cigna ID cards represent all products

��

��

��

��

��

��

��Name John Doe

Cigna Health and Life Insurance Company

Group 00699998Issuer (80840)ID 100000008

PCP None SelectedNo Referral Required

XYZ Sample CompanyHoldings Co.

RxBIN 600428 RxPCN 05180000RxGrp 00688888RxID 100000008 00

CopaysPrimary Care $25Specialist $25Urgent Care $100ER $200

030409116687

00000000001

0000001072

7117

>0000019116687

001003040

��

��

��

��

��

��

��

RUN_DATE 20130314 05:58:28DATA_SEQ_NO 0000001CLIENT_NUMBER 003040UHG_TYPE DIG1CARDDOC_ID 9116687/000001-00DOC_ID 9116687/000001-01DOC_ID 9116687/000001-02DOC_SEQ_ID 0000001NAME Doe ,JohnMAILSET_NUMBER 0000001CUST_KEY1 00699998CUST_KEY2 100000008CUST_KEY3 00CUST_KEY4 JohnCUST_KEY5CUST_KEY6 Doe

Wha

tdo

esitmean?

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��Yo

urshare

ofthepa

ymen

tforh

ealth

care

services

may

beba

sed

upon

ourag

reem

entwith

your

prov

ider.Yo

urprov

ider

may

billyo

ufora

mou

ntsup

totheprov

ider's

regu

larbilledch

arge

s.

'Cigna

'isaregistered

service

mark,

andthe'Tree

ofLife'isaservice

mark,

ofCign

aIntellectua

lProp

erty,Inc.,licen

sed

foru

seby

Cign

aCo

rporationan

dits

operatingsubsidiarie

s.Allprod

ucts

andservices

are

prov

ided

byor

throug

hsuch


san

dno

tbyCign

aCo

rporation.

Such


sinclud

eCo

nnectic

utGen

eral

Life

Insuranc

eCo

mpa

ny,Cign

aHealth

andLife

Insuranc

eCo

mpa

ny,Cign

aHealth

Man

agem

ent,

Inc.

andCign

aDen

talHealth

,Inc.

TheCign

aDen

tal

PPO

isun

derw

rittenor

administered

byCo

nnectic

utGen

eral

LIfe

Insuranc

eCo

mpa

nyor

Cign

aHealth

andLife

Insuranc

eCo

mpa

nywith

netw

ork

man

agem

entservices

prov

ided

byCign

aDen

talHealth

,Inc.,an

dcertain

ofits


s.

Send All Claims To 1000 Great-West Drive Kennett, MO 63857-3749 Payer ID #62308Customers & Health Care Professionals call 1-866-494-2111

Rx Claims: Pharmacy Service Center, PO Box 3598, Scranton PA 18505-0598For Pharmacists Only 800-351-9170

Mask 601 Issue Date: 03/14/13

*117*

�� 00000000 �� DIRECT �� USPS �� John Doe �� 888 N Main St �� Olympia, WA 98502

�� 20130313

�� Thu Mar 14, 2013 @ 05:58:28

�� N

�� 601

��

��

��

��

��

��

��

Name John Doe

Cigna Health and Life Insurance Company

Group 00699998Issuer (80840)ID 100000008

PCP None SelectedNo Referral Required

XYZ Sample CompanyHoldings Co.

RxBIN 600428 RxPCN 05180000RxGrp 00688888RxID 100000008 00

CopaysPrimary Care $25Specialist $25Urgent Care $100ER $200

030409116687

00000000001

0000001072

7117

>0000019116687

001003040

��

��

��

��

��

��

��

RUN_DATE 20130314 05:58:28DATA_SEQ_NO 0000001CLIENT_NUMBER 003040UHG_TYPE DIG1CARDDOC_ID 9116687/000001-00DOC_ID 9116687/000001-01DOC_ID 9116687/000001-02DOC_SEQ_ID 0000001NAME Doe ,JohnMAILSET_NUMBER 0000001CUST_KEY1 00699998CUST_KEY2 100000008CUST_KEY3 00CUST_KEY4 JohnCUST_KEY5CUST_KEY6 Doe

Wha

tdo

esitmean?

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��Yo

urshare

ofthepa

ymen

tforh

ealth

care

services

may

beba

sed

upon

oura

gree

men

twith

your

prov

ider.Yo

urprov

ider

may

billyo

ufora

mou

ntsup

totheprov

ider's

regu

larbilledch

arge

s.

'Cigna

'isaregistered

service

mark,

andthe'Tree

ofLife'isaservice

mark,

ofCign

aIntellectua

lProp

erty,Inc.,licen

sed

foru

seby

Cign

aCo

rporationan

dits


s.Allp

rodu

ctsan

dservices

are

prov

ided

byor

throug

hsuch


san

dno

tbyCign

aCo

rporation.

Such


sinclud

eCo

nnectic

utGen

eral

Life

Insuranc

eCo

mpa

ny,Cign

aHe

alth

andLife

Insuranc

eCo

mpa

ny,Cign

aHealth

Man

agem

ent,

Inc.

andCign

aDen

talH

ealth

,Inc.

TheCign

aDen

tal

PPO

isun

derw

rittenor

administered

byCo

nnectic

utGe

neralLIfe

Insuranc

eCo

mpa

nyor

Cign

aHealth

andLife

Insuranc

eCo

mpa

nywith

netw

ork

man

agem

entservices

prov

ided

byCign

aDen

talH

ealth

,Inc.,an

dcertain

ofits


s.

Send All Claims To 1000 Great-West Drive Kennett, MO 63857-3749 Payer ID #62308Customers & Health Care Professionals call 1-866-494-2111

Rx Claims: Pharmacy Service Center, PO Box 3598, Scranton PA 18505-0598For Pharmacists Only 800-351-9170

Mask 601 Issue Date: 03/14/13

*117*

�� 00000000 �� DIRECT �� USPS �� John Doe �� 888 N Main St �� Olympia, WA 98502

�� 20130313

�� Thu Mar 14, 2013 @ 05:58:28

�� N

�� 601

Glo

bal H

ealt

h B

en

efi

ts

• PCP selection encouraged• Patients in these Cigna-administered plans use Cigna PPO or Cigna OAP networks in the U.S., as indicated on the back of the card• Network Savings Program logo on back of card indicates out-of-network discounts may apply

11

11

10

13 12

14

10

10

12

12

13

14

14

13

15

1

9

4

8

5

1

8

4

9

9

1

3

Sh

are

d A

dm

inis

trati

on

(S

AR

) C

ign

a C

ho

ice F

un

d® O

pen

Acc

ess

Plu

s

• PCP selection encouraged• Cigna Choice Fund® and medical plan type indicated• Most coinsurance information shown• Coinsurance/deductible is paid directly to the doctor/facility by Cigna using

patient’s available health funds. Explanation of Payment (EOP) will show any remaining amount due from patient

• Cigna Care Network is available

WWW.CIGNA.COMYou may be asked to present this card when you receive care. The card does not guarantee coverage. You must comply with all terms and conditions of the plan. Willful misuse of this card is considered fraud.INPATIENT ADMISSION:Your provider must call the toll-free number listed below to pre-certify the above services. Refer to your plan documents for your pre-certi�cation requirements. Failure to do so may a�ect bene�ts. In an emergency, seek care immediately, then call your primary care doctor as soon as possible for further assistance and directions on follow-up care within ### hours.Coinsurance/deductible is paid directly to the doctor/facility by Cigna using individual’s available health funds.For Pharmacy, call ABC Company 1.800.XXX.XXXX (Not a Cigna Company)For Vision, call ABC Company 1.800.XXX.XXXX (Not a Cigna Company) Send claims to: CAD Name, PO Box XXXX, Anytown, USA 12345-6789TPV Name, PO Box XXXX, Anytown, USA 12345-6789All Others: PO Box XXXX, Anytown, USA 12345-6789Customer Service: 1.800.XXX.XXXX MH/SA: 1.800.XXX.XXXXWe encourage you to use a PCP as a valuable resource and personal health advocate. AWAY FROM HOME CARECat#

Legal entity nameCoverage effective date: MM/DD/CCYY

Group: 1234567Issuer (80840)

ID: U23456789 01Name: John PublicPCP: John Smith PCP Name Ln2PCP Phone: XXX.XXX.XXXX

ID card acct nameRxBIN XXXXXX RxPCN XXXXXXXX

DOI

Choice Fund OA Plus No referral required PCP Visit 15%/20% Specialist 15%/20% Hospital ER 20% Vision Yes Rx 30%/40%/50% Network Coinsurance: In 90%/10% Out 70%/30% Med/Rx deductible applies

Network Savings Program

TPV logo CSN logo

Cigna Care Network

Clientlogo

NSPlogo

• Coinsurance/deductible should not be collected at the time of service unless you have accessed the Cigna Cost of Care Estimator®on the Cigna for Heath Care Professionals website (CignaforHCP.com) to obtain an estimate of the patient’s costs, and provide a copy of the estimate to the patient

• Collecting at the time of service without accessing the Cigna Cost of Care Estimator may result in overpayment and require a refund to the patient

Shar

ed A

dmin

istr

atio

n PP

O

AWAY FROM HOME CARE

You may be asked to present this card when you receive care. The card does not guarantee coverage. You must comply with all terms and conditions of the plan. Willful misuse of this card is considered fraud.INPATIENT ADMISSION:Your provider must call the toll-free number listed below to pre-certify your medical services or bene�ts may be a�ected. Refer to yourplan documents for your plan’s precerti�cation requirements. In an emergency, seek care immediately, then notify Cigna within 48 hours.Mail all non-medical claims and correspondence to: ID card name backSAR fund nameSubmit/mail claims to: Cigna Payor 62308, PO Box 188004, Chattanooga, TN 37422-8004 All other: TPV N&A print linePre-certi�cation: Member Srvc Nu Pharmacy Questions: 1.800.244.6224Eligibility, Bene�t and Claim questions please call: SAR TPA phoneTo access the online provider directory go to www.CignaSharedAdministration.comTo access member pharmacy tools go to www.myCigna.com

Bene�ts are not insured by Cigna HealthCareCat#


Group: 1234567Issuer (80840)

ID: U23456789 01Name: John PublicSThis plan is self-funded by:ID card account nameFund #: SAR FRxBIN Rx Bin RxPCN XXXXXXXXDOI

Provider network:Cigna HealthCare PPO Doctor visit $10 Specialist $20 Coinsurance In-network 90% / 10% Out-of-network 70% / 30% Rx 30% / 40% / 50%

Deductible applies

Clientlogo

TPV logo

Shar

ed A

dmin

istr

atio

n O

AP

AWAY FROM HOME CARE

You may be asked to present this card when you receive care. The card does not guarantee coverage. You must comply with all terms and conditions of the plan. Willful misuse of this card is considered fraud.INPATIENT ADMISSION:Your network provider must call the toll-free number listed below to pre-certify the above services. Refer to your plan documents for your pre-certi�cation requirements. Failure to do so may a�ect bene�ts. In an emergency, seek care immediately, then call your primary care doctor as soon as possible for further assistance and directions on follow-up care within ### hours.Mail all non-medical claims and correspondence to: Fund nameFund address Send claims to: Claims address All others: PO Box XXXX, Anytown, USA 12345-6789Pre-certi�cation: Member Srvc Nu Pharmacy Questions: Pharm NumEligibility, Bene�t and Claim Questions: Please call Payor NumTo access the online provider directory go to www.cignasharedadministration.comTo access member pharmacy tools go to www.mycigna.comWe encourage you to use a PCP as a valuable resource and personal health advocate.

Cat#


Group: 1234567Issuer (80840)

ID: U23456789 01Name: John PublicSPCP: James Smith PCP name Ln2PCP phone: 860-555-1212Fund NameFund #: Fund numberRxBIN XXXXXX RxPCN XXXXXXXXDOI

Open Access Plus No referral required PCP visit $15 Specialist $20 Rx 30% / 40% / 50%

Network coinsurance: In 90% / 10% Out 70% / 30%

Deductible applies

Clientlogo

TPV logo

• PCP selection encouraged• No referrals required• Cigna Care Network is available

11

10

11 12

12

13

13

14

15 17

14

15 17

16

16

11

12

13

14 16

18

6

57

31

8

5

5

7

7

4

4

3

3

1

1

9

4

HM

O o

r PO

S O

pen

Acc

ess

• PCP selection encouraged• No referrals required• HMO Open Access: In-network coverage only, except emergency care• POS Open Access: Offered as an HMO or Network plan; in-network and out-of-network coverage

SAR


Group: 1234567Issuer (80840)

ID: U23456789 01Name: John PublicPCP: James Smith PCP Name Ln2PCP Phone: XXX.XXX.XXXX


DOI

POS (or HMO) Open Access No referral required PCP Visit $15/$25 Specialist $15/$25 Hospital ER $50 Urgent Care $25 Vision Yes Rx $10/20%/40%/100% Rx Indiv Deduct $50 Coinsurance applies

Clientlogo

TPV logoCSN logo

NSPlogo


Cigna Care Network

You may be asked to present this card when you receive care. The card does not guarantee coverage. You must comply with all terms and conditions of the plan. Willful misuse of this card is considered fraud.INPATIENT ADMISSION:Your network provider must call the toll-free number listed below to pre-certify the above services. Refer to your plan documents for your pre-certi�cation requirements. Failure to do so may a�ect bene�ts. In an emergency, seek care immediately, then call your primary care doctor as soon as possible for further assistance and directions on follow-up care within ### hours.

For information about mental health services and coverage, call MHSA Stmt TelMed Group: Sunset Med GroupSend claims to: For pharmacy, call ABC Company 1.800.XXX.XXXX (Not a Cigna Company)For vision, call ABC Company 1.800.XXX.XXXX (Not a Cigna Company) Cigna claims: PO Box XXXX, Anytown, USA 12345-6789TPV name, PO Box XXXX, Anytown, USA 12345-6789CSN name, PO Box XXXX, Anytown, USA 12345-6789Customer service: 1.800.XXX.XXXX MH/SA: 1.800.XXX.XXXX

WWW.CIGNA.COM

Man

ag

ed

Care

Pla

ns:

Op

en

Acc

ess WWW.CIGNA.COM

You may be asked to present this card when you receive care. The card does not guarantee coverage. You must comply with all terms and conditions of the plan. Willful misuse of this card is considered fraud.INPATIENT ADMISSION AND OUTPATIENT PROCEDURES:Your network provider must call the toll-free number listed below to pre-certify the above services. Refer to your plan documents for your pre-certi�cation requirements. Failure to do so may a�ect bene�ts. In an emergency, seek care immediately, then call your primary care doctor as soon as possible for further assistance and directions on follow-up care within ### hours.For pharmacy, call ABC Company 1.800.XXX.XXXX (Not a Cigna Company)For vision, call ABC Company 1.800.XXX.XXXX (Not a Cigna Company) Send claims to: CAD name, PO Box XXXX, Anytown, USA 12345-6789TPV name, PO Box XXXX, Anytown, USA 12345-6789All others: PO Box XXXX, Anytown, USA 12345-6789Customer service: 1.800.XXX.XXXX MH/SA: 1.800.XXX.XXXXWe encourage you to use a PCP as a valuable resource and personal health advocate.

• PCP selection encouraged• No referrals required• Open Access Plus: In-network and out-of-network coverage • Open Access Plus In-network: In-network coverage only, except emergency care

Cat#


Group: 1234567Issuer (80840)

ID: U23456789 01Name: John PublicPCP: James Smith PCP Name Ln2PCP phone: XXX.XXX.XXXX


DOI

Open Access Plus No referral required PCP visit $10/$25 Specialist $10/$25 Hospital ER $50 Urgent care $25 Vision Yes Rx $10/20/30 Network Coinsurance: In 90%/10% Out 70%/30% Med/Rx deductible applies


TPV logoCSN logo

Cigna Care Network

Clientlogo

NSPlogo

Ope

n A

cces

s Plu

sN

etw

ork

Ope

n A

cces

sYou may be asked to present this card when you receive care. The card does not guarantee coverage. You must comply with all terms and conditions of the plan. Willful misuse of this card is considered fraud.INPATIENT ADMISSION:Your provider must call the toll-free number listed below to pre-certify the above services. Refer to your plan documents for your pre-certi�cation requirements. Failure to do so may a�ect bene�ts. In an emergency, seek care immediately, then call your primary care doctor as soon as possible for further assistance and directions on follow-up care within ### hours.

For information about mental health services and coverage, call MHSA Stmt TelMed Group: Sunset Med GroupSend claims to: 123 Main Street, Suite 999, Anytown, USA 12345-6789For Pharmacy, call ABC Company 1.800.XXX.XXXX (Not a Cigna Company)For Vision, call ABC Company 1.800.XXX.XXXX (Not a Cigna Company) Cigna Claims: PO Box XXXX, Anytown, USA 12345-6789TPV Name, PO Box XXXX, Anytown, USA 12345-6789CSN Name, PO Box XXXX, Anytown, USA 12345-6789Customer Service: 1.800.XXX.XXXX MH/SA: 1.800.XXX.XXXX

WWW.CIGNA.COM

• PCP selection encouraged• No referrals required• In-network coverage only, except emergency care

AWAY FROM HOME CARE

5

SAR


Group: 1234567Issuer (80840)



DOI

Network Open AccessNo referral required PCP Visit $10/$25 Specialist $10/$25 Hospital ER $50 Urgent Care $25 Vision Yes Rx $10/20%/40%/100% Rx Indiv Deduct $50 Coinsurance applies


Clientlogo

NSPlogo

TPV logo CSN logo

Cigna Care Network

11

12

13

14

10

11

13

1415

10

10

13

12

12

14

18

18

5

5

18

93

4

7

6

6

7

8

3

41

9

25

7

1

8

4

39

65

• PCP selection encouraged• Cigna Choice Fund® and medical plan type indicated• Most coinsurance information shown• Coinsurance/deductible is paid directly to the doctor/facility by Cigna using

patient’s available health funds. Explanation of Payment (EOP) will show any remaining amount due from patient

• Coinsurance/deductible should not be collected at the time of service unless you have accessed the Cigna Cost of Care Estimator®on the Cigna for Heath Care Professionals website (CignaforHCP.com) to obtain an estimate of the patient’s costs, and provide a copy of the estimate to the patient

• Collecting at the time of service without accessing the Cigna Cost of Care Estimator may result in overpayment and require a refund to the patient

bn

bo

bo

Net

wor

k

• PCP selection required• Referrals required• In-network coverage only, except emergency care

You may be asked to present this card when you receive care. The card does not guarantee coverage. You must comply with all terms and conditions of the plan. Willful misuse of this card is considered fraud.INPATIENT ADMISSION:Your provider must call the toll-free number listed below to pre-certify the above services. Refer to your plan documents for your pre-certi�cation requirements. Failure to do so may a�ect bene�ts. In an emergency, seek care immediately, then call your primary care doctor as soon as possible for further assistance and directions on follow-up care within ### hours.

For information about mental health services and coverage, call MHSA Stmt TelMed Group: Sunset Med GroupSend claims to: 123 Main Street, Suite 999, Anytown, USA 12345-6789For Pharmacy, call ABC Company 1.800.XXX.XXXX (Not a Cigna Company)For Vision, call ABC Company 1.800.XXX.XXXX (Not a Cigna Company) Cigna Claims: PO Box XXXX, Anytown, USA 12345-6789TPV Name, PO Box XXXX, Anytown, USA 12345-6789CSN Name, PO Box XXXX, Anytown, USA 12345-6789Customer Service: 1.800.XXX.XXXX MH/SA: 1.800.XXX.XXXX

WWW.CIGNA.COM

Man

aged

Car

e Pl

ans:

Prim

ary

Care

Phy

sici

ans

HM

O o

r PO

S

• PCP selection required• Referrals required• HMO: In-network coverage only, except emergency care• POS: Offered as an HMO or Network plan; in-network and out-of-network coverage

• PCP selection encouraged• No referral required• LocalPlus: In-network and out-of-network coverage• LocalPlus IN: In-network coverage only, except emergency care

Cat#


Group: 1234567Issuer (80840)

ID: U23456789 01Name: John PublicPCP: John SmithPCP phone: XXX-XXX-XXXXID card acct name

RxBIN Rx Bin RxPCN Rx Contr

DOI

HMO (or POS) PCP visit $15 Specialist $15 Hospital ER $50 Urgent care $25 Vision Yes Rx 41/$20/$40 Rx indiv deduct $50

Coinsurance applies


Clientlogo

NSPlogo

WWW.CIGNA.COMYou may be asked to present this card when you receive care. The card does not guarantee coverage. You must comply with all terms and conditions of the plan. Willful misuse of this card is considered fraud.INPATIENT ADMISSION:Your network provider must call the toll-free number listed below to pre-certify the above services. Refer to your plan documents for your pre-certi�cation requirements. Failure to do so may a�ect bene�ts. In an emergency, seek care immediately, then call your primary care doctor as soon as possible for further assistance and directions on follow-up care within ### hours.

Med group: Sunset Med GroupSend claims to: 123 Main Street, Suite 999, Anytown, USA 12345-678

For pharmacy: Call ABC Company 1.800.XXX.XXXX (Not a Cigna Company)For vision: Call ABC Company 1.800.XXX.XXXX (Not a Cigna Company) Cigna: PO Box XXXXX, Anytown, USA 12345-6789

Member services: 1.800.XXX.XXXX MH/SA: 1.800.XXX.XXXX C

Man

ag

ed

Care

Pla

ns:

Lo

calP

lus®

WWW.CIGNA.COMYou may be asked to present this card when you receive care. The card does not guarantee coverage. You must comply with all terms and conditions of the plan. Willful misuse of this card is considered fraud.INPATIENT ADMISSION AND OUTPATIENT PRECEDURES:Your provider must call the toll-free number listed below to pre-certify the above services. Refer to your plan documents for your pre-certi�cation requirements. Failure to do so may a�ect bene�ts. In an emergency, seek care immediately, then call your primary care doctor as soon as possible for further assistance and directions on follow-up care within EF hours.Coinsurance/deductible is paid directly to the doctor/facility by Cigna using individual’s available health funds.Carve out 1 Prt LineCarve out 2 Prt Line Send claims to: CAD Name, PO Box XXXX, Anytown, USA 12345-6789TPV Name, PO Box XXXX, Anytown, USA 12345-6789All Other: PO Box XXXX, Anytown, USA 12345-6789Customer Service: 1.800.XXX.XXXX MH/SA: 1.800.XXX.XXXXWe encourage you to use a PCP as a valuable resource and personal health advocate. AWAY FROM HOME CARE

Open Access Plus


Group: 1234567Issuer (80840)

ID: U23456789 01Name: John PublicPCP: James Smith Jane SmithPCP Phone: 860.123.4567

ABC12 & Sons CompanyRxBIN XXXXXX RxPCN XXXXXXXX

DOI

LocalPlus No referral required PCP Visit $10 Specialist $15 Hospital ER $50 Urgent Care $25 Vision Yes Rx $10/20/30 Network coinsurance: In 90%/10% Out 70%/30% Med/Rx deductible applies


TPV logo CSN logoClientlogo

NSPlogo

Cat #

bl

OAP#


Group: 1234567Issuer (80840)



DOI

Network PCP Visit $15/$20 Specialist $15/$20 Hospital ER $50 Urgent Care $25 Vision Yes Rx $10/20%/40%/100% Rx Indiv Deduct $50 Coinsurance applies

Clientlogo

TPV logoCSN logo

NSPlogo


Cigna Care Network

11

10

10

1811

12

12

12

13

13

14

13

14 15

18

1

1

57

2

4

39

2

8

1

56

7

4

39

8

9

4

76

Str

ate

gic

Allia

nce

s

AWAY FROM HOME CARE

WWW.CIGNA.COMYou may be asked to present this card when you receive care. The card does not guarantee coverage. You must comply with all terms and conditions of the plan. Willful misuse of this card is considered fraud.INPATIENT ADMISSION:Your network provider must call the toll-free number listed below to pre-certify the above services. Refer to your plan documents for your pre-certi�cation requirements. Failure to do so may a�ect bene�ts. In an emergency, seek care immediately, then call your primary care doctor as soon as possible for further assistance and directions on follow-up care within 48 hours.

Coinsurance/deductible is paid directly to the doctor/facility by Cigna using individual’s available health funds.

For pharmacy: Call ABC Company 1.800.XXX.XXXX (Not a Cigna Company)For vision: Call ABC Company 1.800.XXX.XXXX (Not a Cigna Company) Send claims to: CSN name, PO Box XXXXX, Anytown, USA 12345-6789 All other: PO Box XXXXX, Anytown, USA 12345-6789 Customer service: 1.800.XXX.XXXX MH/SA: 1.800.XXX.XXXX

We encourage you to use a PCP as a valuable resource and personal health advocate. Cat#

Legal entity nameCoverage effective date: MM/DD/CCYYGroup: 1234567Issuer (80840)ID: U23456789 01Name: John PublicPCP: John Smith PCP name Ln2PCP phone: 860.555.1212ID card acct nameRxBIN XXXXXX RxPCN XXXXXXXX

DOI

Open Access Plus No referral required

PCP visit $15 Specialist $30 Hospital ER $50 Urgent care $25 Vision Yes Rx $10/$20/$40/90% Rx indiv deduct $50 Network coinsurance: In 90%/10%


Clientlogo

NSPlogo

TPV / Alliancelogo

CareLinklogo

• PCP selection encouraged

• No PCP selection required• No referrals required• PPO: In-network and out-of-network coverage • EPO: In-network coverage only, except emergency care

Cat#

Legal entity name Coverage effective date: MM/DD/CCYY

Group: 1234567Issuer (80840)

ID: U23456789 01Name: John Public

ID card acct name

RxBIN XXXXXX RxPCN XXXXXXXX

DOI

PPO Dr. visit $10/$25 Specialist $10/$25 Hospital ER $50 Urgent care $25 Vision Yes Rx $10/20/30

Network coinsurance: In 90%/10% Out 70%/30%

Med/Rx deductible appliesNSPlogo


Clientlogo

TPV logoCSN logo

Cigna Care Network

AWAY FROM HOME CARE

WWW.CIGNA.COMYou may be asked to present this card when you receive care. The card does not guarantee coverage. You must comply with all terms and conditions of the plan. Willful misuse of this card is considered fraud.INPATIENT ADMISSION AND OUTPATIENT PROCEDURES:Your network provider must call the toll-free number listed below to pre-certify the above services. Refer to your plan documents for your pre-certi�cation requirements. Failure to do so may a�ect bene�ts. In an emergency, seek care immediately, then call your primary care doctor as soon as possible for further assistance and directions on follow-up care within ### hours.

For pharmacy, call ABC Company 1.800.XXX.XXXX (Not a Cigna Company)For vision, call ABC Company 1.800.XXX.XXXX (Not a Cigna Company) Send claims to: CAD name, PO Box XXXX, Anytown, USA 12345-6789TPV name, PO Box XXXX, Anytown, USA 12345-6789

All others: PO Box XXXX, Anytown, USA 12345-6789

Customer service: 1.800.XXX.XXXX MH/SA: 1.800.XXX.XXXX

Ind

em

nit

y P

lan

s

1

5

bk

You may be asked to present this card when you receive care. The card does not guarantee coverage. You must comply with all terms and conditions of the plan. Willful misuse of this card is considered fraud.INPATIENT ADMISSION:Your provider must call the toll-free number listed below to pre-certify the above services. Refer to your plan documents for your pre-certi�cation requirements. Failure to do so may a�ect bene�ts. In an emergency, seek care immediately, then call your primary care doctor as soon as possible for further assistance and directions on follow-up care within ### hours.

Coinsurance/deductible is paid directly to the doctor/facility by Cigna using individual’s available health funds.

Note: You can reduce your out-of-pocket expenses if you use a Network Savings Program provider. Use of a Network Savings Program provider does not a�ect your bene�t coverage. For help �nding a participating provider, please visit our website, or callthe toll-free number listed on this card.For Pharmacy, call ABC Company 1.800.XXX.XXXX (Not a Cigna Company)For Vision, call ABC Company 1.800.XXX.XXXX (Not a Cigna Company)

Send Claims to: PO Box XXXX, Anytown, USA 12345-6789

Customer Service: 1.800.XXX.XXXX MH/SA: 1.800.XXX.XXXX

WWW.CIGNA.COM

• No PCP selection required• No referrals required• Patient files claims

Cat#


Group: 1234567Issuer (80840)

ID: U23456789 01Name: John Public

ID card acct name

RxBIN XXXXXX RxPCN XXXXXXXX

DOI

Indemnity Rx $10/20%/40%/100% Rx indiv deduct $50 Indiv deduct $300 Family deduct $500 Hospital deduct $200 ER deduct $50 Coinsurance: Medical 80%/20% Med/Rx deductible applies


Clientlogo

NSPlogo

PP

O o

r E

PO

Pla

ns

11

10

11

12

13

14

15

10

10

12

13

14

12

13

14 15

18

57

1

9

5

5

7

7

31

9

1

9 3

4

3

4

6

Cigna,” the “Tree of Life” logo and “GO YOU” are registered service marks of Cigna Intellectual Property, Inc., licensed for use by Cigna Corporation and its operating subsidiaries. All products and services are provided by or through such operating subsidiaries and not by Cigna Corporation. Such operating subsidiaries include Cigna Health and Life Insurance Company, Connecticut General Life Insurance Company, and HMO or service company subsidiaries of Cigna Health Corporation.

591795 q 2014-256 05/14 © 2014 Cigna. Some content provided under license.

MORE WAYS TO ACCESS PATIENT INFORMATION WHEN YOU NEED IT

USE OUR ELECTRONIC TOOLS• LogintotheCignaforHealthCareProfessionalswebsite(CignaforHCP.com)

• Connecttousthroughelectronicdatainterchange(EDI):visitCigna.com/EDIVendorstolearnmore

• Callourautomatedphonesystem1.800.88Cigna(882.4462)

CONDUCT ADMINISTRATIVE TRANSACTIONS ELECTRONICALLYCigna’sconvenienteServicestoolshelpyoumanagetheadministrativedetailsofhealthcare.

• Accesspatienteligibilityandbenefits

• Estimatepatientout-of-pocketcosts

• Viewandsubmitprecertificationrequests

• Checkclaimstatus

• Enrollonlineforelectronicfundstransfer(EFT),thenview,print,andshareonlineremittancereportsthesamedayyoureceiveelectronicpayments

• Receiveelectronicremittanceadviceandautomaticallyloadittoyouraccountsreceivablesystem

• Submitquestionsaboutfeeschedulesandspecificpatientbenefits

LEARN MOREToaccessoureducationalresources,logintoCignaforHCP.com>Resources>eCoursesforcoursesaboutEDI,eligibility&benefits,estimatingpatientoutofpocketcosts,precertification,electronicclaimsubmission,claimstatusinquiry,enrollinginandmanagingEFT,onlineremittancereports,andmore.

Documents

QUICK GUIDE TO CIGNA ID CARDS - Center Care · 2 GWH-Cigna Plans • PCP selection encouraged • No referrals required • GWH-Cigna ID cards represent all products XYZ Company RXBIN