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1 CIGNA ANNUAL REPORT | 2020 SHAREHOLDER LETTER1A MESSAGE FROM OUR PRESIDENT AND CEO David CordaniBy all accounts, 2020 was an extraordinary year. The health crisis, social unrest and political tensions that unfolded could have each defined a year in their own right; together they converged to create one of the most unsettling periods in modern history. Families and communities were rocked by fear, uncertainty, pain, loss and sorrow. It was a year that many of us hope to never see repeated. However, as I reflect back, I cannot help but also see the bright spots that were part of the picture: the valuable lessons many of us learned about compassion and empathy; the medical advances that led to the development of vaccines at a pace never before seen in human history; the joining together of countless voices worldwide to demand a more equitable and equal society.

2 And the remarkable resilience shown by so many in the midst of the year s relentless a global health leader, Cigna navigated 2020 by staying focused on meeting and balancing the needs of those we serve and on keeping our promises. This meant: Keeping our purpose to improve people s lives by delivering health, well-being and peace of mind front and center and taking meaningful steps throughout the year to fulfill this promise; Taking decisive action to support our clients, customers, patients, partners and communities in the wake of the global pandemic; 1 Speaking out against racism and reaffirming our commitment to diversity, inclusion, equity and equality, including by launching our Building Equity and Equality Program.

3 2 and Delivering on our financial commitments to our shareholders by growing our adjusted revenue by 14%, to $160 billion, and delivering adjusted earnings per share of $ consistent with our overall , 4 You can see the complete summary of our 2020 accomplishments on the following couldn t be more proud of the way our more than 70,000 colleagues around the globe showed up every day to ask what more they could do to be a force for positive change, both inside and outside our company. The results they achieved, for the benefit of our stakeholders, are a testament to their dedication and flexibility.

4 It is a privilege to lead such an extraordinary and caring HEALTH CARE MORE AFFORDABLE IS A TOP PRIORITY AROUND THE GLOBE Health care costs continue to rise as populations age and become sicker. In addition, in the United States, pharmacological interventions are exploding at a rate and pace that far exceeds the growth of surgical and medical device interventions with spending on pharmaceuticals increasing 26% per capita from 2014 to That growth continues today with many of the preventive, curative and treatment innovations coming from the pharmacy space.

5 One day, hopefully soon, we could see new drugs come to market to treat conditions such as Alzheimer s 2 SHAREHOLDER LETTER disease, heart disease and cancer. But with these advances come elevated costs as many researchers have calculated that expenditures for prescription drugs and other pharmacy services will continue to rise in the next 5 10 years. This underscores the need to bring innovative thinking to the challenge of affordability by, for example, leveraging value-based care to drive access and care coordination, align incentives, and lower costs; dramatically evolving programs for chronic care by eliminating cost barriers to treatment to incentivize 100% drug adherence.

6 And transforming business models to drive predictability and affordability for high-cost Cigna, affordability will continue to be our number one focus in 2021 as we recognize that individuals and companies alike need affordable solutions that enable them to achieve optimal health. Finding innovative ways to help them do that is the central underpinning of our overall THE STIGMA OUT OF MENTAL HEALTHWe all know that 2020 has taken a toll on the mental well-being of many across the country. Many people are feeling more isolated and lonely, and parents are feeling the stress of managing kids virtual homeschooling while trying to put in a day s work.

7 Studies have shown surging rates of anxiety and depression amid the At the same time, Americans are less equipped than ever to recover from these difficulties. Cigna s 2020 Resilience Index found that resilience is at risk for more than 60% of Americans and the most affected group is young adults age 18 23, the same group that self-classified as the loneliest generation in earlier studies we , there is greater recognition of the link between mental and physical health with the World Health Organization stating that there is no health without mental health.

8 8 This proclamation is backed by science showing that perceived stress is a risk factor for illnesses such as type 2 diabetes and heart disease and that someone with a chronic medical condition is seven times more likely to have an underlying mental health or substance-related the same time, the stigma associated with mental health persists, and those who most need help may be reluctant to seek treatment. At Cigna, our goal is to ensure that our customers and patients receive the behavioral health services they need.

9 With the largest virtual behavioral health network in the United States, we were well positioned to respond when demand for behavioral health services rose dramatically in 2020. Still, we continued to grow our virtual network throughout the year, increasing it by 150% to include more than 52,000 TECHNOLOGY AND DATA TO ENHANCE ACCESS TO AND PERSONALIZATION OF HEALTH virtual care was widely embraced in 2020, but it s just the tip of the iceberg in terms of what s possible. Technology is enabling people to become more involved in their health than ever before, and it is a key driver of the expansion of home-based care, thanks to innovations such as smart glucometers, which remotely monitor the blood sugar levels of patients with diabetes.

10 Studies have long demonstrated that innovations like these can reduce the need for hospital care and thus the costs for patients managing a chronic This type of rapid innovation will enable the delivery of more personalized care to address what people want and need, delivered where and how they want to receive believe that this type of care will also play an important role in rooting out health disparities from our health care system by expanding access to affordable care and treatment that breaks through cultural, social or geographic barriers.