• Abstract and Figures
• Public Full-text

Cigna Health and Life Insurance Company may change the premiums of this Policy only once per Calendar Year, on January 1st at renewal, after 60 days’ written notice to the Insured Person. However, We will not change the premium schedule for this Policy on an individual basis, but only for all Insured Persons in the same class and covered under the same Policy as You. Cigna Health and Life Insurance Company (“Cigna”) Cigna California Bronze Notice of Right to Examine Policy If You are not satisfied, for any reason, with the terms of this Policy, You may return it by mail or other delivery method, to Us not less than 10 days of receipt for enrollees under age 65, or within 30 days of receipt for enrollees age 65 and over, except for Federally Eligible Defined Individuals. You shall be permitted to return the Policy after its delivery to You and to have any premium paid or membership fees refunded. We will then cancel Your coverage as of the original Effective Date This Policy will then be null and void. If You wish to correspond with Us for this or any other reason, write: Cigna Individual Services P. O. Box 30365 Tampa, FL 33630-3365 1-877-484-5967 Include Your Cigna identification number with any correspondence. This number can be found on Your Cigna identification card. THIS POLICY MAY NOT APPLY WHEN YOU HAVE A CLAIM! PLEASE READ! This Policy was issued to You by CIGNA HEALTH AND LIFE INSURANCE COMPANY (referred to herein as Cigna) based on the information You provided in Your application, a copy of which is attached to the Policy. If You know of any intentional misrepresentation of material fact in Your application, You should advise the Company immediately regarding the incorrect information; otherwise, Your Policy may not be a valid contract. THIS IS NOT A MEDICARE SUPPLEMENT POLICY AND WILL NOT DUPLICATE MEDICARE BENEFITS. Guaranteed Renewable This Policy is monthly or quarterly medical coverage subject to continual payment by the Insured Person. Cigna will renew this Policy except for the specific events stated in the Policy each Calendar Year. Cigna may change the premiums of this Policy once per Calendar Year on January 1st at renewal after 60 days’ written notice to the Insured. However, We will not change the premium schedule for this Plan on an individual basis, but only for all Insureds in the same class and covered under the same Plan as You. Coverage under this Policy is effective at 12:01 a.m. Eastern time on the Effective Date shown on the Policy’s specification page. Signed for Cigna by: Anna Krishtul, Corporate Secretary CACHIND-EPO012017 Cigna California Bronze 2017 A MILC0705 Starting in January 2014, you cannot be denied health insurance because you have health problems or a pre-existing condition, and your health insurance premiums cannot be based on your health status. You may also qualify for low cost or free health insurance for yourself or your Dependents. Covered California You can buy health insurance through Covered California. The State of California set up Covered California to help people and families, like you, find affordable health insurance. You can use Covered California if you do not have insurance through your employer, Medi-Cal or Medicare. You must apply during an open or special enrollment period. Open enrollment begins November 1, 2016 and ends January 31, 2017. If you have a life change such as marriage, divorce, a new child or loss of a job, you can apply during a special enrollment period. Through Covered California, you may also get help paying for your health insurance: Receive tax credits: You can use your tax credit to help pay your monthly premium. • Reduce your out of pocket costs: Out-of-pocket costs are how much you pay for things like going to the doctor or hospital or getting prescription drugs. • To qualify for help paying for insurance, you must: • Meet certain household income limits • Be a U.S. citizen, U.S. national or be lawfully present in the U.S. • Other rules and requirements apply. Medi-Cal Is Changing Too Free health insurance is available through Medi-Cal. Medi-Cal is California’s health care program for people with low incomes. Starting in 2014, you can get Medi-Cal if: • You are less than 65 years old • Your income is low • You are a U.S. citizen, U.S. national or lawfully present in the U.S. • Your eligibility is based on your income. It is not based on how much money you have saved or if you own your own home. You do not have to be on public assistance to qualify for Medi-Cal. You can apply for Medi-Cal anytime. To qualify for Medi-Cal if you are over 65, disabled or a refugee, other rules and requirements apply. For More Information To learn more about Covered California or Medi-Cal, visit www.CoveredCA.com or call 800-300- 1506. You can also call or visit your county social services office. CACHIND-EPO012017 Cigna California Bronze 2017 A MILC0705 IMPORTANT NOTICES Network Adequacy Provision Cigna's Network Adequacy Provision establishes criteria for authorization of services by a Non- Participating health care professional at the In-Network level of benefits when a qualified, Participating health care professional is not available to provide Medically Necessary services within a reasonable distance from the Insured Person’s home or within reasonable appointment availability timeframes. If at least one (1) Participating health care professional is not available within the established mileage specifications from the Insured Person’s home, or in certain states, from the Insured Person’s home or work location, the Insured Person may receive authorization to visit a Non-Participating health care professional at the In-Network benefit level. Requests for network adequacy are subject to Medical Necessity review of all supporting information in order to make a determination of coverage. You may begin the process by contacting Cigna at the Customer Service toll-free phone number on the back of your Cigna ID card. Cigna 24-Hour Health Information Line The Cigna 24-hour Health Information Line provides 24/7/365 toll-free access to a registered nurse via telephone – 1-888-992-4462. Skilled nurses provide confidential and convenient information regarding symptoms, minor illnesses/injuries, chronic conditions, preventive care. Nurses can also give assistance in answering many health-related questions, including finding the right care in the right setting at the right time. In case of a medical emergency, call 911. Direct Access to Obstetricians and Gynecologists You do not need prior authorization from the plan or from any other person (including a primary care provider) in order to obtain access to obstetrical or gynecological care from a health care professional in our network who specializes in obstetrics or gynecology. The health care professional, however, may be required to comply with certain procedures, including obtaining prior authorization for certain services, following a pre-approved treatment plan, or procedures for making referrals. For a list of participating health care professionals who specialize in obstetrics or gynecology, visit www.myCigna.com or contact Customer Service at the phone number listed on the back of your ID card. Selection of a Primary Care Provider This plan may require or allow the designation of a primary care provider. You have the right to designate any primary care provider who participates in the network and who is available to accept you or your Dependents. If your plan requires the designation of a primary care provider, Cigna may designate one for you until you make this designation. For information on how to select a primary care provider, and for a list of the participating primary care providers, visit www.myCigna.com or contact Customer Service at the phone number listed on the back of your ID card. For children, you may designate a pediatrician as the primary care provider. CACHIND-EPO012017 Cigna California Bronze 2017 A MILC0705 Dental Services If you opt to receive dental services that are not covered services under this Policy, a participating dental provider may charge you his or her usual and customary rate for those services. Prior to providing a patient with dental services that are not a covered benefit, the dentist should provide to the patient a treatment plan that includes each anticipated service to be provided and the estimated cost of each service. If you would like more information about dental coverage options, you may call member services (phone number appears on myCigna.com) or your insurance broker. To fully understand your coverage, you may wish to carefully review this Policy document. Discrimination is Against the Law Cigna complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Cigna does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. Cigna: • Provides free aids and services to people with disabilities to communicate effectively with us, such as: • Qualified sign language interpreters • Written information in other formats (large print, audio, accessible electronic formats, other formats) • Provides free language services to people whose primary language is not English, such as: • Qualified interpreters • Information written in other languages If you need these services, contact Customer Service at the toll-free number shown on your ID card, and ask a Customer Service Associate for assistance. If you believe that Cigna has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance by sending an email to [email protected] or by writing to the following address: Cigna Executive Office of Complaints P.O.

Load more

  136

Copy Link