QUICK GUIDE TO CIGNA ID CARDS - Center Care

1 591795 q 05/14 THN-2014-256 QUICK GUIDE TO CIGNA ID CARDS2014-2015WE PACK A LOT OF IMPORTANT INFORMATION ON OUR ID CARDS . This brochure can help define and clarify information that appears on CIGNA s most common customer ID CARDS . It can also help you understand the requirements associated with our various plans, allowing you to quickly and efficiently serve your may occasionally update this brochure during the year. Download the most current version at > Health care Professionals > Resources > Doing Business with NOTE: There are various standard CIGNA ID CARDS shown in this brochure that are subject to regulatory oversight. As a result, the actual ID card content may vary in order to conform to legislative and regulatory requirements. The ID CARDS shown are samples and may vary from the actual GUIDE TO CIGNA ID CARDSR efer to this key for explanations of the information found on the sample CIGNA ID CARDS featured in this Use this ID number for all claims and Indicates a seamless network where a patient can receive in-network care on a regional or statewide For patients with coinsurance, submit claims to CIGNA or its designee, and receive an Explanation of Payment (EOP), which will show any remaining amount due from Collect any copayment at the time of May read as Connecticut General Life Insurance Co.

2 , CIGNA Health and Life Insurance Company or CIGNA HealthCare of XXXX, Inc. 6 ID CARDS with the CIGNA care Network logo indicate the patient s liability varies based on the health care professional s CIGNA care designation status. Refer to the online health care professional directory to determine a physician s CIGNA care designation Effective date of Name of patient s primary care physician (PCP).9 Network Savings Program (NSP) logo indicates that out-of-network discounts may be available to the Client If a third party administers services in conjunction with CIGNA , the ID card may include multiple logos and may show a different claim address or telephone number on the back of the Precertification requirements may be shown as either Inpatient Admission or Inpatient Admission and Outpatient Procedures.

3 13 Submit claims to the claim submission address shown on the Call the Customer Service number(s) indicated on the card. Some plans have dedicated numbers for accessing information be sure to check the card for the correct Away From Home care indicates the patient has access to the CIGNA national Indicates Shared Union Client-specific network (CSN) CARDS Quickly view ID card information (front and back) for the entire family Easily print, email or scan right from smartphone Health care professional directory Locate doctors and health care facilities Access maps for instant driving directionsHealth wallet Store and organize all contact info for doctors, hospitals and pharmacies Add health care professionals to contact list right from a claim or directory searchClaims View and search recent and past claims Bookmark and organize claims for easy referenceTrackers View in-network and out-of-network medical and dental year-to-date deductibles, as well as out-of-pocket and annual maximumsCoverage See plan coverage and benefit information for medical, dental.

4 Pharmacy Access and view health fund balances Review plan deductibles and coinsuranceDrug search Compare prescription drug costs at more than 60,000 pharmacies nationwide Find closest pharmacy location using GPSTHE MYCIGNA MOBILE APP: APP-SOLUTELY CONVENIENTThe myCigna Mobile App gives customers a simple way to personalize, organize and access their important health and benefits information on the go. CIGNA customers may present their ID card information, claims information and coverage eligibility to you via the app with their cell phone or : Customers can get the free myCigna Mobile App from the App StoreSMor Google PlayiOS Apple version or higherAndroid OS version or higherThe Apple logo is a trademark of Apple Inc., registered in the and other countries. App Store is a service mark of Apple Inc. | Android and Google Play are trademarks of Google Inc.

5 *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 GWH- CIGNA Plans PCP selection encouraged No referrals required GWH- CIGNA ID CARDS represent all productsXYZ CompanyRXBIN 600428 RXPCN 05180000 Issuer 80840 Group Plan 123456789 John PublicID 123456789 01 COPAY:Primary care $30 Specialist $40 Urgent care $65 PCP: None SelectedNo Referral RequiredFor plan & benefit details, please visit All Claims To1000 Great-West DriveKennett, MO 63857-3749 Payer ID #62308 Members and Providers Call1-866-494-2111 GWH-CIGNAOpen Access PlusER $200 Plan TypeXYZ CompanyIIN 600428 Control 05180000 Issuer 80840 Group Plan 00654321 Member FiveID 100000005 COPAY:Primary care $30 Specialist $40 Urgent care $65 Preventive care $20 PCP: None SelectedNo Referral RequiredFor plan & benefit details, please visit Contractor.

6 Connecticut General Life Insurance CompanySubmit All Claims To1000 Great- West DriveKennett, MO 63857-3749 Payer ID #80705 Members and Providers Call1-866-494-2111 GWH-CIGNAOpen Access PlusMembers: 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.

7 Your plan is paired with the GWH- CIGNA network. To find a GWH- CIGNA provider, please visit your member website at For Pharmacists Only 1-800-XXX-XXXXR318 (5/10)Mask 401 For providers not in your primary network, visit : 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. 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 Date: 01/01/12 GWH-CignaPlan Type PCP selection encouraged No referrals required GWH- CIGNA ID CARDS represent all products NameJohnDoeCignaHealthand Life InsuranceCompanyGroup00699998 Issuer(80840)ID100000008 PCPNoneSelectedNo $25 Specialist$25 UrgentCare $100ER $200030409116687000000000010000001072711 7>0000019116687001003040 RUN_DATE 20130314 05:58:28 DATA_SEQ_NO 0000001 CLIENT_NUMBER 003040 UHG_TYPE DIG1 CARDDOC_ID 9116687/000001-00 DOC_ID 9116687/000001-01 DOC_ID 9116687/000001-02 DOC_SEQ_ID 0000001 NAME Doe ,JohnMAILSET_NUMBER 0000001 CUST_KEY1 00699998 CUST_KEY2 100000008 CUST_KEY3 00 CUST_KEY4 JohnCUST_KEY5 CUST_KEY6 DoeWhatdoesit mean?

8 Yourshareofthepaymentforhealthcareservic esmaybe baseduponour agreementwithy oufor amountsup to the provider'sregularbilledcharges.' CIGNA 'is aregisteredservicemark,and the 'Treeof Life'isaservicemark,of CignaIntellectualProperty,Inc.,licensedf or use by CignaCorporationand its productsand services areprovidedby or throughsuch operatingsubsidiariesandnot by InsuranceCompany,CignaHealthand Life InsuranceCompany,CignaHealthManagement,I nc. and CignaDentalHealth,Inc. The CignaDentalPPOis underwrittenor administeredby ConnecticutGeneralLIfe InsuranceCompanyorCignaHealthand Life InsuranceCompanywith networkmanagementservicesprovidedby CignaDentalHealth,Inc.,and certainof its ClaimsTo1000 Great-WestDrive Kennett,MO63857-3749 Payer ID #62308 Customers&HealthCareProfessionalscall 1-866-494-2111Rx Claims:PharmacyServiceCenter,PO Box 3598,ScrantonPA 18505-0598 For PharmacistsOnly800-351-9170 Mask601 IssueDate:03/14/13*117* 00000000 DIRECT USPS JohnDoe 888 N MainSt Olympia,WA98502 20130313 Thu Mar 14, 2013@ 05:58:28 N 601 NameJohnDoeCignaHealthand Life InsuranceCompanyGroup00699998 Issuer(80840)ID100000008 PCPNoneSelectedNo $25 Specialist$25 UrgentCare $100ER $200030409116687000000000010000001072711 7>0000019116687001003040 RUN_DATE 20130314 05:58.

9 28 DATA_SEQ_NO 0000001 CLIENT_NUMBER 003040 UHG_TYPE DIG1 CARDDOC_ID 9116687/000001-00 DOC_ID 9116687/000001-01 DOC_ID 9116687/000001-02 DOC_SEQ_ID 0000001 NAME Doe ,JohnMAILSET_NUMBER 0000001 CUST_KEY1 00699998 CUST_KEY2 100000008 CUST_KEY3 00 CUST_KEY4 JohnCUST_KEY5 CUST_KEY6 DoeWhatdoesit mean? Yourshareofthepaymentforhealthcareservic esmaybe baseduponour agreementwithy oufor amountsup to the provider'sregularbilledcharges.' CIGNA 'is aregisteredservicemark,and the 'Treeof Life'isaservicemark,of CignaIntellectualProperty,Inc.,licensedf or use by CignaCorporationand its productsand services areprovidedby or throughsuch operatingsubsidiariesandnot by InsuranceCompany,CignaHealthand Life InsuranceCompany,CignaHealthManagement,I nc. and CignaDentalHealth,Inc. The CignaDentalPPOis underwrittenor administeredby ConnecticutGeneralLIfe InsuranceCompanyorCignaHealthand Life InsuranceCompanywith networkmanagementservicesprovidedby CignaDentalHealth,Inc.

10 ,and certainof its ClaimsTo1000 Great-WestDrive Kennett,MO63857-3749 Payer ID #62308 Customers&HealthCareProfessionalscall 1-866-494-2111Rx Claims:PharmacyServiceCenter,PO Box 3598,ScrantonPA 18505-0598 For PharmacistsOnly800-351-9170 Mask601 IssueDate:03/14/13*117* 00000000 DIRECT USPS JohnDoe 888 N MainSt Olympia,WA98502 20130313 Thu Mar 14, 2013@ 05:58:28 N 601 Global Health Benefits PCP selection encouraged Patients in these CIGNA -administered plans use CIGNA PPO or CIGNA OAP networks in the , as indicated on the back of the card Network Savings Program logo on back of card indicates out-of-network discounts may apply11111013121410101212131414131519485 1849913 Shared Administration (SAR) CIGNA Choice Fund Open Access Plus 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.