quick guide to cigna id cards · • pcp selection encouraged • no referrals required •...
TRANSCRIPT
591795 p 11/13
QUICK gUIde to CIgna Id Cards
2013
WE PACk A LOT OF IMPORTANT INFORMATION INTO OUR ID CARDS. ThisbrochurecanhelpdefineandclarifyinformationthatappearsonCigna’smostcommoncustomerIDcards.Itcanalsohelpyouunderstandtherequirementsassociatedwithourvariousplans,allowingyoutoquicklyandefficientlyserveyourpatients.
Wemayoccasionallyupdatethisbrochureduringtheyear.DownloadthemostcurrentversionatCigna.com>HealthCareProfessionals>ResourcesforHealthCareProfessionals>DoingBusinesswithCigna.
PLEASE NOTE: TherearevariousstandardCignaIDcardsshowninthisbrochurethataresubjecttoregulatoryoversight.Asaresult,theactualIDcardcontentmayvaryinordertoconformtolegislativeandregulatoryrequirements.TheIDcardsshownaresamplesandmayvaryfromtheactualcards.
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.
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• 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
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Mask 601 Issue Date: 03/14/13
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• 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
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• 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-certification requirements. Failure to do so may affect benefits. 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 12345-6789
All Others: PO Box XXXX, Anytown, USA 12345-6789
Customer 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 CARE850702
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 600428 RxPCN 02150000
DOI
Choice Fund Open Access 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
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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#
Legal entity nameCoverage effective date: MM/DD/CCYY
Group: 1234567Issuer (80840)
ID: U23456789 01Name: John PublicSThis plan is self-funded by:ID card account nameFund #: SAR FRxBIN Rx Bin RxPCN 02150000DOI
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
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OA
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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-certification requirements. Failure to do so may affect benefits. 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-certification: Member Srvc Nu Pharmacy Questions: Pharm NumEligibility, Benefit 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#
Legal entity nameCoverage effective date: MM/DD/CCYY
Group: 1234567Issuer (80840)
ID: U23456789 01Name: John PublicSPCP: James Smith PCP name Ln2PCP phone: 860-555-1212Fund NameFund #: Fund numberRxBIN 600428 RxPCN 02150000DOI
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
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• 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
Legal entity nameCoverage effective date: MM/DD/CCYY
Group: 1234567Issuer (80840)
ID: U23456789 01Name: John PublicPCP: James Smith PCP Name Ln2PCP Phone: XXX.XXX.XXXX
ID card acct nameRxBIN 600428 RxPCN 02150000
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
Network Savings Program
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-certification requirements. Failure to do so may affect benefits. 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 Tel
Med 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 12345-6789
Customer 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-certification requirements. Failure to do so may affect benefits. 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.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#
Legal entity nameCoverage effective date: MM/DD/CCYY
Group: 1234567Issuer (80840)
ID: U23456789 01Name: John PublicPCP: James Smith PCP Name Ln2PCP phone: XXX.XXX.XXXX
ID card acct nameRxBIN 600428 RxPCN 02150000
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
Network Savings Program
TPV logoCSN logo
Cigna Care Network
Clientlogo
NSPlogo
Op
en A
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etw
ork
Op
en 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-certification requirements. Failure to do so may affect benefits. 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 Tel
Med 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 12345-6789
Customer 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
Legal entity nameCoverage effective date: MM/DD/CCYY
Group: 1234567Issuer (80840)
ID: U23456789 01Name: John PublicPCP: James Smith PCP Name Ln2PCP Phone: XXX.XXX.XXXX
ID card acct nameRxBIN 600428 RxPCN 02150000
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
Network Savings Program
Clientlogo
NSPlogo
TPV logo CSN logo
Cigna Care Network
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• 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
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• 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-certification requirements. Failure to do so may affect benefits. 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 Tel
Med 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 12345-6789
Customer Service: 1.800.XXX.XXXX MH/SA: 1.800.XXX.XXXX
WWW.CIGNA.COM
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• 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
• No referral required• LocalPlus: In-network and out-of-network coverage• LocalPlus IN: In-network coverage only, except emergency care
Cat#
Legal entity nameCoverage effective date: MM/DD/CCYY
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
Network Savings Program
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-certification requirements. Failure to do so may affect benefits. 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
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-certification requirements. Failure to do so may affect benefits. 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 12345-6789
All Other: PO Box XXXX, Anytown, USA 12345-6789
Customer 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
Legal entity nameCoverage effective date: MM/DD/CCYY
Group: 1234567Issuer (80840)
ID: U23456789 01Name: John PublicPCP: James Smith Jane SmithPCP Phone: 860.123.4567
ABC12 & Sons CompanyRxBIN 600428 RxPCN 02150000
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
Network Savings Program
TPV logo CSN logoClientlogo
NSPlogo
Cat #
bl
OAP#
Legal entity nameCoverage effective date: MM/DD/CCYY
Group: 1234567Issuer (80840)
ID: U23456789 01Name: John PublicPCP: James Smith PCP Name Ln2PCP Phone: XXX.XXX.XXXX
ID card acct nameRxBIN 600428 RxPCN 02150000
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
Network Savings Program
Cigna Care Network
11
10
10
1811
12
12
12
13
13
14
13
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18
1
1
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2
4
39
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• No PCP selection required• No referrals required• In-network and out-of-network coverage
2012 Starbridge - CIGNA HealthCare PPO
2012 Starbridge - Beech Street
012412
2012 FundamentalCare - CIGNA HealthCare PPO
SM
SM
SM
A V I A N T N E T W O R K
Send Claims to: TPV / Alliance Mailing Address
All others to: CIGNA HealthCare, P.O. Box 188004, Chattanooga, TN 37422 Payor 62308
Customer Service: 1.800.XXX.XXXX CIGNA 24-hour Nurseline: 1.866.XXX.XXXX
AWAY FROM HOME CARE
Provider: Participant is enrolled in a limited-benefit plan. For hospital services, collect patientresponsibility when service is rendered or make financial arrangements with the patient in accordance with your policies.
You may be asked to present this card when you receive care. The card does not guaranteecoverage. You must comply with all terms and conditions of the plan. Willful misuse of this card isconsidered fraud.This plan does not require pre-certification of coverage for inpatient or outpatient services. Claims willbe paid according to terms and conditions of the plan. In the case of an emergency, seek careimmediately, then call your family physician for further assistance and direction regarding follow up care.
Send Claims to:
Connecticut General Life Insurance Company, PO Box 55270, Phoenix, AZ 85078-5270 Payor 59225
Customer Service: 1.800.XXX.XXXX CIGNA 24-hour Nurseline: 1.866.XXX.XXXX
AWAY FROM HOME CARE
Provider: Participant is enrolled in a limited-benefit plan. For hospital services, collect patientresponsibility when service is rendered or make financial arrangements with the patient in accordance with your policies.
You may be asked to present this card when you receive care. The card does not guaranteecoverage. You must comply with all terms and conditions of the plan. Willful misuse of this card isconsidered fraud.This plan does not require pre-certification of coverage for inpatient or outpatient services. Claims willbe paid according to terms and conditions of the plan. In the case of an emergency, seek careimmediately, then call your family physician for further assistance and direction regarding follow up care.
Send Claims to: TPV / Alliance Mailing Address
All others to: CIGNA HealthCare, P.O. Box 188004, Chattanooga, TN 37422 Payor 62308
Customer Service: 1.800.XXX.XXXX CIGNA 24-hour Nurseline: 1.866.XXX.XXXX
AWAY FROM HOME CARE
Provider: Participant is enrolled in a limited-benefit plan. For hospital services, collect patientresponsibility when service is rendered or make financial arrangements with the patient in accordance with your policies.
You may be asked to present this card when you receive care. The card does not guaranteecoverage. You must comply with all terms and conditions of the plan. Willful misuse of this card isconsidered fraud.This plan does not require pre-certification of coverage for inpatient or outpatient services. Claims willbe paid according to terms and conditions of the plan. In the case of an emergency, seek careimmediately, then call your family physician for further assistance and direction regarding follow up care.
Coverage Effective Date: 00/00/0000
ID: AMI
Name: Name
Account Number: 2466518
Group Name:Group Number:
Doctor Visit $25Specialist $25Network Coinsurance:
In 80%/20%Out 80%/20%
www.starbridge.comPrimary Network: CIGNA HealthCare PPOSecondary Network: Beech StreetConnecticut General Life Insurance Company
TPV / AllianceLogo
www.starbridge.com
A V I A N T N E T W O R K
Doctor Visit $25Specialist $25Network Coinsurance:
In 80%/20%Out 80%/20%
www.starbridge.comPrimary Network: Beech StreetConnecticut General Life Insurance Company
Coverage Effective Date: 00/00/0000
ID: Use Primary Insured’s Social Security Number
Name: Name
Group Name:Group Number:
For Benefits, Claim Status, Eligibility or Customer Service, Call 1-8XX-XXX-XXXX
Coverage Effective Date: 00/00/0000
ID: AMI
Name: Name
Account Number: 2466518
Group Name:Group Number:
Doctor Visit $25Specialist $25Network Coinsurance:
In 80%/20%Out 80%/20%
www.fundamentalcare.com
A V I A N T N E T W O R K
Primary Network: CIGNA HealthCare PPOSecondary Network: Beech StreetConnecticut General Life Insurance Company
TPV / AllianceLogo
2012 Starbridge - CIGNA HealthCare PPO
2012 Starbridge - Beech Street
012412
2012 FundamentalCare - CIGNA HealthCare PPO
SM
SM
SM
A V I A N T N E T W O R K
Send Claims to: TPV / Alliance Mailing Address
All others to: CIGNA HealthCare, P.O. Box 188004, Chattanooga, TN 37422 Payor 62308
Customer Service: 1.800.XXX.XXXX CIGNA 24-hour Nurseline: 1.866.XXX.XXXX
AWAY FROM HOME CARE
Provider: Participant is enrolled in a limited-benefit plan. For hospital services, collect patientresponsibility when service is rendered or make financial arrangements with the patient in accordance with your policies.
You may be asked to present this card when you receive care. The card does not guaranteecoverage. You must comply with all terms and conditions of the plan. Willful misuse of this card isconsidered fraud.This plan does not require pre-certification of coverage for inpatient or outpatient services. Claims willbe paid according to terms and conditions of the plan. In the case of an emergency, seek careimmediately, then call your family physician for further assistance and direction regarding follow up care.
Send Claims to:
Connecticut General Life Insurance Company, PO Box 55270, Phoenix, AZ 85078-5270 Payor 59225
Customer Service: 1.800.XXX.XXXX CIGNA 24-hour Nurseline: 1.866.XXX.XXXX
AWAY FROM HOME CARE
Provider: Participant is enrolled in a limited-benefit plan. For hospital services, collect patientresponsibility when service is rendered or make financial arrangements with the patient in accordance with your policies.
You may be asked to present this card when you receive care. The card does not guaranteecoverage. You must comply with all terms and conditions of the plan. Willful misuse of this card isconsidered fraud.This plan does not require pre-certification of coverage for inpatient or outpatient services. Claims willbe paid according to terms and conditions of the plan. In the case of an emergency, seek careimmediately, then call your family physician for further assistance and direction regarding follow up care.
Send Claims to: TPV / Alliance Mailing Address
All others to: CIGNA HealthCare, P.O. Box 188004, Chattanooga, TN 37422 Payor 62308
Customer Service: 1.800.XXX.XXXX CIGNA 24-hour Nurseline: 1.866.XXX.XXXX
AWAY FROM HOME CARE
Provider: Participant is enrolled in a limited-benefit plan. For hospital services, collect patientresponsibility when service is rendered or make financial arrangements with the patient in accordance with your policies.
You may be asked to present this card when you receive care. The card does not guaranteecoverage. You must comply with all terms and conditions of the plan. Willful misuse of this card isconsidered fraud.This plan does not require pre-certification of coverage for inpatient or outpatient services. Claims willbe paid according to terms and conditions of the plan. In the case of an emergency, seek careimmediately, then call your family physician for further assistance and direction regarding follow up care.
Coverage Effective Date: 00/00/0000
ID: AMI
Name: Name
Account Number: 2466518
Group Name:Group Number:
Doctor Visit $25Specialist $25Network Coinsurance:
In 80%/20%Out 80%/20%
www.starbridge.comPrimary Network: CIGNA HealthCare PPOSecondary Network: Beech StreetConnecticut General Life Insurance Company
TPV / AllianceLogo
www.starbridge.com
A V I A N T N E T W O R K
Doctor Visit $25Specialist $25Network Coinsurance:
In 80%/20%Out 80%/20%
www.starbridge.comPrimary Network: Beech StreetConnecticut General Life Insurance Company
Coverage Effective Date: 00/00/0000
ID: Use Primary Insured’s Social Security Number
Name: Name
Group Name:Group Number:
For Benefits, Claim Status, Eligibility or Customer Service, Call 1-8XX-XXX-XXXX
Coverage Effective Date: 00/00/0000
ID: AMI
Name: Name
Account Number: 2466518
Group Name:Group Number:
Doctor Visit $25Specialist $25Network Coinsurance:
In 80%/20%Out 80%/20%
www.fundamentalcare.com
A V I A N T N E T W O R K
Primary Network: CIGNA HealthCare PPOSecondary Network: Beech StreetConnecticut General Life Insurance Company
TPV / AllianceLogo
Fu
nd
am
en
tal C
are
• No PCP selection required• No referrals required• In-network and out-of-network coverage
2012 Starbridge - CIGNA HealthCare PPO
2012 Starbridge - Beech Street
012412
2012 FundamentalCare - CIGNA HealthCare PPO
SM
SM
SM
A V I A N T N E T W O R K
Send Claims to: TPV / Alliance Mailing Address
All others to: CIGNA HealthCare, P.O. Box 188004, Chattanooga, TN 37422 Payor 62308
Customer Service: 1.800.XXX.XXXX CIGNA 24-hour Nurseline: 1.866.XXX.XXXX
AWAY FROM HOME CARE
Provider: Participant is enrolled in a limited-benefit plan. For hospital services, collect patientresponsibility when service is rendered or make financial arrangements with the patient in accordance with your policies.
You may be asked to present this card when you receive care. The card does not guaranteecoverage. You must comply with all terms and conditions of the plan. Willful misuse of this card isconsidered fraud.This plan does not require pre-certification of coverage for inpatient or outpatient services. Claims willbe paid according to terms and conditions of the plan. In the case of an emergency, seek careimmediately, then call your family physician for further assistance and direction regarding follow up care.
Send Claims to:
Connecticut General Life Insurance Company, PO Box 55270, Phoenix, AZ 85078-5270 Payor 59225
Customer Service: 1.800.XXX.XXXX CIGNA 24-hour Nurseline: 1.866.XXX.XXXX
AWAY FROM HOME CARE
Provider: Participant is enrolled in a limited-benefit plan. For hospital services, collect patientresponsibility when service is rendered or make financial arrangements with the patient in accordance with your policies.
You may be asked to present this card when you receive care. The card does not guaranteecoverage. You must comply with all terms and conditions of the plan. Willful misuse of this card isconsidered fraud.This plan does not require pre-certification of coverage for inpatient or outpatient services. Claims willbe paid according to terms and conditions of the plan. In the case of an emergency, seek careimmediately, then call your family physician for further assistance and direction regarding follow up care.
Send Claims to: TPV / Alliance Mailing Address
All others to: CIGNA HealthCare, P.O. Box 188004, Chattanooga, TN 37422 Payor 62308
Customer Service: 1.800.XXX.XXXX CIGNA 24-hour Nurseline: 1.866.XXX.XXXX
AWAY FROM HOME CARE
Provider: Participant is enrolled in a limited-benefit plan. For hospital services, collect patientresponsibility when service is rendered or make financial arrangements with the patient in accordance with your policies.
You may be asked to present this card when you receive care. The card does not guaranteecoverage. You must comply with all terms and conditions of the plan. Willful misuse of this card isconsidered fraud.This plan does not require pre-certification of coverage for inpatient or outpatient services. Claims willbe paid according to terms and conditions of the plan. In the case of an emergency, seek careimmediately, then call your family physician for further assistance and direction regarding follow up care.
Coverage Effective Date: 00/00/0000
ID: AMI
Name: Name
Account Number: 2466518
Group Name:Group Number:
Doctor Visit $25Specialist $25Network Coinsurance:
In 80%/20%Out 80%/20%
www.starbridge.comPrimary Network: CIGNA HealthCare PPOSecondary Network: Beech StreetConnecticut General Life Insurance Company
TPV / AllianceLogo
www.starbridge.com
A V I A N T N E T W O R K
Doctor Visit $25Specialist $25Network Coinsurance:
In 80%/20%Out 80%/20%
www.starbridge.comPrimary Network: Beech StreetConnecticut General Life Insurance Company
Coverage Effective Date: 00/00/0000
ID: Use Primary Insured’s Social Security Number
Name: Name
Group Name:Group Number:
For Benefits, Claim Status, Eligibility or Customer Service, Call 1-8XX-XXX-XXXX
Coverage Effective Date: 00/00/0000
ID: AMI
Name: Name
Account Number: 2466518
Group Name:Group Number:
Doctor Visit $25Specialist $25Network Coinsurance:
In 80%/20%Out 80%/20%
www.fundamentalcare.com
A V I A N T N E T W O R K
Primary Network: CIGNA HealthCare PPOSecondary Network: Beech StreetConnecticut General Life Insurance Company
TPV / AllianceLogo
2012 Starbridge - CIGNA HealthCare PPO
2012 Starbridge - Beech Street
012412
2012 FundamentalCare - CIGNA HealthCare PPO
SM
SM
SM
A V I A N T N E T W O R K
Send Claims to: TPV / Alliance Mailing Address
All others to: CIGNA HealthCare, P.O. Box 188004, Chattanooga, TN 37422 Payor 62308
Customer Service: 1.800.XXX.XXXX CIGNA 24-hour Nurseline: 1.866.XXX.XXXX
AWAY FROM HOME CARE
Provider: Participant is enrolled in a limited-benefit plan. For hospital services, collect patientresponsibility when service is rendered or make financial arrangements with the patient in accordance with your policies.
You may be asked to present this card when you receive care. The card does not guaranteecoverage. You must comply with all terms and conditions of the plan. Willful misuse of this card isconsidered fraud.This plan does not require pre-certification of coverage for inpatient or outpatient services. Claims willbe paid according to terms and conditions of the plan. In the case of an emergency, seek careimmediately, then call your family physician for further assistance and direction regarding follow up care.
Send Claims to:
Connecticut General Life Insurance Company, PO Box 55270, Phoenix, AZ 85078-5270 Payor 59225
Customer Service: 1.800.XXX.XXXX CIGNA 24-hour Nurseline: 1.866.XXX.XXXX
AWAY FROM HOME CARE
Provider: Participant is enrolled in a limited-benefit plan. For hospital services, collect patientresponsibility when service is rendered or make financial arrangements with the patient in accordance with your policies.
You may be asked to present this card when you receive care. The card does not guaranteecoverage. You must comply with all terms and conditions of the plan. Willful misuse of this card isconsidered fraud.This plan does not require pre-certification of coverage for inpatient or outpatient services. Claims willbe paid according to terms and conditions of the plan. In the case of an emergency, seek careimmediately, then call your family physician for further assistance and direction regarding follow up care.
Send Claims to: TPV / Alliance Mailing Address
All others to: CIGNA HealthCare, P.O. Box 188004, Chattanooga, TN 37422 Payor 62308
Customer Service: 1.800.XXX.XXXX CIGNA 24-hour Nurseline: 1.866.XXX.XXXX
AWAY FROM HOME CARE
Provider: Participant is enrolled in a limited-benefit plan. For hospital services, collect patientresponsibility when service is rendered or make financial arrangements with the patient in accordance with your policies.
You may be asked to present this card when you receive care. The card does not guaranteecoverage. You must comply with all terms and conditions of the plan. Willful misuse of this card isconsidered fraud.This plan does not require pre-certification of coverage for inpatient or outpatient services. Claims willbe paid according to terms and conditions of the plan. In the case of an emergency, seek careimmediately, then call your family physician for further assistance and direction regarding follow up care.
Coverage Effective Date: 00/00/0000
ID: AMI
Name: Name
Account Number: 2466518
Group Name:Group Number:
Doctor Visit $25Specialist $25Network Coinsurance:
In 80%/20%Out 80%/20%
www.starbridge.comPrimary Network: CIGNA HealthCare PPOSecondary Network: Beech StreetConnecticut General Life Insurance Company
TPV / AllianceLogo
www.starbridge.com
A V I A N T N E T W O R K
Doctor Visit $25Specialist $25Network Coinsurance:
In 80%/20%Out 80%/20%
www.starbridge.comPrimary Network: Beech StreetConnecticut General Life Insurance Company
Coverage Effective Date: 00/00/0000
ID: Use Primary Insured’s Social Security Number
Name: Name
Group Name:Group Number:
For Benefits, Claim Status, Eligibility or Customer Service, Call 1-8XX-XXX-XXXX
Coverage Effective Date: 00/00/0000
ID: AMI
Name: Name
Account Number: 2466518
Group Name:Group Number:
Doctor Visit $25Specialist $25Network Coinsurance:
In 80%/20%Out 80%/20%
www.fundamentalcare.com
A V I A N T N E T W O R K
Primary Network: CIGNA HealthCare PPOSecondary Network: Beech StreetConnecticut General Life Insurance Company
TPV / AllianceLogo
PP
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lan
s
sta
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dg
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ign
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• No PCP selection required• No referrals required• In-network and out-of-network coverage
2012 Starbridge - CIGNA HealthCare PPO
2012 Starbridge - Beech Street
012412
2012 FundamentalCare - CIGNA HealthCare PPO
SM
SM
SM
A V I A N T N E T W O R K
Send Claims to: TPV / Alliance Mailing Address
All others to: CIGNA HealthCare, P.O. Box 188004, Chattanooga, TN 37422 Payor 62308
Customer Service: 1.800.XXX.XXXX CIGNA 24-hour Nurseline: 1.866.XXX.XXXX
AWAY FROM HOME CARE
Provider: Participant is enrolled in a limited-benefit plan. For hospital services, collect patientresponsibility when service is rendered or make financial arrangements with the patient in accordance with your policies.
You may be asked to present this card when you receive care. The card does not guaranteecoverage. You must comply with all terms and conditions of the plan. Willful misuse of this card isconsidered fraud.This plan does not require pre-certification of coverage for inpatient or outpatient services. Claims willbe paid according to terms and conditions of the plan. In the case of an emergency, seek careimmediately, then call your family physician for further assistance and direction regarding follow up care.
Send Claims to:
Connecticut General Life Insurance Company, PO Box 55270, Phoenix, AZ 85078-5270 Payor 59225
Customer Service: 1.800.XXX.XXXX CIGNA 24-hour Nurseline: 1.866.XXX.XXXX
AWAY FROM HOME CARE
Provider: Participant is enrolled in a limited-benefit plan. For hospital services, collect patientresponsibility when service is rendered or make financial arrangements with the patient in accordance with your policies.
You may be asked to present this card when you receive care. The card does not guaranteecoverage. You must comply with all terms and conditions of the plan. Willful misuse of this card isconsidered fraud.This plan does not require pre-certification of coverage for inpatient or outpatient services. Claims willbe paid according to terms and conditions of the plan. In the case of an emergency, seek careimmediately, then call your family physician for further assistance and direction regarding follow up care.
Send Claims to: TPV / Alliance Mailing Address
All others to: CIGNA HealthCare, P.O. Box 188004, Chattanooga, TN 37422 Payor 62308
Customer Service: 1.800.XXX.XXXX CIGNA 24-hour Nurseline: 1.866.XXX.XXXX
AWAY FROM HOME CARE
Provider: Participant is enrolled in a limited-benefit plan. For hospital services, collect patientresponsibility when service is rendered or make financial arrangements with the patient in accordance with your policies.
You may be asked to present this card when you receive care. The card does not guaranteecoverage. You must comply with all terms and conditions of the plan. Willful misuse of this card isconsidered fraud.This plan does not require pre-certification of coverage for inpatient or outpatient services. Claims willbe paid according to terms and conditions of the plan. In the case of an emergency, seek careimmediately, then call your family physician for further assistance and direction regarding follow up care.
Coverage Effective Date: 00/00/0000
ID: AMI
Name: Name
Account Number: 2466518
Group Name:Group Number:
Doctor Visit $25Specialist $25Network Coinsurance:
In 80%/20%Out 80%/20%
www.starbridge.comPrimary Network: CIGNA HealthCare PPOSecondary Network: Beech StreetConnecticut General Life Insurance Company
TPV / AllianceLogo
www.starbridge.com
A V I A N T N E T W O R K
Doctor Visit $25Specialist $25Network Coinsurance:
In 80%/20%Out 80%/20%
www.starbridge.comPrimary Network: Beech StreetConnecticut General Life Insurance Company
Coverage Effective Date: 00/00/0000
ID: Use Primary Insured’s Social Security Number
Name: Name
Group Name:Group Number:
For Benefits, Claim Status, Eligibility or Customer Service, Call 1-8XX-XXX-XXXX
Coverage Effective Date: 00/00/0000
ID: AMI
Name: Name
Account Number: 2466518
Group Name:Group Number:
Doctor Visit $25Specialist $25Network Coinsurance:
In 80%/20%Out 80%/20%
www.fundamentalcare.com
A V I A N T N E T W O R K
Primary Network: CIGNA HealthCare PPOSecondary Network: Beech StreetConnecticut General Life Insurance Company
TPV / AllianceLogo
2012 Starbridge - CIGNA HealthCare PPO
2012 Starbridge - Beech Street
012412
2012 FundamentalCare - CIGNA HealthCare PPO
SM
SM
SM
A V I A N T N E T W O R K
Send Claims to: TPV / Alliance Mailing Address
All others to: CIGNA HealthCare, P.O. Box 188004, Chattanooga, TN 37422 Payor 62308
Customer Service: 1.800.XXX.XXXX CIGNA 24-hour Nurseline: 1.866.XXX.XXXX
AWAY FROM HOME CARE
Provider: Participant is enrolled in a limited-benefit plan. For hospital services, collect patientresponsibility when service is rendered or make financial arrangements with the patient in accordance with your policies.
You may be asked to present this card when you receive care. The card does not guaranteecoverage. You must comply with all terms and conditions of the plan. Willful misuse of this card isconsidered fraud.This plan does not require pre-certification of coverage for inpatient or outpatient services. Claims willbe paid according to terms and conditions of the plan. In the case of an emergency, seek careimmediately, then call your family physician for further assistance and direction regarding follow up care.
Send Claims to:
Connecticut General Life Insurance Company, PO Box 55270, Phoenix, AZ 85078-5270 Payor 59225
Customer Service: 1.800.XXX.XXXX CIGNA 24-hour Nurseline: 1.866.XXX.XXXX
AWAY FROM HOME CARE
Provider: Participant is enrolled in a limited-benefit plan. For hospital services, collect patientresponsibility when service is rendered or make financial arrangements with the patient in accordance with your policies.
You may be asked to present this card when you receive care. The card does not guaranteecoverage. You must comply with all terms and conditions of the plan. Willful misuse of this card isconsidered fraud.This plan does not require pre-certification of coverage for inpatient or outpatient services. Claims willbe paid according to terms and conditions of the plan. In the case of an emergency, seek careimmediately, then call your family physician for further assistance and direction regarding follow up care.
Send Claims to: TPV / Alliance Mailing Address
All others to: CIGNA HealthCare, P.O. Box 188004, Chattanooga, TN 37422 Payor 62308
Customer Service: 1.800.XXX.XXXX CIGNA 24-hour Nurseline: 1.866.XXX.XXXX
AWAY FROM HOME CARE
Provider: Participant is enrolled in a limited-benefit plan. For hospital services, collect patientresponsibility when service is rendered or make financial arrangements with the patient in accordance with your policies.
You may be asked to present this card when you receive care. The card does not guaranteecoverage. You must comply with all terms and conditions of the plan. Willful misuse of this card isconsidered fraud.This plan does not require pre-certification of coverage for inpatient or outpatient services. Claims willbe paid according to terms and conditions of the plan. In the case of an emergency, seek careimmediately, then call your family physician for further assistance and direction regarding follow up care.
Coverage Effective Date: 00/00/0000
ID: AMI
Name: Name
Account Number: 2466518
Group Name:Group Number:
Doctor Visit $25Specialist $25Network Coinsurance:
In 80%/20%Out 80%/20%
www.starbridge.comPrimary Network: CIGNA HealthCare PPOSecondary Network: Beech StreetConnecticut General Life Insurance Company
TPV / AllianceLogo
www.starbridge.com
A V I A N T N E T W O R K
Doctor Visit $25Specialist $25Network Coinsurance:
In 80%/20%Out 80%/20%
www.starbridge.comPrimary Network: Beech StreetConnecticut General Life Insurance Company
Coverage Effective Date: 00/00/0000
ID: Use Primary Insured’s Social Security Number
Name: Name
Group Name:Group Number:
For Benefits, Claim Status, Eligibility or Customer Service, Call 1-8XX-XXX-XXXX
Coverage Effective Date: 00/00/0000
ID: AMI
Name: Name
Account Number: 2466518
Group Name:Group Number:
Doctor Visit $25Specialist $25Network Coinsurance:
In 80%/20%Out 80%/20%
www.fundamentalcare.com
A V I A N T N E T W O R K
Primary Network: CIGNA HealthCare PPOSecondary Network: Beech StreetConnecticut General Life Insurance Company
TPV / AllianceLogo
11
11
13
14
11
13
14
15
13
14
15
5
5
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4
3
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4
4
7
7
3
3
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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-certification requirements. Failure to do so may affect benefits. 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 600428 RxPCN 02150000
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%
Network Savings Program
Clientlogo
NSPlogo
TPV / Alliancelogo
• PCP selection encouraged
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• 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 600428 RxPCN 02150000
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
Network Savings Program
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-certification requirements. Failure to do so may affect benefits. 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
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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-certification requirements. Failure to do so may affect benefits. 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 affect your benefit coverage. For help finding 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#
Legal entity nameCoverage effective date: MM/DD/CCYY
Group: 1234567Issuer (80840)
ID: U23456789 01Name: John Public
ID card acct name
RxBIN 600428 RxPCN 02150000
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
Network Savings Program
Clientlogo
NSPlogo
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“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 such operating subsidiaries and not by Cigna Corporation. Such operating subsidiaries include Connecticut General Life Insurance Company, Cigna Health and Life Insurance Company, Cigna Behavioral Health, Inc., and HMO or service company subsidiaries of Cigna Health Corporation and Cigna Dental Health, Inc. All models are used for illustrative purposes only.
591795 p THN-2013-195 11/13 © 2013 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>HealthCareProfessionals>Resources>DoingBusinesswithCigna>HowtoSubmitClaimstoCignatolearnmore
• Callourautomatedphonesystem1.800.88Cigna(882.4462)
CONDUCT ADMINISTRATIVE TRANSACTIONS ONLINECigna’sconvenienteServicestoolshelpyoumanagetheadministrativedetailsofhealthcare.
• Accesspatienteligibilityandbenefits
• Estimatepatientliability
• Viewandsubmitprecertificationrequests
• Checkclaimstatus
• Enrollonlineforelectronicfundstransfer(EFT),thenview,print,andshareonlineremittancereportsthesamedayyoureceiveelectronicpayments
• Receiveelectronicremittanceadviceandautomaticallyloadittoyouraccountsreceivablesystem
• Submitquestionsaboutfeeschedulesandspecificpatientbenefits
LEARN MOREToaccessoureducationalresources,logintoCignaforHCP.com>Resources>MedicaleCoursesforcoursesaboutEDI,electronicclaimsubmission,claimstatusinquiry,appeals,andmore.