What The CIGNA Plans Do Not Cover

The services listed below are not covered under the CIGNA Medical Plans (PPO and/or HMO, as noted). This listing also includes certain limitations that apply to services that were listed elsewhere as covered under the Plans...

  • Cosmetic surgery unless:

    • A person receives an injury that results in bodily damage requiring the surgery;

    • It qualifies as reconstructive surgery following another surgery, and both the initial surgery and the reconstructive surgery are essential and medically necessary;

    • It qualifies as reconstructive surgery following a mastectomy, including surgery and reconstruction of the noncancerous breast to achieve symmetry; or

    • It is performed to correct a congenital abnormality on one of your dependents who has not reached skeletal maturity.

  • Hearing aids or examinations for prescription or fitting of hearing aids.

  • Treatment of the teeth or gums except as described under Dental Services .

  • Treatment for an injury arising out of, or in the course of, any employment for wage or profit.

  • Treatment for sickness that is covered under any Workers' Compensation or similar law.

  • Charges made by a hospital that is owned or operated by the United States government if such charges are directly related to military-service-connected Sickness or Injury.

  • Any charges for which payment cannot lawfully be made.

  • Charges that the person is not legally required to pay.

  • Charges that would not have been made if the person had no insurance.

  • Charges above the reasonable and customary charges.

  • Charges for unnecessary care, treatment or surgery, except as specified in Utilization Review .

  • Custodial services, education or training.

  • Charges for which you or any one of your dependents are paid or entitled to payment for those expenses by or through a public program, other than Medicaid.

  • Experimental drugs or substances not approved by the Food and Drug Administration, or for drugs labeled: "Caution - limited by federal law to investigational use."

  • Experimental procedures or treatment methods not approved by the American Medical Association, the American Dental Association or the appropriate medical or dental specialty society.

  • Charges that are excluded because you do not comply with any utilization review or second opinion requirements.

  • Charges made by a Physician for or in connection with surgery that exceeds the maximum when two or more surgical procedures are performed at one time. See Multiple Surgical Procedures.

  • In vitro fertilization, artificial insemination or similar procedures.

  • Charges made by an assistant surgeon in excess of 20% of the surgeon's allowable charge; or for charges made by a cosurgeon in excess of the surgeon's allowable charge plus 20% (for purpose of this limitation, allowable charge means the amount payable to the surgeon prior to any reductions due to coinsurance or deductible amounts).

  • Routine eye refractions or charges in connection with the purchase or replacement of eyeglasses or contact lenses; however, the purchase of the first pair of eyeglasses or contact lenses that follows cataract surgery will be covered.

  • Charges in connection with eye exercises and for surgical treatment for the correction of a refractive error, including radial keratotomy, when eyeglasses or contact lenses may be worn.

  • Charges for supplies, care, treatment or surgery that are not considered essential for the necessary care and treatment of an injury or sickness, except for preventive care as specified elsewhere in this handbook.

  • Charges made for or in connection with tired, weak or strained feet for which treatment consists of routine footcare, including but not limited to, the removal of calluses and corns or the trimming of nails unless medically necessary.

  • Speech therapy, except as provided under speech therapy expenses.

  • Charges made by any covered provider who is a member of your family or your dependent's family. (For purposes of this provision, a family member includes spouse/domestic partner, children, brother, sister, parent, or grandparent.)

  • Expenses that are eligible for payment under the mandatory part of any auto insurance policy written to comply with:

    • A "no fault" insurance law, or

    • An uninsured motorist insurance law.

    CIGNA will take into account any adjustment option chosen under such part by your or any one of your dependents.

  • Charges for or in connection with an elective abortion unless:

    • The Physician certifies in writing that the pregnancy would endanger the life of the mother, or

    • The expenses are incurred to treat medical complications due to the abortion.

  • Charges for reports, evaluations, examinations, or hospitalizations not required for health reasons, such as employment, insurance or government licenses and court ordered forensic or custodial evaluations.

  • Reversal of voluntary sterilization procedures, and certain infertility services.

  • Transsexual surgery and related services.

  • Treatment of erectile dysfunction (however, penile implants are covered when an established medical condition is the cause of erectile dysfunction).

  • Therapy to improve general physical condition.

  • Personal or comfort items such as personal care kits, television, and telephone rental in hospitals.

  • Amniocentesis, ultrasound, or any other procedures requested solely for sex determination of a fetus, unless medically necessary to determine the existence of a sex-linked genetic disorder.

  • Charges for over-the-counter disposable or consumable supplies, including orthotic devices.

  • Charges for medical and surgical services intended primarily for the treatment or control of obesity that are not medically necessary, such as gastric bypass, gastric balloons, jaw wiring, stomach stapling, and jejunal bypass.

  • Non-medical ancillary services, including but not limited to vocational rehabilitation, behavioral training, biofeedback, hypnosis, sleep therapy, employment counseling, and education services for learning disabilities, developmental delays, autism, or mental retardation.

  • Cosmetic, dietary supplements, health and beauty aids, and nutritional formulas.

Back to Top

A Final Note...

If you (or a dependent) have coverage under this Plan and another Plan, the benefits you would otherwise receive under this Plan may be reduced in accordance with the provisions of this Plan's rules for coordinating benefits. For details, see Effect Of Benefits On Other Plans: Coordination of Benefits.

Back to Top