2018 NO COST-SHARE PREVENTIVE MEDICATIONS

1 At Cigna, your health and well-being is important to us. We want you to live life to the fullest. Taking your PREVENTIVE MEDICATIONS regularly can help you get and stay NO COST-SHARE PREVENTIVE MEDICATIONSby drug categoryHealth care reform requires coverage of certain PREVENTIVE MEDICATIONS at no COST-SHARE to youHealth care reform under the Patient Protection and Affordable Care Act (PPACA) requires plans to cover certain PREVENTIVE MEDICATIONS and products at 100%, or no COST-SHARE ($0) to you.* The PREVENTIVE Services Task Force and the Institute of Medicine provides guidance on which drug classes should be covered. These recommendations are meant to help prevent disease, as well as meet women s unique health care needs.

2 PREVENTIVE medication coverage This drug list shows the prescription MEDICATIONS and over-the-counter medicines (available without a prescription) and products available to you at no COST-SHARE (copay, coinsurance and/or deductible). This list is updated as the PREVENTIVE Services Task Force makes new recommendations. You should log into or check your plan materials to learn more about how your plan covers PREVENTIVE MEDICATIONS . You can also use the Drug cost tool to estimate how much your MEDICATIONS may exemptions to the coverage of contraceptivesPPACA allows certain employers to exclude contraceptives from coverage due to religious beliefs. If you re a woman with medical coverage though one of these employers, Cigna will let you know that your plan does not cover these MEDICATIONS .

3 Where required by law, Cigna will offer to pay for your contraceptives and/or certain MEDICATIONS at no extra cost to you (if you choose). This coverage is private and confidential and isn t administered, funded by or connected in any way to your employer s health the right PREVENTIVE medicationThere are many PREVENTIVE MEDICATIONS covered under PPACA. You should talk with your doctor to find out which medication or product may be right for you. If your doctor feels a certain contraceptive medication or smoking cessation medication on this list isn t right for you, ask your doctor to call us. Together, we ll look for other MEDICATIONS and products (not on this list) that may be available at no COST-SHARE to you.

4 For PREVENTIVE MEDICATIONS (including over-the-counter medicines) to be covered, you ll need to get a prescription from your doctor.* The no- cost share PREVENTIVE coverage under the Affordable Care Act remains in effect at this time. Should health care reform change, we will review the guidance at that by: Cigna Health and Life Insurance Company, Connecticut General Life Insurance Company or their affiliates. 855125 l 08/17 This drug list shows the prescription MEDICATIONS and over-the-counter medicines and products available to you at no COST-SHARE under PPACA. This list is updated as the PREVENTIVE Services Task Force makes new ProductsAscriptinAspir 81aspirinaspirin ECAspir-lowBayer chewable aspirinbuffered aspirinBufferinchildren s aspirinEcotrinEcPirinLite Coat Aspirinlow-dose aspirin ECtri-buffered aspirinBreast Cancer Prevention Available to femalesraloxifenetamoxifenBarrier ContraceptionAvailable to femalesCaya ContouredConceptrolFC2 Female CondomFemcapGynol IIToday Contraceptive SpongeVCFWide Seal DiaphragmBowel Prep Products for Colorectal Cancer ScreeningsAvailable to males and females 50 75 years of ageAlophen bisacodyl Bisa-laxClearlaxColyte With Flavor PacketsCorrectolDucodylDulcolax GavilaxGavilyte-CGavilyte-GGavilyte-NGen tle

5 LaxativeGentlelaxGialaxGlycolaxGoLytelyH ealthylaxLaxaclearlaxative tabletMiralaxMoviprepNatura-laxNulytely With Flavor PacksOsmopreppeg 3350peg 3350-electrolytepeg 3350 with flavor packspeg-prepPowderlaxPrepopikPurelaxSmo othlaxSuprepTriLyte with flavor packetswomen s laxativeCholesterol MEDICATIONS +Available to males and females 40-75 years of ageatorvastatin 10mg, 20mg fluvastatin 20mg, 40mg fluvastatin ER 80mg lovastatin 20, 40mg pravastatin 10mg, 20mg, 40mg, 80 mgrosuvastatin 5mg, 10mg simvastatin 10 mg, 20mg, 40 mgEmergency ContraceptionAvailable to femalesAfteraEcontra EZEllaFallback sololevonorgestrelMy WayNext Choice One DoseOpcicon One-StepOption 2 ReactTa ke Ac tio nHormonal Contraception^*Available to femalesAltaveraAlyacenAmethiaAmethia LOApriAranelleAshlynaAubraAvianeAzurette BalzivaBekyreeBlisovi 24 FEBlisovi FEBriellynCamilaCamreseCamrese loCaziantChatealCryselleCyclafemCyredDas ettaDayseeDeblitaneDelyladesogestrel-eth inyl estradioldesogestr-eth estrad eth estradrospirenone-eth estra-levomefdrospirenone-ethinyl estradiolElinestEmoquetteEnpresseEnskyce ErrinEstaryllaethynodiol-ethinyl estradiolFalminaFayosim+ For plans renewing on or after November 1, 2017, these MEDICATIONS are covered at no cost ($0)

6 As PREVENTIVE MEDICATIONS under the Patient Protection and Affordable Care Act (PPACA). This means that, as of your plan s renewal date, you won t pay any money to fill a prescription for these MEDICATIONS . PPACA coverage requirements do not apply to all plans; for those plans, you ll have to pay your plan s PREVENTIVE COST-SHARE to fill these MEDICATIONS . To find out how your plan covers PPACA PREVENTIVE MEDICATIONS , log into and use the Drug cost tool or check your plan Contraception^* (continued)FemynorGianviGildagiaHeatheri ntrovaleIsibloomJencyclaJolessaJolivette JuleberJunelJunel FEJunel FE 24 Kaitlib FEKarivaKelnor 1-35 KimidessKurveloLarinLarin 24 FELarin FELarissiaLayolis FELeenaLessinalevonestlevonorgestrel-eth estradiollevonorg-eth estrad eth estradLevora-28 Lomedia 24 FELorynalow-ogestrelLuteraLyzaMarlissaMi belas 24 FEMicrogestinMicrogestin 24 FEMicrogestin FEMono-LinyahMononessaMyzilraNeconNikkiN ora-benorethindronenorethindron-ethinyl estradiolnorethin-eth estra-ferrous fumnorgestimate-ethinyl estradiolNorlydaNorlyrocNortrelOcellaOrs ythiaPhilithPimtreaPirmellaPortiaPrevife mQuasenseRajaniReclipsenRivelsaSetlakinS harobelSprintecSronyxSyedaTa rin a FETilia FETri FemynorTri-EstaryllaTri-Legest

7 FETri-LinyahTri-Lo-EstaryllaTri-Lo-Marzi aTri-Lo-SprintecTrinessaTrinessa LOTri-PrevifemTri-SprintecTrivora-28 VelivetVesturaVienvaVioreleVyfemlaWeraWy mzya FEXulaneZarahZenchentZenchent FEZovia 1-35eZovia 1-50e^ If your doctor feels these MEDICATIONS aren t right for you, ask him/her to call us. There may be other brands available at no COST-SHARE to you* Generic hormonal contraceptives are available at no COST-SHARE to you, even though they may not be listed hereFall Prevention/Vitamin D SupplementationAvailable to adults 65 years of age and older to prevent fallsBaby D DropsBaby vitamin D3D3-2000D3-50D dropsDecaraDelta D3 Dialyvite Vitamin D3 MaxD-vi-solD-vitaJust DKids vitamin D3 Maximum D3 Optimal D3 Optimal D3 MReplestaReplesta NXSuper Daily D3 Thera-DVitajoy daily Dvitamin Dvitamin D3vitamin D-400 Folic Acid SupplementationAvailable to females (Only includes products containing mg mg of folic acid)

8 Daily prenatalFA-8folic acidKPNOne daily prenatalPerry PrenatalPrenatalPrenatal completePrenatal formulaPrenatal Formula-DHAP renatal multi + DHAP renatal multivitaminPrenatal multivitamin-DHAP renatal vitaminRight Step prenatal vitaminsUrosexCigna reserves the right to make changes to this drug list without notice. Your plan may cover additional MEDICATIONS ; please refer to your enrollment materials for details. Cigna does not take responsibility for any medication decisions made by the doctor or pharmacist. Cigna may receive payments from manufacturers of certain preferred brand MEDICATIONS , and in limited instances, certain non-preferred brand MEDICATIONS , that may or may not be shared with your plan depending on its arrangement with Cigna.

9 Depending upon plan design, market conditions, the extent to which manufacturer payments are shared with your plan and other factors as of the date of service, the preferred brand medication may or may not represent the lowest- cost brand medication within its class for you and/or your benefit plans vary, but in general to be eligible for coverage a drug must be approved by the Food and Drug Administration (FDA), prescribed by a health care professional, purchased from a licensed pharmacy and medically necessary. If your plan provides coverage for certain prescription drugs with no COST-SHARE , you may be required to use an in-network pharmacy to fill the prescription. If you use a pharmacy that does not participate in your plan s network, your prescription may not be covered, or reimbursement may be limited by your plan s copayment, coinsurance or deductible requirements.

10 Certain features described in this document may not be applicable to your specific health plan, and plan features may vary by location and plan type. Refer to your plan documents for costs and complete details of your plan s prescription drug Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company (CHLIC), Connecticut General Life Insurance Company, Tel-Drug, Inc., Tel-Drug of Pennsylvania, , and HMO or service company subsidiaries of Cigna Health Corporation, including Cigna HealthCare of Arizona, Inc., Cigna HealthCare of California, Inc., Cigna HealthCare of Colorado, Inc., Cigna HealthCare of Connecticut, Inc.