CIGNA 2019 ANNUAL REPORT The Power of We. THIS YEAR We invested in growth. We capitalized on innovation. We committed to the future. 02 Shareholder Letter 13 Cigna Foundation 14 Cigna Connects 17 Milestones, Awards & Recognitions 20 Cigna in Perspective 24 Corporate & Board of Directors TABLE OF CONTENTS 1 A message from our President and CEO, David Cordani DRIVEN BY THE POWER OF WE I often talk about the importance of partnerships to and with the communities where we live and work. The deliver the best results for all of our stakeholders, which Power of We magnifies and unleashes the impact we is why one of Cigna’s key strategic imperatives is to be can have on society and for those we serve, makes our the undisputed partner of choice for health care. solutions available to more people, and fuels our ability As one recent example of Cigna’s emphasis on to continue investing and delivering outstanding results partnering, as well as our commitment to our customers, for our shareholders. clients and communities, I often share the details of a partnership we formed with the city of San Diego this CUSTOMERS AT THE CENTER OF ALL WE DO past year to address the unique health needs of the city’s first responders. Above all, the Power of We drives Cigna to continue First responders – notably firefighters, police, putting our customers at the center of all we do, each emergency medical teams and 911 dispatchers – are on the and every day. front lines serving their neighbors and communities at their One of the first things Cigna and Express Scripts did moments of greatest need. Given the unique pressures after coming together was to update our mission, which they face, it’s unsurprising that 85% of them have reported is to improve the health, well-being and peace of mind symptoms related to behavioral health issues.1 of those we serve. Through our partnership in San Diego, we’re giving We embody this mission through a global workforce them access to behavioral wellness treatment and other which embraces its collective role as champions for our resources that help them better cope with traumatic customers – providing the right services and solutions, at and high-stress situations while on the job. the right time, to contribute to the diverse health needs This initiative, and so many others like it, reflects of our customers in a highly personalized way. the values and attributes Cigna’s colleagues around the This means customers like Bryan Ott, who developed world aspire to every day, including empathy, partnership diabetes at age 30 – and didn’t even realize it until Cigna- and an unwavering belief in what’s possible. provided data identified his elevated A1C level, and At Cigna, we call this the “Power of We.” Through the associated risk for other diseases. Bryan attributed a mix Power of We, Cigna’s colleagues are bound by a shared of medical intervention and health coaching to putting mission, values and strategy. It reminds and inspires us him back on track, remarking that “I’m adding time onto on a daily basis that we are far more powerful when we my life instead of subtracting it from my life.” work together, in close partnership with each other, as It also includes customers like Kerry Petryck, who well as with our customers, patients and clients; with lost 44 pounds through her participation in a well-being health care professionals; with government agencies; program conceived by Cigna and her employer, our 2 SHAREHOLDER LETTER The Power of We magnifies the impact we can have on society and fuels our ability to continue delivering outstanding results for our shareholders. client American Eagle Outfitters. Kerry remarks that she in pharmacy cost savings.4 Today, everyone we serve doesn’t know if “I’d be the healthy person I am now” now has access to these pharmacy services, including without the benefit of this program. our industry-leading Accredo specialty pharmacy. These are only a couple of the millions of individual Our specialist pharmacists have deep expertise in healthy lives we help shape every day. 21 disease states5 – bringing tailored, personalized care to Our commitment extends to our innovative online millions of people. And in 2019 alone, 550 Accredo nurses6 tools and digital apps to help make the health care system traveled more than nine million miles to reach patients easier to navigate, and is why Cigna offers a customer throughout the United States.7 support line that makes a live operator available to all We’ve also added Express Scripts’ home delivery of our customers, 24 hours a day, seven days a week, pharmacy to our Cigna network, which ensures our clients’ every day of the year.2 employees get the clinical support they need – when and That’s the Power of We – more than 70,000 how they want it. colleagues2 who focus on how we can help our customers Further, our combination has accelerated our ability live better lives. to bring an array of innovative health care solutions to the marketplace. A handful of our 2019 highlights TRANSFORMING HEALTH CARE included our: By leveraging the resources of our combined company, › Patient Assurance Program, capping the 30-day we’re positioned with leading capabilities to drive transform- out-of-pocket cost of insulin at $25; ational change in health care and to deliver whole person › Embarc Benefit ProtectionSM Program, which will health – meaning treating each person holistically, both put life-saving gene therapy in reach of those mind and body. who need it; Our market-leading medical and behavioral › Digital Health Formulary, the industry’s first, to capabilities take a research-based approach to improve help customers and clients make better decisions connectivity and deliver whole person solutions for from 300,000 digital health tools; and, better physical and mental health outcomes. A three-year › Health Connect 360, our innovative tool that study, released last year, of more than 210,000 customers, generates deep personalized insights at the found that Cigna’s health engagement incentive programs clinical level and enables better health outcomes. improve health outcomes and lower total medical costs an average of 10%.3 Our improved pharmacy capabilities through Express Scripts play a pivotal role in our ability to deliver excellent service and clinical support. In 2019, Express Scripts saved its clients and customers more than $50 billion SHAREHOLDER LETTER 3 BUILDING PARTNERSHIPS TO DRIVE INNOVATION We continued to embrace partnering as a key point of Another example of the premium Cigna places on differentiation and a growth driver for Cigna in 2019, partnerships is our long history of innovative, value- and will continue to do so in 2020 and beyond. based arrangements with health care professionals For example, beginning in April 2020, we are making in our U.S. Commercial and Government businesses. pharmacy care more affordable by enhancing pharmacy Across our top 40 markets in the United States and all networks and pharmaceutical manufacturer value for of our Medicare business, more than 65% of Cigna’s Prime Therapeutics’ 28 million members who are covered medical payments are now in value-based arrangements.8 by 23 health plans, plus employer and government Importantly, 92% of the health care providers in our programs such as Medicare and Medicaid. programs are delivering a differentiated level of quality Other recent examples are our partnerships of care and 90% believe that Cigna is the industry leader with, and investments in, emerging companies such as in this area.9 Oscar Health. With Oscar, we can do more to give small This provides meaningful opportunity for our businesses access to affordable, fully insured health plans Medicare Advantage business, whose growth is anchor- that broaden choice and prioritize whole person health. ed in the geographies where we have deep health Cigna will focus on four geographies with Oscar in 2020, care provider partnerships. We already capitalized and will test, learn and look to expand over time. on this growth opportunity in 2019 by accelerating Outside of the United States, Cigna also announced our geographic expansion in Medicare Advantage and the formation of a new partnership with Australia-listed bringing new solutions to market – all of which has nib Group, to create a health care data science venture. contributed to our high Medicare Advantage customer This joint venture will analyze and interpret underlying NPS levels, averaging approximately 70 across our individual disease risks, and provide guidance on markets. We are excited about our opportunities for how risks can be best prevented, mitigated, managed future customer growth in this business, which is or treated. projected to be 10% to 15% on an annualized basis over the next five years.10 4 SHAREHOLDER LETTER The Lab is our state-of-the-art research facility where diverse experts collaborate on cutting-edge solutions. SHAREHOLDER LETTER 5 ADVANCING OUR SOCIAL RESPONSIBILITY PLATFORM The Power of We extends to our emphasis on fostering This is all a part of Cigna’s commitment to advocate for diversity and inclusion in our organization, as well as the next generation. We believe that all Americans need healthy and vibrant communities where we live and work. and deserve a sustainable (and therefore affordable) We’re especially proud of our efforts to ensure a health care system that helps bring them health and workplace that respects the diversity and inclusion of vitality. We believe that the essential elements of this our colleagues’ cultures, beliefs and values. Cigna is system require: committed to respecting and protecting the rights of every employee. In recognition of our endeavors to › Employers, individuals and the government to remain celebrate our colleagues’ differences and contributions, highly engaged and motivated to drive and adopt Cigna achieved “Best of the Best” workplace awards solutions that advance the transformation of our in 2019 from Professional Woman’s Magazine, Hispanic health care system, and contribute to its financing; Network Magazine and Black EOE Journal, as well › Partnership between the private sector (to drive as recognition from Diversity, Inc.