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KeyManaged care plansManaged care plans are designed to manage cost, utilization,and quality. Depending on the plan, customers may havecoverage for participating providers only, or have bothin‑network and out‑of‑network benefits. Some plans requirereferrals for specialty care and the selection of a primary careprovider (PCP).Network: Network Open AccessPlans that use this network offer customers access to participatingproviders, with no referrals required.›››››Flexible plan designs allow for an array of cost-sharing options,including copayments, coinsurance, and deductibles.Customers can select a PCP to help coordinate care;it’s recommended, but not required.Referrals are not required to see participating specialists.Precertification may still be required for certain servicesand procedures.No out-of-network coverage, except for emergencies.*For a directory of providers who participate in this network,visit Cigna.com Find a Doctor.Network: Open Access PlusPlans that use this network offer customers access to a large,national network of providers. The plans include health advocacyprograms to help customers engage in wellness initiatives andmanage chronic conditions.›››Customers can select a PCP to help coordinate care;it’s recommended, but not required.Referrals are not required to see specialists.Precertification may still be required for certain servicesand procedures.For a directory of providers who participate in this network,visit Cigna.com Find a Doctor.Networks: Health Maintenance Organization (HMO)Open Access or Point of Service (POS) Open AccessPlans that use these networks offer customers access to localproviders and a variety of different benefit options. The plansinclude negotiated network-specific discounts and fee schedules,along with robust medical management, to help reduce use ofnonessential procedures.›››Customers can select a PCP to help coordinate care;it’s recommended, but not required.Referrals are not required to see specialists.Precertification may still be required for certain servicesand procedures.For a directory of providers who participate in these networks,visit Cigna.com Find a Doctor.* Emergency services as defined in their plan.Refer to this key for explanations of theinformation found on the sample Cigna ID cardsfeatured in this brochure.1 Use this ID number for all claims and inquiries.2 Indicates a seamless network where a patientcan receive in-network care on a regional orstatewide basis.3 For patients with coinsurance, submit claimsto Cigna or its designee, and receive anexplanation of payment (EOP), which will showany remaining amount due from the patient.4 Collect any copayment at the time of service.5 May read as: “Cigna Health and Life InsuranceCompany” or “Connecticut General LifeInsurance Co.” or “Cigna HealthCare ofXXXX, Inc.”6 ID cards with the Cigna Care Network logoindicate the patient’s liability varies basedon the provider’s Cigna Care designationstatus. Refer to the online provider directoryat Cigna.com Find a Doctor to determine aphysician’s Cigna Care designation status.7 Effective date of coverage.8 Name of patient‘s primary care provider (PCP).9 Network Savings Program (NSP) logo indicatesthat out-of-network discounts may be availableto the customer.10 Employer name.11 If a third party administers services inconjunction with Cigna, the ID card mayinclude multiple logos, and show a differentclaim address or telephone number on theback of the card.12 Precertification requirements may be shownas either “Inpatient Admission” or “InpatientAdmission and Outpatient Procedures.’’13 Submit claims to the claim submission addressshown on the card.14 Call the customer service number(s) indicatedon the card. Some plans have dedicatednumbers for accessing information. Alwayscheck the card for the correct number or referto the Important contact information page inthis guide.15 “Away From Home Care” indicates the patienthas access to the Cigna national Away FromHome Care feature.16 Indicates shared administration repricing.17 Union identifier.18 Client-specific network (CSN) logo.34

MANAGED CARE PLANS (CONTINUED)Networks: LocalPlus or LocalPlusINTPV logo11CAD logoWWW.CIGNA.COM18ClientlogoLegal entity nameCoverage effective date: MM/DD/CCYYLocalPlus (or LocalPlusIN)Group: 1234567No referral requiredIssuer (80840)PCP Visit 10Specialist 15 4ID: U23456789 01 1HospitalER 50Name: John PublicUrgent Care 25PCP: James SmithVisionYesJane SmithRx 10/20/30Network coinsurance:PCP Phone: 860.123.45679In90%/10%ABC12 & Sons CompanyOut70%/30%NSPRxBIN XXXXXX RxPCN XXXXXXXXMed/Rx deductible applieslogoDOI LabelCat #Network Savings ProgramYou 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 or INPATIENT ADMISSION AND OUTPATIENT PRECEDURES: 12Your Network provider must call the toll-free number listed below to pre-certify the above services. Refer to your plan documentsfor your pre-certification requirements. Failure to do so may affect benefits. In an emergency, seek care immediately, then call yourprimary care doctor as soon as possible for further assistance and directions on follow-up care within ## hours.Carve out 1 Prt Line 13Carve out 2 Prt LineSend claims to:CAD Name, PO Box XXXX, Anytown, USA 12345-6789TPV Name, PO Box XXXX, Anytown, USA 12345-6789All Other: PO Box XXXX, Anytown, USA 12345-6789Customer Service: 800.XXX.XXXX 14MH/SA: 800.XXX.XXXX15We encourage you to use a PCP as a valuable resource and personal health advocate.Open Access PlusAWAY FROM HOME CAREPCP requiredReferral requiredAway from Home CareOut-of-network uragedNoYesNoFor more information, see the next page.Networks: HMO, POS, or HMO POSSelect2Preferred HospitalClientlogo5Legal Entity NameHMOCoverage Effective Date MM/DD/CCYY 7No Referred RequiredGroup: 1234567PCP Visit 15Issuer (80840)Specialist 15U23456789 01 1ID:Hospital ER 504Name:John PublicUrgent Care 25PCP: James Smith 8VisionYesPCP Name Ln2Rx 10/20/40PCP Phone: XXX-XXX-XXXXRx Indiv Deduct 50ID Card Acct Name 10Coinsurance Applies 3RxBIN 017010 RxPCN 0215 COMM NSPlogo 9RxGroup: 1234567Cat#Network Savings ProgramDOI LabelWWW.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.12 INPATIENT ADMISSION or INPATIENT ADMISSION AND OUTPATIENT SERVICESYour 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 affectbenefits. In an emergency, seek care immediately, then call your primary care doctor as soon aspossible for further assistance and directions on follow-up care within ### hours.For information about mental health services and coverage, call XXX.XXX.XXXXMedGroup: Sunset Med GroupSend claims to: 123 Main Street, Suite 999, Anytown, USA 12345-678Cigna:PO Box XXXXX, Anytown, USA 12345-6789Member Services: 1-XXX-XXX-XXXXMH/SA: 1-XXX-XXX-XXXXPCP requiredReferral requiredAway from Home CareHMOYesYesNoNoPOSYesYesNoYesHMO POSYesYesNoYesFor more information, see the next page.413For Pharmacy call ABC Company 1-XXX-XXX-XXXX (not a Cigna Company)For Vision call ABC Company 1-XXX-XXX-XXXX (not a Cigna Company)Cigna Vision P.O. Box 385018, Birmingham, AL 32538/5018COut-of-network benefits

KeyNetworks: LocalPlus or LocalPlusINPlans that use these networks offer customers accessto participating providers in their local area, or in anyarea in the country where one exists, for coverage at thein‑network cost.››››In areas where these networks are not available,customers can access care through our Away FromHome Care feature for coverage at the in-network cost.If customers choose to access care from providersoutside the LocalPlus network (or outside the AwayFrom Home Care feature when the LocalPlus networkisn’t available), they will likely pay more. (Customerswith the LocalPlusIN plan will pay the full cost oftheir care.*)Referrals are not required to see specialists.Precertification may still be required for certain servicesand procedures.For a directory of providers who participate in thesenetworks, visit Cigna.com Find a Doctor.Networks: HMO, POS, or HMO POSPlans that use these networks offer customers cost savingsand access to a local network of providers.›››Customers must select a network-participating PCP tocoordinate care for coverage at the in-network cost.Referrals are required to see specialists exceptOB/GYNs.HMO POS plans include benefits and features similar toHMO plans, plus out-of-network coverage at reducedbenefit levels.For a directory of providers who participate in thesenetworks, visit Cigna.com Find a Doctor.Refer to this key for explanations of theinformation found on the sample Cigna ID cardsfeatured in this brochure.1 Use this ID number for all claims and inquiries.2 Indicates a seamless network where a patientcan receive in-network care on a regional orstatewide basis.3 For patients with coinsurance, submit claimsto Cigna or its designee, and receive anexplanation of payment (EOP), which will showany remaining amount due from the patient.4 Collect any copayment at the time of service.5 May read as: “Cigna Health and Life InsuranceCompany” or “Connecticut General LifeInsurance Co.” or “Cigna HealthCare ofXXXX, Inc.”6 ID cards with the Cigna Care Network logoindicate the patient’s liability varies basedon the provider’s Cigna Care designationstatus. Refer to the online provider directoryat Cigna.com Find a Doctor to determine aphysician’s Cigna Care designation status.7 Effective date of coverage.8 Name of patient‘s primary care provider (PCP).9 Network Savings Program (NSP) logo indicatesthat out-of-network discounts may be availableto the customer.10 Employer name.11 If a third party administers services inconjunction with Cigna, the ID card mayinclude multiple logos, and show a differentclaim address or telephone number on theback of the card.12 Precertification requirements may be shownas either “Inpatient Admission” or “InpatientAdmission and Outpatient Procedures.’’13 Submit claims to the claim submission addressshown on the card.14 Call the customer service number(s) indicatedon the card. Some plans have dedicatednumbers for accessing information. Alwayscheck the card for the correct number or referto the Important contact information page inthis guide.15 “Away From Home Care” indicates the patienthas access to the Cigna national Away FromHome Care feature.16 Indicates shared administration repricing.* Except for emergency services as defined by their plan.17 Union identifier.18 Client Arranged Deal (CAD) network logo.5

MANAGED CARE PLANS (CONTINUED)Networks: Network or Network POSTPV logobl11CSN logoTiered Benefits1862Legal entity name 5Coverage effective date: MM/DD/CCYYGroup: 1234567Issuer (80840)ID: U23456789 01 1Name: John PublicPCP: James Smith 8PCP Name Ln2PCP Phone: XXX.XXX.XXXXID card acct name 10RxBIN XXXXXX RxPCN XXXXXXXXDOI7WWW.CIGNA.COMClientlogoYou may be asked to present this card when you receive care. The card does not guarantee coverage. You must comply with allterms and conditions of the plan. Willful misuse of this card is considered fraud.12INPATIENT ADMISSION:Your provider must call the toll-free number listed below to pre-certify the above services. Refer to your plan documents for yourpre-certification requirements. Failure to do so may affect benefits. In an emergency, seek care immediately, then call your primarycare doctor as soon as possible for further assistance and directions on follow-up care within ### hours.NetworkPCP Visit 15/ 20Specialist 4 15/ 20Hospital ER 50Urgent Care 25VisionYesRx 10/20%/40%/100%Rx Indiv Deduct 50Coinsurance applies93OAP#For information about mental health services and coverage, call MHSA Stmt TelMed Group: Sunset Med GroupSend claims to: 123 Main Street, Suite 999, Anytown, USA 12345-6789 13For Pharmacy, call ABC Company 800.XXX.XXXX (Not a Cigna Company)For Vision, call ABC Company 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 12345-6789Customer Service: 800.XXX.XXXX 14MH/SA: 800.XXX.XXXXboPCP requiredReferral requiredAway from Home CareOut-of-network benefitsNetworkYesYesNoNoNetworkPOSYesYesNoYesFor more information, see the next page.Networks: PPO or EPOSELF FUNDED NJ Arbitrations: YESas of: MM/DD/CCYYTPV LOGO11WWW.CIGNA.COMCAD or NBN logoTiered BenefitsLegal Entity Name 5Coverage Effective Date: MM/DD/CCYYGroup: 1234567Issuer (80840)ID: U23456789 01 1Name: John Public1867ID Card Acct Name 109RxBIN 017010 RxPCN 0215COMMNSPRxGroup: 1234567logoDOI LabelNetwork Savings ProgramClientlogoPPODr. Visit 15Specialist 10/ 25Hospital ER 4 50Urgent Care 25VisionYesRx 10/20/30Network Coinsurance:In90%/10%3 70%/30%OutMed/Rx Deductible AppliesCat #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.12 INPATIENT ADMISSION: or INPATIENT ADMISSION AND OUTPATIENT PROCEDURES:Your Network provider must call the toll-free number listed below to pre-certify the above services. Referto your plan documents for your pre-certification requirements. Failure to do so may affect benefits. In anemergency, seek care immediately, then call your primary care doctor as soon as possible for furtherassistance 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 Dental call ABC Company 1-XXX-XXX-XXXX (not a Cigna Company)For Vision call ABC Company 1-XXX-XXX-XXXX (not a Cigna Company)Cigna Vision P.O. Box 385018, Birmingham, AL 35238-5018Send Claims to:CAD Name, P.O. BOX XXXX, ANYTOWN, USA 12345-6789TPV Name, P.O. BOX XXXX, ANYTOWN, USA 12345-6789All Others: P.O. BOX XXXXX, ANYTOWN, USA 12345-67891314Customer Service: 1-800-XXX-XXXX MH/SA: 1-800-XXX-XXXXPCP requiredReferral requiredAway from Home CareOut-of-network benefitsPPONoNoYesYesEPOEncouragedNoYesNoFor more information, see the next page.615AWAY FROM HOME CARE

KeyNetworks: Network or Network POSPlans that use these networks offer customers costsavings, local convenience, and choice.›››Customers must select a network-participating PCP tocoordinate care for coverage at the in-network cost.Referrals are required to see specialists exceptOB/GYNs.Network POS plans include benefits and features similarto Network plans, plus out-of-network coverage atreduced benefit levels.For a directory of providers who participate in thesenetworks, visit Cigna.com Find a Doctor.Networks: PPO or Exclusive Provider Organization (EPO)Plans that use these networks offer customers access toparticipating providers across the country.PPO:››Both in- and out-of-network benefits are available.Customers can access services from providers whodo not participate in the network, but will assumeadditional costs and be reimbursed at a lowercoinsurance level.EPO:››No out-of-network coverage, except in emergencies.*Referrals are not required to see network-participatingspecialists.For a directory of providers who participate in thesenetworks, visit Cigna.com Find a Doctor.Refer to this key for explanations of theinformation found on the sample Cigna ID cardsfeatured in this brochure.1 Use this ID number for all claims and inquiries.2 Indicates a seamless network where a patientcan receive in-network care on a regional orstatewide basis.3 For patients with coinsurance, submit claimsto Cigna or its designee, and receive anexplanation of payment (EOP), which will showany remaining amount due from the patient.4 Collect any copayment at the time of service.5 May read as: “Cigna Health and Life InsuranceCompany” or “Connecticut General LifeInsurance Co.” or “Cigna HealthCare ofXXXX, Inc.”6 ID cards with the Cigna Care Network logoindicate the patient’s liability varies basedon the provider’s Cigna Care designationstatus. Refer to the online provider directoryat Cigna.com Find a Doctor to determine aphysician’s Cigna Care designation status.7 Effective date of coverage.8 Name of patient‘s primary care provider (PCP).9 Network Savings Program (NSP) logo indicatesthat out-of-network discounts may be availableto the customer.10 Employer name.11 If a third party administers services inconjunction with Cigna, the ID card mayinclude multiple logos, and show a differentclaim address or telephone number on theback of the card.12 Precertification requirements may be shownas either “Inpatient Admission” or “InpatientAdmission and Outpatient Procedures.’’13 Submit claims to the claim submission addressshown on the card.14 Call the customer service number(s) indicatedon the card. Some plans have dedicatednumbers for accessing information. Alwayscheck the card for the correct number or referto the Important contact information page inthis guide.15 “Away From Home Care” indicates the patienthas access to the Cigna national Away FromHome Care feature.16 Indicates shared administration repricing.17 Union identifier.* Emergency services as defined in their plan.18 Client-specific network (CSN) or ClientArranged Deal (CAD) network logo.7

MANAGED CARE PLANS (CONTINUED)Network: Cigna SureFit Market-specificnetwork nameIn Network OnlyAdministered by Cigna Health and Life Insurance CompanyGroup: 00699999Issuer (80840)ID: 666666666Name: John Doe1A8PCP: Jeremiah B Johnson MDReferral RequiredCigna SureFit HCA of the FrontRangePrimary CareSpecialistUrgent CareERHospitalG 25/0% 50/0% 15/0%Ded/20%Ded/10%You may have to show this card when you receive care. This doesn’t guarantee coverage. Notusing this card correctly is fraud. For emergencies, call 911 or get immediate care. Contact yourdoctor after you get emergency services. If you don’t know if your situation is an emergency,call your doctor or our 24/7 Health Information Line. Customers: Check your plan documentsfor out-of-network (OON) precertification requirements. This may affect your OON benefits.Health Care Professionals: Check your provider contract for precertification requirements.Customers: myCigna.comHealth Care Professionals: CignaforHCP.comMedical Claims PO Box 188061 Chattanooga, TN 37422-8061 Payer ID #62308 13Rx Claims: Pharmacy Service Center, PO Box 188053, Chattanooga TN 37422-8053Customers & Health Care Professionalscall 866-494-2111 14RxBIN 017010 RxPCN 05180000RxGrp 00699999 RxID 222222222 00For Pharmacists Only 800-351-9170Mask 606Issue Date: 10/25/17WWW.CIGNA.COMMarket-specificnetwork nameYou may be asked to present this card when you receive care. The card does not guarantee coverage. Youmust comply with all terms and conditions of the plan. Willful misuse of this card is considered fraud.INPATIENT ADMISSION or INPATIENT ADMISSION AND OUTPATIENT PROCEDURES:Your network provider mst call the toll-free number listed below to pre-certify the above services. Referto your plan documents for your pre-certification requirements Failure to do so may affect benefits. Inan emergency, seek care immediately, then call your primary care doctor as soon as possible for furtherassistance and directions on follow-up care within ### hours.Administered by Cigna Health and Life Insurance Company1For pharmacy, call ABC Company 800.XXX.XXXX (Not a Cigna Company)For vision, call ABC Company 800.XXX.XXXX (Not a Cigna Company)83Send claims to:CAD name, PO Box XXXX, Anytown, USA 12345-6789TPV name, PO Box XXXX, Anytown, USA 12345-6789All others: PO Bo

efficiently serve your patients. We may occasionally update this brochure during the year. Download the most current version at Cigna.com Health Care Providers Coverage and Claims ID Cards. Important information about this guide Please note: Some Cigna ID cards include a “G” in the upper-righ