By using Cigna's websites or any Cigna products, software, mobile applications, or other electronic or web-based services (collectively referred to as the "Service"), you agree to the following terms and conditions. Your continued access or use of the Service shall be deemed your acceptance of this Legal Disclaimer.
CareAllies is a registered service mark of Cigna Intellectual Property, Inc., licensed for use by Cigna Corporation and its operating subsidiaries. Cigna Corporation is a holding company and is not an insurance or an operating company. Therefore, products and services are provided exclusively by such operating subsidiaries and not by Cigna Corporation. "Cigna" may refer to Cigna Corporation itself or one or more of its subsidiaries, but when used in connection with the provision of a product or service, always refers to a subsidiary.
The product descriptions, if any, provided on the Service are not intended to constitute offers to sell or solicitations in connection with any products or services. Some products may not be available in all jurisdictions. Anyone interested in a particular product should contact the indicated Cigna business to determine whether the product is available in their jurisdiction and to request a copy of the applicable policy or prospectus for a complete description of the product.
Cigna grants a nonexclusive, limited permission to the owners of other websites ("Linking Site Owners") to link to Cigna websites using text links. Such link shall not (a) suggest that Cigna promotes or endorses any third party's causes, websites, products or services, or (b) be used or associated with any inflammatory, pornographic, defamatory or unlawful site or materials in any way, or in any manner that would disparage or adversely affect the name, reputation and goodwill of Cigna and its products and services.
Cigna retains and reserves all rights to its domain names, trade names, trademarks and logos, copyrights and all other intellectual property. We reserve the right to withdraw permission for any link.
Linking Site Owners shall indemnify, defend and hold harmless Cigna from and against all liability, demands, claims, suits, losses, damages, infringement of proprietary rights, causes of action, fines, or judgments (including costs, attorneys' and witnesses' fees, and expenses incident thereto), arising out of their failure to comply with the terms and conditions of this "Links to Cigna Websites" section.
Linking Site Owners who desire to link to Cigna websites using Cigna's "Tree of Life" logo must comply with the requirements set forth in Link to Our Site with a Cigna Logo, including the completion of the Linking License Application Form and execution of the Linking License Agreement.
While using the Service, you may access certain non-Cigna websites or content. Cigna neither reviews, controls, nor endorses the content and accuracy of any non-Cigna websites or other material, and therefore will not be responsible for their content and accuracy. Your access to non-Cigna websites and non-Cigna content is at your sole risk.
Other websites on the Internet may contain unedited, sexually explicit, violent, racist or other types of material, which may be offensive to you. Please access other websites at your own discretion.
All material including any link to other sites and content found at linked sites is provided "as is" and without any express or implied warranties including warranties of merchantability or fitness for a particular purpose. Due to the nature of the Internet, Cigna does not warrant that access to the Service will be uninterrupted or error free. Cigna does not warrant or make any representations regarding the usefulness of or the expected results of the material contained on the Service. Note that some jurisdictions may not allow the exclusion of implied warranties so some of the above exclusions may not apply to you. Please check your local laws for any such restrictions.
Cigna cannot and does not guarantee or warrant that files available for downloading from the Service are free of viruses, worms, Trojan horses or other code that has contaminating or destructive properties. Cigna does not make any express or implied warranties, representations or endorsements whatsoever (including without limitation warranties of title, noninfringement or fitness for a particular purpose) with respect to the files available for downloading from the Service. In no event will Cigna be liable to you or to anyone else for any decision made or action taken by you or anyone else in reliance on results obtained from use of files downloaded from the Service. These files may be downloaded and/or reprinted for personal use only. Permission to reprint or electronically reproduce any document or graphic in whole or in part for any reason except for personal use is expressly prohibited, unless prior written consent is obtained from the appropriate Cigna copyright holder.
The health information on the Service is provided by Cigna solely for informational purposes as a public service to promote consumer health. It does not constitute medical advice and is not intended to be a substitute for proper medical care provided by a physician. Cigna assumes no responsibility for any circumstances arising out of the use, misuse, interpretation or application of any information supplied on the Service. Always consult with your doctor for appropriate examinations, treatment, testing, and care recommendations. Do not rely on information on this site as a tool for self-diagnosis. Cigna does not advertise, market or promote products or services to individuals who participate in its wellness, health promotion and chronic condition management programs.
The Service may from time to time contain forward-looking statements that include information about financial prospects, plans and objectives of management for future operations, economic conditions, trends and known uncertainties. Cigna cautions the reader that actual results could differ materially from those that Cigna expects, depending on the outcome of certain factors. In some cases, Cigna describes uncertainties when offering forward-looking statements. Some factors that could cause Cigna's actual results to differ materially from forward-looking statements ("Risk Factors") are listed in the most recent Form 10-K or Form 10-Q Cigna filed with the Securities and Exchange Commission.
Cigna does not undertake any obligation to correct or update any forward-looking statements on the Service. Cigna also cautions the reader that the list of Risk Factors that appears in the most recent Form 10-K or Form 10-Q Cigna filed with the SEC may be modified by any subsequent SEC filings, such as Form 8-K, proxy statements, and other SEC filings. Cigna will not update the Risk Factors listed in any of Cigna's SEC filings prior to the next required SEC filing. The list of Risk Factors provided in any of Cigna's SEC filing may not be complete, and speaks only as of the date filed with the SEC.
There are references throughout the Service to various trademarks or service marks and these, whether registered or not, are the property of their respective owners.
Your use of social networking media, including but not limited to participation in or use of blogs, threaded discussions, message boards and wikis (“Social Media”), is conditioned upon your compliance with the following:
- Do not post or transmit any unlawful, threatening, abusive, libelous, defamatory, racist, obscene, vulgar, pornographic, profane or indecent information. This includes, without limitation, any transmissions that are or that encourage illegal conduct. This ban includes anything that would constitute a criminal offense, give rise to civil liability or otherwise violate any local, state, national or international law.
- Never post or transmit comments containing harassing or offensive language, using sexual references, sexual nicknames, racial slurs or rude or deliberately offensive comments.
- Do not engage in disruptive activity online, including excessive use of scripts, sound waves or scrolling (repeating the same message over and over).
- Do not post or transmit any information, software or other material that violates or infringes the rights of others. This prohibition includes material that constitutes an invasion of privacy or publicity rights permission from the owner.
- Never post or transmit any information, software or other material that contains a virus, worm, Trojan horse or other code that has contaminating or destructive properties.
- Do not post any information, software or other material for commercial purposes.
- Do not solicit other users to join or contribute money to any online service or other organization, or advocate or attempt to persuade users to join in legal or illegal schemes.
- Never pretend to be any other person or entity. Site users also may not falsely represent their professional or other affiliation with any person or entity.
- Do not use the Service to collect personally identifiable information in violation of the policies contained in the CIGNA Privacy Information.
You agree that Cigna, at our sole and absolute discretion, determines whether any information transmitted or received violates this provision.
You also agree to indemnify and hold Cigna and our employees, officers, directors and agents harmless from any claim or demand, including reasonable attorneys' fees, made by a third party arising from any information or material you contribute to the Social Media you access via the Service.
Cigna has no obligation to monitor Social Media. But we reserve the right to monitor any and all information transmitted or received through the Service. Cigna may examine, record, copy and use any information on the Service in accordance with the CIGNA Privacy Information. We reserve the right, in our sole and absolute discretion to remove any information or materials, in whole or in part, from Social Media.
When using the Service or Social Media, please be certain that anything you disclose does not compromise your personal safety. Please don't provide your name, phone number, social security number or any other personally identifying information to people you do not know. Don't continue any conversation online that makes you feel uncomfortable. Protect your safety and privacy.
Certain web and smartphone applications of the Service have been designed to run on a personal computer, standard laptop or web-enabled mobile device. If you view or use the Service on a mobile or handheld device you may experience some display and functionality limitations. You may experience varying wireless network coverage and speed, depending on your geographic location and telecommunications provider. The Service should not be used while operating any motor vehicle, or in any other manner that might endanger yourself or others.
If your mobile device uses Global Positioning System (GPS) technology, trackers, or other location tracking tools, your location information may be used for purposes of determining your location when using a function on the Service that uses such information. While using the Service, if you allow your location information to be obtained, we will use this information solely to return your estimated location and to provide you with more personalized results and/or services. Cigna does not monitor your GPS tracking or location information, and does not save this information. We will not use this information to identify you or disclose this information to any third parties.
By using the Service you expressly agree and acknowledge that Cigna shall not be responsible for any of the following: (a) performance limitations and/or failures experienced in connection with any wireless or Wi-Fi service used to access the Service; (b) data transmitted through wireless access that may be intercepted by unauthorized persons; or (c) your failure to physically secure and/or monitor your personal computer, laptop or wireless device or to protect your passwords, resulting in unauthorized access to the Service and/or your Cigna account or plan information.
While using any web-enabled mobile or handheld device to use the Service, standard mobile phone carrier and data usage charges will apply. You expressly agree and acknowledge that the use of any mobile or handheld device is at your sole risk and shall be in accordance with all applicable local, state and federal laws.
By using the Service, you agree to receive any applicable software updates that may be issued from time to time by Cigna. You agree to accept and install such updates as part of your use of the Service. You also agree not to reverse engineer, modify, decompile, adapt, translate, disassemble, or otherwise attempt to discover the source code of the Service and/or any Cigna application.
You agree by accessing the Service that under no circumstances or any theories of liability under international or civil, common or statutory law including but not limited to strict liability, negligence or other tort theories or contract, patent or copyright laws, will Cigna be liable for damages of any kind occurring from the use of the Service or any information, goods or services obtained on the Service including direct, indirect, consequential, incidental, or punitive damages (even if Cigna has been advised of the possibility of such damages), to the fullest extent permitted by law. Some jurisdictions do not allow the exclusion or limitation of certain damages so some of these limitations may not apply to you.
Financial calculators/calculations are provided for illustrative purposes only. You are responsible for verifying the accuracy and suitability of all assumptions and calculations. Please seek the advice of licensed and/or competent individuals before making any investment or financial planning decisions. Do not rely solely on financial calculators/calculations or financial or retirement information found on the Service.
Except as expressly stated upon initial access to a specific Cigna application or website, or section of such application or site, the Service does not direct content to Minors and do not intend to collect personal information from Minors and therefore are not subject to the Children's Online Privacy Protection Act.
If you allow your minor child, or a child for whom you are legal guardian (a "Minor"), to access and use the Service, you agree that you will be solely responsible for: (i) the online conduct of such Minor; (ii) monitoring such Minor's access to and use of the Service; and (iii) the consequences of any use.
Cigna reserves the right, but not the obligation, to terminate your access to the Service if it determines in its sole and absolute discretion that you are involved in infringing activity, including alleged acts of first-time or repeat infringement, regardless of whether the material or activity is ultimately determined to be infringing. Cigna and its service providers accommodate and do not interfere with standard technical measures used by copyright owners to protect materials. Cigna has implemented procedures for receiving written notification of claimed infringements and for processing such claims in accordance with the Act. Our designated agent to receive notification of claimed infringement is:
Troy Larson, Esq.
The Cigna Companies, including Cigna and Cigna Intellectual Property, Inc. (CIPI)
Two Liberty Place
1601 Chestnut Street
Philadelphia, PA 19192
Any notice regarding any infringement of copyright or of other proprietary rights must include the following information:
- A signature of a person authorized to act on behalf of (i) the owner of an exclusive right that is allegedly infringed or (ii) the person defamed.
- Identification of the copyrighted work claimed to have been infringed, or, if multiple copyrighted works at a single online site are covered by a single notification, a representative list of such works at that site.
- Identification of the material that is claimed to be infringing, or to be the subject of infringing activity, including information reasonably sufficient to permit us to locate the material.
- Information reasonably sufficient to permit us to contact you, such as your address, telephone number, and/or electronic mail address.
- A statement that you have a good faith belief that use of the material in the manner complained of is not authorized by the copyright or other proprietary right owner, its agent, or the law.
If you choose to access the Service from outside the United States you do so on your own initiative and are responsible for compliance with U.S. and local laws, if and to the extent that local laws are applicable.
Software is subject to United States export controls. No software may be downloaded or otherwise exported or re-exported (i) into (or to a national resident of) Cuba, Iraq, Libya, North Korea, Iran, Syria, or any other country to which the U.S. has embargoed goods, or (ii) to anyone on the U.S. Treasury Department list of Specially Designated Nationals or the U.S. Commerce Department's Table of Deny Orders. You represent and warrant that you are not located in, under the control of, or a national resident of any such country or on any such list. You agree to comply with U.S. export control laws and that you will not transfer any software or other content from the Service to a foreign national or foreign country in violation of those laws.
Compensation to Third Parties
Compensation is paid to third party brokers and insurance sales people for placing a Client's ("Client" refers to employers or other groups sponsoring a health benefit plan) insurance coverage and/or plan administration contract with Cigna. This compensation is typically in the form of a percentage of premiums collected in the case of insurance policies, or a fixed, per-employee per-month rate (in the case of self-funded plans).
Additional compensation may be paid to brokers and insurance sales people based on persistency or other non-case-specific factors, sometimes referred to as "contingent commissions." This additional compensation is not part of the regular commissions.
Reports are sent to its employer policyholders and contract-holders regarding the commission and contingent commissions paid to brokers or insurance sales people for their use in preparing their Annual Return and report (Form 5500) where required under federal law (ERISA). Upon request, we will also disclose how the client may receive more information directly from the broker or sales person regarding compensation arrangements.
The primary compensation received with respect to insurance policies is the policyholder paid insurance premium. The primary source of revenue in connection with administrative services contracts is the service fees paid by the self-insured plan sponsor and/or the plan.
We negotiate for additional revenue from some third party vendors. We negotiate the additional revenue as part of the overall structure of each vendor agreement. The nature of negotiated contracts with vendors is that they are generally based on the aggregation of all business related to the contract and are not client-specific.
Cigna retains this additional revenue for its sole and exclusive use, applying it in part to the overall cost of maintaining Client programs and other business expenses. The aggregate revenue generated from the third party vendors, including programs designed to generate cost savings for the client, allows Cigna to cover the cost of client programs and other business expenses and to offer lower premiums and administrative fees to its Clients.
Cigna may offer programs and services where a third party vendor supplies all or part of the program or services. The claim amount charged to the Client for the program or services includes both an amount to cover the vendor fees and an amount for Cigna's related and other expenses. The disease management program is an example of a vendor program where the Client may be charged more than the amount charged by the vendor for the program.
Another example can be found in the rates for pharmacy benefits negotiated with a pharmacy benefit manager (PBM). The rates charged to a Client are typically expressed as a percentage discount from average wholesale price. Cigna may offer lower discounts to the Client than the discounts that Cigna is offered by the PBM. Cigna may obtain or retain all or a portion of drug manufacturer revenue that it receives from the PBM or directly from the drug manufacturer. This revenue may be based on factors including membership volume, volume of drug usage or placement of a drug on the formulary. Cigna's drug formulary changes occasionally based on clinical efficacy, net drug cost and market share considerations. Customer reimbursements will differ depending on where the drug falls in the formulary. Changes to the formulary can impact the revenue paid by drug manufacturers to Cigna or the PBM.
Cigna may also receive transition fees when it changes third party vendors. These fees are paid to Cigna by the vendor to cover implementation and related expenses such as staffing or administrative changes that Cigna incurs during the transition. Cigna may receive marketing fees or commissions from vendors for placing the business with the vendor. These may be calculated on a per-member per-month (PMPM) basis, flat rate, or on a percentage basis. Cigna may receive other compensation from its third party vendors. For example, Cigna may receive payment for the development and installation of special computer systems or programs necessary for Cigna to deliver a particular service to its Clients.
Cigna may receive performance guarantee payments if a vendor does not meet performance targets.
Cigna uses a specialized vendor to negotiate discounts for large out-of-network (OON) claims. When a large out of network claim is received, the vendor will negotiate with the provider to obtain a lower rate, or discount, to the charges. The amount for the claim charged to our Client will reflect the discounted charges and an administrative fee will be charged for providing the savings program. Similar savings programs are in place for secondary networks and to audit large, complex hospital claims.
When a third party should have been responsible for the claims incurred by a customer (as a result of an automobile accident, for example), after paying the claim, Cigna may try to obtain reimbursement from the third party source. Cigna currently pursues reimbursement using a specialized subrogation vendor. For successful efforts, a percentage of the recovery is retained by Cigna. Additionally, Cigna has priority right to reimbursement of any stop loss payments. Any excess is credited to the Client.
In most situations, Cigna processes claims directly and the claim amount collected by Cigna from the Client equals the amount paid to the provider. Where a third party manages a particular type of medical service, a portion of the claim amount paid to the third party may in turn be paid to Cigna by the third party to cover Cigna's costs of administration and other business costs. A Customer's coinsurance, deductible and lifetime maximum are calculated based on the entire claim amount including the portion retained by Cigna to cover costs.
Certain Cigna companies directly provide or arrange for the provision of covered health care services including, but not limited to Cigna Behavioral Health and Cigna HealthCare of Arizona. Their charges for providing or arranging for these services are reimbursed as claims.
In an effort to assure that high dollar claims are correctly billed and paid in accordance with industry and other applicable standards, we have extended our claims review program to include a review of select facility claims for billing and coding errors. This program is now available for all self-funded customers. Effective December 1, 2009, the Clinical Claims Review (CCR) program will be treated as a savings initiative pursuant to the Savings Initiative provision of your administrative services agreement and we will be retaining the specified fee for the savings realized.
Many of the group health insurance policies and employee health benefit plans that Cigna administers cover expenses incurred for services from health care professionals or facilities who do not participate in the Cigna health care professional network. Those policies and plans include Maximum Reimbursable Charge ("MRC") provisions that may limit the amount of an out-of-network charge that will be considered by Cigna in calculating reimbursement. The plan sponsor (your employer or other organization) may choose one of the following MRC provisions:
Under this option, a data base compiled by FAIR Health, Inc. (an independent non-profit company) is used to determine the billed charges made by health care professionals or facilities in the same geographic area for the same procedure codes using data. The maximum reimbursable amount is then determined by applying a percentile (typically the 70th or 80th percentile) of billed charges, based upon the FAIR Health, Inc. data. For example, if the plan sponsor has selected the 80th percentile, then any portion of a charge that is in excess of the 80th percentile of charges billed for the particular service in the same relative geographic area (as determined using the FAIR Health, Inc. data) will not be considered in determining reimbursement and the patient will be fully responsible for such excess.
This option uses a schedule of charges established using a methodology similar to that used by Medicare to determine allowable fees for services within a geographic market or at a particular facility. The schedule amount is then multiplied by a percentage (110%, 150% or 200%) selected by the plan sponsor to produce the MRC.
In the limited situations where a Medicare-based amount is not available (e.g., a certain type of health care professional or procedure is not covered by Medicare or charges relate to covered services for which Medicare has not established a reimbursement rate), the MRC is determined based on the lesser of:
There is no MRC with respect to services for which there is not enough charge data in a geographic area to determine a MRC charge.
Under this option, the MRC is determined based on the lesser of:
In some cases, the ACR amount will not be used and the MRC is determined based on the lesser of:
Whether the MRC I, MRC II or ACR methodology is used, the customer is responsible for all charges over the MRC amount, as well as any applicable deductible and coinsurance amounts for charges that do not exceed the MRC. The claim is also subject to all other exclusions and limitations in the applicable benefit plan.
If you are enrolled in a Cigna-administered plan, you and your authorized representatives can find the MRC for a particular procedure and geographic location by calling the 800 number on your ID card.
If you use a health care professional who is not in the Cigna network, be sure to check your plan documents to make sure that your plan covers out-of-network services. If you have a Flexible Spending Account, you may be able to use that money for out-of-network services.
Cigna Home Delivery Pharmacy does not make efforts to identify or eradicate human trafficking from its direct supply chains for tangible goods that it offers for sale.
We reserve the right to make changes to the Service and our Legal Disclaimer. We encourage you to review the Service and these terms periodically for any updates or changes. Your continued access or use of the Service shall be deemed your acceptance of these Legal Disclaimers and any changes and the reasonableness of these standards for notice of changes. Use of the Service and purchases of products from the Service will be governed by and construed in accordance with the laws of the Commonwealth of Pennsylvania, without giving effect to its conflict of law provisions. You agree that any legal action or proceeding between you and Cigna will be brought exclusively in a federal or state court of competent jurisdiction sitting in Philadelphia, Pennsylvania. If any provision of this agreement shall be unlawful, void, or for any reason unenforceable, then that provision shall be deemed severable from this agreement and shall not affect the validity and enforceability of any remaining provisions.