About The CIGNA Medical Plans

If you are a Mainland employee, you may enroll in one of the following CIGNA Medical Plans...

• CIGNA Low Option Preferred Provider Organization Open Access Plus (PPO OA+) Plan,

• CIGNA High Option Preferred Provider Organization Open Access Plus (PPO OA+) Plan, or

• CIGNA Network Health Maintenance Organization (HMO) Plan.

You may also be eligible to enroll in the Kaiser Permanente HMO, depending on where you live.

This section provides a summary of the key provisions of the CIGNA Plans and outlines many of the services covered under those Plans. CIGNA, as the Claims Administrator, pays benefits based on the specific provisions outlined in the applicable plan booklet. Copies of this booklet are available for your review from your local Human Resources representative. You are also encouraged to call CIGNA directly if you have any questions regarding plan provisions or the benefits available to you.

All three CIGNA medical plan options provide comprehensive medical coverage. The Plans provide benefits for your covered medical expenses when you are diagnosed and treated for a non-occupational illness or accidental injury.

If you are injured or become ill as of a result of a work-related incident, you may be eligible for Worker's Compensation benefits, including medical benefits. If you suffer a work-related illness or injury, you should contact your manager. He or she will arrange medical care for you and report the incident. For more details, see Survivor and Disability.

However, the Plans differ in several significant areas, as outlined in the following sections.

Choice Of Doctor Or Provider

CIGNA Low Option PPO Open Access Plus (OA+) Plan and CIGNA High Option PPO Open Access Plus (OA+) Plan—Individuals enrolled in one of these plans may visit any qualified medical provider. However, the Plans pay higher benefits when a "network" provider is used. Both PPO Plans use the Open Access Plus network, and you can keep your out-of-pocket costs down when you use providers in the network.

CIGNA Network HMO Plan—Individuals enrolled in this Plan must use network providers and/or have their care coordinated by their primary care physician (PCP). Female participants may obtain services directly from their obstetrician/gynecologist without having to confer with their PCP. No benefits are paid for unapproved non-network care. There is one exception: Benefits will be paid if emergency care is received outside the HMO network due to medical necessity.

Pre-Existing Condition Limitations

A pre-existing condition limitation is an injury or illness for which you or a covered dependent receives treatment, incurs expenses, or receives a diagnosis within 90 days prior to the coverage effective date under this Plan. Charges relating to a pre-existing condition are not covered until you or your dependents have been covered by the Plan for one year. Pregnancy is not considered a pre-existing condition.

Under the PPO Plans, the pre-existing condition limitation applies for a one-year period. If you were covered by another health care plan within 63 days of becoming covered under the applicable PPO Plan, your prior health coverage will count toward the Plan's one-year pre-existing condition limitation period. In order to reduce a pre-existing condition limitation period, you will need to submit proof of prior coverage along with your enrollment material.

No pre-existing condition limitations apply under the Network HMO Plan. Once your coverage takes effect, the Plan will begin paying benefits for any eligible charges.

If you leave A&B, you will be entitled to receive a certificate of prior coverage, which can be used to offset any pre-existing condition limitations that may apply under your new coverage. For details, see When Coverage Ends.

Payment Provisions

To determine what benefits you may be eligible to receive, it's important you understand the following payment provisions that apply to the administration of the Plans. These provisions include...

• Deductibles

• Copayments

• Coinsurance

• Out-of-Pocket Maximums

• Lifetime Maximum Benefits

These payment provisions are explained in the sections below. The following table summarizes the major payment provisions.

Filing Claims

When you receive eligible medical services, you or your provider must file a claim with CIGNA for benefits to be paid. In general, claims will be filed automatically when you use network providers. If you use non-network providers, you must send your medical bills and completed claim form to CIGNA for reimbursement at the address listed on the back of your ID card. You may obtain a claim form from your local Human Resources representative or online via the Company intranet.

When you complete your claim, be sure to follow the form's instructions, and include the following information...

• Your name and Social Security Number,

• The Employer's name and Account Number (your Account Number is the seven-digit policy number shown on your medical ID card),

• The patient's name (if different than yours),

• Copies of the itemized medical bills (including dates of service), and

• The diagnosis and specific services or supplies provided (if not noted on the bill).

If you seek covered services outside the United States, you will also need to include the following information with your claim...

• The name of the country where services were received,

• The currency of the country were services were received,

• The exchange rate on the date services were received,

• A written English translation of the claim and itemization of services rendered (if possible), and

• The receipt showing the out-of-pocket payment (if applicable).

Feel free to contact CIGNA directly at 1-800-CIGNA-24 or the toll-free number listed on the back of your ID card if you need assistance in filing a claim.

Utilization Review

The utilization review (UR) process is used to certify the medical necessity and length of stay for any hospital confinement. Specifically, UR applies to:

• Initial inpatient hospital admissions

• Extended inpatient hospital stays

• Other inpatient stays at facilities such as skilled nursing facilities, rehabilitative hospitals, and sub-acute facilities

Pre-Admission Certification (PAC) must be requested prior to each hospital stay. For hospital stays that required an extension, Continued Stay Review (CSR) should be requested before the end of the original certified length of stay.

You are responsible for ensuring the UR process is completed for services requiring review and to follow up with your network provider to confirm the process has been completed. However, this process is usually handled automatically under the...

• HMO Plan, and

• PPO Plans when you use network providers.

If you are enrolled in one of the PPO Plans and use non-network providers, you must handle the UR process by following the notification process as outlined below.

Note, however, that regardless of the type of provider you use, you are ultimately responsible for ensuring that the UR process is completed for any services requiring such a review.

Case Management

Case management is a voluntary program CIGNA provides to assist individuals with treatment needs that extend beyond the acute care setting. The program is intended to ensure that patients receive appropriate care in the most effective setting possible, whether at home, as an outpatient, or as an inpatient. Case management professionals can offer quality, cost-effective treatment alternatives, as well as assistance with obtaining needed medical resources.

To request case management services, you, your dependent, or your physician may call the toll-free number on your medical ID card during normal business hours, Monday through Friday.

The following is a summary of covered services, and the benefits that are paid for these services, under the CIGNA Medical Plans. Keep in mind that these expenses incurred for listed services must be recommended by a physician and must be considered essential for the necessary care and treatment of an injury or a sickness (unless the covered service listed is for preventive care). 

This information is divided into the following major categories...

• At The Doctor's Office

• At The Hospital

• Surgery

• Maternity Services

• Mental Health/Substance Abuse Treatment

• Other Frequently Utilized Services

Additional details on these and other covered services, is provided under Description of Covered Services; details on the Plans' prescription drug benefits are provided under Prescription Drug Benefits Under The CIGNA Plans.

Note that the benefit descriptions provided below are summaries; they do not reflect all limitations or restrictions. For complete details, refer to the official plan document or booklet (available from your local Human Resources representative), or contact CIGNA directly at the number shown on your medical ID card.

At The Doctor's Office

At The Hospital

Note: Failure to obtain utilization review for any hospitalization services that require it will result in an additional fee (as outlined previously under Utilization Review); also, benefits are paid only if the stay and services provided are considered medically necessary.

Surgery

Maternity Services

For important details regarding these benefits and your rights under federal law, see Maternity Services.

Mental Health/Substance Abuse Treatment

Includes treatment for mental and nervous disorders, as well as alcoholism and drug abuse, up to the maximum benefits. Treatment must be provided by a licensed psychiatrist (M.D.) or licensed psychologist.

Other Frequently Utilized Services

Prescription Drug Benefits Under The CIGNA Plans

The PPO and HMO Plans pay benefits for prescription drugs that have been ordered as a result of an accidental injury, illness, or pregnancy. You have two ways to fill your prescriptions: at a retail pharmacy (for medications up to a 30-day supply) and through the mail (for medications up to a 90-day supply).

The following is a summary of additional services covered under the CIGNA Medical Plans; this section also provides more details on some of the covered services outlined previously.

In general, the benefit payment provisions apply to these services. For additional details, refer to the CIGNA plan booklet available from your local Human Resources representative, or contact CIGNA directly at the number on your medical ID card.

Acupuncture

To receive network benefits, treatment must be performed by a physician.

Allergy Injections

Covered when administered at a physician's office.

Ambulance

See Transportation Services later in this section.

Ambulatory Surgical Center Charges (or Free-Standing Surgical Center)

Includes treatment, services, and supplies performed in an ambulatory surgical center for services in connection with the surgical procedure.

Anesthetics

Includes both the anesthetics and the charges for administering them.

Appliances

Includes any appliance that replaces a lost body organ or part, or helps an impaired one to work, such as an artificial limb or eye. Only the first charge for the first appliance is covered.

Assistant Surgeon Services

The expenses for the services of an assistant surgeon will be covered at 20% of the amount of the covered expenses for the surgeon's charges for the surgery. An assistant surgeon is a physician with the designation of M.D., D.O., D.M.D, or D.P.M. Surgical assistant's services are not covered.

Birth Center Charges

Includes room and board, other services and supplies, and anesthetics as described above.

Birth Control Devices

Covered when provided in a doctor's office; note that oral contraceptives are covered under the prescription drug portion of the medical plan.

Blood or Blood Derivatives

Only if not donated or replaced.

Chemical Dependency Treatment

Includes both inpatient and outpatient services.

Chemotherapy

Covered as any other expense.

Chiropractic Care

When performed by a physician, such as a licensed Doctor of Chiropractic (D.C.). Benefits are limited to $1,500 per calendar year, per covered individual.

The plan does not cover charges for:

• Chronic conditions.

• Vitamin therapy.

• Maintenance or preventive treatment.

• Treatment of children under 12 years old unless the chiropractor obtains a signed consent form from the parent or guardian of the child before rendering care. A copy of this consent form must accompany the bill or the claim will be denied.

Dental Services

Most dental services are covered if needed as a necessary, but incidental, part of a larger service in the treatment of an underlying medical condition. Dental expenses are eligible if they are charges...

• For a continuous course of dental treatment that started within six months of an injury to sound natural teeth.

• Made by a hospital for room and board or necessary services and supplies.

• Made by the outpatient department of a hospital for surgery.

• Made by a physician for any of the following surgical procedures:

  • Excision of epulis (a benign gingival mass)

  • Excision of unerupted impacted tooth, including removal of alveolar bone and sectioning of the tooth

  • Removal of residual root (when performed by a dentist other than the one who extracted the tooth)

  • Intraoral drainage of acute alveolar abscess with cellulitis

  • Alveolectomy

  • Gingivectomy, for gingivitis or periodontitis

Additional dental benefits are provided under the FlexSolutions Dental Plans, which are described under the About The Dental Plans section.

Durable Medical Equipment

Includes appliances that replace a lost body organ or part, or helps an impaired one to function; orthotic devices, such as arm, leg, neck, or back braces; hospital-type beds; equipment needed to increase mobility, such as a wheelchair; respirators or other equipment for the use of oxygen; and monitoring devices. The equipment must be for repeated use and cannot be a consumable or disposable item. It must be used primarily for medical purposes and it must be appropriate for use in the home. The equipment may be purchased or rented, as determined by the Claims Administrator. Only the first charge for the first appliance is covered.

Emergency Room Visits

Covered only if it is determined that the services are medically necessary and the individual could not have used a less-intensive or more appropriate place of service, diagnostic or treatment alternative. Non-emergency use of an emergency room is not covered. For a definition of emergency services, see Emergency Services.

Foot Care

Care and treatment of the feet, if needed due to severe systemic disease. Routine care such as removal of warts, corns or calluses; the cutting and trimming of toenails; and foot care for flat feet, fallen arches and chronic foot strain are covered services only if due to severe systemic disease.

Health Care Provider's Services

Includes the services of a licensed or certified Health Care Provider, while acting within the scope of that license or certification. Such services are payable as any other eligible expense.

Hearing Aids/Hearing Exams

Benefits are limited to $1,500 every 36 months. This benefit does not include repairs, replacements or batteries.

Home Health Care

Includes temporary or part-time nursing care by (or supervised by) a registered graduate nurse (R.N.); temporary or part-time care by a home health aide; and physical, occupational and/or speech therapy. To be eligible for payment, home health care services must be:

• Received from a licensed home health agency,

• Part of a home health care plan, and

• Performed while you are under the continuing care of a physician.

Services are not covered if they are provided by a person who is related to you by birth or marriage or who lives with you or your dependents.

Hospice Care Charges

Hospice care is an integrated program of care that provides comfort and support services for terminally ill patients ("terminally ill" generally means that the patient has a prognosis of six months or less to live). Coverage for hospice care includes:

• Semi-private room and board and other services and supplies provided while the patient is confined in a hospice facility, hospital, skilled nursing facility, home health care agency, or any other licensed facility or agency under a hospice care program

• Services provided by a hospice facility on an outpatient basis

• Professional physician services

• Services provided by a psychologist, social worker, family counselor, or ordained minister for individual and family counseling, including bereavement counseling within one year after the person's death

• Pain relief treatment, including drugs, medicines, and medical supplies

• Services provided by a home health agency for:

  • Part-time nursing care by (or supervised by) a registered graduate nurse (R.N.)

  • Part-time care provided by a home health aide

  • Physical, occupational, and speech therapy

  • Medical supplies, physician-prescribed medications, and laboratory services to the extent that such charges would have been payable if the person had been confined in a hospital or hospice facility

The following charges are not considered eligible expenses under the Plan:

• Services provided by a person who is related to you by birth or marriage, or who lives with you or your dependents

• Charges for any period when you or your dependent is not under the care of a physician

• Services or supplies not listed in the hospice care program

• Any healing or life-prolonging procedures

• Any services that are also payable under another portion of this Plan

• Any services or supplies that are mainly to aid a person in daily living

• Charges for more than three bereavement counseling sessions

Hospital Charges

Includes room and board charges, whether the charges are for a ward, semi-private room or an intensive care unit. Charges made for a private room are eligible as a covered expense up to the hospital's regular daily charge for a semi-private room. Also includes other services and supplies.

Hospital Charges/Well Baby Care

Includes routine care during a covered newborn's initial hospital confinement, such as nursery care, physician visits, and charges for circumcision and other services and supplies.

Inpatient Rehabilitation Therapy

Inpatient rehabilitative therapy is covered only if intensive and multidisciplinary rehabilitation is necessary to improve the patient's ability to function independently. Covered services include services of a hospital or rehabilitation facility (such as skilled nursing facilities, rehabilitation hospitals and sub-acute facilities) for room, board, care, and treatment during confinement. Benefits are limited to 120 days per calendar year, per covered individual.

Laboratory Tests and X-rays

Includes X-rays or tests for diagnosis or treatment of an illness or injury, performed either on an inpatient or outpatient basis.

Licensed Counselor Services

Services of a licensed counselor (including a social worker) provided for the treatment of a mental or nervous disorder or chemical dependency are covered as long as you obtain a referral before the covered expenses are incurred. To obtain services, you must coordinate your care through CIGNA by calling the 800 number indicated on your ID card.

Mammography

Available to covered employees and spouses/domestic partners under the Plans' preventive health care services (and also includes breast examinations). Under the Plans, mammograms provided as part of preventive/routine care are limited to...

• One baseline mammogram between the ages of 35 and 39

• One mammogram every year for women age 40 or older, or as required due to medical necessity

Maternity Services

Includes both office visits and hospital services.

Note: Federal law protects the benefit rights of mothers and newborns related to any hospital stay in connection with childbirth. In general, group health programs and health insurance issuers may not:

• Restrict benefits for the length of hospital stay for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, federal law generally does not prohibit the mother’s or newborn’s attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable).

• Require that a provider obtain authorization from the program or the insurance issuer for prescribing a length of stay of up to 48 hours (or 96 hours).

For a hospital delivery, the hospital length of stay begins at the time of delivery (or at the time of the last delivery in the case of multiple births). For a delivery outside the hospital, the hospital length of stay begins at the time the mother or newborn is admitted as a hospital patient in connection with childbirth by the attending physician.

Medical Supplies

Includes blood or blood derivatives, only if not donated or replaced, and surgical supplies, such as bandages and dressings. Surgical supplies given during surgery or a diagnostic procedure are included in the overall cost for that surgery or diagnostic procedure.

Multiple Surgical Procedures

When more than one surgical procedure is performed during the same operative session, the covered expenses for the subsequent procedures are limited to 50% of the covered expenses for those procedures when they are performed on their own.

Nursing Services

Includes the services of a trained nurse. This includes services of a Registered Graduate Nurse (R.N.), a Licensed Practical Nurse (L.P.N.), or a Licensed Vocational Nurse (L.V.N.).

Organ/Tissue Transplants

Note: Benefits for organ/tissue transplants are covered only when you obtain services in-network.

Includes evaluation, donor search, organ procurement/tissue harvest, transplant procedures, and hospital and physician fees, but only if CIGNA is notified before the scheduled date of any of these activities, and the transplant procedures are performed at a designated CIGNA Lifesource Center. Benefits include the replacement of tissue and/or organ for heart, lung, heart/lung, liver, kidney, pancreas, kidney/pancreas, and bone marrow/stem cell transplants, immunosuppressive medication, and donor's medical costs.

Donor charges are considered covered only if the recipient is covered under this Plan. Expenses for a donor will be reduced by the Plan if they are payable from another plan.

The Plan also provides benefits for travel and lodging expenses for the patient and one companion when traveling to a Lifesource facility as directed by CIGNA (limitations may apply).

Other Hospital Services

Includes room and board, surgeon charges and physician visits.

Outpatient Short-Term Rehabilitative Therapy

Services for treatment and medical care by an occupational therapist, speech therapist or physical therapist provided the therapy is ordered and monitored by a physician. It must be given in accordance with a written treatment plan, submitted by a physician and approved by the Plan. Progress reports may be requested by the Plan at various intervals to ensure treatment is medically necessary. Benefits are limited to 90 visits per calendar year combined.

Oxygen

Includes charges for administering oxygen, as well as the rental of any required equipment.

Pap Smear/Pelvic Examination

Available annually to covered employees and spouses/domestic partners under the Plans' preventive health care services.

Physical Therapy

See Outpatient Short-Term Rehabilitative Therapy.

Physician Services

Includes hospital, office and home visits, and emergency room treatment services. Also includes surgery, reconstructive surgery, assistant surgeon services, and multiple surgical procedures as defined elsewhere in this section.

Prescribed Drugs and Medicines

Includes drugs and medicines provided on an inpatient basis. For information regarding the outpatient prescription drug benefits available under the Plans, see Prescription Drug Benefits.

Preventive Health Care

The following services are covered up to Plan limits as long as they are provided by network physicians (under the PPO Plans) or by your PCP (under the HMO Plan)...

• Annual routine physical exams for adults (including pap smears, pelvic exams and mammograms for women as outlined elsewhere in this section); and

• Well baby/well child care services for children through age five.

The HMO Plan also provides benefits for chromosome testing based on medical necessity.

Private Duty Nursing

Covered as part of a home health care plan if approved by CIGNA; not covered while confined in a facility.

Psychiatric Treatment

Includes inpatient and outpatient treatment for mental and nervous disorders, as well as alcoholism and drug abuse, up to the maximum benefits. Treatment must be performed by a licensed psychiatrist (M.D.) or licensed psychologist. Benefits for outpatient treatment are limited to 35 visits per calendar year; inpatient treatment is limited to 30 days per calendar year.

Radiation Therapy

Covered as any other expense.

Reconstructive Breast Surgery

If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women’s Health and Cancer Rights Act of 1998 (WHCRA). For individuals receiving mastectomy-related benefits, coverage will be provided in a manner determined in consultation with the attending physician and the patient, for:

• All stages of reconstruction of the breast on which the mastectomy was performed,

• Surgery and reconstruction of the other breast to produce a symmetrical appearance,

• Prostheses, and

• Treatment of physical complications of all stages of the mastectomy, including lymphedemas.

These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this program.

Reconstructive Surgery

Includes reconstructive surgery to improve the function of a body part when the malfunction is the direct result of a birth defect, illness, accidental injury, or a prior surgery performed to treat an illness or accidental injury that occurs while the individual is covered under this Plan.

Rehabilitation Therapy

Includes services of a hospital or rehabilitative facility. Inpatient therapy is limited to 120 days per confinement (either in a hospital, rehabilitation facility or both) each calendar year. Outpatient therapy is limited to 90 days each calendar year (combined with occupational, physical and speech therapy), regardless of whether the services are performed in a hospital or rehabilitative facility.

Rentals

Includes rental of a durable medical equipment, such as a wheelchair, hospital-type bed or device to help with breathing when paralyzed. CIGNA's approval is required.

Routine Physical Exam

See Preventive Health Care.

Second Surgical Opinion

Includes services of a physician to provide a second opinion to confirm the need for elective surgery ("elective surgery" meaning a surgical procedure that is not considered an emergency and that may be avoided without undue risk to the patient).

Skilled Nursing Facility

Includes room and board, and other services and supplies. Covered expenses are limited to the facility's regular daily charge for a semi-private room. Payment limited to the first 120 days of confinement each calendar year.

Social Worker's Services

Includes the services of a clinical social worker for psychological testing and psychotherapy only. To receive network benefits under the PPO Plans, or to be covered under the HMO Plan, you must coordinate your care through CIGNA. You can do so by calling the 800 number indicated on your ID card and accessing the mental health benefits information.

Speech Therapy

Includes the services of a licensed speech therapist only when the services must be given to restore speech lost or impaired that occurs while the individual is covered under this Plan. The therapy must be ordered and monitored by a physician, and be given in accordance with a written treatment plan, submitted by a physician and approved by the Plan. Progress reports may be requested by the Plan at various intervals to ensure treatment is medically necessary. Benefits are limited to 90 visits per calendar year combined with occupational, rehabilitative and physical therapy.

Speech therapy is not covered if such therapy is...

• Used to improve speech skills that have not fully developed

• Considered custodial or educational

• Intended to maintain speech communication

• Not expected to improve the patient's ability to speak

Surgery

Includes physician services for surgery, reconstructive surgery, assistant surgeon services, and multiple surgical procedures as defined elsewhere in this section.

Surgical Supplies

Includes bandages and dressings.

Transportation Services

Includes services provided by a professional ground ambulance service to and from the nearest medical hospital qualified to provide the required treatment. Benefits are paid only for a true emergency.

Well Baby/Well Child Care

See Preventive Health Care.

Well Woman Care

See Preventive Health Care.

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.

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.