591795 p 11/13 QUICK gUIde to CIgna Id Cards
591795 p 11/13 QUICK gUIde to CIgna Id Cards
591795 p 11/13 QUICK gUIde to CIgna Id Cards
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RUN_DATE DATA_SEQ_NO CLIENT_NUMBER UHG_TYPE DOC_ID DOC_SEQ_ID NAME MAILSET_NUMBER CUST_KEY1 CUST_KEY2 CUST_KEY3 CUST_KEY4 CUST_KEY5<br />
CUST_KEY6 Doe 9<strong>11</strong>6687/000001-00<br />
9<strong>11</strong>6687/000001-01<br />
9<strong>11</strong>6687/000001-02<br />
20<strong>13</strong>0314 DIG1CARD 00699998 100000008<br />
John Doe 0000001<br />
003040 0000001 05:58:28 ,John<br />
RUN_DATE DATA_SEQ_NO CLIENT_NUMBER UHG_TYPE DOC_ID DOC_SEQ_ID NAME MAILSET_NUMBER CUST_KEY1 CUST_KEY2 CUST_KEY3 CUST_KEY4 CUST_KEY5<br />
CUST_KEY6 Doe 9<strong>11</strong>6687/000001-00<br />
9<strong>11</strong>6687/000001-01<br />
9<strong>11</strong>6687/000001-02<br />
20<strong>13</strong>0314 DIG1CARD 00699998 100000008<br />
John Doe 0000001<br />
003040 0000001 05:58:28 ,John<br />
Primary Care $30 Specialist $40<br />
Urgent Care $65 Preventive Care $20<br />
PCP: None Selected<br />
No Referral Required<br />
For plan & benefit details, please visit myCIGNAforhealth.com<br />
Plan Contrac<strong>to</strong>r: Connecticut General Life Insurance Company<br />
Members and Providers Call<br />
1-866-494-2<strong>11</strong>1<br />
GWH-Cigna Plans<br />
03040 9<strong>11</strong>6687 0000 0000001 0000001 072 7<strong>11</strong>7<br />
03040 9<strong>11</strong>6687 0000 0000001 0000001 072 7<strong>11</strong>7<br />
XYZ Company<br />
RXBIN 600428 10<br />
RXPCN 05180000<br />
Issuer 80840<br />
Group Plan 123456789<br />
John Public<br />
ID 123456789 01 1<br />
COPAY:<br />
Primary Care $30 4 Specialist $40<br />
Urgent Care $65 ER $200<br />
PCP: None Selected<br />
No Referral Required<br />
8<br />
>000001 9<strong>11</strong>6687 001 003040<br />
>000001 9<strong>11</strong>6687 001 003040<br />
For plan & benefit details, please visit myCIGNAforhealth.com<br />
• PCP selection encouraged<br />
• No referrals required<br />
• GWH-Cigna ID cards represent all products<br />
Cigna Health Cigna and Health Life Insurance and LifeCompany<br />
Insurance Company<br />
GWH-Cigna<br />
GWH-CIGNA Plan Type<br />
Open<br />
Plan<br />
Access<br />
Type<br />
Plus<br />
Submit All Claims To<br />
1000 Great-West Drive<br />
Kennett, MO 63857-3749<br />
Payer ID #62308<br />
Members and Providers Call<br />
1-866-494-2<strong>11</strong>1<br />
Group 00699998 Group 00699998<br />
Issuer (80840) Issuer (80840)<br />
ID 100000008 ID 100000008 1<br />
Copays Copays 4<br />
Name JohnName Doe John Doe<br />
Primary Care Primary $25 Care $25<br />
PCP NonePCP Selected None Selected<br />
Specialist $25<br />
No Referral Required 8<br />
Specialist $25<br />
No Referral Required<br />
Urgent Care $100 Urgent Care $100<br />
ER $200<br />
XYZ Sample<br />
XYZ<br />
CompanyHoldings<br />
Sample CompanyHoldings<br />
Co.<br />
ER $200<br />
Co.<br />
<strong>11</strong><br />
10<br />
RxBIN 600428 RxPCN 05180000<br />
RxGrp 00688888<br />
RxBIN 600428 RxPCN 05180000<br />
RxGrp 00688888<br />
RxID 100000008<br />
RxID 100000008<br />
00<br />
00<br />
5<br />
<strong>13</strong> 12<br />
14<br />
9<br />
12<br />
<strong>13</strong><br />
14<br />
9<br />
Members: Carry this card at all times. Pretreatment authorization must be obtained for hospital<br />
admissions, outpatient surgeries performed outside a physician’s office and for the other services<br />
specified in the benefit plan. Member is responsible for obtaining authorization for non-network<br />
services. Failure <strong>to</strong> follow pretreatment authorization procedures may result in a reduction of<br />
benefits. In an emergency, seek care immediately, then call your primary care doc<strong>to</strong>r as soon as<br />
possible for further assistance. We encourage you <strong>to</strong> use a primary care physician as a valuable<br />
resource and personal health advocate.<br />
CIGNA has multiple networks. Your plan is paired with the GWH-CIGNA network. To find a<br />
GWH-CIGNA provider, please visit your member website at myCIGNAforhealth.com.<br />
Providers: Pretreatment authorization must be received for all services listed above and as<br />
specified in the member’s benefit plan by calling the number on the front of this card or online<br />
at CignaforHCP. com. Emergency hospital admissions must be reported within 48 hours.<br />
Notice: Possession of this card does not guarantee coverage or payment for the service or<br />
procedure reviewed. Please call the Member and Providers number on the front of this card for<br />
eligibility information.<br />
For providers not in your primary<br />
network, visit multiplan.com<br />
For Pharmacists Only 1-800-XXX-XXXX<br />
What doesit mean?<br />
What doesit mean?<br />
R318 (5/10) Mask 401<br />
Your share of the payment for health care services may be based<br />
upon our agreement withyour provider. Your provider may billyou<br />
for amounts up <strong>to</strong> the provider's regular billed charges.<br />
*<strong>11</strong>7* *<strong>11</strong>7*<br />
'Cigna' is aregistered service mark, and the 'Tree of Life' isaservice<br />
mark, of Cigna Intellectual Property, Inc., licensed for use by Cigna<br />
Corporation and its operating subsidiaries. All products and services are<br />
provided by or throughsuch operating subsidiaries and not by Cigna<br />
Your share of the payment for health care services may be based<br />
Corporation. Such operating subsidiaries include Connecticut General<br />
upon our agreement withyour provider. Your provider may billyou<br />
Life Insurance Company, Cigna Health and Life Insurance Company, Cigna<br />
for amounts up <strong>to</strong> the provider's regular billed charges.<br />
Health Management, Inc. and Cigna Dental Health, Inc. The Cigna Dental<br />
PPO is underwritten or administered by Connecticut General LIfe Insurance<br />
Issue Date: 01/01/12<br />
Company 'Cigna' is aregistered orCigna Health service and mark, Life Insurance and the 'Tree Company of Life' with isaservice network<br />
management mark, of Cigna services Intellectual provided Property, by Cigna Inc., Dental licensed Health, for use Inc., by and Cigna certain<br />
of Corporation its operating and subsidiaries. its operating subsidiaries. All products and services are<br />
provided by or throughsuch operating subsidiaries and not by Cigna<br />
Corporation. Such operating subsidiaries include Connecticut General<br />
Life Insurance Company, Cigna Health and Life Insurance Company, Cigna<br />
Health Management, Inc. and Cigna Dental Health, Inc. The Cigna Dental<br />
PPO is underwritten or administered by Connecticut General LIfe Insurance<br />
Company orCigna Health and Life Insurance Company with network<br />
management services provided by Cigna Dental Health, Inc., and certain<br />
of its operating subsidiaries.<br />
Send All Claims To<br />
Send<br />
1000<br />
All<br />
Great-West<br />
Claims To<br />
Drive<br />
1000<br />
Kennett,<br />
Great-West<br />
MO63857-3749<br />
Drive Kennett,<br />
Payer<br />
MO63857-3749<br />
ID #62308<br />
Payer ID #62308<br />
Cus<strong>to</strong>mers &Health Care Professionals call 1-866-494-2<strong>11</strong>1<br />
Rx Claims: Pharmacy Cus<strong>to</strong>mers Service Center, &Health PO Box 3598, Care Scran<strong>to</strong>n Professionals PA 18505-0598call 1-866-494-2<strong>11</strong>1<br />
Rx Claims:<br />
For<br />
Pharmacy<br />
Pharmacists<br />
Service<br />
Only<br />
Center,<br />
800-351-9170<br />
PO Box 3598, Scran<strong>to</strong>n PA 18505-0598<br />
For Pharmacists Only 800-351-9170<br />
Mask 601 Issue Date: 03/14/<strong>13</strong><br />
Mask 601 Issue Date: 03/14/<strong>13</strong><br />
Global Health Benefits<br />
• PCP selection encouraged<br />
• No referrals required<br />
• GWH-Cigna ID cards represent all products<br />
00000000<br />
00000000<br />
DIRECT<br />
USPS<br />
DIRECT<br />
USPS<br />
John Doe<br />
888 N Main JohnSt<br />
Doe<br />
Olympia, 888 WA N98502<br />
Main St<br />
Olympia, WA 98502<br />
10<br />
1<br />
20<strong>13</strong>03<strong>13</strong><br />
20<strong>13</strong>03<strong>13</strong><br />
Thu Mar 14, 20<strong>13</strong> @ 05:58:28<br />
N<br />
Thu Mar 14, 20<strong>13</strong> @ 05:58:28<br />
601<br />
N<br />
601<br />
• PCP selection encouraged<br />
• Patients in these Cigna-administered plans use Cigna PPO or Cigna OAP networks in the U.S., as indicated on the back of the card<br />
• Network Savings Program logo on back of card indicates out-of-network discounts may apply<br />
12<br />
14<br />
<strong>13</strong><br />
9<br />
15<br />
1