Health insurance policy number example

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Health insurance policy number example

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.

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 Group

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 12345-6789

TPV Name, PO Box XXXX, Anytown, USA 12345-6789

CSN Name, PO Box XXXX, Anytown, USA 12345-6789

Customer Service: 1.800. XXX. XXXX

Name: John Public

PCP Phone: XXX. XXX. XXXX

RxBIN XXXXXX RxPCN XXXXXXXX

Open Access Plus

No referral required

Med/Rx Deductible Applies

WWW.CIGNA.COM

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)

We encourage you to use a PCP as a valuable resource and personal health advocate.

MH/SA: 1.800. XXX. XXXX

Name: John Public

PCP Phone: XXX. XXX. XXXX

RxBIN XXXXXX RxPCN XXXXXXXX

POS (or HMO) Open Access

No referral required

WWW.CIGNA.COM

For information about mental health services and coverage, call MHSA Stmt Tel

Med Group: Sunset Med Group

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 12345-6789

TPV Name, PO Box XXXX, Anytown, USA 12345-6789

CSN Name, PO Box XXXX, Anytown, USA 12345-6789

Customer Service: 1.800. XXX. XXXX

Legal Entity Name

Coverage Effective Date: MM/DD/CCYY

Name: John Public

PCP: James Smith
Jane Smith

PCP Phone: 860. 123. 4567

ABC12 & Sons Company

RxBIN XXXXXX RxPCN XXXXXXXX

LocalPlus (or LocalPlusIN)

No referral required

Med/Rx Deductible Applies

WWW.CIGNA.COM

Carve out 1 Prt Line
Carve out 2 Prt Line

CAD Name, PO Box XXXX, Anytown, USA 12345-6789
TPV Name, PO Box XXXX, Anytown, USA 12345-6789

All Others: PO Box XXXX, Anytown, USA 12345-6789

MH/SA: 1.800. XXX. XXXX

We encourage you to use a PCP as a valuable resource and personal health advocate.

Open Access Plus

Name: John Public

PCP Phone: XXX. XXX. XXXX

RxBIN Rx Bin RxPCN Rx Contr

WWW.CIGNA.COM

Med Group: Sunset Med Group

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 XXXX, Anytown, USA 12345-6789

Member Services: 1.800. XXX. XXXX

MH/SA: 1.800. XXX. XXXX

Name: John Public

PCP Phone: XXX. XXX. XXXX

RxBIN XXXXXX RxPCN XXXXXXXX

WWW.CIGNA.COM

For information about mental health services and coverage, call MHSA Stmt Tel

Med Group: Sunset Med Group

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 12345-6789

TPV Name, PO Box XXXX, Anytown, USA 12345-6789

CSN Name, PO Box XXXX, Anytown, USA 12345-6789

Customer Service: 1.800. XXX. XXXX

Name: John Public

RxBIN XXXXXX RxPCN XXXXXXXX

Med/Rx Deductible Applies

WWW.CIGNA.COM

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)

MH/SA: 1.800. XXX. XXXX

Select a market

Cigna SureFit®

Administered by Cigna Health and Life Insurance Company

Coverage effective date: MM/DD/CCYY

Name: John Public

PCP phone: 888.999.1234

ID card acct name

RxBIN 600428 RxPCN 00600000

RxID 122222222 00

Med/Rx Deductible Applies

WWW.CIGNA.COM

You may have to show this card when you receive care. This doesn’t guarantee coverage. Not using this card correctly is fraud. For emergencies, call 911 or get immediate care. Contact your doctor 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 documents for out-of-network (OON) precertification requirements. This may affect your OON benefits.
Health Care Professionals: Check your provider contract for precertification requirements.

Customers: myCigna.com
Health Care Professionals: CignaforHCP.com

Medical Claims: PO Box 188061 Chattanooga, TN 37422-8061 Payer ID #62308

Rx Claims: Pharmacy Service Center, PO Box 188053, Chattanooga TN 37422-8053

Customers & Health Care Professionals: call 1-866-494-2111

For Pharmacists Only 800- 351-9170

Issue Date: 10/25/17

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.

Your network provider mst 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)

CAD name, PO Box XXXX, Anytown, USA 12345-6789

TPV name, PO Box XXXX, Anytown, USA 12345-6789

All others: PO Box XXXX, Anytown, USA 12345-6789

Connect Network

Cigna Health and Life Insurance Company

Medical/Rx/Pediatric Dental and Vision

RxID 030000002 00

Cigna DPPO Advantage

You may have to show this card when you receive care. This doesn’t guarantee coverage. Not using this card correctly is fraud. For emergencies, call 911 or get immediate care. Contact your doctor 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: Your plan may limit or exclude out-of-network (OON) benefits. Check your plan documents for precertification or other requirements that may apply to services from OON providers. Health Care Professionals: Check your provider contract for precertification requirements.

Customers: myCigna.com
Health Care Professionals: CignaforHCP.com

Dental Claims: Cigna Dental PO Box 188037 Chattanooga, TN 37422-8037 Payer ID #62308

Rx Claims: Pharmacy Service Center, PO Box 188053, Chattanooga, TN 37422-8053

For Premium, Billing and Enrollment Questions Please Call: 1-877- 900-1237

For Benefit and Claim Questions Please Call: 1-866- 494-2111

Routine Vision Health Care Professionals Please Call: 1-877- 478-7557

For Pharmacists Only Please Call: 800- 351-9170

Issue Date: 01/01/2017

No Referral Required

RxID 030000001 00

Cigna DPPO Advantage

You may have to show this card when you receive care. This doesn’t guarantee coverage. Not using this card correctly is fraud. For emergencies, call 911 or get immediate care. Contact your doctor 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: Your plan may limit or exclude out-of-network (OON) benefits. Check your plan documents for precertification or other requirements that may apply to services from OON providers. Health Care Professionals: Check your provider contract for precertification requirements.

Customers: myCigna.com
Health Care Professionals: CignaforHCP.com

Issue Date: 11/22/2016

Focus Network

Cigna Health and Life Insurance Company
Medical/Rx

No Referral Required

RxID 911111112 00

Rx Copay $0/10/25/50/100

Rx Coins 0%/0%/10%/20%/50%

You may have to show this card when you receive care. This doesn’t guarantee coverage. Not using this card correctly is fraud. For emergencies, call 911 or get immediate care. Contact your doctor 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: Your plan may limit or exclude out-of-network (OON) benefits. Check your plan documents for precertification or other requirements that may apply to services from OON providers. Health Care Professionals: Check your provider contract for precertification requirements.

Health Care Professionals: CignaforHCP.com

For Pharmacists Only Please Call: 800- 351-9170

Issue Date: 12/02/15

Open Access
Plus

No Referral Required

RxID 020000001 00

Cigna DPPO Advantage

You may have to show this card when you receive care. This doesn’t guarantee coverage. Not using this card correctly is fraud. For emergencies, call 911 or get immediate care. Contact your doctor 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: Your plan may limit or exclude out-of-network (OON) benefits. Check your plan documents for precertification or other requirements that may apply to services from OON providers. Health Care Professionals: Check your provider contract for precertification requirements.

Health Care Professionals: CignaforHCP.com

For Pharmacists Only Please Call: 800- 351-9170

Issue Date: 11/22/2016

To verify benefits, please see the contact information on the back of this card.

No Referral Required

Preferred Care Network in the U.S.: Cigna Healthcare

International Network
provided by:

CUSTOMERS AND HEALTH CARE FACILITIES / DOCTORS:
US HEALTH CARE FACILITIES / DOCTORS: Payer ID# Cigna – 62308

Fax Claims: AT&T Access Code + 800. 243. 6998 or 302 .797. 3150

Network Savings Program

Name: John Public

PCP Phone: XXX. XXX. XXXX

RxBIN XXXXXX RxPCN XXXXXXXX

Choice Fund OA Plus

No referral required

Med/Rx Deductible Applies

WWW.CIGNA.COM

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)

We encourage you to use a PCP as a valuable resource and personal health advocate.

MH/SA: 1.800. XXX. XXXX

Group: 1234567
Issuer (80840)

Name: John Public

PCP: James Smith
PCP Name Ln2
PCP Phone: 860- 555-1212

Fund #: Fund Number
RxBIN XXXXXX RxPCN XXXXXXXX

Open Access Plus

No referral required

WWW.CIGNA.COM

Mail all non-medical claims and correspondence to: ID card name back
SAR Fund name

To access the online provider directory go to www.CignaSharedAdministration.com

To access member pharmacy tools go to www.myCigna.com

Benefits are not insured by Cigna HealthCare

Group: 1234567
Issuer (80840)

Name: John Public

PCP: James Smith
PCP Name Ln2
PCP Phone: 860- 555-1212

RxBIN XXXXXX RxPCN XXXXXXXX

Open Access Plus

No referral required

WWW.CIGNA.COM

Coinsurance/deductible is paid directly to the doctor/facility by Cigna using individual’s available health funds.

Customer Service: 1.800. XXX. XXXX

We encourage you to use a PCP as a valuable resource and personal health advocate.

Name: John Public

RxBIN XXXXXX RxPCN XXXXXXXX

Med/Rx Deductible Applies

WWW.CIGNA.COM

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 call the toll-free number listed on this card.

Send Claims to: PO Box XXXX, Anytown, USA 12345-6789

Customer Service: 1.800. XXX. XXXX

Select an item number in this key to view its location on the sample ID card.

Managed care plans are designed to manage cost, utilization, and quality. Depending on the plan, customers may have coverage for participating providers only, or have both in‑network and out‑of‑network benefits. Some plans require referrals for specialty care and the selection of a primary care provider (PCP).

Plans that use this network offer customers access to participating providers, 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 services and 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.

* Emergency services as defined in their plan.

Plans that use this network offer customers access to a large national network of providers. The plans include health advocacy programs to help customers engage in wellness initiatives and manage 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 services and procedures.

For a directory of providers who participate in this network, visit Cigna.com > Find a Doctor.

Plans that use these networks offer customers access to local providers and a variety of different benefit options. The plans include negotiated network-specific discounts and fee schedules, along with robust medical management, to help reduce use of non-essential 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 services and procedures.

For a directory of providers who participate in these networks, visit Cigna.com > Find a Doctor.

Plans that use these networks offer customers access to participating providers in their local area, or in any area in the country where one exists, for coverage at the in-network cost.

In areas where these networks are not available, customers can access care through our Away From Home Care feature for coverage at the in-network cost.
If customers choose to access care from providers outside the LocalPlus network (or outside the Away From Home Care feature when the LocalPlus network isn’t available), they will likely pay more. (Customers with the LocalPlusIN plan will pay the full cost of their care. * )
Referrals are not required to see specialists.
Precertification may still be required for certain services and procedures.

For a directory of providers who participate in these networks, visit Cigna.com > Find a Doctor.

* Except for emergency services as defined by their plan.

Plans that use these networks offer customers cost savings and access to a local network of providers.

Customers must select a network-participating PCP to coordinate care for coverage at the in-network cost.
Referrals are required to see specialists except OB/GYNs.
HMO POS plans include benefits and features similar to HMO plans, plus out-of-network coverage at reduced benefit levels.

For a directory of providers who participate in these networks, visit Cigna.com > Find a Doctor.

Plans that use these networks offer customers cost savings, local convenience, and choice.

Customers must select a network-participating PCP to coordinate care for coverage at the in-network cost.
Referrals are required to see specialists except OB/GYNs.
Network POS plans include benefits and features similar to Network plans, plus out-of-network coverage at reduced benefit levels.

For a directory of providers who participate in these networks, visit Cigna.com > Find a Doctor.

Plans that use these networks offer customers access to participating providers across the country.

Both in- and out-of-network benefits are available.
Customers can access services from providers who do not participate in the network, but will assume additional costs and be reimbursed at a lower coinsurance level.

No out-of-network coverage, except in emergencies. *
Referrals are not required to see network-participating specialists.

For a directory of providers who participate in these networks, visit Cigna.com > Find a Doctor.

* Emergency services as defined in their plan.

Plans that use this network offer customers access to local physician and hospital groups for personal, patient-centered care.

Customers must select a network-participating PCP to coordinate their care.
Referrals are required to see specialists.
No out-of-network coverage or Away From Home Care, except in emergencies. **

For a directory of providers who participate in this network, visit Cigna.com > Find a Doctor.

* * Specific network names tied to Cigna SureFit may vary by market.

** Emergency services as defined in their plan.

Cigna offers Individual & Family Plans with medical, pharmacy, and (when applicable) pediatric dental benefits in Arizona, Colorado, Florida, Illinois, Missouri, North Carolina, Tennessee, and Virginia. Depending on the plan, customers will have access to providers who participate in either our Connect or LocalPlus Network. The network name will appear on the top right of the ID card.

Plans that use this network offer customers access to providers in their local area.

Customers must select a network-participating PCP * to coordinate their care.
Referrals are required to see specialists. *
No out-of-network coverage or Away From Home Care, except in emergencies. **

For a directory of providers who participate in this network, visit Cigna.com/IFP-Providers.

* * PCP selection and referrals are encouraged in Missouri. Referrals are not required, but encouraged, in Memphis, Tennessee.

** Emergency services as defined in their plan.

Plans that use this network offer customers access to participating providers in their local area, or in any area in the country where one exists, for coverage at the in-network cost.

In areas where this networks is not available, customers can access Away From Home Care for coverage at the in‑network cost.
If customers choose to access care from providers outside this network (or outside the Away From Home Care feature when the LocalPlus Network isn’t available), they will likely pay more.
Referrals are not required to see specialists.
Precertification may still be required for certain services and procedures.

For a directory of providers who participate in this network, visit Cigna.com/IFP-Providers.

Plans that use this network offer customers access to providers in their local area.

Customers can select a PCP to help coordinate care; it’s recommended, but not required.
Referrals are not required to see specialists.
Visits to non-participating providers will not be covered, except for emergencies. *

For a directory of providers who participate in this network, visit Cigna.com/IFP-Providers.

* Emergency services as defined in their plan.

Plans that use these networks offer customers access to providers who participate in the national Open Access Plus (OAP) Network or OAPIN Network.

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 services and procedures.
OAP Network – In Arizona, Connecticut, Maryland, North Carolina, and South Carolina , customers can access care through our Away from Home Care feature using the OAP Network for coverage at the in-network cost.
In Maryland , AccessIN plan customers can use the OAPIN Network for coverage at the in-network cost. Visits to non-participating providers are not covered, except in emergencies. *

For a directory of providers who participate in these networks, visit Cigna.com/IFP-Providers.

* Emergency services as defined in their plan.

We offer Cigna Global Health Benefits® plans for globally mobile employees, including U.S. expatriates and inpatriates to the U.S. There are multiple coverage options encompassing medical, business travel medical, dental, life, accidental death and dismemberment, and a range of ancillary coverage. The network name will appear on the ID card.

Cigna Global Health Benefits plans that use these networks offer medical coverage to individuals, for unexpected illness and injuries that occur while traveling in the U.S. on international business outside of their home or permanent assignment country.

For more information and to access the directory of participating providers, visit CignaEnvoy.com.

Cigna Global Health Benefits plans that use these networks offer medical coverage outside the U.S. for globally mobile customers, including U.S. expatriates and inpatriates to the U.S., and their dependents.

For more information and to access the directory of participating providers, visit CignaEnvoy.com.

These plans combine an employer-funded health reimbursement account (HRA) or employer/employee-funded tax-advantaged health savings account (HSA) with PPO, EPO, Open Access Plus, LocalPlus, or indemnity plans. Customers will have access to providers who participate in either our Connect or LocalPlus Network. The network name will appear on the top right of the ID card. the network aligned to their plan.

Plans that use these networks offer customers access to a suite of providers, and allow them to be in charge of how and when they spend their health fund dollars.

Referrals are not required to see specialists.
Typically, no copayments are required.
Providers should bill Cigna directly.
Precertification may still be required for certain services and procedures.

For a directory of providers who participate in these networks, visit Cigna.com > Find a Doctor.

Shared Administration Repricing plans are offered by the Cigna Taft-Hartley and Federal Business Segment. They are designed for Taft-Hartley and federal plan employers that want to continue processing and paying their own claims, and retain customer and provider services, or use a third-party administrator to perform these functions.

Plans that use these networks offer customers access to a national network of providers.

Referrals are not required to see specialists.
Both in- and out-of-network benefits are available. Customers can access providers that participate in a national network, which includes Away From Home Care.

For a directory of providers who participate in these networks, visit CignaSharedAdministration.com.

Cigna has entered into strategic alliances with several nationally recognized health care companies. These plans give our customers access to an alliance’s network of providers and discounts in specific geographic areas. They also provide the alliance’s customers with access to Cigna’s national provider network and discounts outside their specific geographic area.

Referrals are not required to see specialists.
Precertification may still be required for certain services and procedures.
Claims should be submitted to the payer ID on the customer’s ID card.

These plans give customers the freedom to choose any provider.

No network requirements.
Referrals are not required to see specialists.

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SOURCE:

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