• Present this ID card each time you visit a health care professional.
• If you have questions or to elect or change your PCP, please visit
our website or call the toll-free customer service number located
on your ID card.
Group: 00881700
Issuer (80840)
ID:
234567891
Name:
JOHN M DOE
PCP: Jessica A. Doright DO
GCigna HealthCare of Illinois, Inc.
Medical/Rx
Referral Required
Cigna Plus
RxBIN 017010 RxPCN 0518GWH
RxGrp 00881700
RxID 234567891 00
Primary Care
Specialist
Urgent Care
ER
Hospital
Ded-50%
Ded-50%
Ded-50%
Ded-50%
Ded-50%
03040 9090436 0000 0000002 0000002 251 116
>000002 9090436 003040
1 00500-0005-L
RUN_DATE 20200907 12:45:50DATA_SEQ_NO 0000002CLIENT_NUMBER 003040UHG_TYPE DIG1CARDDOC_ID 9090436/000002-00DOC_ID 9090436/000002-01DOC_ID 9090436/000002-02DOC_SEQ_ID 0000002NAME DOE ,JOHNMAILSET_NUMBER 0000002CUST_KEY1 00881700CUST_KEY2 234567891CUST_KEY3 00CUST_KEY4 JOHNCUST_KEY5 MCUST_KEY6 DOECUST_KEY7 234567891CUST_KEY8 09/02/2020CUST_KEY9 M
What does it mean?
Ded/Coin - Subject to the plan deductible and/or coinsurance
Ded - Subject to the plan deductible amount
Coin - Subject to the plan coinsurance amount
Copay - Subject to the copayment amount
PCP - Primary Care Physician
Urgent Care - After hours/urgent care
ER - Emergency Room
Hospital or Hospital Stay - Inpatient hospital
Rx- Pharmacy
THE FOLLOWING NOTICE APPLIES TO CUSTOMERS COVERED UNDER LOUISIANA PLANS
NOTICE: YOUR SHARE OF THE PAYMENT FOR HEATHCARE SERVICE MAY BE BASED ON
THE AGREEMENT BETWEEN YOUR HEALTH PLAN AND YOUR PROVIDER. UNDER CERTAIN
CIRCUMSTANCES, THIS AGREEMENT MAY ALLOW YOUR PROVIDER TO BILL YOU FOR
AMOUNTS UP TO THE PROVIDER'S REGULAR BILLED CHARGES.
'Cigna' and the 'Tree of Life' logo are registered service marks of
Cigna Intellectual Property, Inc., licensed for use by Cigna Corporation
and its operating subsidiaries. All products and services are provided by or through
such operating subsidiaries and not by Cigna Corporation. Such operating
subsidiaries include Connecticut General Life Insurance Company (CGLIC)
Cigna Health and Life Insurance (CHLIC), Cigna Health Management, Inc.
and Cigna Dental Health, Inc. The Cigna Dental PPO is underwritten or administered
by CGLIC or CHLIC with network management services provided by Cigna
Dental Health, Inc., and certain of its operating subsidiaries. In Arizona and
Louisiana, the insured Dental PPO product is referred to as the 'CG Dental PPO'
(CGLIC) or 'CH Dental PPO' (CHLIC). In Texas, the insured dental product offered
by CGLIC and CHLIC is referred to as the 'Cigna Dental Choice Plan'.
The Cigna Dental PPO Network(s) is a national reference to our network; in Texas
this network(s) will be utilized with the Cigna Dental Choice Plan
Medical Claims
PO Box 188061 Chattanooga, TN 37422-8061 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
For Pharmacists Only: 800-351-9170
Mask 606 Issue Date: 09/07/20
*116*
00000000
DIRECT
USPS
JOHN DOE
9999 W FARWELL AVE
APT 999
CHICAGO, IL 60626
20200907
Mon Sep 07, 2020 @ 12:45:50
N
606
Lorem ipsum
• Present this ID card each time you visit a health care professional.
• If you have questions or to elect or change your PCP, please visit
our website or call the toll-free customer service number located
on your ID card.
Group: 00881200
Issuer (80840)
ID:
456789123
Name:
JOHN E DOE
GCigna Health and Life Insurance Company
Medical/Rx
No Referral Required
Florida Connect
RxBIN 017010 RxPCN 0518GWH
RxGrp 00881200
RxID 456789123 00
Primary Care
Specialist
Urgent Care
ER
Hospital
$25-0%
$60-0%
$50-0%
Ded-$600-0%
Ded-20%
03040 9091187 0000 0000001 0000001 252 117
>000001 9091187 003040
1 00500-0005-L
RUN_DATE 20200908 11:30:45DATA_SEQ_NO 0000001CLIENT_NUMBER 003040UHG_TYPE DIG1CARDDOC_ID 9091187/000001-00DOC_ID 9091187/000001-01DOC_ID 9091187/000001-02DOC_SEQ_ID 0000001NAME DOE ,JOHNMAILSET_NUMBER 0000001CUST_KEY1 00881200CUST_KEY2 456789123CUST_KEY3 00CUST_KEY4 JOHNCUST_KEY5 ECUST_KEY6 DOECUST_KEY7 456789123CUST_KEY8 11/01/2020CUST_KEY9 M
What does it mean?
Ded/Coin - Subject to the plan deductible and/or coinsurance
Ded - Subject to the plan deductible amount
Coin - Subject to the plan coinsurance amount
Copay - Subject to the copayment amount
PCP - Primary Care Physician
Urgent Care - After hours/urgent care
ER - Emergency Room
Hospital or Hospital Stay - Inpatient hospital
Rx- Pharmacy
THE FOLLOWING NOTICE APPLIES TO CUSTOMERS COVERED UNDER LOUISIANA PLANS
NOTICE: YOUR SHARE OF THE PAYMENT FOR HEATHCARE SERVICE MAY BE BASED ON
THE AGREEMENT BETWEEN YOUR HEALTH PLAN AND YOUR PROVIDER. UNDER CERTAIN
CIRCUMSTANCES, THIS AGREEMENT MAY ALLOW YOUR PROVIDER TO BILL YOU FOR
AMOUNTS UP TO THE PROVIDER'S REGULAR BILLED CHARGES.
'Cigna' and the 'Tree of Life' logo are registered service marks of
Cigna Intellectual Property, Inc., licensed for use by Cigna Corporation
and its operating subsidiaries. All products and services are provided by or through
such operating subsidiaries and not by Cigna Corporation. Such operating
subsidiaries include Connecticut General Life Insurance Company (CGLIC)
Cigna Health and Life Insurance (CHLIC), Cigna Health Management, Inc.
and Cigna Dental Health, Inc. The Cigna Dental PPO is underwritten or administered
by CGLIC or CHLIC with network management services provided by Cigna
Dental Health, Inc., and certain of its operating subsidiaries. In Arizona and
Louisiana, the insured Dental PPO product is referred to as the 'CG Dental PPO'
(CGLIC) or 'CH Dental PPO' (CHLIC). In Texas, the insured dental product offered
by CGLIC and CHLIC is referred to as the 'Cigna Dental Choice Plan'.
The Cigna Dental PPO Network(s) is a national reference to our network; in Texas
this network(s) will be utilized with the Cigna Dental Choice Plan
Medical Claims
PO Box 188061 Chattanooga, TN 37422-8061 Payer ID #62308
Rx Claims
Pharmacy Service Center, PO Box 188053, Chattanooga TN 37422-8053
For Premium, Billing and Enrollment
Questions please call: 1-877-484-5967
For Benefit and Claim questions please
call: 1-866-494-2111
For Pharmacists Only: 800-351-9170
Mask 606 Issue Date: 09/08/20
*117*
00000000
DIRECT
USPS
JOHN DOE
9999 SPINDLETOP DR
ORLANDO, FL 32819
20200908
Tue Sep 08, 2020 @ 11:30:45
N
606
• Present this ID card each time you visit a health care professional.
• If you have questions or to elect or change your PCP, please visit
our website or call the toll-free customer service number located
on your ID card.
Group: 00881200
Issuer (80840)
ID:
456789123
Name:
JOHN E DOE
GCigna Health and Life Insurance Company
Medical/Rx
No Referral Required
Florida Connect
RxBIN 017010 RxPCN 0518GWH
RxGrp 00881200
RxID 456789123 00
Primary Care
Specialist
Urgent Care
ER
Hospital
$25-0%
$60-0%
$50-0%
Ded-$600-0%
Ded-20%
03040 9091187 0000 0000001 0000001 252 117
>000001 9091187 003040
1 00500-0005-L
RUN_DATE 20200908 11:30:45DATA_SEQ_NO 0000001CLIENT_NUMBER 003040UHG_TYPE DIG1CARDDOC_ID 9091187/000001-00DOC_ID 9091187/000001-01DOC_ID 9091187/000001-02DOC_SEQ_ID 0000001NAME DOE ,JOHNMAILSET_NUMBER 0000001CUST_KEY1 00881200CUST_KEY2 456789123CUST_KEY3 00CUST_KEY4 JOHNCUST_KEY5 ECUST_KEY6 DOECUST_KEY7 456789123CUST_KEY8 11/01/2020CUST_KEY9 M
What does it mean?
Ded/Coin - Subject to the plan deductible and/or coinsurance
Ded - Subject to the plan deductible amount
Coin - Subject to the plan coinsurance amount
Copay - Subject to the copayment amount
PCP - Primary Care Physician
Urgent Care - After hours/urgent care
ER - Emergency Room
Hospital or Hospital Stay - Inpatient hospital
Rx- Pharmacy
THE FOLLOWING NOTICE APPLIES TO CUSTOMERS COVERED UNDER LOUISIANA PLANS
NOTICE: YOUR SHARE OF THE PAYMENT FOR HEATHCARE SERVICE MAY BE BASED ON
THE AGREEMENT BETWEEN YOUR HEALTH PLAN AND YOUR PROVIDER. UNDER CERTAIN
CIRCUMSTANCES, THIS AGREEMENT MAY ALLOW YOUR PROVIDER TO BILL YOU FOR
AMOUNTS UP TO THE PROVIDER'S REGULAR BILLED CHARGES.
'Cigna' and the 'Tree of Life' logo are registered service marks of
Cigna Intellectual Property, Inc., licensed for use by Cigna Corporation
and its operating subsidiaries. All products and services are provided by or through
such operating subsidiaries and not by Cigna Corporation. Such operating
subsidiaries include Connecticut General Life Insurance Company (CGLIC)
Cigna Health and Life Insurance (CHLIC), Cigna Health Management, Inc.
and Cigna Dental Health, Inc. The Cigna Dental PPO is underwritten or administered
by CGLIC or CHLIC with network management services provided by Cigna
Dental Health, Inc., and certain of its operating subsidiaries. In Arizona and
Louisiana, the insured Dental PPO product is referred to as the 'CG Dental PPO'
(CGLIC) or 'CH Dental PPO' (CHLIC). In Texas, the insured dental product offered
by CGLIC and CHLIC is referred to as the 'Cigna Dental Choice Plan'.
The Cigna Dental PPO Network(s) is a national reference to our network; in Texas
this network(s) will be utilized with the Cigna Dental Choice Plan
Medical Claims
PO Box 188061 Chattanooga, TN 37422-8061 Payer ID #62308
Rx Claims
Pharmacy Service Center, PO Box 188053, Chattanooga TN 37422-8053
For Premium, Billing and Enrollment
Questions please call: 1-877-484-5967
For Benefit and Claim questions please
call: 1-866-494-2111
For Pharmacists Only: 800-351-9170
Mask 606 Issue Date: 09/08/20
*117*
00000000
DIRECT
USPS
JOHN DOE
9999 SPINDLETOP DR
ORLANDO, FL 32819
20200908
Tue Sep 08, 2020 @ 11:30:45
N
606
• Present this ID card each time you visit a health care professional.
• If you have questions or to elect or change your PCP, please visit
our website or call the toll-free customer service number located
on your ID card.
Group: 00881700
Issuer (80840)
ID:
234567891
Name:
JOHN M DOE
PCP: Jessica A. Doright DO
GCigna HealthCare of Illinois, Inc.
Medical/Rx
Referral Required
Cigna Plus
RxBIN 017010 RxPCN 0518GWH
RxGrp 00881700
RxID 234567891 00
Primary Care
Specialist
Urgent Care
ER
Hospital
Ded-50%
Ded-50%
Ded-50%
Ded-50%
Ded-50%
03040 9090436 0000 0000002 0000002 251 116
>000002 9090436 003040
1 00500-0005-L
RUN_DATE 20200907 12:45:50DATA_SEQ_NO 0000002CLIENT_NUMBER 003040UHG_TYPE DIG1CARDDOC_ID 9090436/000002-00DOC_ID 9090436/000002-01DOC_ID 9090436/000002-02DOC_SEQ_ID 0000002NAME DOE ,JOHNMAILSET_NUMBER 0000002CUST_KEY1 00881700CUST_KEY2 234567891CUST_KEY3 00CUST_KEY4 JOHNCUST_KEY5 MCUST_KEY6 DOECUST_KEY7 234567891CUST_KEY8 09/02/2020CUST_KEY9 M
What does it mean?
Ded/Coin - Subject to the plan deductible and/or coinsurance
Ded - Subject to the plan deductible amount
Coin - Subject to the plan coinsurance amount
Copay - Subject to the copayment amount
PCP - Primary Care Physician
Urgent Care - After hours/urgent care
ER - Emergency Room
Hospital or Hospital Stay - Inpatient hospital
Rx- Pharmacy
THE FOLLOWING NOTICE APPLIES TO CUSTOMERS COVERED UNDER LOUISIANA PLANS
NOTICE: YOUR SHARE OF THE PAYMENT FOR HEATHCARE SERVICE MAY BE BASED ON
THE AGREEMENT BETWEEN YOUR HEALTH PLAN AND YOUR PROVIDER. UNDER CERTAIN
CIRCUMSTANCES, THIS AGREEMENT MAY ALLOW YOUR PROVIDER TO BILL YOU FOR
AMOUNTS UP TO THE PROVIDER'S REGULAR BILLED CHARGES.
'Cigna' and the 'Tree of Life' logo are registered service marks of
Cigna Intellectual Property, Inc., licensed for use by Cigna Corporation
and its operating subsidiaries. All products and services are provided by or through
such operating subsidiaries and not by Cigna Corporation. Such operating
subsidiaries include Connecticut General Life Insurance Company (CGLIC)
Cigna Health and Life Insurance (CHLIC), Cigna Health Management, Inc.
and Cigna Dental Health, Inc. The Cigna Dental PPO is underwritten or administered
by CGLIC or CHLIC with network management services provided by Cigna
Dental Health, Inc., and certain of its operating subsidiaries. In Arizona and
Louisiana, the insured Dental PPO product is referred to as the 'CG Dental PPO'
(CGLIC) or 'CH Dental PPO' (CHLIC). In Texas, the insured dental product offered
by CGLIC and CHLIC is referred to as the 'Cigna Dental Choice Plan'.
The Cigna Dental PPO Network(s) is a national reference to our network; in Texas
this network(s) will be utilized with the Cigna Dental Choice Plan
Medical Claims
PO Box 188061 Chattanooga, TN 37422-8061 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
For Pharmacists Only: 800-351-9170
Mask 606 Issue Date: 09/07/20
*116*
00000000
DIRECT
USPS
JOHN DOE
9999 W FARWELL AVE
APT 999
CHICAGO, IL 60626
20200907
Mon Sep 07, 2020 @ 12:45:50
N
606
Lorem ipsum
INDIVIDUAL & FAMILY PLANS
Network: Connect
PCP required Referral required Away from Home Care Out-of-network benefits
No* No* No No
PCP required Referral required Away from Home Care Out-of-network benefits
No* No* No No
For more information, see the next page.
*PCP selection and referrals are required only in Illinois.
*PCP selection and referrals are required only in Illinois.
14
14
13
13
1
1
3
3
4
4
8
8
Connect (Market Name)
(Market Name)
Network: Cigna Plus
10