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Cigna Proposal
COPY Cigna Dental Benefit Solutions for: City of Miami Request for Proposals for Employee Benefit Dental Plan RFP Number - 495345 July 2015 A Proposal for: Dental HMO and Dental PPO Coverages Provided by: Cigna Health and Life Insurance Company (CHLIC), Cigna Dental Health Plan of Arizona, Inc., Cigna Dental Health of Colorado, Inc., Cigna Dental Health of Florida, Inc., Cigna Dental Health of North Carolina, Inc., Cigna Dental Health of Ohio, Inc., Cigna Dental Health of Texas, Inc., and Cigna Dental Health of Virginia, Inc. are the legal names of the companies submitting this response to the City of Miami Request for Proposal. In this proposal, CHLIC, Cigna Dental Health Plan of Arizona, Inc., Cigna Dental Health of Colorado, Inc., Cigna Dental Health of Florida, Inc., Cigna Dental Health of North Carolina, Inc., Cigna Dental Health of Ohio, Inc., Cigna Dental Health of Texas, Inc., and Cigna Dental Health of Virginia, Inc. may use the name "Cigna" and other service marks, or division/trade names, in reference to CHLIC, Cigna Dental Health Plan of Arizona, Inc., Cigna Dental Health of Colorado, Inc., Cigna Dental Health of Florida, Inc., Cigna Dental Health of North Carolina, Inc., Cigna Dental Health of Ohio, Inc., Cigna Dental Health of Texas, Inc., and Cigna Dental Health of Virginia, Inc. and/or the products and services offered by CI LIC, Cigna Dental Health Plan of Arizona, Inc., Cigna Dental Health of Colorado, Inc., Cigna Dental Health of Florida, Inc., Cigna Dental Health of North Carolina, Inc., Cigna Dental Health of Ohio, Inc., Cigna Dental Health of Texas, Inc., and Cigna Dental Health of Virginia, Inc. and affiliated Cigna companies. All affiliated Cigna companies and operating subsidiaries are indirectly wholly owned subsidiaries of Cigna Corporation, a publicly traded corporation. "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. City of Miami RFP Number 495345 Cover Page The Cover Page should include the Proposer's name; Contact Person for the RFP; Firm's Liaison for the Contract; Primary Office Location; Local Business Address, if applicable; Business Phone and Fax Numbers, if applicable Email addresses; Title of RFP; RFP Number; Federal Employer Identification Number. Proposer's Name: Cigna Health and Life Insurance Company (CHLIC), Cigna Dental Health Plan of Arizona, Inc., Cigna Dental Health of Colorado, Inc.,. Cigna Dental Health of Florida, Inc., Cigna Dental Health of North Carolina, Inc., Cigna Dental Health of Ohio, Inc., Cigna Dental Health of Texas, Inc., Cigna Dental Health of Virginia, Inc. Contact Name: Dina D'Angelo, Client Manager Firm's Liaison for the Contract: Dina D'Angelo, Client Manager Phone: 954.790.8152 FAX: 954.514.6905 Email: dina.d'angelo@cigna.com Primary Office Location - 900 Cottage Grove Road, Bloomfield, CT 06002 Local Business Address - 1571 Sawgrass Corporate Parkway, Suite 140 Sunrise, FL 33323 Business Phone — 860.226.6000 Fax Number - 954.514.6905 Email — dina.d'angelo@,cigna.com Title of RFP - Request for Proposals for Employee Benefit Dental Plan RFP Number - 495345 Federal Employer Identification Number CHLIC 59-1031071 Cigna Dental Health Plan of Arizona, Inc. 86-0807222 Cigna Dental Health of Colorado, Inc. 59-2675861 Cigna Dental Health of Florida, Inc. 59-1611217 Cigna Dental Health of North Carolina, Inc. 56-1803464 Cigna Dental Health of Ohio, Inc. 59-2579774 Cigna Dental Health of Texas, Inc. 59-2676977 Cigna Dental Health of Virginia, Inc. 52-2188914 Copyright 2015 Page 1 of 28 Cigna City of Miami RFP Number 495345 This page intentionally left blank. Copyright 2015 Page 2 of 28 Cigna City of Miami Employee Dental Plan RFP Number 495345 Certification Statement Please quote on this form, if applicable, net prices for the item(s) listed. Return signed original and retain a copy for your files. Prices should include all costs, including transportation to destination. The City reserves the right to accept or reject all or any part of this submission. Prices should be firm for a minimum of 180 days following the time set for closing of the submissions. Agreed. In the event of errors in extension of totals, the unit prices shall govern in determining the quoted prices. This is inapplicable. We (I) certify that we have read your solicitation, completed the necessary documents, and propose to furnish and deliver, F.O.B. DESTINATION, the items or services specified herein. This is inapplicable. The undersigned hereby certifies that neither the contractual party nor any of its principal owners or personnel have been convicted of any of the violations, or debarred or suspended as set in section 18-107 or Ordinance No. 12271. To the best of our knowledge and belief, Cigna hereby certifies that neither the contractual party nor any of its principal owners or personnel have been convicted of any of the violations, or debarred or suspended as set in section 18-107 or Ordinance No. 12271. All exceptions to this submission have been documented in the section below (refer to paragraph and section). EXCEPTIONS: None. Copyright 2015 Page 3 of 28 Cigna City of Miami • Employee Dental Plan RFP Number 495345 We (I) certify that any and all information contained in this submission is true; and we (I) further certify that this submission is made without prior understanding, agreement, or k connection with any corporation, firm, or person submitting a submission for the same materials, supplies, equipment, or service, and is in all respects fair and without collusion or fraud. We (I) agree to abide by all terms and conditions of this solicitation and certify that I am authorized to sign this submission for the submitter. Please print the following and sign your name: SUPPLIER NAME: Cigna Health and Life Insurance Company (CHLIC), Cigna Dental Health Plan of Arizona, Inc., Cigna Dental Health of Colorado, Inc., Cigna Dental Health of Florida, Inc., Cigna Dental Health of North Carolina, Inc., Cigna Dental Health of Ohio, Inc., Cigna Dental Health of Texas, Inc., Cigna Dental Health of Virginia, Inc. ADDRESS: Cigna Health and Life Insurance Company, Inc., 900 Cottage Grove Road, Bloomfield, CT 06002 Cigna Dental Health Plan of Arizona, Inc., 1571 Sawgrass Corporate Parkway, Suite 140 Sunrise, FL 33323 Cigna Dental Health of Colorado, Inc. 1571 Sawgrass Corporate Parkway, Suite 140 Sunrise, FL 33323 Cigna Dental Health of Florida, Inc. 1571 Sawgrass Corporate Parkway, Suite 140 Sunrise, FL 33323 Cigna Dental Health of North Carolina, Inc. 1571 Sawgrass Corporate Parkway, Suite 140 Sunrise, FL 33323 Cigna Dental Health of Ohio, Inc. 1571 Sawgrass Corporate Parkway, Suite 140 Sunrise, FL 33323 Cigna Dental Health of Texas, Inc. 1640 Dallas Parkway, Plano, TX 75093 Cigna Dental Health of Virginia, Inc. 1571 Sawgrass Corporate Parkway, Suite 140 Sunrise, FL 33323 PHONE: 813.637.1201 FAX: 813.637.1264 EMAIL: Morris.Mirabella cni,cigna.com BEEPER: Not Available SIGNED BY: r Morris Dean Mirabella TITLE: Vice President DATE: July 10th, 2015 FAILURE TO COMPLETE, SIGN, AND RETURN THIS FORM SHALL DISQUALIFY THIS BID. Copyright 2015 Cigna City of Miami Employee Dental Plan RFP Number 495345 Certifications Legal Name of Firm: Cigna Health and Life Insurance Company (CHLIC), Cigna Dental Health Plan of Arizona, Inc., Cigna Dental Health of Colorado, Inc., Cigna Dental Health of Florida, Inc., Cigna Dental Health of North Carolina, Inc., Cigna Dental Health of Ohio, Inc., Cigna Dental Health of Texas, Inc., and Cigna Dental Health of Virginia, Inc. Address, City, State, Zip: _1571 Sawgrass Corporate Parkway, Suite 140 Sunrise, FL 33323 Contact Name: Dina D'Angelo Contact Title: Client Manager Phone: 954.514.6877 FAX: 954.514.6905 Email: dina.d'angelo@cigna.com Entity Type: Partnership, Sole Proprietorship, Corporation, etc. - Corporation Year Established: Cigna Health and Life Insurance Company, Inc. CHLIC is a corporation, originally incorporated May 2, 1963, as Orange State Life Insurance Company. After several transactions, it was acquired by Cigna Corporation on April 1, 2008. The company was renamed to CHLIC on March 5, 2010. Cigna Dental Health Plan of Arizona, Inc. 1995 Cigna Dental Health of Colorado, Inc. 1986 Cigna Dental Health of Florida, Inc. 1973 Cigna Dental Health of North Carolina, Inc. 1992 Cigna Dental Health of Ohio, Inc. 1985 Cigna Dental Health of Texas, Inc. 1986 Cigna Dental Health of Virginia, Inc. 1999 Office Location: City of Miami, Miami -Dade County, or Other — Sunrise, Florida Occupational License Number: 90689 Occupational License Issuing Agency: City of Miami, Finance Director, Jose M. Fernandez Occupational License Expiration Date: September 30, 2015 Please list and acknowledge all addendum/addenda received. List the addendum/addenda number and date of receipt (i.e. Addendum No. 1, 7/1/07). If no addendum/addenda was/were issued, please insert N/A. - Addendum No. 1, 7/17/2015 Addendum No. 2, 7/20/2015 If Bidder has a Local Office, as defined under Chapter 18/Articlle III, Section 18-73 of the City Code, has Bidder filled out, notarized, and included with its bid response the "City of Miami Local Office Certification" form? YES OR NO? (The City of Miami Local Office Certification form is located in the Oracle Sourcing system ("iSupplier"), under the Header/Notes and Attachments Section of this solicitation) No, the "City of Miami Local Office Certification" form will not be included with response. Copyright 2015 Page 5 of 28 Cigna City of Miami Employee Dental Plan RFP Number 495345 City of Miami Purchasing Department Miami Riverside Center 444 SW 2nd Avenue, 6th Floor Miami, Florida 33130 Web Site Address: httpa/ci.miami.fl.us/procurement Terms and Conditions 1. General Conditions ACCEPTANCE OF GOODS OR EQUIPMENT - Any good(s) or equipment delivered under this formal solicitation, if applicable, shall remain the property of the seller until a physical inspection and actual usage of the good is made, and thereafter is accepted as satisfactory to the City. It must comply with the terms herein and be fully in accordance with specifications and of the highest quality. In the event the goods/equipment supplied to the City are found to be defective or does not conform to specifications, the City reserves the right to cancel the order upon written notice to the Contractor and return the product to the Contractor at the Contractor's expense. This is inapplicable to the administrative services and insurance products contemplated under this Proposal. 1.2. ASSIGNMENT - Contractor agrees not to subcontract, assign, transfer, convey, sublet, or otherwise dispose of the resulting Contract, or any or all of its right, title or interest herein, without City of Miami's prior written consent. Cigna agrees not to assign the contract in whole without prior written notice; however, while Cigna serves as the sole provider of services requested in this proposal, a number of the services under our contracts are performed by affiliates of Cigna or by subcontracted vendors with a particular expertise in order to help contain costs without prior written approval for such subcontractors. These subcontracted arrangements are in place to service our entire book of business and have not been specifically contracted to service this RFP arrangement. Cigna will remain wholly responsible for provision of all services for which it contracts with the City of Miami. Copyright 2015 Page 6 of 28 Cigna City of Miami Employee Dental Plan RFP Number 495345 1.3. AUDIT RIGHTS AND RECORDS RETENTION - The Successful Bidder/Proposer agrees to provide access at all reasonable times to the City, or to any of its duly authorized representatives, to any books, documents, papers, and records of Contractor which are directly pertinent to this formal solicitation, for the purpose of audit, examination, excerpts, and transcriptions. The Successful Bidder/Proposer shall maintain and retain any and all of the books, documents, papers and records pertinent to the. Contract for three (3) years after the City makes final payment and all other pending matters are closed. Contractor's failure to or refusal to comply with this condition shall result in the immediate cancellation of this contract by the City. While Cigna's record retention requirements meet or exceed the three years requested by the City of Miami, no audit shall review claims paid more than two years before the date of the audit. Our standard is to allow audit one year after termination. Cigna shall maintain all books, documents, accounting records and other evidence pertaining to the goods and services provided under this Contract and make such materials available at its offices at all reasonable times during the Contract period and for three (3) years from the date of the final payment under this agreement for inspection by county or by any other governmental entity or agency participating in the funding of this agreement, or any authorized agents thereof; copies of said records to be furnished if requested. Such records shall include those books, documents and accounting records that represent the contractor's costs of manufacturing, acquiring or delivering the products and services governed by this agreement. Below is what we provided in last bid to them but I'm fine with what you have above. Fully Insured Under a fully insured arrangement, Cigna is fully responsible for claims administration and carries all risk associated with such processes; therefore, external audits are not permitted. Cigna has an internal claim quality assurance program to monitor internal performance standards to ensure the accuracy of claims payment. However, when required by applicable state or federal law and in keeping with the standards of the industry and Cigna's standard audit and review procedures, Cigna shall cooperate with a required audit or review of applicable documents conducted by a duly authorized representative. ASO Claim audits are permitted in accordance with the following "terms: Upon 45 days advance written request, documents relating only to claims administration services shall be made available to the City for its audit or inspection. The City of Miami will designate with Cigna's consent, an independent and a third party auditor to conduct the audit. In addition, the City of Miami and Cigna will agree upon the date for the audit during regular business hours at Cigna's office(s). The City of Miami may review payment documents relating to a random, statistically valid sample of 225 claims paid. The scope of the audit may include types of claims prone to overpayments provided the types of claims prone to underpayments are equally included and will exclude electronic analysis. Any claim adjustments will be based upon the actual claims reviewed and not on statistical Copyright 2015 Page 7 of 28 Cigna City of Miami Employee Dental Plan RFP Number 495345 projections or extrapolations. Such audits shall be conducted pursuant to the terms of Cigna's Claim Audit Agreement executed by all parties. In addition, if the City of Miami has 5,000 or more employee members, the City may conduct one such audit every plan year (but not within six months of a prior audit); otherwise, the City of Miami may conduct one such audit every two plan years (but not within 18 months of a prior audit). No audit shall review claims paid more than two years before the date of the audit. The City of Miami will remain responsible for all costs associated with an audit. 1.4. AVAILABILITY OF CONTRACT STATE-WIDE- Any Governmental, not -for - profit or quasi -governmental entity in the State of Florida, may avail itself of this contract and purchase any and all goods/services, specified herein from the successful bidder(s)/proposer(s) at the contract price(s) established herein, when permissible by federal, state, and local laws, rules, and regulations. Each Governmental, not -for -profit or quasi -governmental entity which uses this formal solicitation and resulting bid contract or agreement will establish its own contract/agreement, place its own orders, issue its own purchase orders, be invoiced there from and make its own payments, determine shipping terms and issue its own exemption certificates as required by the successful bidder(s)/proposer(s). Agreed, however, Cigna reserves the right to review additional claims information and request client -specific information to fully evaluate our response to another jurisdiction's request for proposal. We reserve the right to adjust our response based on the information provided to us. 1.10. AWARD OF CONTRACT: A. The Formal Solicitation, Bidder's/Proposer's response, any addenda issued, and the purchase order shall constitute the entire contract, unless modified in accordance with any ensuing contract/agreement, amendment or addenda. To the extent that the responses in this RFP are mutually agreed upon, Cigna agrees to be bound by that language. Because this is a fully insured product, our insurance policy and certificate will be issued. These are filed documents, and there is very little flexibility to change the provisions. In a self -insured arrangement, Cigna will issue our administrative services only agreement. If changes in the language occur during the process of preparing the final ASO agreement, Cigna will be liable only for those mutually agreed -upon provisions entered into as part of the executed ASO agreement. Discrepancies, if any, between the RFP and the ASO agreement will be decided in favor of the ASO agreement. C. The award of this contract may be preconditioned on the subsequent submission of other documents as specified in the Special Conditions or Technical Specifications. Bidder/Proposer shall be in default of its Copyright 2015 Page 8 of 28 Cigna City of Miami Employee Dental Plan RFP Number 495345 contractual obligation if such documents are not submitted in a timely manner and in the form required by the City. Where Bidder/Proposer is in default of these contractual requirements, the City, through action taken by the Purchasing Department, will void its acceptance of the Bidder's/Proposer's Response and may accept the Response from the next lowest responsive, responsible Bidder or Proposal most advantageous to the City or re -solicit the City's requirements. The City, at its sole discretion, may seek monetary restitution from Bidder/Proposer and its bid/proposal bond or guaranty, if applicable, as a result of damages or increased costs sustained as a result of the Bidder's/Proposer's default. Acknowledged. Should Cigna fail to submit other documents as specified in the Special Conditions or Technical Specifications, the City may procure services from other sources; however, Cigna cannot be liable for any excess costs occasioned thereby. F. Where the contract involves a single shipment of goods to the City, the contract term shall conclude upon completion of the expressed or implied warranty periods. This is inapplicable to the insurance services contemplated by this proposal. G. The City reserves the right to award the contract on a split -order, lump sum or individual -item basis, or such combination as shall best serve the interests of the City unless otherwise specified. This is inapplicable to the insurance services contemplated by this proposal. 1.14. BRAND NAMES - If and wherever in the specifications brand names, makes, models, names of any manufacturers, trade names, or bidder/proposer catalog numbers are specified, it is for the purpose of establishing the type, function, minimum standard of design, efficiency, grade or quality of goods only. When the City does not wish to rule out other competitors' brands or makes, the phrase "OR EQUAL" is added. When bidding/proposing an approved equal, Bidders/Proposers will submit, with their response, complete sets of necessary data (factory information sheets, specifications, brochures, etc.) in order for the City to evaluate and determine the equality of the item(s) bid/proposed. The City shall be the sole judge of equality and its decision shall be final. Unless otherwise specified, evidence in the form of samples may be requested if the proposed brand is other than specified by the City. Such samples are to be furnished after formal solicitation opening/closing only upon request of the City. If samples should be requested, such samples must be received by the City no later than seven (7) calendar days after a formal request is made. This is inapplicable to the insurance services contemplated by this proposal. 1.19. COMPLIANCE WITH FEDERAL, STATE AND LOCAL LAWS - Contractor understands that contracts between private entities and local governments are subject to certain laws and regulations, including laws pertaining to public records, conflict of interest, records keeping, etc. City and Contractor agree to comply with and observe all applicable laws, codes and ordinances as that may in any way affect the goods or equipment offered, including but not limited to: A. Executive Order 11246, which prohibits discrimination against any Copyright 2015 Page 9 of 28 Cigna City of Miami Employee Dental Plan RFP Number 495345 employee, applicant, or client because of race, creed, color, national origin, sex, or age with regard to, but not limited to, the following: employment practices, rate of pay or other compensation methods, and training selection. B. Occupational, Safety and Health Act (OSHA), as applicable to this Formal Solicitation. C. The State of Florida Statutes, Section 287.133(3)(A) on Public Entity Crimes. D. Environment Protection Agency (EPA), as applicable to this Formal Solicitation. E. Uniform Commercial Code (Florida Statutes, Chapter 672). F. Americans with Disabilities Act of 1990, as amended. G. National Institute of Occupational Safety Hazards (NIOSH), as applicable to this Formal Solicitation. H. National Forest Products Association (NFPA), as applicable to this Formal Solicitation. L City Procurement Ordinance City Code Section 18, Article III. J. Conflict of Interest, City Code Section 2-611;61. K. Cone of Silence, City Code Section 18-74. L. The Florida Statutes Sections 218.73 and 218.74 on Prompt Payment. Lack of knowledge by the bidder/proposer will in no way be a cause for relief from responsibility. Non-compliance with all local, state, and federal directives, orders, and laws may be considered grounds for termination of contract(s). Copies of the City Ordinances may be obtained from the City Clerk's Office. Agreed, as applicable to the insurance services contemplated by this Request for Proposal. Cigna has processes in place to comply with federal laws, regulatory requirements, and state laws to the extent they are not preempted by provisions of federal laws that are applicable to our services. 1.23. COPYRIGHT OR PATENT RIGHTS Bidders/Proposers warrant that there has been no violation of copyright or patent rights in manufacturing, producing, or selling the goods shipped or ordered and/or services provided as a result of this formal solicitation, and bidders/proposers agree to hold the City harmless from any and all liability, loss, or expense occasioned by any such violation. Cigna shall indemnify and save harmless the City of Miami against any claim arising from the actual or alleged infringement of any third -party intellectual property right by any copyrighted, patented or un-patented invention, process, or article provided by Cigna to the City of Miami in the course of performance of the contract. Upon default by the successful Bidder/Proposer to meet any terms of this agreement, the City will notify the Bidder/Proposer of the default and will provide the contractor three (3) days (weekends and holidays excluded) to remedy the default. Failure on the contractor's part to correct the default within the required three (3) days shall result in the Contract being Copyright 2015 Page 10 of 28 Cigna City of Miami Employee Dental Plan RFP Number 495345 terminated and upon the City notifying in writing the contractor of its intentions and the effective date of the termination. The following shall constitute default: A. Failure to perform the work or deliver the goods/services required under the Contract and/or within the time required or failing to use the subcontractors, entities and personnel as identified and set forth, and to the degree specified in the Contract. B. Failure to begin the work under this Contract within the time specified. C. Failure to perform the work with sufficient workers and equipment or with sufficient materials to ensure timely completion. D. Neglecting or refusing to remove materials or perform new work where prior work has been rejected as nonconforming with the terms of the Contract. E. Becoming insolvent, being declared bankrupt, or committing any act of bankruptcy or insolvency, or making an assignment for the benefit of creditors, if the insolvency, bankruptcy, or assignment renders the successful Bidder/Proposer incapable of performing the work in accordance with and as required by the Contract. F. Failure to comply with any of the terms of the Contract in any material respect. All costs and charges incurred by the City as a result of a default or a default incurred beyond the time limits stated, together with the cost of completing the work, shall be deducted from any monies due or which may become due on this Contract. Agreed, however, the City of Miami is liable for its obligations to sufficiently fund the claims bank account and pay fees or premium as required under the Administrative Services Only (ASO) agreement or insurance contract. Cigna specifically reserves its right to immediately terminate for default if the City of Miami fails to pay fees or premiums due or fails to sufficiently fund the claims bank account in accordance with the ASO agreement or insurance contract. 1.33. ESTIMATED QUANTITIES —Estimated quantities or estimated dollars are provided for your guidance only. No guarantee is expressed or implied as to quantities that will be purchased during the contract period. The City is not obligated to place an order for any given amount subsequent to the award of this contract. Said estimates may be used by the City for purposes of determining the low bidder or most advantageous proposer meeting specifications. The City reserves the right to acquire additional quantities at the prices bid/proposed or at lower prices in this Formal Solicitation. This is inapplicable to the insurance services contemplated by this proposal. 1.41. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA) - Any person or entity that performs or assists the City of Miami with a function or activity involving the use or disclosure of "individually identifiable health information (IIHI) and/or Protected Health Information (PHI) shall comply with the Health Insurance Portability and Accountability Act (HIPAA) of 1996 and the City of Miami Privacy Standards. IIIPAA mandates for privacy, Copyright 2015 Page 11 of 28 Cigna City of Miami Employee Dental Plan RFP Number 495345 security and 'electronic transfer standards, which include but are not limited to: H. Making internal practices, books and records related to PHI available to the City of Miami for compliance audits. This information is restricted and we are unable to share with the City of Miami; however, we would work with the City of Miami to answer any inquiries without divulging restricted information. PHI shall maintain its protected status regardless of the form and method of transmission (paper records, and/or electronic transfer of data). The Bidder/ Proposer must give its customers written notice of its privacy information practices including specifically, a description of the types of uses and disclosures that would be made with protected health information. In accordance with the requirements of the HIPAA Privacy Rule, Cigna will distribute for , fully insured clients, as part of the enrollment process, a notice of privacy practices that reflects HIPAA privacy regulations for subscribers in our insured plans. The notice of privacy practices is accessible anytime online, and is reissued at least once every three years to subscribers. As a business associate of a self -funded client, Cigna does not create or distribute the notice of privacy practices for the client. 1.42 INDEMNIFICATION - Contractor shall indemnify, hold harmless and defend the City, its officials, officers, agents, directors, and employees, from liabilities, damages, losses, and costs, including, but not limited to reasonable attorney's fees, to the extent caused by the negligence, recklessness or intentional wrongful misconduct of Contractor and persons employed or utilized by Contractor in the performance of this Contract and will indemnify, hold harmless and defend the City, its officials, officers, agents, directors and employees against, any civil actions, statutory or similar claims, injuries or damages arising or resulting from the permitted work, even if it is alleged that the City, its officials and/or employees were negligent. These indemnifications shall survive the term of this Contract. In the event that any action or proceeding is brought against City by reason of any such claim or demand, Contractor shall, upon written notice from City, resist and defend such action or proceeding by counsel satisfactory to City. The Contractor expressly understands and agrees that any insurance protection required by this Contract or otherwise provided by Contractor shall in no way limit the responsibility to indemnify, keep and save harmless and defend the City or its officers, employees, agents and instrumentalities as herein provided. The indemnification provided above shall obligate Contractor to defend at its own expense to and through appellate, supplemental or bankruptcy proceeding, or to provide for such defense, at City's option, any and all claims of liability and all suits and actions of every name and description which may be brought against City whether performed by Contractor, or persons employed or utilized by Contractor. This indemnity will survive the cancellation or expiration of the Contract. This indemnity will be interpreted under the laws of the State of Florida, including without limitation and which conforms to the limitations of §725.06 and/or §725.08, Fla. Statues, as amended from time to time as applicable. Contractor shall require all Sub -Contractor agreements to include a provision that Copyright 2015 Page 12 of 28 Cigna City of Miami Employee Dental Plan RFP Number 495345 they will indemnify the City. ASO Funding Under an ASO arrangement, Cigna shall use ordinary and reasonable care in the performance of its duties, but shall not be liable to the City of Miami for mistakes of judgment or other actions taken in good faith (including benefits erroneously overpaid). Cigna will indemnify and hold the City of Miami harmless from and against all extra - contractual (non -benefit) costs, damages, judgments, attorneys' fees, expenses, and liabilities of any kind or nature which occur as the result of Cigna's gross negligence or intentional wrongdoing concerning the administration of claims under the City of Miami's plan. Fully Insured Funding With respect to fully insured products, Cigna will indemnify and hold the City of Miami, its officers, directors, agents, and/or employees (acting in the scope of their employment and not as claimants under the plan), harmless from and against all costs, damages, judgments, attorneys' fees, expenses, obligations, and liabilities of any kind or nature, which occur as the result of Cigna's failure to pay valid claims within the twin and conditions of the policy where such failure is not due to any action or inaction by the City of Miami, its officers, directors, agents, and/or employees. Subcontracted Arrangements Our subcontracted arrangements are in place to service our entire book of business and have not been specifically contracted to service this RFP arrangement. Therefore our subcontracts do not include this provision. Cigna will remain wholly responsible for provision of all services for which it contracts with the City of Miami. The Contractor agrees and recognizes that the City shall not be held liable or responsible for any claims which may result from any actions or omissions of the Contractor in which the City participated either through review or concurrence of the Contractor's actions. In reviewing, approving or rejecting any submissions by the Contractor or other acts of the Contractor, the City in no way assumes or shares any responsibility or liability of the Contractor or Sub -Contractor, under this Agreement. ASO Funding Under an ASO arrangement, Cigna shall use ordinary and reasonable care in the performance of its duties, but shall not be liable to the City of Miami for mistakes of judgment or other actions taken in good faith (including benefits erroneously overpaid). Cigna will indemnify and hold the City of Miami harmless from and against all extra - contractual (non -benefit) costs, damages, judgments, attorneys' fees, expenses, and liabilities of any kind or nature which occur as the result of Cigna's gross negligence or intentional wrongdoing concerning the administration of claims under the City of Miami's plan. Fully Insured With respect to fully insured products, Cigna will indemnify and hold the City of Miami, its officers, directors, agents, and/or employees (acting in the scope of their employment and not as claimants under the plan), harmless from and against all costs, damages, judgments, attorneys' fees, expenses, obligations, and liabilities of any kind or nature, which occur as the result of Cigna's failure to pay valid claims within the terms Copyright 2015 Page 13 of 28 Cigna City of Miami Employee Dental Plan RFP Number 495345 and conditions of the policy where such failure is not due to any action or inaction by the City of Miami, its officers, directors, agents, and/or employees. Subcontracted Arrangements Our subcontracted arrangements are in place to service our entire book of business and have not been specifically contracted to service this RFP arrangement. Therefore our subcontracts do not include this provision. Cigna will remain wholly responsible for provision of all services for which it contracts with the City of Miami. 1.44. INSPECTIONS - The City may, at reasonable times during the term hereof, inspect Contractor's facilities and perform such tests, as the City deems reasonably necessary, to determine whether the goods and/or services required to be provided by the Contractor under this Contract conform to the terms and conditions of the Formal Solicitation. Contractor shall make available to the City all reasonable facilities and assistance to facilitate the performance of tests or inspections by City representatives. All tests and inspections shall be subject to, and made in accordance with, the provisions of the City of Miami Ordinance No. 12271 (Section 18-79), as same may be amended or supplemented from time to time. ASO Claim Audit: City of Miami may, in accordance with the following requirements and at no additional charge while this agreement is in effect, audit Cigna Health and Life Insurance Company's (CHLIC's) payment of plan coverage subject to the following conditions: i. City of Miami shall provide to CHLIC a scope of audit letter and the fully executed Claim Audit Agreement, together with a 45-day advance written request for audit. City of Miami will designate with CHLIC' s consent, such consent not to be unreasonably withheld, an independent, third party auditor to conduct the audit (the "auditor"). In addition, City of Miami and CHLIC will agree upon the date for the audit during regular business hours at CHLIC's office(s). City of Miami shall be responsible for its auditor's costs. The audit shall be conducted in accordance with the terms of CHLIC' s Claim Audit Agreement, which is hereby agreed to by the City of Miami and which shall be signed by the Auditor before the start of the audit. ii. City of Miami may conduct one such audit every 2-plan years (but not within 18 months of a prior audit). iii. Auditor will review payment documents (subject to any contrary terms in participating health care professional agreements) relating to a random, statistically valid sample of 225 claims paid during the two prior plan years and not previously audited. If the audit identifies any claim adjustments, any such adjustments will be made in accordance with this agreement and based upon the actual claims reviewed and not upon statistical projections or extrapolations. Fully Insured Under a fully insured arrangement, Cigna is fully responsible for claims administration and carries every risk associated with such processes; therefore, we cannot permit an Copyright 2015 Page 14 of 28 Cigna City of Miami Employee Dental Plan RFP Number 495345 external audit; however, Cigna has an internal claim quality assurance program to monitor internal performance standards to ensure the accuracy of claims payment. 1.49. MANUFACTURER'S CERTIFICATION - The City reserves the right to request from bidders/proposers a separate Manufacturer's Certification of all statements made in the bid/proposal. Failure to provide such certification may result in the rejection of bid/proposal or termination of contract/agreement, for which the bidder/proposer must bear full liability. This is inapplicable to the insurance services contemplated by this proposal. In addition, any and all commodities, equipment, and services required by the City in conjunction with construction projects are solicited under a distinctly different solicitation process and shall not be purchased under the terms, conditions and awards rendered under this solicitation, unless such purchases are determined to be in the best interest of the City. This is inapplicable to the insurance services contemplated by this proposal. 1.55. OCCUPATIONAL LICENSE - Any person, firm, corporation or joint venture, with a business location in the City of Miami and is submitting a Response under this Formal Solicitation shall meet the City's Occupational License Tax requirements in accordance with Chapter 31.1, Article I of the City of Miami Charter. Others with a location outside the City of Miami shall meet their local Occupational License Tax requirements. A copy of the license must be submitted with the response; however, the City may at its sole option and in its best interest allow the Bidder/Proposer to supply the license to the City during the evaluation period, but prior to award. We have provided a copy of our Miami business tax certificate in the list of Attachments section of the proposal binder. 1.57. OWNERSHIP OF DOCUMENTS - It is understood by and between the parties that any documents, records, files, or any other matter whatsoever which is given by the City to the successful Bidder/Proposer pursuant to this formal solicitation shall at all times remain the property of the City and shall not be used by the Bidder/Proposer for any other purposes whatsoever without the written consent of the City. Claim or payment data recorded for or otherwise integrated into Cigna's data processing systems during the ordinary course of business, any information which Cigna reasonably deems to be proprietary in nature, or any infoiriiation which Cigna reasonably believes it cannot divulge due to applicable state and/or federal privacy restrictions will be considered the property of Cigna. Cigna will only use the City of Miami's data to carry out the obligations under the contract, as applicable by law, and as permitted by use under the HIPAA and HITECH regulations. For a self -insured arrangement, Cigna will give the City of Miami reasonable access to claim records and data, subject to Cigna's standard confidentiality procedures and agrees to transfer claim data to a successor administrator to the extent administratively feasible Copyright 2015 Page 15 of 28 Cigna City of Miami Employee Dental Plan RFP Number 495345 • and to the extent the parties negotiate a mutually agreeable fee. For a fully insured product, Cigna will provide certain reports to clients to enable them to administer their coverage plans. If termination of the contract occurs, Cigna would transfer infatuation to a designated carrier upon receipt of a suitable confidentiality and hold harmless agreement from that carrier. 1.59. PERFORMANCE/PAYMENT BOND —A Contractor may be required to furnish a Performance/Payment Bond as part of the requirements of this Contract, in an amount equal to one hundred percent (100%) of the contract price. This is inapplicable to the insurance services contemplated by this proposal. 1.61. PRICE ADJUSTMENTS — Any price decrease effectuated during the contract period either by reason of market change or on the part of the contractor to other customers shall be passed on to the City of Miami. This is inapplicable to the insurance services contemplated by this proposal. 1.65. PROPERTY - Property owned by the City of Miami is the responsibility of the City of Miami. Such property furnished to a Contractor for repair, modification, study, etc., shall remain the property of the City of Miami. Damages to such property occurring while in the possession of the Contractor shall be the responsibility of the Contractor. Damages occurring to such property while in route to the City of Miami shall be the responsibility of the Contractor. In the event that such property is destroyed or declared a total loss, the Contractor shall be responsible for replacement value of the property at the current market value, less depreciation of the property, if any. This is inapplicable to the insurance services contemplated by this proposal. 1.69. QUALITY OF GOODS, MATERIALS, SUPPLIES, PRODUCTS, AND EQUIPMENT - All materials used in the manufacturing or construction of supplies, materials, or equipment covered by this solicitation shall be new. The items bid/proposed must be of the latest make or model, of the best quality, and of the highest grade of workmanship, unless as otherwise specified in this Solicitation. This is inapplicable to the insurance services contemplated by this proposal. 1.70. QUALITY OF WORK/SERVICES - The work/services performed must be of the highest quality and workmanship. Materials furnished to complete the service shall be new and of the highest quality except as otherwise specified in this Solicitation. This is inapplicable to the insurance services contemplated by this proposal. 1.74. SAMPLES - Samples of items, when required, must be submitted within the time specified at no expense to the City. If not destroyed by testing, Copyright 2015 Page 16 of 28 Cigna City of Miami Employee Dental Plan RFP Number 495345 bidders)/proposer(s) will be notified to remove samples, at their expense, within 30 days after notification. Failure to remove the samples will result in the samples becoming the property of the City. This is inapplicable to the insurance services contemplated by this proposal. 1.75. SELLING, TRANSFERRING OR ASSIGNING RESPONSIBILITIES - Contractor shall not sell, assign, transfer or subcontract at any time during the term of the Contract, or any part of its operations, or assign any portion of the performance required by this contract, except under and by virtue of written permission granted by the City through the proper officials, which may be withheld or conditioned, in the City's sole discretion. Cigna agrees not to assign the contract in whole; however, while Cigna serves as the sole provider of services requested in this proposal, a number of the services under our contracts are performed by affiliates of Cigna or by subcontracted vendors with a particular expertise in order to help contain costs without prior written approval for such subcontractors. Every such service will be supervised by Cigna, which will be wholly responsible and liable for the services set forth in the contract. 1.76. SERVICE AND WARRANTY —When specified, the bidder/proposer shall define all warranty, service and replacements that will be provided. Bidders/Proposer must explain on the Response to what extent warranty and service facilities are available. A copy of the manufacturer's warranty, if applicable, should be submitted with your response. This is inapplicable to the insurance services contemplated by this proposal. 1.80. TERMINATION —The City Manager on behalf of the City of Miami reserves the right to terminate this contract by written notice to the contractor effective the date specified in the notice should any of the following apply: A. The contractor is determined by the City to be in breach of any of the terms and conditions of the contract. B. The City has determined that such termination will be in the best interest of the City to terminate the contract for its own convenience; C. Funds are not available to cover the cost of the goods and/or services. The City's obligation is contingent upon the availability of appropriate funds. Cigna agrees that the City of Miami may reserve the right to terminate this contract. In addition, Cigna understands that the City of Miami's obligation to pay under this contract is contingent upon an annual appropriation of funds, however, the City of Miami is liable for its obligations to sufficiently fund the claims bank account and pay fees or premium as required under the Administrative Services Only (ASO) agreement or insurance contract. Cigna specifically reserves its right to immediately terminate if the City of Miami fails to pay fees or premiums due or fails to sufficiently fund the claims bank account in accordance with the ASO agreement or insurance contract. 1.82. TIMELY DELIVERY -Time will be of the essence for any orders placed as a result of this solicitation. The City reserves the right to cancel such orders, or any part thereof, without obligation, if delivery is not made within the times) specified on Copyright 2015 Page 17 of 28 Cigna City of Miami Employee Dental Plan RFP Number 495345 their Response. Deliveries are to be made during regular City business hours unless otherwise specified in the Special Conditions. This is inapplicable to the insurance services contemplated by this proposal. 1.83. TITLE - Title to the goods or equipment shall not pass to the City until after the City has accepted the goods/equipment or used the goods, whichever comes first. This is inapplicable to the insurance services contemplated by this proposal. 2. Special Conditions 2.5. NON -APPROPRIATION OF FUNDS In the event no funds or insufficient funds are appropriated and budgeted or are otherwise unavailable in any fiscal period for payments due under this contract, then the City, upon written notice to the Proposer or assignee of such occurrence, shall have the unqualified right to terminate the contract without any penalty or expense to the City. No guarantee, warranty or representation is made that any particular or any project(s) will be awarded to any firm(s). Agreed. Cigna understands that the City of Miami's obligation to pay under this contract is contingent upon an annual appropriation of funds. However, Cigna reserves the right to suspend bank account claim payments or immediately terminate this agreement if the City of Miami fails to sufficiently fund the claims bank account or fails to pay fees or premiums beyond the grace period. 2.6. MINIMUM QUALIFICATION REQUIREMENTS The City is seeking a single administrator for both its Dental DPPO and DHMO plans. However, a proposal may be submitted for either plan. For a Proposer to be deemed responsive, the following minimum qualification requirements listed below shall be satisfied. In determining said responsiveness, each such minimum qualification requirement shall be addressed in detail in the proposal submittal. Failure to meet each of the below minimum qualification requirements and/or failure to provide sufficient detailed documentation concerning the same, shall result in the Proposal being deemed non -responsive. Proposer shall: A. Be licensed by the State of Florida, Office of Insurance Regulations to provide the plan services throughout the term of the contract; Cigna Health and Life Insurance Company (CHLIC) is licensed to transact the business of insurance by the insurance departments of all 50 states/jurisdictions, and is subject to the regulation of each of those states within the scope of applicable law. CHLIC is subject to applicable federal laws and regulations. B. Have demonstrated level of good performance with public entities of equivalent size, including municipalities, for a minimum of three (3) years; Acknowledged, please see the references provided for recommendations from public entities and or municipalities that are happy with Cigna's performance. Copyright 2015 Page 18 of 28 Cigna City of Miami Employee Dental Plan RFP Number 495345 C. Have an organization that has demonstrated the ability to deliver cost- effective service, and efficient loss control and claims processing; Agreed. D. Have sufficient telephone service, including toll -free and local service 8:00 AM-5:00 PM (Eastern time), to handle inquiries directly from plan participants as well as authorized City representatives; Cigna chose to be the only national health service company to expand our customer service hours to include the weekends, holidays, and overnight hours. Our toll -free customer service number, 800.Cigna24 is staffed 24 hours a day, 7 days a week, 365 days a year, to answer questions about coverage, DHMO dental office transfers, DPPO claims, procedures, or any other concerns. Our voice response system is also available 24 hours a day, 7 days a week, 365 days a year. DHMO members can use the voice response system to view eligibility and coverage information, or they can use our automated quick transfer option to change network dental offices. DEPO/DPPO/indemnity members can use the voice response system to check claim status, eligibility, and coverage information. The toll -free number provides assistance 24-hours a day, allowing the member to enter their zip code and hear a list of nearby dental offices via the dental office locator. The toll -free number can also fax this list immediately to assist in enrollment or dental office transfers for the DHMO. Members can also enter a dentist's phone number to see if he or she participates in the network. If there are multiple dentists with the same phone number, the system will speak back the name of each dentist, and clearly identifies DHMO capped dental offices. The system updates this infoiitiation nightly. E. Confirm that: No commission shall be included in the proposed rates; Confiuined. F. Assume current policy benefit structure and provide a "no loss/no gain" assumption of risk and credit for all annual deductibles; City of Miami will determine their employees' eligibility; therefore, there will be no loss of coverage for any employees or COBRA participants if the client remits premium on the start date. Our coverage and exclusions or limitations, however, may differ from the current DPPO plan. DHMO Procedures in progress, such as crown and bridge, denture, and root canal treatment, are not covered. For Texas there may be a limited payment for orthodontic treatment in progress; we may contribute a flat dollar amount toward the original fee based on the number of months remaining in treatment and the plan's coverage level. Members may call customer service to discuss their situation. Copyright 2015 Page 19 of 28 Cigna City of Miami Employee Dental Plan RFP Number 495345 DPPO We assume that the prior carrier will have liability for claims incurred before the date that coverage transfers to us. We are able to carry over deductibles and calendar year maximums from the previous carrier. City of Miami is responsible for providing the needed documentation and an additional charge may apply. G. Comply with all federal legislation including but not limited to HIPAA Cealth Insurance Portability and Accountability Act of 1996) and COBRA onsolidated Omnibus Budget Reconciliation Act); Agreed. Cigna has processes in place to comply with federal laws, regulatory requirements, and state laws to the extent they are not preempted by provisions of federal laws that are applicable to our services. H. Agree to allow the City or its representative the right to audit all claims, financial data, and other information relevant to the City's account at no cost to the City; Cigna will allow the City of Miami to audit claims under an ASO arrangement according the details outlined below at no charge; however, the City of Miami is responsible for its auditor's costs. ASO Claim audits are permitted in accordance with the following teinis: Upon 45 days advance written request, documents relating only to claims administration services shall be made available to the City of Miami for its audit or inspection. The City of Miami will designate with Cigna's consent, an independent and a third party auditor to conduct the audit. In addition, the City of Miami and Cigna will agree upon the date for the audit during regular business hours at Cigna's office(s). The City of Miami may review payment documents relating to a random, statistically valid sample of 225 claims paid. The scope of the audit may include types of claims prone to overpayments provided the types of claims prone to underpayments are equally included and will exclude electronic analysis. Any claim adjustments will be based upon the actual claims reviewed and not on statistical projections or extrapolations. Such audits shall be conducted pursuant to the terms of Cigna's Claim Audit Agreement executed by all parties. In addition, if the City of Miami has 5,000 or more employee members, the City of Miami may conduct one such audit every plan year (but not within six months of a prior audit); otherwise, the City of Miami may conduct one such audit every two plan years (but not within 18 months of a prior audit). No audit shall review claims paid more than two years before the date of the audit. The City of Miami will remain responsible for all costs associated with an audit. Fully Insured Under a fully insured arrangement, Cigna is fully responsible for claims administration and carries all risk associated with such processes; therefore, external audits are not peniiitted. Cigna has an internal claim quality assurance program to monitor internalperformance standards to ensure the accuracy of Copyright 2015 Page 20 of 28 Cigna City of Miami Employee Dental Plan RFP Number 495345 claims payment. However, when required by applicable state or federal law and in keeping with the standards of the industry and Cigna's standard audit and review procedures, Cigna shall cooperate with a required audit or review of applicable documents conducted by a duly authorized representative. Waive the pre-existing condition limitations and the actively at work provision for the initial enrollment for those employees who have already satisfied the waiting period for pre-existing conditions under the current - plan; Agreed There are no preexisting condition limitations except for the completion of crown and bridge, denture, or root canal treatment already in progress on the date the member becomes covered by the Cigna Dental Care plan. DPPO Replacement of bridges, crowns, or dentures within five years of the date of installation (on some plans within two or three years) will not be covered unless: • replacement is made necessary by the placement of an original opposing full denture or the necessary extraction of natural teeth after existing prosthetic was installed • bridge, crown or denture, while in the mouth, is damaged beyond repair as a result of injury Missing Teeth Limitation Teeth missing before the plan's start date are not covered under the proposed plan. J. Have bilingual capabilities in the customer service and enrollment assistance areas as well as in communications materials. English and Spanish are mandatory. Creole is also preferred; Agreed. Customer service advocates (CSAs) can assist non -English-speaking members. Bilingual CSAs service Spanish language calls. Members reach Spanish- speaking CSAs via a Spanish prompt selection on the toll -free customer service number. If a bilingual representative is not available, or a member needs help in another language, a CSA will set up a conference call with an interpreter through LanguageLine Solutions, a nationally recognized and certified foreign language interpretation service. Members access this service through our toll -free customer service number, 800. Cigna24. LanguageLine Solutions offers translation services for more than 200 languages including Creole language. K. Have no record of judgments or pending lawsuits against the City and/or bankruptcy, and not have any conflicts of interest that have not been waived by the City Commission; Copyright 2015 Page 21 of 28 Cigna City of Miami Employee Dental Plan RFP Number 495345 There are no pending lawsuits against or with the City of Miami. To the best of our knowledge and belief neither Cigna nor any member, officer, or stockholder of Cigna is in arrears or in default of any debt or contract involving the City of Miami, (as a party to a contract, or otherwise); nor have failed to perform faithfully on any previous contract with the City of Miami. L. Have neither Proposer nor any member, officer, or stockholder of Proposer be in arrears or in default of any debt or contract involving the City, (as a party to a contract, or otherwise); nor have failed to perform faithfully on any previous contract with the City; To the best of our knowledge and belief, neither Cigna, nor any member, officer, or stockholder of Cigna is in arrears or in default of any debt or contract involving the City of Miami, (as a party to a contract, or otherwise); nor has failed to perform faithfully on any previous contract with the City of Miami. M. Not increase Proposer's nationwide current book of business by more than 25%o by the City account; Confirmed. N. Possess at least five (5) years of experience administering claims and providing similar services to those listed in the Scope of Work/Specifications for groups of 3,300 and greater; Continued. O. Provide Claims VS Premium reporting regardless of the number of employees that enroll in the DPPO portion of the Dental benefits (this will not apply to the DHMO portion of benefits); Confirmed. P. Provide quarterly utilization reporting for both DPPO and. DHMO, regardless of the number of employees enrolled in each perspective; Agreed. 2.7. CONTRACT EXECUTION The Proposer(s) evaluated and ranked in accordance with the requirements of this Solicitation, shall be awarded an opportunity to negotiate a contract ("Contract") with the City. The City reserves the right to execute or not execute, as applicable a Professional Services Agreement ("Agreement") with the successful Proposer(s) n substantially the same form as the Agreement included as part of this solicitation (refer to Attachment B). Such Agreement will be furnished by the City, will contain certain terms as are in the City's best interests, and will be subject to approval as to legal form by the City Attorney. As the incumbent carrier, Cigna has included a copy of the current, in -force, insurance policy. The policy, along with a sample copy of our ASO agreement, are included in the List of Attachments section of the proposal binder. Copyright 2015 Page 22 of 28 Cigna City of Miami Employee Dental Plan RFP Number 495345 2.9. INSURANCE REQUIREMENTS INDEMNIFICATION Successful Proposer shall pay on behalf of, indemnify and save City and its officials harmless, from and against any and all claims, liabilities, losses, and causes of action, which may arise out of Proposer's performance under the provisions of the contract, including all acts or omissions to act on the part of Proposer, including any person performing under this Contract for or on Proposer's behalf, provided that any such claims, liabilities, losses and causes of such action are not attributable to the negligence or misconduct of the City and, from and against any orders, judgments or decrees which may be entered and which may result from this Contract, unless attributable to the negligence or misconduct of the City, and from and against all costs, attorneys' fees, expenses and liabilities incurred in the defense of any such claim, or the investigation thereof. ASO Funding Under an ASO arrangement, Cigna shall use ordinary and reasonable care in the performance of its duties, but shall not be liable to the City of Miami for mistakes of judgment or other actions taken in good faith (including benefits erroneously overpaid). Cigna will indemnify and hold the City of Miami harmless from and against all extra - contractual (non -benefit) costs, damages, judgments, attorneys' fees, expenses, and liabilities of any kind or nature which occur as the result of Cigna's gross negligence or intentional wrongdoing concerning the administration of claims under the City of Miami's plan. Fully Insured Funding With respect to fully insured products, Cigna will indemnify and hold the City of Miami, its officers, directors, agents, and/or employees (acting in the scope of their employment and not as claimants under the plan), harmless from and against all costs, damages, judgments, attorneys' fees, expenses, obligations, and liabilities of any kind or nature, which occur as the result of Cigna's failure to pay valid claims within the terms and conditions of the policy where such failure is not due to any action or inaction by the City of Miami, its officers, directors, agents, and/or employees. The Proposer shall furnish to City of Miami, c/o Procurement Department, 444 SW 2nd Avenue, 6th Floor, Miami, Florida 33130, Certificate(s) of Insurance which indicate that insurance coverage has been obtained which meets the requirements as outlined below: I. Commercial General Liability A. Limits of Liability Bodily Injury and Property Damage Liability Each Occurrence $1,000,000 General Aggregate Limit $2,000,000 Personal and Adv. Injury $1,000,000 Products/Completed Operations $1,000,000 Cigna's commercial general liability coverage insures Cigna for third -party bodily injury, property damage, and personal and advertising injury allegations made against the company in the amount of $1 million per occurrence. Cigna does Copyright 2015 Page 23 of 28 Cigna City of Miami Employee Dental Plan RFP Number 495345 however maintain an umbrella policy in the amount of $25 million aggregate which covers us for claims in access of the $1 million limit. j. Endorsements Required City of Miami listed as an additional insured Contingent and Contractual Liability-CGL FORM Premises and Operations Liability- CGL FORM Primary Insurance Clause We have provided our Schedule of Insurance in the List of Attachments section of the proposal binder. II. Business Automobile Liability B. Endorsements Required City of Miami listed as an additional insured Cigna can add the City of Miami as an additional insured on the following policies on a blanket basis: commercial general liability automobile liability (commercial or business auto liability) umbrella/excess liability (excess only to general and auto liability) III. Worker's Compensation Limits of Liability Statutory -State Florida Waiver of Subrogation Employer's Liability A. Limits of Liability $500,000 for bodily injury caused by an accident, each accident $500,000 for bodily injury caused by disease, each employee $500,000 for bodily injury caused by disease, policy limit Cigna maintains workers' compensation coverage in accordance with statutory requirements. Cigna participates directly in the state workers' compensation insurance funds for the following monopolistic states: Ohio, Washington, and Puerto Rico. Workers' Compensation/Employer's Liability Coverage Overview arrtei ACE American Insurance Company and ACE Subsidiaries 7/1 /14-7/1 /15 Statutory Workers' Compensation Limits Employer's Liability limits of $1,000,000 each accident/disease-policy limit/each employee Copyright 2015 Page 24 of 28 Cigna City of Miami Employee Dental Plan RFP Number 495345 IV. Professional Liability/Errors and Omissions Coverage Combined Single Limit Each Claim $ 2,000,000 General Aggregate Limit $ 2,000,000 Retro date included City of Miami listed as an additional insured Excess Form over all applicable liability policies herein contained Cigna will add the City of Miami as an additional insured on the following policies on a blanket basis: • commercial general liability • automobile liability (commercial or business auto liability) • umbrella/excess liability (excess only to general and auto liability) The above policies shall provide the City of Miami with written notice of cancellation or material change from the insurer not less than (30) days prior to any such cancellation or material change. While Cigna's insurance policies contain the standard notice of cancellation endorsement, our insurers are unable to provide any notice of cancellation, nonrenewal, or material changes to clients or third parties. Cigna and its subsidiaries and affiliates engage in numerous contractual relations with varying contractual requirements. Our insurers are unable to unilaterally administer the 30-day notice of cancellation requirement on a blanket basis. More importantly, Cigna's insurance premiums, on every insurance program, are paid in full at policy inception, thereby eliminating any chance of policy cancellation because of nonpayment of premiums. 2.12. SUBCONTRACTOR(S) OR SUBCONSULTANT(S) A Sub -Consultant, herein known as Sub-Contractor(s) is an individual or firm contracted by the Proposer or Proposer's firm to assist in the performance of services required under this Solicitation. A Sub -Contractor shall be paid through Proposer or Proposer's firm and not paid directly by the City. Sub -Contractors are allowed by the City in the performance of the services delineated within this Solicitation. Proposer must clearly reflect in its Proposal the major Sub- Contractors to be utilized in the performance of required services. The City retains the right to accept or reject any Sub -Contractors proposed in the response of Successful Proposer or prior to contract execution. Any and all liabilities regarding the use of a Sub -Contractor shall be borne solely by the Successful Proposer and insurance for each Sub -Contractors must be maintained in good standing and approved by the City throughout the duration of the Contract. Neither Successful Proposer nor any of its Sub -Contractors are considered to be employees or agents of the City. Failure to list all Sub - Contractors and provide the required information may disqualify any proposed Copyright 2015 Page 25 of 28 Cigna City of Miami Employee Dental Plan RFP Number 495345 Sub -Contractors from performing work under this Solicitation. Proposers shall include in their Responses the requested Sub -Contractor information and include all relevant information required of the Proposer. In addition, within five (5) working days after the identification of the award to the Successful Proposer, the Successful Proposer shall provide a list confirming the Sub -Contractors that the Successful Proposer intends to utilize in the Contract, if applicable. The list shall include, at a minimum, the name, location of the place of business for each Sub -Contractor, the services Sub -Contractor will provide relative to any contract that may result from this Solicitation, any applicable licenses, references, ownership, and other information required of Proposer. Cigna serves as the sole provider of services requested in this proposal; however, a number of the services under our contracts are performed by affiliates of Cigna or by subcontracted vendors with a particular expertise in order to help contain costs without prior written approval for such subcontractors. Every such service will be supervised by Cigna, which will be wholly responsible and liable for the services set forth in the contract. As a standard industry practice, Cigna requires its subcontractors to carry appropriate levels of insurance coverage, based upon factors such as contract value and financial exposure. In accordance with standard insurance industry practices, Cigna is unable to accommodate any requests for changes to its insurance programs. Cigna will remain wholly responsible for provision of all services for which it contracts with the City of Miami, notwithstanding that certain services may be performed in part by subcontracted vendors with particular expertise. A number of the services under our contracts are performed by affiliates of Cigna. Cigna may also subcontract with vendors for performance of certain services in order to help contain costs and to make use of the expertise developed by those vendors. All such services will be performed with oversight from Cigna. It is not feasible for Cigna to obtain prior approval from each customer for such arrangements. Cigna will continue to be liable for the services set forth in the contract, even when an assignment is made. A list of Cigna's proposed subcontractors is included in this proposal. 2.13. TERMINATION A. FOR DEFAULT If the successful Proposer(s) defaults in its performance under this Contract and does not cure the default within 30 days after written notice of default, the City Manager may terminate this Contract, in whole or in part, upon written notice without penalty to the City of Miami. In such event the successful Proposer(s) shall be liable for damages including the excess cost of procuring similar supplies or services: provided that if, (1) it is determined for any reason that the successful Proposer(s) was not in default or (2) the successful Proposer(s) failure to perform is without his or his subcontractor's control, fault or negligence, the termination will be deemed to be a termination for the convenience of the City of Miami. Copyright 2015 Page 26 of 28 Cigna City of Miami Employee Dental Plan RFP Number 495345 Cigna agrees that the City of Miami may terminate for default; however, the City of Miami is liable for its obligations to sufficiently fund the claims bank account and pay fees or premium as required under the Administrative Services Only (ASO) agreement or insurance contract. Cigna specifically reserves its right to immediately terminate for default if the City of Miami fails to pay fees or premiums due or fails to sufficiently fund the claims bank account in accordance with the ASO agreement or insurance contract. Cigna agrees that, in the event of its failure to perform, the City of Miami may procure services from other sources; however, Cigna does not agree to be responsible for any additional purchase and administrative costs associated with a re -procurement. B. FOR CONVENIENCE The City Manager may terminate this Contract, in whole or in part, upon 30 days prior written notice when it is in the best interests of the City of Miami. If this Contract is for supplies, products, equipment, or software, and so terminated for the convenience by the City of Miami thesuccessful Proposer(s) will be compensated in accordance with an agreed upon adjustment of cost. To the extent that this Contract is for services and so terminated, the City of Miami shall be liable only for payment in accordance with the payment provisions of the Contract for those services rendered prior to termination. Agreed. ASO Funding This agreement is effective on the start date and shall remain in effect until the earliest of the following dates: • the date which is at least 30 days from the date that either party provides written notice to the other party of termination of this agreement • the start date of any applicable law or governmental action, which prohibits performance of the activities required by this agreement • the date upon which employer fails to fund the bank account as required by this agreement, or fails to pay Cigna Health and Life Insurance Company (CHLIC) any charges identified in this agreement when due, provided CHLIC notifies employer of its election to end agreement • any other date mutually agreed upon by the parties Fully Insured Funding The standard insurance policy provides for teiiinnation by the policyholder as of F any premium due date with written notice to the insurance company before that date. Cigna reserves the right to end the contract immediately in case of Copyright 2015 Page 27 of 28 Cigna City of Miami Employee Dental Plan RFP Number 495345 nonpayment of premiums beyond the grace period, or if the number of insured employees is less than 70 percent of those eligible. Because the insurance policy and certificate are documents filed with the state, there is very little flexibility to change the provisions of our policy. 2.14. ADDITIONAL TERMS AND CONDITIONS No additional terms and conditions included as part of your solicitation response shall be evaluated or considered, and any and all such additional terms and conditions shall have no force or effect and are inapplicable to this solicitation. If submitted either purposely, through intent or design, or inadvertently, appearing separately in transmittal letters, specifications, literature, price lists or warranties, it is understood and agreed that the General Conditions and Special Conditions in this solicitation are the only conditions applicable to this solicitation and that the Proposer's authorized signature affixed to the Proposer's acknowledgment form attests to this. If a Professional Services Agreement (PSA) or other Agreement is provided by the City and is expressly included as part of this solicitation, no additional terms or conditions which materially or substantially vary, modify or alter the terms or conditions of the PSA or Agreement, in the sole opinion and reasonable discretion of the City will be considered. Any and all such additional terms and conditions shall have no force or effect and are inapplicable to this PSA or Agreement. As the incumbent administrator of the City of Miami's medical benefit plan, Cigna's preference would be to add any applicable dental provision to the existing Administrative Services Only agreement already in place. Otherwise, Cigna will require that certain operational provisions be added to fully describe our services. Cigna reserves the right to request further modifications if we are selected as your administrator. Cigna agrees to work in good faith to negotiate this, or any other agreement, to be agreeable to the Parties. With respect to the fully insured plans, please note that our insurance policy and certificate will be issued and made a part of the Agreement as well as the insurance policy and certificate are filed documents. We currently have a PSA in place for dental DHMO with the City of Miami which has been negotiated in good faith in the past. Copyright 2015 Page 28 of 28 Cigna City of Miami Table of Contents RFP Number 495345 Pages Section 1: Cover Page 1 Certification Statement 2- 4 Employee Dental plan 5-28 Section 2: Table of Contents Section 3: Executive Overview Section 4: Proposer's Organization, Qualifications, Capabilities & Financial Stability Section 5: Proposed Network and Plan(s) Designs Section 6: Customer Service, Banking, Reporting Capabilities, & Benefit Administration Section 7: Price and Cost Effectiveness Section 8: Local Preference Section 9: Performance Guarantees 1 1-14 '1-14 1-9 1-3 1-5 1 1-4 Section 10: List of Attachments 1-524 A. Attachment A 1-65 B. Service Fee Schedules 66-69 C. Provider Directories 70 D. Sample Communication Materials and ID Cards 71-98 E. Claim Process Flow Chart 99 F. GeoAccess Reports 100-193 G. Disruption Reports 194-197 H. Reports Sample 198-214 I. Sample Implementation Calendar 215-216 J. Contracts .... 217-331 K. Certificates of Insurance 332-334 L. Schedule of Insurance 335 M. Certificate of Authority 336-337 N. Cigna 2014 Annual Report 338-519 O. Miami Business Tax Certificate 520 P. Notice of Privacy Practices 521-524 Copyright 2015 Page 1 of 1 City of Miami Executive Summary Thank you for the opportunity to present this proposal to City of Miami. Cigna has extensive experience in meeting the service needs of government education coverage programs, with more than 1.7 million members in our dedicated government education segment service centers. Why City of Miami should choose Cigna. While the need for dental insurance has risen for both public and private sector clients, finding the appropriate dental plan that offers the right combination of choice, savings, quality, and service is an ongoing challenge, At Cigna, we understand our clients' long-term strategic goals, and have 45 years of proven dental leadership and stability administering them. It is our mission to find the appropriate balance of coverage, network availability, and cost for our clients. Choice RFP Number 495345 What you can expect from Cigna • innovative plans, funding arrangements, and features • dedicated account management team • time -saving eCommerce capabilities • nationwide discounts Our goal is to provide you with a program that fits your budget and provides extensive coverage for your employees' dental needs. We believe the Cigna Dental Care (DHMO) and Cigna DPPO plans are the right options for your employees. The Cigna. DHMO plan provides a broad range of covered services. Our patient charge schedule options allow you to choose from a wide range of coverage levels and premiums. Each patient charge schedule covers a wide array of dental procedures, including orthodontics. Our plans provide preventive services with no patient charge and without deductibles or annual dollar maximums to limit care. The Cigna DPPO plan, with its plan design flexibility, cost-effectiveness, and extensive dentist choice, is one of the most sought-after plan coverage's in the market today. Our DPPO plan coverage is easily adaptable to meet your specific coverage or financial needs. With the Cigna DPPO plan there is no gatekeeper element; members do not need to choose a primary dentist at enrollment and can visit specialists at any time without referrals. They can also choose to visit out -of -network dentists at a higher out-of-pocket cost. Savings We are dedicated to helping you achieve your savings goals while offering your employees quality dental coverage. Our DHMO plans are typically 30-40 percent lower in premiums, and have 40-50 percent less out-of-pocket expenses than a comparable indemnity plan. Covered services and coverage levels are also the same for every location served by Cigna Dental Care network dentists. Our patient charges are pre-set, pre -published fees and are not discounts from the dentists' usual charges. Copyright 2015 Page 1 of 14 Cigna City of Miami Executive Summary RFP Number 495345 Employees nationwide will pay the same amount for services, and they will always know their costs in advance. Our Cigna DPPO plans offer deeper discounts than many other carriers. Our contracted fee schedules are based on a discount of average area charges. Our average discount nationwide is over 30 percent. Some carriers discount individual dentists' charges, resulting in higher claim costs and more out-of-pocket charges to the member. Network Cigna Dental's networks are among the largest in the country with over 80,000 DHMO dentists contracted access points and over 347,500 DPPO dentists contracted access points. We conduct on -site reviews of every DHMO general dentists' office, and 20 percent of DPPO offices since they also participate in the DHMO. And should the opportunity exist for us to maximize network expansion to better meet your needs; we will work closely with you to meet those objectives. Within Total Cigna DPPO, we offer two levels: All participating dentists are consolidated into one directory, which you can easily search online at Cigna.com and myCigna.com. Our seamless networks also mean members will receive the same coverage wherever they live, from dentists held to the same quality standards. Network dentists are pre -qualified through our NCQA-based credentialing process. They are also monitored on an ongoing basis through our stringent quality management program. Service Your local account management team and onsite representatives will work with you to create a strategic service plan that outlines enrollment activities, network recruitment plans, and communications initiatives. This team is equipped and ready to deliver service that goes above and beyond what you would typically expect. From case installation to contract renewals, they advocate on your behalf to deliver seamless service so you can receive the most from your coverage program. And because our customer service centers are measured against the same Copyright 2015 Page 2 of 14 Cigna City of Miami Executive Summary standards, employees can be assured of the same quality service, whichever Cigna Dental plan they select. Members may call our customer service department at 1.800.Cigna24 with questions about coverage, network dental offices, procedures, or any other concerns. The Scranton, Pennsylvania customer service claim center is available 24 hours a day, seven days a week. Our voice response system is available 24-hours a day, 7 days a week, except from 1:00 a.m. through 10:00 , a.m. on Sundays for maintenance. DHMO members can use the voice response system to view eligibility and coverage information or they can use our automated quick transfer option to change network dental offices. DPPO members can use the voice response system to check claim status, eligibility, and coverage information. Employees may also use the internet to learn more about their dental coverage. With www.Cigna.com, requests are processed by a team of trained internet service specialists. And by using myCigna.com, they can find their coverage information and health and wellness information personalized to their preferences and profiles. Cigna: The Right Decision RFP Number 495345 Time -saving Web capabilities Cigna's websites at www.Cigna.com and myCigna.com provide convenient access to dental plan information. • eligibility verification • personalized coverage information • claim status inquiry (DPPO) • enhanced treatment cost estimator • benefit manager toolkit • frequently asked questions • dentist search with maps and directions • on-line claim forms (DPPO) • printable ID cards • dental prevention and wellness information with WebMD articles • glossary of dental terms • DHMO network dental office transfer requests We look forward to this opportunity with City of Miami. As an industry leader, our team will provide you and your employees with quality dental care, member -focused service, and accessible networks - while helping you maintain and manage costs. Cigna is the best choice when selecting a dental plan Copyright 2015 Page 3 of 14 Cigna City of Miami Executive Summary RFP Number 495345 Organization Overview Cigna and its predecessor companies have a long history of supporting Americans' health care needs. Starting with the formation of Connecticut General Life Insurance Company (CGLIC) and Insurance Company of North America (INA), we have more than 200 years of history. In 1990, Cigna became the largest investor -owned managed care organization in the country, and still concentrates on meeting client needs for best -in -class health care and employee benefit plan coverage and services. Cigna Health and Life Insurance Company (CHLIC) is a corporation, originally incorporated May 2,-1963, as Orange State Life Insurance Company. After several transactions, it was acquired by Cigna Corporation on April 1, 2008. The company was renamed to CHLIC on March, 5, 2010. It is an indirect, wholly owned subsidiary of Cigna Corporation, a publicly traded corporation. Cigna`s rich and exciting history reveals the foundation of experience that shapes our current plan coverage and business strategies. Today, Cigna companies comprise one of the nation's leading providers of employee benefits, health care coverage, and insurance products to businesses and individuals worldwide. No matter how much success we have enjoyed, Cigna has never wavered from its main purpose — to improve the health, well-being, and sense of security of the individuals we serve. Copyright 2015 Page 4 of 14 Cigna City of Miami Executive Summary RFP Number 495345 Qualifications and Capabilities Cigna provides extensive coverage's, features that focus on overall wellness, flexible plan designs, large networks, competitive pricing, versatile funding options, and unique service and technology options. This, along with our multi -plan coverage capabilities, consistent national offerings, and ability to handle even the most complex cases gives us a unique competitive advantage. Extensive Coverage Every DHMO plan is not the same —our standard DHMO plans have richer coverages than many other carriers. We offer more than 100 plan options to choose from to help meet the City's one -of -a -kind needs and budget. This variety of DHMO plan options gives clients more choice and price flexibility when choosing dental coverage for their employees. Flexible Plan Designs - We offer a wide range of DHMO and DPPO plans. We can offer plans alone or packaged based on your specific coverage and savings goals. We also provide a variety of DHMO patient charge schedules (PCSs), including those with member's out-of-pocket expenses expressed as fixed copays or coinsurance, and fully customizable DPPO plans. Unique Plan Coverage Features - Because regular, routine oral care helps employees address minor problems before they become major and more expensive to treat, employees also have the option of selecting one of the following WellnessPlus® features for our DPPO plans: • progressive maximum • progressive coinsurance coverage • progressive/regressive coinsurance coverage With WellnessPlus, members who receive preventive services on an annual basis will be rewarded with an increase in their annual dollar maximum or coverage level (depending on the feature chosen by the client) in the following year up to the amount specified by the client's plan design. This incentive feature is designed to encourage preventive care because regular, oral care may help employees address minor problems before they become major and more expensive to treat. In addition to WellnessPlus, we offer Cigna Waiver Saver®. Cigna Dental Waiver Saver is a plan design feature that allows Class I services to not be applied to a members plan deductible and/or maximums. This plan design feature strives to focus on encouraging employees to seek preventive care by removing any perceived/real financial barriers (such as out-of-pocket costs). Plan designs with features placing a greater focus on providing incentives to employees to seek preventive and diagnostic care may over time result in the early detection of oral health problems and reduce the need for more costly restorative services. Employees also see an immediate benefit since the waiving of their deductibles is realized at first use of the plan. Employees are able to see that the amount left in their annual maximum remains the same after the use of the plan for Class I services. This demonstrates that the entire annual maximum amount will be available for the cost of potential restorative procedures if ever needed, therefore reducing their potential out-of-pocket costs. Broad Network Access - Cigna's dental networks are among the largest in the country with over 80,000 DHMO dentist access points and over 347,500 DPPO dentist access points. We perfoini on -site reviews of DHMO general dentists' offices, and 20 percent of DPPO offices since they Copyright 2015 Page 5 of 14 Cigna City of Miami Executive Summary RFP Number 495345 also participate in the DHMO. We continue to grow, so we can customize our networks to better serve your needs. We have 40 field -based professionals across the United States dedicated to network recruitment and dentist support. Versatile Funding Options - We have several funding options available. Our DPPO plan coverage's are available self -funded as well as fully insured; both non -participating and participating. Most other carriers do not offer a participating arrangement. Advanced Technology - ' Our dental online self-service options make it simple for your employees to use our plans. The dental treatment cost estimator is a user-friendly, web -based tool available through the health care professional directory on myCigna that allows members enrolled in any Cigna dental plan to easily estimate and plan for their dental care costs —both on a procedure code level and a treatment level for over 400 treatments and procedures. This online tool helps members understand their estimated out-of-pocket costs, view what their savings would be in- and out -of -network with Cigna health care professionals, and display what the treatment or procedure would cost without insurance. The dental treatment cost estimator bases estimates on the member's actual benefit plan design, including coinsurance/copays, maximums, and deductibles. Cigna Mobile App for Apple and Android Phones Cigna provides customized mobile access to dental benefits, helping employees stay connected on the go. • Enrollment information • Charge schedules and benefit summaries • Claim information • "Find a Dentist" search • Out-of-pocket dental cost estimates • Educational videos • Risk -assessment tools Copyright 2015 Page 6 of 14 Cigna City of Miami Executive Summary RFP Number 495345 Unique Service Capabilities - Your local account management team will work with you to create a strategic service plan that outlines enrollment activities, communications initiatives, and network recruitment plans. This team is equipped and ready to deliver service that goes above and beyond what you would typically expect. They provide consultative support so you can receive the most from your coverage program from case installation to contract renewals. Healthy Rewards® This program is available to our dental members. It provides discounts on services like acupuncture, chiropractic services, massage therapy, laser vision correction, vitamins, herbal supplements, and nonprescription health and beauty products. There are no added fees or limits to the number of services members can use. The Cigna Dental Oral Health Integration Program® - Cigna dental members have access to the Cigna Dental Oral Health Integration Program, which provides enhanced dental coverage to members with specific medical conditions associated with oral health, including 100 percent reimbursements of copays/coinsurance on certain procedures, discounts on dental prescription products, and behavioral guidance on issues affecting oral health. The Cigna Dental Oral Health Integration Program offers enhanced dental coverage for members with the following medical conditions: • diabetes • cardiovascular • cerebrovascular disease (stroke) • premature, low -birth weight deliveries • head and neck radiation • organ transplants • chronic kidney disease • other medical conditions As your needs change, you can rely on Cigna for consistent quality, broad network access, and exceptional service. We are confident that we have the experience, focus, and plans to keep your employees healthy and productive for years to come. Integrated Total Health Solutions Organizations that combine their Cigna medical plan with other Cigna programs open the door to new opportunities to improve health, which can lower overall costs when combining benefits. Copyright 2015 . Page 7 of 14 Cigna City of Miami Executive Summary RFP Number 495345 Proposed Networks & Plan Designs We are at this time proposing the Cigna Dental HMO network along with the Cigna Total DPPO network. Benefit plan summaries have been provided in Section 5 of the proposal. Additionally detailed responses regarding proposed network and plan designs have been provided in Attachment A which is located in Section 10 of the proposal. Copyright 2015 Page 8 of 14 Cigna City of Miami Executive Summary RFP Number 495345 Customer Service Cigna chose to be the only national health service company to expand our customer service hours to include the weekends, holidays, and overnight hours. Our toll -free customer service number, 1.800.Cigna24 is staffed 24 hours a day, 7 days a week to answer questions about coverage, DHMO dental office transfers, DPPO claims, procedures, or any other concerns. Our voice response system is available 24 hours a day, 7 days a week. DHMO members can use the voice response system to view eligibility and coverage information or they can use our automated quick transfer option to change network dental offices. DPPO members can use the voice response system to check claim status, eligibility, and coverage information. The toll -free number provides assistance 24-hours a day, allowing the member to enter their zip code and hear a list of nearby dental offices via the dental office locator. This list can also be faxed immediately to assist in enrollment or dental office transfers for the DHMO. Members can also enter a dentist's phone number to see if he or she participates in the network. If there are multiple dentists with the same phone number, the system will speak back the name of each dentist, and clearly identifies DHMO capped dental offices. This information is updated nightly. Members can access over 1,000 health and dental topics through our health information line by calling our toll -free number. Updated network information, referral status, and eligibility verification is also available on our website at myCigna.com. Our customer service organization focuses on providing the best service and customer satisfaction for our members. Copyright 2015 Page 9 of 14 Cigna City of Miami Executive Summary RFP Number 495345 Banking Fully Insured The proposed plan is fully insured; banking will be administered by Cigna. ASO Citibank or JPMorgan Chase administers our ASO banking arrangements; however, the City may select any bank to fund their program account. We issue claim checks through our claim administration process with several controls in place. As checks are issued, the daily issue data is sent to Citibank or JPMorgan Chase. Checks are paid through the central disbursing account for ASO accounts. This is an unfunded, zero -balance account, so when checks are paid, it becomes momentarily overdrawn. There is an estimated three to four day float for single payment checks and a five to seven day float for bulk payment checks. Paid checks are matched against the outstanding issue file and immediately transferred to the account from which they were drawn. This ensures that your account is not debited unless the paid and outstanding checks match in the issue file. Your account is then debited, and the central disbursing account is credited, bringing the latter to its proper zero -balance. You have a choice of daily or weekly funding for your account. The required imprest amount for an ASO account is the greater of three days average claim activity or $10,000 if funded daily, or the greater of seven days average claim activity or $10,000 if funded weekly. If you choose daily funding, Citibank or JPMorgan Chase will wire request funds from your bank daily for the aggregate amount of checks cleared the night before. If you choose weekly funding, they will ram.: wire request funds from your local bank on the first business day of each week for the aggregate amount of checks cleared the prior week. Your local bank must honor the request for funds via Fed Wire transfer the same day to immediately restore your account to the imprest balance. Funding arrangements can be made using the Automated Clearing House, which requires an additional day's imprest whether funding daily or weekly. We provide daily, weekly, or monthly registers of checks issued or cleared and a monthly ASO worksheet summarizing claim activity. Citibank or JPMorgan Chase supplies us with a detailed monthly statement and reconciliation. Paid checks are microfilmed and kept in the financial services unit as proof of payment. Copyright 2015 Page 10 of 14 Cigna City of Miami Executive Summary RFP Number 495345 Reporting Cigna offers a wide range of dental plan coverage's and features that meet the needs of existing and prospective clients. Dental utilization information was integrated into the consultative analytics platform (CAP) in late 2011 to enable more flexible request parameters, a consistent look and feel to medical/pharmacy/other reporting and updated norm information. We generally provide a standard package of dental information reports quarterly or annually at no charge. There is a charge for standard reports produced more frequently and for optional reports. Reporting includes: 1. Dental Summary — Exhibits total costs (including employer paid and member cost share) and per capita costs compared to book of business norms. 2. Dental Utilization by Type of Service — Exhibits per capita cost and utilization by service category. 3. Dental Utilization by Type of Service and Network — Exhibits per capita cost and utilization by service category by network option for a single time period. 4. Dental Cleanings Utilization Exhibits percent of unique members with one or more cleanings. 5. Dental Top Quality 10 Procedure Types — Exhibits the top 10 procedures based on the number of services in descending order. 6. Dental Network Utilization and Cost Share — Exhibits percent of claims paid by the member versus employer and amounts paid in network. 7. Dental Claim Cost and Savings Summary — Exhibits waterfall of total charges, savings and discounts for one or two time periods versus norm. 8. Dental Claim Distribution (all services, including orthodontic) — Exhibits payable claims by dollar range counted by unique member with orthodontic costs. 9. Dental Claim Distribution (excluding orthodontic) — Exhibits payable claims by dollar range counted by unique member without orthodontic costs. 10. Dental Customer Base Summary — Exhibits summary of population enrollment by plan coverage and age band. 11. Dental DHMO Summary — Exhibits summary statistics for member numbers, utilization, and savings for the DHMO plan coverage's only. 12. Dental Utilization by Type of Service (DHMO ONLY) — Exhibits service categories details for DEMO utilization only. Copyright 2015 Page 11 of 14 Cigna City of Miami Executive Summary RFP Number 495345 Benefit Administration Your account management team skillfully coordinates resources to effectively manage your coverage plan. The team provides designated resources for customer service, accounting, claims, and underwriting and brings the expertise that translates to exceptional service delivery, focused on building processes and tools that best meet your needs. The account management team consists of: New Business Manager New business manager, Yesenia Sanchez, oversees the account management process. Yesenia is responsible for: 1. responding to bid specifications 2. working with underwriters to price proposed plans 3. understanding your needs and determining the best plan coverage and funding options available 4. working with the implementation team and account management team Client Manager The client manager (CM) ensures your account is implemented properly, and will work with you to develop an account management process for ongoing service. The CM is specifically responsible for: 1. monitoring services and ensuring that they are delivered to your satisfaction 2. conducting regular account management meetings 3. analyzing and communicating financial and utilization reports, whether web -based or hard copy Implementation Manager The implementation manager (IM) is responsible for the overall successful implementation of your plan. The IM coordinates activities between the City and Cigna departments, including sales and other service partners in underwriting, claim processing, contracts, eligibility, and billing to ensure efficient and accurate execution of the plan. Client Engagement Manager A client engagement manager (CEM) supports your team with technical expertise in covered services, processes, and health and wellness strategy. The CEM works closely with the client manager, implementation manager, client service partner, and other members of Cigna's internal team to service your account on an ongoing basis and to ensure that client and member support is provided efficiently and effectively. The CEM is the primary contact between your human resource staff and Cigna for addressing routine coverage questions, supporting member education, coordinating the open enrollment process, and facilitating scheduled service meetings. They work closely with you to develop, implement, and facilitate health and wellness and health advocacy programs and events. Client Service Partner The client service partner (CSP) is your single point of contact for escalated call, claim, billing, and eligibility questions. The CSP manages ongoing tracking and trending of your service Copyright 2015 Page 12 of 14 Cigna City of Miami Executive Summary RFP Number 495345 experience to identify opportunities for service improvement. They work closely with your account management team (including your client engagement manager) to monitor service trends and identify opportunities for improvement. Eligibility Account Specialist The eligibility account specialist (EAS) updates member eligibility based on the receipt of information/enrollment data from the City. The EAS will work with the City to reconcile error reports; ensuring accurate eligibility information is maintained in our eligibility system. They are also your contact for client -specific questions or service issues about automated and manual eligibility. Other Team Members Supporting the account service team are service representatives from each of the following: claim, eligibility, billing, local health plans, contracts and compliance, banking, underwriting, and reporting. Account team bios have been provided in Section 4 of the proposal. Copyright 2015 Page 13 of 14 Cigna City of Miami Executive Summary RFP Number 495345 Price and Cost Effectiveness Financial exhibits have been provided in Section 7 of the proposal. Copyright 2015 Page 14 of 14 Cigna City of Miami RFP Number 495345 Proposer's Organization, Qualifications, Capabilities & Financial Stability a) Provide documentation that demonstrates Proposer's ability to satisfy all of the minimum qualification requirements pursuant to Section 2.6. Proposers who do not meet the minimum qualification requirements or who fail to provide supporting documentation may be deemed non -responsive. We have provided financial reporting in the List of Attachments section of the proposal binder. Describe the Proposer's organizational history and structure; years Proposer and/or firm has been in business providing a similar service(s), and indicate whether the City has previously awarded any contracts to the Proposer/firm. Proposer should include the name of the organization, business phone/fax/email address, contact person and Federal Employee Identification Number. Cigna and its predecessor companies have a long history of supporting the health care needs of Americans. Starting with the formation of Connecticut General Life Insurance Company (CGLIC) and Insurance Company of North America (INA), we have over 200 years of history. Founded in 1865, CGLIC began offering health -related coverage in 1912 and later expanded to group accident and sickness in 1919. Both CGLIC and INA, which merged in 1982 to form Cigna, were among the first major carriers to introduce health care cost containment and management programs, as well as to explore the development of HMOs. The standard group health indemnity plan, including major medical and hospital and surgical coverage, was first introduced in 1954. Cigna Health and Life Insurance Company (CHLIC) is a corporation, originally incorporated May 2, 1963, as Orange State Life Insurance Company. After several transactions, it was acquired by Cigna Corporation on April 1, 2008. The company was renamed to CHLIC on March 5, 2010. It is wholly owned by CGLIC, which is an indirect wholly owned subsidiary of Cigna Corporation, a publicly traded corporation. CHLIC is licensed to transact the business of insurance by the insurance department of each of the 50 states, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands, and is subject to the regulation of each of those jurisdictions within the scope of applicable law. Cigna has been offering health coverage services to America's local governments and school districts for more than half a century. Incorporating this experience with new research, Cigna has been able to develop programs focused on generating results by improving health and wellness. Our innovative approach to improving health and wellness across the employee population saves local governments money now and in the future. Today, we provide health coverage and services that are critical to improving overall health. Our ability to combine medical, phativacy, dental, behavioral, senior/retiree, and wellness coverage for government sector clients allows for a 360 approach to health improvement that keeps employees and your fiscal plan Copyright 2015 Page 1 of 14 Cigna City of Miami RFP Number 495345 healthy. By building a partnership with you and your community, we can create meaningful value for local governments and school districts. The rich and exciting history of Cigna reveals the foundation of experience that shapes our current plans and business strategies. Cigna and its predecessor companies have illustrated not only our ability to anticipate changes, but also a special devotion to our clients, as we participated in our nation's dynamic growth and prosperity. Today, Cigna companies comprise one of the nation's leading provider of member services, health care coverage, and insurance plan coverage to businesses and members worldwide. Cigna refers to various operating subsidiaries of Cigna Corporation, and these subsidiaries provide plans and services, not Cigna Corporation. These subsidiaries include CGLIC, CHLIC, Cigna Home Delivery Pharmacy and its affiliates, Cigna Behavioral Health, Inc., Cigna Health Management, Inc., HMO or service company subsidiaries of Cigna Health Corporation, and Cigna Dental Health, Inc. Cigna works with many clients around the world including Fortune 500 companies, smaller and mid -size companies, organizations, and institutions —many with multiple sites and members located across time zones and global borders. Behind its geographical scope, financial strengths, and leading portfolio of plans and services are over 35,000 Cigna employees worldwide. Their dedication to customer service and their commitment to quality truly make Cigna a leading health service company. Cigna defines health as more than the absence of sickness. To us, health is intertwined with a sense of well-being and sense of security. Cigna is one of the most successful, well -managed companies in the group insurance industry: • Cigna offers the largest dental network in the U.S. with more than 370,000 dentist locations. • Cigna is the first national health service company to provide live customer service 24 hours a day, 7 days a week, 365 days of the year. Currently Cigna administers medical and DHMO benefits for City of Miami. Proposer's Name: Cigna Health and Life Insurance Company (CHLIC), Cigna Dental Health Plan of Arizona, Inc., Cigna Dental Health of Colorado, Inc., Cigna Dental Health of Florida, Inc., Cigna Dental Health of North Carolina, Inc., Cigna Dental Health of Ohio, Inc., Cigna Dental Health of Texas, Inc., Cigna Dental Health of Virginia, Inc. Business Phone — 860.226.6000 Fax Number - 954.514.6905 Email — dina.d'angelo@cigna.com Contact person: - Dina D'Angelo, Client Manager Copyright 2015 Page 2 of 14 Cigna City of Miami RFP Number 495345 Federal Employer Identification Number CHLIC 59-1031071 Cigna Dental Health Plan of Arizona, Inc. 86-0807222 Cigna Dental Health of Colorado, Inc. 59-2675861 Cigna Dental Health of Florida, Inc. 59-1611217 Cigna Dental Health of North Carolina, Inc. 56-1803464 Cigna Dental Health of Ohio, Inc. 59-2579774 Cigna Dental Health of Texas, Inc. 59-2676977 Cigna Dental Health of Virginia, Inc. 52-2188914 Provide a list of all principals, owners or directors. David M. Cordani, Texas A&M Alumni, Class of 1988 President and Chief Executive Officer Cigna Corporation Matthew G. Manders President Regional and Operations Thomas McCarthy Executive Vice President & Chief Financial Officer Herb Fritch President Cigna-HealthSpring Nicole Jones Executive Vice President & General Counsel Lisa Bacus Executive Vice President & Global Chief Marketing Officer Mark Boxer Executive Vice President & Global Chief Information Officer Jason Sadler President International Markets John M. Murabito Executive Vice President Human Resources & Services Copyright 2015 Page 3 of 14 Cigna City of Miami RFP Number 495345 d) Provide a copy of the Proposer's Certificate of Authority issued by the State of Florida, Office of Insurance Regulation, for the type of plan/services provided. We have provided the certificate of authority in the List of Attachments section of the proposal binder. e) Provide (1) the number of years in existence of Proposer, both nationally and in the Florida market; (2) the current number of employees enrolled in the Proposer's plan, both nationally and in Florida, and (3) the primary markets served. Also, discuss specifically, Proposer's involvement in providing dental care benefits, particularly in the South Florida market. Cigna and its predecessor companies have a long history of supporting the health care needs of Americans. Starting with the formation of Connecticut General Life Insurance Company (CGLIC) and Insurance Company of North America (INA), we have over 200 years of history. Founded in 1865, CGLIC began offering health -related coverage in 1912 and later expanded to group accident and sickness in 1919. Both CGLIC and INA, which merged in 1982 to form Cigna, were among the first major carriers to introduce health care cost containment and management programs, as well as to explore the development of HMOs. The standard group health indemnity plan, including major medical and hospital and surgical coverage, was first introduced in 1954. Cigna Health and Life Insurance Company (CHLIC) is a corporation, originally incorporated May 2, 1963, as Orange State Life Insurance Company. After several transactions, it was acquired by Cigna Corporation on April 1, 2008. The company was renamed to CHLIC on March 5, 2010. It is wholly owned by CGLIC, which is an indirect wholly owned subsidiary of Cigna Corporation, a publicly traded corporation. CHLIC is licensed to transact the business of insurance by the insurance department of each of the 50 states, .the District of Columbia, Puerto Rico, and the U.S. Virgin Islands, and is subject to the regulation of each of those jurisdictions within the scope of applicable law. The DPPO plan coverage was introduced in July 1996, and licensed at varying times in states throughout the nation. DHMO were established in the years listed below: Cigna Dental Health Plan of Arizona, Inc., 1995 Cigna Dental Health of Colorado, Inc. 1986 Cigna Dental Health of Florida, Inc. 1973 Cigna Dental Health of North Carolina, Inc. 1992 Cigna Dental Health of Ohio, Inc. 1985 Cigna Dental Health of Texas, Inc. 1986 Cigna Dental Health of Virginia, Inc. 1999 Copyright 2015 Page 4 of 14 Cigna City of Miami RFP Number 495345 The current number of employees and members enrolled in the our plan, both nationally and in Florida is as follows: DHMO d'i1a�r",. k354zyA}'��'ih State v Employees } Depende s S^i��, r" �v �Mem ier ,�'�ryrys 6)yy i`jP�ie]2*�f t7�; �waaa, w,297}�,. 2S.� � �r Mi���... < tt,i 4f"Tt'S's�r'�5 ��;a�1�1i't'II+��'�u'L{�'kGe�t��^S'��ig"r�3�i�rN"v�t.�.Y:- j;{��y+(�.Cd; Florida 76,157 75,431 151,588 National 676,509 641,304 1,317,813 DPPO f 1 E^F S F State � � "}�` j.s2",'i,5''t� ' f. 4 k ti; 'fi �,` `$ }t Ern to eses ts^,�e Jt'YF^i„k }. �M1f si 4,ya. 'iT453�M " Si gal'EV#F! v d �' � �`k V cP�'l�.snt�^5 Depenc ents) r„d6s: Wt f�� !A�y,t(ilCi},.{S :4 t K"�FY) $yy l d yC Mer�nbeTs RfR {^'41Nt`.�i S"'4; A-. :..'FS:i` Z\4F�SR ni Florida 337,162 344,569 681,731 National 4,958,315 5,603,154 10,561,469 f) Provide the current number of employees of Proposer; Proposer employees' depth and experience, and number and job classifications of employees anticipated to be assigned to the City's account, particularly in Miami -Dade and Broward Counties, including the overall qualifications of assigned staff particularly its experience with dental benefit administration in Florida and with public entities. Include discussion of employees' diversity and ability of speaking more than one language, particularly Spanish and Creole. g) We are the incumbent medical and dental DHMO carrier for the City of Miami. The same account management team will also service the dental plans. We have included the account team bios in this section with our submission. Cigna has partnered with the City of Miami as a part of the existing medical and current DHMO plan by making every effort to assign bi-lingual (Spanish & English) speaking individuals as our primary day-to-day contacts in the Client Engagement Manager and On -site Representative roles. Provide a list of two (2) clients of equivalent size who, for whatever reason, discontinued to use Proposer's services within the past year's and indicate the reasons for same, including contact name and number. Proposer shall list as well as two current clients, of equivalent size, including contact name and number. The City reserves the right to contact any reference as part of the evaluation process. Also include your company's total enrollment for 2013 vs. your 2014 enrollment. Copyright 2015 Page 5 of 14 Cigna City of Miami RFP Number 495345 Terminated References City of Coral Springs Benefits Provided - DHMO & DPPO Name of Contact — Dale Pazdra Telephone Number — 954.344.1152 School District of Osceola County Benefits Provided - DHMO & DPPO Name of Contact — Ken F. DeBord, Director Risk & Benefits Management Telephone Number — 407.870.4905 Active References Cigna has provided contact information for current clients in Attachment A as a response to request for references. Total Enrollment 2013 vs 2014 otat tlt. 3 Iat ,Enrollrnent 2013 11,476,179 2014 12,134,766 h) List the subcontractors or sub consultants and include a brief history of their background and experience. i) Cigna serves as the sole provider of services requested in this proposal; however, a number of the services under our contracts are performed by affiliates of Cigna or by subcontracted vendors with a particular expertise in order to help contain costs without prior written approval for such subcontractors. Every such service will be supervised by Cigna, which will be wholly responsible and liable for the services set forth in the contract. Provide detailed responses to Attachment A, as applicable. Failure to complete, in full, Attachment and return same with Proposal shall deem any Proposal received non -responsive. We have provided the Attachment A in the List of Attachments section of the proposal binder. Provide any other information which the Proposer deems relevant to its organization and/or its ability to provide quality dental care services to the City. Noted. Copyright 2015 Page 6 of 14 Cigna City of Miami RFP Number 495345 Describe Proposer's past performance and experience specifically for groups with over 3,300 employees. Cigna has been offering health plans to America's local governments and school districts for more than half a century. Incorporating this experience with new research, Cigna has been able to develop programs focused on generating results by improving health. Our innovative approach to improving health across the employee population saves the community money now and in the future. By creating meaningful value, local governments and school districts help stretch the community's budget to maintain, and even increase, the services the community needs and wants. We listen and learn what the City of Miami's needs, then partner with you to develop custom and innovative solutions to meet and exceed expectations. 1) It is the intention of the City for all contracts to be awarded on a no -commission basis. No commission shall be included in the proposed rates. Acknowledged. Copyright 2015 Page 7 of 14 Cigna City of Miami RFP Number 495345 This page intentionally left blank. Copyright 2015 Page 8 of 14 Cigna Biography , , ®� gna. 1571 Sawgrrass Corporate Parkway, Suite 300 Sunrise, Florida 33323 954.790.8152 dina.dangelo@cigna.com Dina D'Angelo Client Manager Account Role Responsibilities include: overall account management responsible for renewal of accounts, service team supervision, renewal strategy discussions with clients and brokers, financial and claims experience reporting. Also participates in new account installation and finalist presentations. Biographical Information Dina D'Angelo joined Cigna in April 2006. She has over 22 years of experience in the healthcare industry. She has held positions in Provider Relations, Contracting and Client Management with Tenet, HCA, United and now Cigna. She has 15 years of Client Management experience. Her book of business consists of middle market municipality business in the State of Florida. Dina holds an insurance license in the State of Florida and a Bachelor of Science Degree in Business. Copyright 2015 Page 9 of 14 Cigna Biography 1,10R. Cigna. 1571 Sawgrrass Corporate Parkway Suite 140 Sunrise, FL 33323 954.514.6893 Melissa.Menendez@eigna.com Melissa Menendez Client Engagement Manager South Florida, Sales As a Client Engagement Manager (CEM), Melissa provides outstanding service to exceed customer and consultant's expectations. She facilitates account health and wellness strategy, programs, events and communication; and educates membership on capabilities, tools, and programs. Melissa leads Open Enrollment strategy and execution initially, and at renewal. She also provides reporting (related to clinical trends, health & wellness strategy utilization) and supports consultant business development strategies. EXPERIENCE: Melissa began her health services career in 2004 with a national carrier in the South Florida market. EDUCATION: In November 2009, Melissa joined the CIGNA regional market team, where she has successfully managed large and complex accounts in South Florida. Mrs. Menendez earned a degree from Miami Dade Collage in Business Administration. She also earned her 2-15 Life, Health and Variable License in 2007. Multilingual — Speaks Spanish Copyright 2015 Page 10 of 14 Cigna Biography %4'$*',s �'Cigna. 1571 Sawgrass Corporate Parkway Suite 140 Sunrise, FL 33323 Jennifer.Miles@Cigna.com 1.860.902.5888 Jennifer Miles Client Service Executive Cigna Jennifer Miles is a Client Service Executive (CSE) based in Sunrise, Florida In this role, Jennifer is a key member of your account management team with expertise in Cigna's service administration capabilities. Jennifer has ownership and accountability for ongoing, end to end service delivery, ensuring your satisfaction with Cigna's products and services and delivering upon an exceptional client service experience. Jennifer will be your primary Cigna contact for all operational service related to claim processing, customer service, eligibility, billing, banking and benefit structure. These primary functions include customizing service delivery to meet your needs, and negotiating with internal and external partners and customers to resolve service issues and requests. Jennifer will proactively trend service activities, act as a key benefit resource expert, monitor ongoing processes, develop service plans for continuous improvement and communicate with you on a regular basis regarding service strategy and service results on your account. Jennifer has received the following recognition awards: • Cigna Champions Jennifer began her career with Cigna in 2010 as a Client Strategy Specialist and has held the following positions: • Senior Client Engagement Manager • Client Service Executive Jennifer is a graduate of The University Of Central Florida in Orlando, FL with a Bachelor of Arts Degree in Event Management Copyright 2015 Page 11 of 14 Cigna Biography Cigna. P.C. Box 3299 53 Glenmaura Natlanai Blvd Scranton, PA 18505-0299 570-496-5048 Ed Boynosky Client Service Executive Ed Boynosky is a Client Service Executive (CSE) responsible for delivering superior service to his Cigna clients. In the CSE role, Ed serves as the primary service contact. Ed is a key member of the account management team with ownership and accountability for ongoing service delivery. With the support of an internal team of subject matter experts in benefit administration, billing, banking and eligibility, Ed ensures we deliver upon an exceptional client service experience. Ed leverages continuous improvement methodologies to develop a high quality, end- to -end member service experience. Ed began his career with Cigna in 2001 with Member Services and has held the following positions: • Service Representative • Claim Processor • Client Service Partner • Client Service Executive • Benefit Implementation Lead • Implementation Specialist He has received numerous recognition awards including Cigna Champion. Ed holds a Bachelor of Science degree in Business Administration from the University of Denver. Prior to employment at Cigna in 2001, Ed worked for Fortune 500 Companies that included the Yellow Corporation, as an Operations Manager and. AT&T as Quality Development Manager.While at AT&T, Ed received the Model of Excellence Award in 1999. Ed joined the Client Service Team during November 2006 and currently handles all dental products serviced in the Florida and Carolina markets, building on a commitment to customer service that began over 25 years ago. Copyright 2015 Page 12 of 14 Cigna Biography At CO,A Ligna. Scranton, PA Carrie.Cortese@Cigna.com 860,902.0928 Carrie Cortese Director of Client Service Executives Client Implementation and Service Service Operations Carrie Cortese is a Client Service Executive Director for the Southeast Regional markets, responsible for building and sustaining client relationships by delivering superior service. She works closely with the Client Service Executive teams, the Implementation teams, as well as the Account Management team to remove barriers and ensure expedient resolutions. Carrie began her career with Cigna in 2001. She has held a number of increasingly responsible positions in various operations of the business, including Customer Service, Claim, Performance Guarantee's, Specialty Products (Dental, Vision, Pharmacy and Individual and Family Plans) and Client Implementation and Service. She has managed books of business including all product lines including Taft- Hartley, Government and Municipality cases. Carrie is a graduate of The Pennsylvania State University, holding a Bachelor of Science. Carrie also uses her Six Sigma training to ensure her clients are operating efficiently. Copyright 2015 Page 13 of 14 Cigna Biography Cigna. 1751 Sawgrass Corporate Parkway Suite 140 Sunrise, FL 33323 Diane,Buchman cr Cigna.com Phone 954-514-6833 Diane Buchman Implementation Manager Diane's responsibility as an Implementation Manager is to serve as the primary source of contact for her Cigna clients during the implementation process — ensuring installation into the Cigna systemin an accurate and timely manner. Prior to accepting a position with Cigna in February 1997, Diane worked as a Benefits Analyst for a Medical Staffing firm. She has been working in the benefits industry for more than 20 years. In 1997, Diane joined Cigna as a Client Service Specialist. In November 1998, she joined the Case Installation Team where she now manages the implementation process for new and growing accounts in South Florida. In addition, she coordinates the internal revisions needed if major benefit/structure changes are requested by existing clients. Diane has successfully managed accounts ranging in size from 200 employees to 30,000 eligible employees including varying products and funding types. Diane graduated from the University of Georgia with a Bachelor's degree in Business Administration majoring in Management Information Systems. Copyright 2015 Page 14 of 14 Cigna City of Miami RFP Number 495345 5. Proposed Network and Plan(s) Designs a) Provide detailed responses to Attachment A, as applicable. Failure to complete, in full, Attachment and return same with Proposal shall deem any Proposal received non -responsive. Cigna has provided responses to Attachment A. The completed document is in the List of Attachments section of the proposal binder. b) Provide any other information which the Proposer deems relevant to its organization and/or its ability to provide quality dental health care services to the City. Benefit summaries for DPPO and DHMO plans have been included in this section. Copyright 2015 Page 1 of 9 Cigna Cigna Healthcare Financial Exhibit for: City of Miami (Non -Executive) Effective Date: January 01, 2016 ek��er� Cigna. This is a summary of benefits for your dental plan. All deductibles, plan maximums, and service specific maximums (dollar & occurrence) cross accumulate between In and out of network. .s .�G`c,�1r,Asi � s„i nsz's'j'.tay. i ,7k�,t,y., - 'i: R � � }}� . �� h ,,,,f ,.'3'1� :taF A$ ty "+x'Q" V 1; 7<r g{a.�V e, i P .' ;t3X.: ", ff h .en. s � � x$ ifi��7 . .'?'n �s ^� nt z�aa�« , i t a ,., Tc.YE/ � Y ^`�*% ? . " R k ? �y k`.i §. � id A., ,i� revR ,� Td ai ,r~,. t .P.P liy.� A O .v ' �i� i � 1 7 41r ;. � n 3."� 5 _ $'�#f=" . , �$ t.0 a cork YUI. i .-v�a� ?.S Calendar Year Maximum (Class I, II, III Expenses) $1000, Class I Applies $1000, Class I Applies Calendar Year Deductible ' Per Individual Per Family $100 $300 $100 $300 Class I Expenses - Preventive & Diagnostic Care Oral Exams Cleanings Routine X-Rays Fluoride Application Space Maintainers (limited to non -orthodontic treatment) Non -Routine X-Rays 100%, No Deductible 100%, No Deductible Class II Expenses - Basic Restorative Care Sealants Emergency Care to Relieve Pain Fillings Oral Surgery - Simple Extractions 80%, After Deductible 80%, After Deductible Class III Expenses - Major Restorative Care Oral Surgery - All Except Simple Extraction Surgical Extraction of Impacted Teeth Anesthetics Major Periodontics Minor Periodontics Root Canal Therapy / Endodontics Relines, Rebases, and Adjustments Repairs -Bridges, Crowns, and Inlays Repairs - Dentures Crowns / Inlays / Onlays Dentures Bridges Brush Biopsy Stainless Steel/Resin Crowns 50%, After Deductible 50%, After Deductible Class IV Expenses - Orthodontia Coverage for Eligible Children Only Lifetime Maximum 50%, No Deductible $1500 50%, No Deductible $1500 Missing Tooth Provision Teeth missing prior to coverage under the Cigna Dental plan are not covered. Late Entrant Limit 50% coverage on Class III and IV for a specified time period. Pretreatment Review Available on a voluntary basis when extensive work in excess of $200 Is proposed. Dental Plan Reimbursement Levels Based on Contracted Fees 90th Percentile Additional Member Responsibility in excess of Coinsurance None Yes, the difference between Billed Charges and the plan reimbursement Student/Dependent Age 26/26 P0010 Network. Prepared by Underwriting. 07/23/2015 01:35 PM Copyright 2015 Page 2 of 9 Cigna Cigna Healthcare Financial Exhibit for: City of Miami (Non -Executive) Effective Date: January 01, 2016 Cigna Dental PPO Procedure Exams Prophylaxis (cleanings) Fluoride X-Rays (routine) X-Rays (non -routine) Model Minor Perio (non -surgical) Perio Surgery Crowns and Inlays Prosthesis Over Implants Bridges Dentures and Partials Relines, Rebases Adjustments Repairs - Bridges Repairs - Dentures Sealants Space Maintainers Alternate Benefit Orthodontia Exclusions and Limitations: Exclusions & Limitations Two per calend'ar year Four per calendar year 1 per calendar year for people under 19 Bitewings: 2 per calendar year Full mouth: 1 every 3 calendar year. Panorex: 1 every 3 calendar year Payable only when in conjunction with Ortho workup Various limitations depending on the service Various limitations depending on the service Replacement every 5 years 1 per every 5 years if unserviceable and cannot be repaired. Benefits are based on the amount payable for non -precious metals. No porcelain or white/tooth colored material on molar crowns or bridges. Replacement every 5 years Replacement every 5 years Covered If more than 6 months after installation Covered if more than 6 months after Installation Reviewed if more than once Reviewed if more than once Limited to posterior tooth. One treatment per tooth every three years up to age 14 Limited to non -Orthodontic treatment When more than one covered Dental Service could provide suitable treatment based on common dental standards, Cigna HealthCare will determine the covered Dental Service on which payment will be based and the expenses that will be Included as Covered Expenses. For dependent children, up to age 19. Benefit Exclusions: * Services performed primarily for cosmetic reasons Replacement of a lost or stolen appliance * Replacement of a bridge or denture within five years following the date of its original Installation * Replacement of a bridge or denture which can be made useable according to accepted dental standards * Procedures, appliances or restorations, other than full dentures, whose main purpose is to change vertical dimension, diagnose or treat conditions of TMJ,, stabilize perlodontally involved teeth, or restore occlusion * Veneers of porcelain or acrylic materials on crowns or panties on or replacing the upper and lower first, second and third molars * Bite registrations; precision or semi -precision attachments; splinting; Surgical implant of any type * Instruction for plaque control, oral hygiene and diet * Dental services that do not meet common dental standards * Services that are deemed to be medical services * Services and supplies received from a hospital * Charges which the person Is not legally required to pay * Charges made by a hospital which performs services for the U.S. Government if the charges are directly related to a condition connected to a military service * Experimental or investigational procedures and treatments * Any injury resulting from, or in the course of, any employment for wage or profit * Any sickness covered under any workers' compensation or similar law * Charges in excess of the reasonable and customary allowances * To the extent that payment is unlawful Where the person resides when the expenses are Incurred; * Procedures performed by a Dentist who is a member of the covered person's family (covered person's family is limited to a spouse, siblings, parents, children, grandparents, and the spouse's siblings and parents); * For charges which would not have been made If the person had no insurance; For charges for unnecessary care, treatment or surgery; * To the extent that you or any of your Dependents is in any way paid or entitled to payment for those expenses by or through a public program, other than Medicaid; * To the extent that benefits are paid or payable for those expenses 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 HealthCare will take into account any adjustment option chosen under such part by you or any one of your Dependents. * In addition, these benefits will be reduced so that the total payment will not be more than 100% of the charge made for the Dental Service if benefits are provided for that service under this plan and any medical expense plan or prepaid treatment program sponsored or made available by your Employer. In Texas, the insured dental product offered by COLIC and CHLIC is referred to as the Cigna Dental Choice Plan, and this plan utilizes the national Cigna Dental PPO network. This benefit summary highlights some of the benefits available under the proposed plan. A complete description regarding the terms of coverage, exclusions and limitations, including legislated benefits, will be provided in your insurance certificate or plan description. Benefits are insured and/or administered by Cigna HealthCare. Did you know that all. of Cigna's dental plans include the Cigna Dental Oral Health Integration Program? This program was designed tc address research that supports the association of oral health to overall health and provides 100% reimbursement of copays or coinsurance for customers with qualifying medical conditions for program eligible procedures. Additionally, registered program members can receive discounts on prescription dental products targeted at high tisk patients as well as articles on behavioral conditions that impact oral health. Cigna Is a registered service mark, and the "Tree of Life" logo Is a service mark, 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 Lite Insurance Company, Cigna Health and. Life Insurance Company, Cigna HealthCare of Connecticut, Inc., and Cigna Dental Health, Inc. and Its subsidiaries. Prepared by Underwriting. Cigna DPPO Network (P0010) 07123/2015 01:35 PM Copyright 20I5 Page 3 of 9 Cigna Cigna Healthcare Financial Exhibit for: City of Miami (Executive) Effective Date: January 01, 2016 Cigna. This Is a summary of benefits far your dental plan. All deductibles, plan maximums, and service specific maximums (dollar & occurrence) cross accumulate between in and out of network. Qj gro s�:k�; ttio Calendar Year Maximum (Class I, II, III Expenses) $1500, Class I Applies $1500, Class I Applies Calendar Year Deductible Per Individual Per Family $50 $150 $50 $150 Class I Expenses - Preventive & Diagnostic Care Oral Exams Cleanings Routine X-Rays Fluoride Application Sealants Space Maintainers (limited to non -orthodontic treatment) Non -Routine X-Rays Emergency Care to Relieve Pain 100%, No Deductible 100%, No Deductible Class II Expenses - Basic Restorative Care Fillings Oral Surgery - Simple Extractions Oral Surgery - All Except Simple Extraction Surgical Extraction of Impacted Teeth Anesthetics Major Periodontics Minor Periodontics Root Canal Therapy/ Endodontics Brush Biopsy 80 % , After Deductible 80 % , After Deductible Class III Expenses - Major Restorative Care Relines, Rebases, and Adjustments Repairs - Bridges, Crowns, and Inlays Repairs - Dentures Crowns./ Inlays / Onlays Dentures Bridges Stainless Steal/Resin Crowns 80 %, After Deductible 80%, After Deductible Class IV Expenses - Orthodontia Coverage for Eligible Children and Adults Lifetime Maximum 80%, No Deductible $1500 80%, No Deductible • $1500 Class V Expenses - TMJ Lifetime Maximum 80 % , After Deductible $750 80 % , After Deductible $750 Missing Tooth Provision Teeth missing prior to coverage under the Cigna Dental plan are not covered. Late Entrant Limit 50 % coverage on Class III and IV for a specified time period. Pretreatment Review Available on a voluntary basis when extensive work In excess of $200 Is proposed. Dental Plan Reimbursement Levels Based on Contracted Fees 90th Percentile Additional Member Responsibility in excess of Coinsurance None Yes, the difference between Billed Charges and the plan reimbursement Student/Dependent Age 26/26 P0010 Network. Prepared by Underwriting. 07/23/2015 01:51 PM Copyright 2015 Page 4 of 9 Cigna Cigna Healthcare Financial Exhibit for: City of Miami (Executive) Effective Date: January 01, 2016 Cigna Dental PPO Procedure Exams Prophylaxis (cleanings) Fluoride X-Rays (routine) X-Rays (non -routine) Model Minor Perio (non -surgical) Perio Surgery Crowns and Inlays Prosthesis Over Implants Bridges Dentures and Partials Relines, Rebases Adjustments Repairs - Bridges Repairs - Dentures Sealants Space Maintainers Alternate Benefit Exclusions and Limitations: Exclusions & Limitations Two per calendar year Four per calendar year 1 per calendar year for people under 19 Bitewings: 2 per calendar year Full mouth: 1 every 3 calendar year, Panorex: 1 every 3 calendar year Payable only when in conjunction with Ortho workup Various limitations depending on the service Various limitations depending on the service Replacement every 5 years 1 per every 6 years if unserviceable and cannot be repaired. Benefits are based on the amount payable for non -precious metals. No porcelain or white/tooth colored material an molar crowns or bridges, Replacement every 5 years Replacement every 5 years Covered If more than 6 months after installation Covered if more than 6 months after installation Reviewed if more than once Reviewed if more than once Limited to posterior tooth. One treatment per tooth every three years up to age 14 Limited to non -Orthodontic treatment When more than one covered Dental Service could provide suitable treatment based on common dental standards, Cigna HealthCare will determine the covered Dental Service on which payment will be based and the expenses that will be Included as Covered Expenses. Benefit Exclusions: * Services performed primarily for cosmetic reasons * Replacement of a lost or stolen appliance * Replacement of a bridge or denture within five years following the date of Its original installation * Replacement of a bridge or denture which can be made useable according to accepted dental standards * Procedures, appliances or restorations, other than full dentures, whose main purpose Is to change vertical dimension, stabilize periodontally involved teeth, or restore occlusion * Veneers of porcelain or acrylic materials on crowns or pontics on or replacing the upper and lower first, second and third molars * Bite registrations; precision or semi -precision attachments; splinting; Surgical implant of any type * Instruction for plaque control, oral hygiene and diet * Dental services that do not meet common dental standards * Services that are deemed to be medical services * Services and supplies received from a hospital * Charges which the person is not legally required to pay * Charges made by a hospital which performs services for the U.S. Govemment If the charges are directly related to a condition connected to a military service * Experimental or investigational procedures and treatments * Any injury resulting from, or In the course of, any employment for wage or profit * Any sickness covered under any workers' compensation or similar law * Charges in excess of the reasonable and customary allowances * To the extent that payment is unlawful where the person resides when the expenses are incurred; * Procedures performed by a Dentist who is a member of the covered person's family (covered person's family is limited to a spouse, siblings, parents, children, grandparents, and the spouse's siblings and parents); * For charges which would not have been made if the person had no insurance; For charges for unnecessary care, treatment or surgery; * To the extent that you or any of your Dependents is In any way paid or entitled to payment for those expenses by or through a public program, other than Medicaid; ' To the extent that benefits are paid or payable for those expenses 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 HealthCare will take into account any adjustment option chosen under such part by you or any one of your Dependents. * In addition, these benefits will be reduced so that the total payment will not be more than 100 h of the charge made for the Dental Service If benefits are provided for that service under this plan and any medical expense plan or prepaid treatment program sponsored or made available by your Employer. In Texas, the insured dental product offered by CGLIC and CHLIC is referred to as the Cigna Dental Choice Plan, and this plan utilizes the national Cigna Dental PPO network. This benefit summary highlights some of the benefits available under the proposed plan. A complete description regarding the terms of coverage, exclusions and limitations, Including legislated benefits, will be provided in your insurance certificate or plan description. Benefits are Insured and/or administered by Cigna HealthCare. Did you know that all of Cigna's dental plans include the Cigna Dental Oral Health Integration Program? This program was designed to address research that supports the association of oral health to overall health and provides 100% reimbursement of copays or coinsurance for customers with qualifying medical conditions for program eligible procedures. Additionally, registered program members can receive discounts on prescription dental products targeted at high risk patients as well as articles on behavioral conditions that Impact oral health. Cigna Is a registered service mark, and the "Tree of Life" logo is a service mark, of Cigna Intellectual Property, Ina., 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, Cigna Health and Life Insurance Company, Cigna HealthCare of Connecticut, Inc., and Cigna Dental Health, Inc. and its subsidiaries. Prepared by Underwntin.. Cigna DPPO Network (P0010) 07/23/2015 01:51 PM Copyright 2015 Page 5 of 9 Cigna Under your plan, you have coverage for hundreds of dental procedures.This overview shows you a small sampling of covered services and what you will pay compared to your estimated cost without coverage. See savings below! Review your plan materials to understand how your plan works. For questions on the plan before enrollment, call 1.800.Cigna24 (1.800.244.6224) and select the"Enrollment Information" prompt. Regular dental visits may do more than brighten your smile. Receiving regular dental care often catches minor problems before they become major and more expensive to treat. And there's an association between gum disease and other conditions, such as preterm birth, heart disease, stroke, diabetes and other health issues. So taking good care of your teeth and gums may help you live a healthier life. Get the most value from your plan Take advantage of your plan's preventive care services - certain services may be covered at no additional cost to you (see below for details). Your plan also covers many other dental services that can help you achieve and maintain a healthy mouth. Sampling of covered procedures z; aCost with Cigna Dentfial Carq What You'll r Pay' Estimated cost without dental coverage Adult cleaning (two per calendar year each at $0) (additional cleanings available at $50 each) , $70—$136 each Child cleaning (two per calendar year each at $0) (additional cleanings available at $40 each) ' 1 ° Y ' '§fit "e•YQ 3���t �4Y 4;Q $53—$102 each Periodic oral evaluation $0 ' {' $40—$76 Comprehensive oral evaluation �' $0 ° a' �_ $62—$118 Topical fluoride (two per calendar year each at $0) (additional topical fluoride available at $15 each) $28—$53 X—rays — (bitewings) 2 films ��� ;'} $33—$63 X—rays—panoramic film ` „0 `` $84—$161 Sealant— pertooth Amalgam filling (silver colored) — 2 surfaces $0 , $118-$226 Composite filling (tooth -colored) —1 surface, Anterior ;f' 0 $120—$231 Molar root canal (excluding final restoration) , a`t,$275 t ;, ry, i _ $852—$1,640 Comprehensive orthodontics —child (up to 19th birthday) — Banding 2 , iz '>qq0 $1,042—$2,005 Periodontal (gum) scaling & root planing —1 quadrant ' + h `� F i45 , F , `,� $179—$344 Periodontal (gum) maintenance r ^ �' " t' i35 t ` $109—$209 Removal/extraction of erupted tooth $120—$231 Removal/extraction of impacted tooth }'>100 `}{ $370—$712 Crown — porcelain fused to high noble metal a $ $230 '' $849—$1,634 Implant supported retainer for porcelain fused to metal fixed partial denture $700 $1,097—$2,112 Occlusal appliance, by report (for treatment ofTMJ) $175 $640-$1,233 Offered by: Connecticut General Life Insurance Company, Cigna Health and Life Insurance Company, or their affiliates jfCigna. DFO STANDA 'AMA 2ot5 Page 6 of 9 85681Nd3 Know what's important to you You can save money on a wide range of services, including: • Preventive care - cleanings, fluoride, sealants, bitewing X-rays, full mouth X-rays, and more • Basic care - tooth -colored fillings (called resin or composite) and silver - colored fillings (called amalgam) • Major services - crowns, bridges, and dentures (including those placed over implants), root canals, oral surgery, extractions, treatment for (gum) disease, specialty care (with an approved referral), and more • Orthodontic care - braces for children and adults • General anesthesia - when medically necessary • Teeth whitening - using take-home bleaching trays and gel Key plan features Finding a network dentist is easy. There are several ways to choose your network general dentist: • Find a dentist at Cigna.com. Our online dental directory is updated weekly. Call 1.800.Cigna24 (1.800.244.6224) to speak with a customer service representative. Our representatives can send you a customized dental directory listing via email. • There is a $5 office visit fee associated with your plan. • No deductibles - you don't have to reach a certain level of out-of-pocket expenses before your insurance kicks in. • No dollar maximums - you don't have to worry about your coverage running out after your covered expenses reach a certain dollar amount. • Easy to understand plan - the fees you pay your dentist are clearly listed on your Patient Charge Schedule (PCS). • There are no claim forms to file and no waiting periods for coverage. • The network general dentist you choose will manage your overall dental care. • Covered family members can choose their own network general dentists - near home, work or school. • You don't need a referral for children under seven to visit a network pediatric dentist. And you don't need a referral to see a network orthodontist. • There's no age limit on sealants, which help prevent tooth decay. • Your plan covers certain procedures to help detect oral cancer in its early stages. • 24/7 access to the Dental Information Line - this line is staffed by trained professionals who can help if you have questions about dental treatment and clinical symptoms. Exceptions Procedure Limit Exams Two per calendar year X-rays (routine) Bitewings: 2 per calendar year X-rays (non -routine) Full mouth: 1 every 3 calendar years. Panorex: 1 every 3 calendar years Crowns and inlays Replacement every 5 years Bridges Replacement every 5 years Dentures and partials Replacement every 5 years Relines, rebases One every 36 months Adjustments Four within the first 6 months after installation Prosthesis over implant Replacement every 5 years if unserviceable and cannot be repaired Temporomandibular Joint (TMJ) treatment One occlusal orthotic device per 24 months Athletic mouth guard One athletic mouth guard per 12 months when listed on your PCS Referrals are required for specialty care services. Specialty treatment' plans require payment authorization for services to be covered under your plan except for Pediatrics, Orthodontics and Endodontics. You `should verify with your Network Specialty Dentist that your treatment plan has been authorized for payment by Cigna before treatment begins. Copyright 2015 Page 7 of 9 Cigna Listed below are the services or expenses which are NOT covered under your Dental Plan and which are your responsibility at the dentist's usual fees. There is no coverage for: • Or in connection with an injury arising out of, or in the course of, any employment for wage or profit • Charges which would not have been made in any facility, other than a hospital or a correctional institution owned or operated by the united states government or by a state or municipal government if the person had no insurance • To the extent that payment is unlawful where the person resides when the expenses are incurred or the services are received • The charges which the person is not legally required to pay • Charges Which would not have been made if the person had no insurance • Due to injuries which are intentionally self-inflicted • Services not listed on the PCS • Services provided by a non -network dentist without Cigna Dental'sprior approval (except emergencies, as described in your plan documents)3 • Services related to an injury or illness paid under workers',compensation, occupational disease or similar laws • Services provided or paid by or through a federal . or state governmental agency or authority, political subdivision or a public program, other than medicaid • Services required while serving in the armed forces of any country or international authority or relating to a declared or, undeclared war or acts of war- • Services performed primarily for cosmetic reasons unless specifically listed on your PCS • General anesthesia, sedation and nitrous oxide, unless specifically listed on your PCS • Prescription medications • Replacement of fixed and/or removable appliances (including fixed and removable orthodontic appliances) that have been lost, stolen, or damaged due to patient abuse, misuse or neglect • Surgical implant of any type unless specifically listed on your PCS • Services considered to be unnecessary or experimental in nature or do not meet commonly accepted dental standards • Procedures or appliances for minor tooth guidance or to control harmful habits • Services and supplies received from a hospital • The completion of crowns, bridges, dentures, or root cana. l treatment already in progress on the effective date of your Cigna Dental coverage4. • The completion of implant supported prosthesis (including crowns, bridges and dentures) already in progress on the effective date of your Cigna Dental coverage, unless. specifically on your PCS4 •• Consultations and/or evaluations associated with. services that are not covered • Endodontic treatment and/or periodontal (gum tissue and supporting bone) surgery of teeth exhibiting a poor or hopeless periodontal prognosis • Bone: grafting and/or guided tissue regeneration when performed at the site of a tooth extraction unless • specificallylisted on your PCS • Bone grafting and/or guided tissue regeneration when performed in:conjunction with an apicoectomy or periradicularsurgery • Intentional root canal treatment in the absence of injury ordisease to solely facilitate a restorative procedure • • Services performed by a prosthodontist • Localized delivery of antimicrobial agents when performed alone or in the absence of traditional periodontal therapy • Any localized delivery of antimicrobial agent procedures when more than eight (8) of these procedures are reported on the same date of service. • Infection control and/or sterilization • The recementation of any inlay, onlay, crown, post and core or fixed bridge within 180 days of initial placement • The recementation of any implant supported prosthesis (induding`crowns, bridges and dentures) within 180 days of initial placement • Services to correct congenital malformations, including the replacement of congenitally missing teeth • The replacement of an occlusal guard (night guard) beyond one per any 24 consecutive month period, when this limitation is noted on the PCS Crowns, bridges and/or implant supported prosthesis used solely for splinting ▪ Resin bonded retainers and associated pontics Should any law require coverage for any particular service(s) noted above, the exclusion or limitation for that service(s) shall not apply. This document outlines the highlights of your plan. For a complete list of both covered and not -covered services, including benefits required by your state, see your insurance certificate or plan description. If there are any differences between the information contained here and the plan documents, the information in the plan documents takes precedence. Copyright 2015 Page 8 of 9 Cigna Cigna. lg( 1. The term"DHMO'is used to referto product designs that may differ by state of residence of enrollee, including but not limited to, prepaid plans, managed care plans, and plans with open access features, 2. Costs listed for the Cigna Dental Care plan do not vary. Estimated costs without dental coverage may vary based on location and dentists' actual charges. These estimated costs are based on charges submitted to Cigna in 2012 and are intended to reflect national average charges as of January 2015 assuming an annual cost increase of three percent. Estimates have been adjusted to reflect the 2011 Cigna DHMO geographical membership distribution. 3. Minnesota residents: You must visit your selected network dentist in order for the charges on the Patient Charge Schedule to apply. You may also visit other dentists that participate in our network or you may visit dentists outside the Cigna Dental Care network, If you do, the fees listed on the Patient Charge Schedule will not apply. You will be responsible for the dentistis usual fee. We will pay 50% of the value of your network benefit for those services. Of course, youfll pay less ifyou visit your selected Cigna Dental Care network dentist, Call Customer Services for more information. Oklahoma residents: DHMO for Oklahoma is an Employer Group Pre -Paid Dental Plan. You may also visit dentists outside the Cigna Dental Care network. If you do, the fees listed on the Patient Charge Schedule will not apply. You will be responsible for the dentistfs usual fee, We pay non -network dentists the same amount weld pay network dentists for covered services. 0f course, youfll pay less if you visit a network dentist In the Cigna Dental Care network. Call Customer Services for more information, 4. California and Texas residents: Treatment for conditions already in progress on the effective date of your coverage are not excluded if otherwise covered under you PCS. Dentists who participate in Cigna's network are independent contractors solely responsible for the treatment provided and are not agents of Cigna. DHMO insurance coverage is set forth on the following policy form numbers: CO, DE, FL, KS, NE, OH, PA, and VA: PB09. AR: HP-POL120; CA: CAPB09, CAVP/A09, or 91994D3; CT: PBO9CT; IL: CG--CDC—ILL—POLICY; LA, HP-POL118; MA: HP-POL134; MI: HP-POL179; MO: PBO9M0; MS: HP-POL117; NC PB09,NC; NV: HP-POL132; NY: HP-POL130; OK: HP-POL115 (CHLIC) and GM6000 DEN201V1 (CGLIC); OR: HP-POL121; SC: HP-POL128;TN: HP-P0L134;TX: PBO9TX; UT: HP-POL129; WA: WAPOL05/11; and WI: HP-POL122. "Cigna"the "Tree of Life"logo,"GOYOU"and"Cigna Dental Care"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, Cigna Health and Life InsuranceCompany, Cigna HealthCare of Connecticut, Inc„ and Cigna Dental Health, Inc. and its subsidiaries. Cigna Dental Care plans are provided by Cigna Dental Health Plan of Arizona, Inc., Cigna Dental Health of California, Inc., Cigna Dental Health of Colorado, Inc., Cigna Dental Health of Delaware, Inc., Cigna Dental Health of Florida, Inc., a Prepaid Limited Health Services Organization licensed under Chapter 636, Florida Statutes, Cigna Dental Health of Kansas, Inc. (Kansas and Nebraska), Cigna Dental Health of Kentucky, Inc., Cigna Dental Health of Maryland, Inc., Cigna Dental Health of Missouri, Inc., Cigna Dental Health of New Jersey, Inc., Cigna Dental Health of North Carolina, Inc., Cigna Dental Health of Ohio, Inc., Cigna Dental Health of Pennsylvania, Inc„ Cigna Dental Health ofTexas, Inc., and Cigna Dental Health ofVirginia, Inc. In other states, Cigna Dental Care coinsurance plans are underwritten by Connecticut General Life Insurance Company, Cigna Health and Life Insurance Company or Cigna HealthCare of Connecticut, Inc„ and administered by Cigna Dental Health, Inc. 856819 11/13 O 2013 Cigna. Some content provided under license, Copyright 2015 Page 9 of 9 Cigna City of Miami RFP Number 495345 Customer Service, Banking, Reporting Capabilities, & Benefit Administration a) Provide detailed responses to Attachment A, as applicable. Failure to complete, in full, Attachment and return same with Proposal shall deem any Proposal received non -responsive. We have provided Attachment A in the List of Attachments section of the proposal binder. b) Provide any other information which the Proposer deems relevant to its organization and/or its ability to provide quality dental health care services to the City. Customer Service Cigna chose to be the only national health service company to expand our customer service hours to include the weekends, holidays, and overnight hours. Our toll -free customer service number, 800.Cigna24 is staffed 24 hours a day, 7 days a week, 365 days a year, to answer questions about coverage, DHMO dental office transfers, DPPOclaims, procedures, or any other concerns. Our voice response system is also available 24 hours a day, 7 days a week, 365 days a year. DHMO members can use the voice response system to view eligibility and coverage information, or they can use our automated quick transfer option to change network dental offices. DEPO/DPPO/indemnity members can use the voice response system to check claim status, eligibility, and coverage information. The toll -free number provides assistance 24-hours a day, allowing the member to enter their zip code and hear a list of nearby dental offices via the dental office locator. The toll -free number can also fax this list immediately to assist in enrollment or dental office transfers for the DHMO. Members can also enter a dentist's phone number to see if he or she participates in the network. If there are multiple dentists with the same .phone number, the system will speak back the name of each dentist, and clearly identifies DHMO capped dental offices. The system updates this information nightly. Members can access over 1,000 health and dental topics through our health information line by calling our toll -free number. Updated network infoiiiiation, referral status, and eligibility verification is available Oil . our website at myCigna. Our customer service organization focuses on providing the quality service and customer satisfaction for our members. Banking Arrangement Citibank® administers our banking arrangements for our program accounts. City of Miami may select any bank to fund the program account. We handle administration, issuing claim checks through our normal claim processing. As we issue checks, we send daily issue data to the program account bank, which stores the information on an outstanding issue file. Checks are paid through a central Copyright 2015 Page 1 of 3 Cigna City of Miami RFP Number 495345 disbursing account a nonfunded, zero -balance account. When checks are paid, the account becomes momentarily overdrawn. We match the paid checks against the outstanding issue file, and then transfer them to the account from which they were drawn. After debiting the account, we credit the central disbursing account, bringing the latter to its proper zero balance. There is approximately a three- to four -day float. An initial deposit or imprest balance is required to ensure adequate money is always available to cover checks cleared. The imprest balance is a noncompensating and non -interest -bearing balance. The final imprest amount is determined during the implementation process. If significant changes occur that cause the account to fall into an overdraft, we may adjust the imprest amount at any time; otherwise, we adjust it annually. Daily or weekly account deposits are available. If depositing daily, the imprest amount is three days of average claim activity. Each day, the bank requests money from the client's local bank for the aggregate amount of checks that cleared the previous night. If depositing weekly, the imprest amount is seven days of average claim activity. On the first business day of each week, the program account bank requests money from. the City of Miami's local bank for the aggregate amount of checks that cleared during the prior week or at any other time the account is overdrawn. The client's local bank must honor the request for money via Fedwire® 1031 automated clearing house (ACH) transfer the same day to restore the account to the imprest balance. City of Miami can obtain current daily/weekly deposit amounts from program bank via automated email or automated fax. Reporting Utilization Reports Cigna offers a wide range of dental plans and features that meet the needs of existing and prospective clients. We integrated dental utilization information into the Consultative AnalyticsSM reports to enable more flexible request parameters and updated norm information, as well as to create a consistent look and feel across our entire reporting portfolio for clients with integrated coverage (Cigna medical, dental, pharmacy, etc.). We generally provide a standard package of dental information reports quarterly or annually at no charge. A charge, however, does apply for standard reports produced more frequently and for optional reports. Dental reports include: • Dental Summary - exhibits total costs (including employer paid and member cost share) and per capita costs compared to book -of -business norms • Dental Utilization by Type of Service - exhibits per capita cost and utilization by service category • Dental Utilization by Type of Service and Network - exhibits per capita cost and utilization by service category by network option for a single period • Dental Cleanings Utilization - exhibits percentage of unique members with one or more cleanings Copyright 2015 Page 2 of 3 Cigna City of Miami RFP Number 495345 • Dental Top Quality 10 Procedure Types - exhibits the top 10 procedures based on the number of services in descending order • Dental Network Utilization and Cost Share - exhibits percentage of claims paid by the member versus employer and amounts paid in -network • Dental Claim Cost and Savings Summary - exhibits waterfall of total charges, savings, and discounts for one or two periods versus norm • Dental Claim Distribution (Every Service, Including Orthodontic) - exhibits payable claims by dollar range counted by unique member with orthodontic costs • Dental Claim Distribution (Excluding Orthodontic) - exhibits payable claims by dollar range counted by unique member without orthodontic costs • Dental Membership Summary - exhibits summary of population enrollment by plan and age band • Dental DHMO Summary - exhibits summary statistics for member numbers, utilization, and savings for the DHMO plan only • Dental Utilization by Type of Service [DHMO ONLY] - exhibits service categories details for DHMO utilization only Financial Reports DHMO We generate reports analyzing premium and income, as well as disbursements for fixed monthly payments, specialty referrals, and administration. These reports are formatted for internal use only. Due to the nature of our prepaid plan coverage, and the expenses associated with production and mailing, we do not provide any standardized reports about this information to the group. DPPO Financial reports are also available to City of Miami monthly that show premium, claim, in force, penetration, and monthly check count. Banking Reports for ASO Cigna provides banking reports to help clients manage cash flow by showing paid and outstanding checks. Our banking reports, including those online at CignaAccess.com, are available by the endof the second week of each month. These reports include: • daily, weekly, and monthly registers of checks issued or cleared • monthly summary of claim activity • detailed monthly statement and reconcilement Our banking reports will enable City of Miami to better plan and manage cash flow needs by maintaining an appropriate funding level, minimizing exposure to account shortages, and maximizing the ability to put cash to work in other endeavors. Copyright 2015 Page 3 of 3 Cigna City of Miami RFP Number 495345 Price and Cost Effectiveness a) Provide detailed responses to Attachment A, as applicable. Failure to complete, in full, Attachment A and return same with Proposal shall result in the Proposal being deemed non -responsive the intention of the City for all contracts to be awarded on a non -commission basis. Consideration will be given during evaluation of same. Cigna has provided responses to Attachment A, the completed document is in the List of Attachments section of the proposal. b) Fees shall be quoted for Plan Years 2016 and 2017. Fee listed shall be the same regardless of plan design type. ■ Payment to the successful Proposer shall be based on actual enrollment of employees. ■ Fees shall not be adjusted at any time during the Plan Year unless the City requests and agrees to contractual changes. Notes: All fees shall be guaranteed for a minimum of 24 months (the initial two (2) Plan Years). a) The City's acceptance of any exceptions taken by the Proposer. c) Rates for option to renew periods shall remain the same unless adjustments are agreed upon the City or the successful Proposer. Any requests for adjustments must be provided by the successful Proposer to the Contract Administrator by May 1st of the year prior to the start of the affected Plan Year. A justification including the successful Proposer's actuarial methodology used to determine the requested adjustment must be submitted with the request. If no request for adjustment is received by May lst, the fees shall remain the same for the option to renew period. Any rate adjustment shall be negotiated and shall be based on any other legislative mandates and industry trend factors. d) Provide any other information which the Proposer deems relevant to its organization and/or its ability to provide quality dental health care services to the City. Cigna has attached financial exhibits in this section of the proposal. Copyright 2015 Page 1 of 5 Cigna 41. -'(C n CITY OF MIAMI PROPOSAL TERMS AND CONDITIONS A. General Terms of this Proposal Cigna HealthCare is pleased to present this Proposal for an Insured and Administrative Services Only group dental benefit plan (the "Plan") sponsored by City of Miami. This proposal is valid for 90 days from its original date of release, 7/24/15. Any revisions or updates made to this proposal will not renew this valid timeframe unless expressly communicated by Cigna HealthCare. The information contained in this Proposal by Cigna HealthCare is proprietary and highly confidential. It is being provided with the understanding that it will not be used by the employer, its representatives or consultants for any purpose other than the evaluation of the Proposal. Under no circumstances is any of the information contained herein (including excerpts, summaries, extracts, and evaluations thereof) to be used, disseminated, disclosed or otherwise communicated to any person or entity other than the employer, its representatives and consultants, and their respective employees who are directly involved in the evaluation process. Proposal Caveats Cigna HealthCare may revise or withdraw this Proposal if: • there is a change to the effective date of the quote • the policy will not be sitused in FL • the Plan benefits are different than shown in the RFP or benefit modifications are requested • the census or experience provided is deemed inaccurate • there is a change in law, regulation, tax rates, or the application of any of these that affects Cigna HealthCare's costs • enrollment varies by more than 15 percent from at least one of the following enrollment levels: 2399 total with 981 in the Non -Executive DPPO, 21 in the Executive DPPO, and 1397 in the DHMO • the employer contribution levels are different than shown in the RFP or other than what the quote assumes • commissions are requested to be different than 0% or $0.00 PEPM • it is requested to interface with a third party vendor • it is requested to provide optional services beyond those listed here as being included in the quote: Mailing of ID cards and SPDs to employee homes • administration of the Plan will require more than the following: o Billing lines: 10 o Billing and Claim Branch Benefit Options: 10 • Cigna HealthCare is not the exclusive provider of Dental benefits for all of City of Miami's employees in all worksites B. Scope and Application of this Proposal Unless otherwise indicated, this Proposal: • supersedes and renders null and void any prior Cigna HealthCare offer or proposal with respect to the Plan. • does not include administration of "run out" claims incurred prior to the effective date. "Cigna" is registered service mark and the "Tree of Life" logo is a service mark of Cigna Intellectual Property, Inc., licensed for use by Cigna Corporation and its operating subsidiaries. All products and services are provided by such operating subsidiaries, and not by Cigna Corporation. Such operating subsidiaries include Connecticut General Life Insurance Company, Cigna Health and Life Insurance Company, and HMO or service company subsidiaries of Cigna Health Corporation and Cigna Dental Health, Inc. Copyright 2015 Page 2 of 5 Cigna • all Insured Premium and/or Rates include the cost of the Health Insurance Assessment (PPACA), beginning on January 1, 2014. Cigna HealthCare reserves the right to modify quoted rates, as necessary, should there be any changes in future regulation or costs. • includes the additional Cigna DPPO healthcare professionals for which Cigna HealthCare retains a portion of the savings generated. • assumes that Cigna HealthCare's standard insurance policy form approved for use in the applicable state by the state insurance regulator will be issued. Because the insurance policy and certificate terms require regulatory approval, there is very little flexibility to change the provisions. The provisions of the insurance policy and certificate will supersede the Proposal in the event of a conflict. • assumes when/if a Cigna HealthCare non -voluntary vision benefit is added to the medical plan, it is added as a rider and always non -excepted, regardless of funding. ASO • includes the additional Cigna DPPO healthcare professionals for which Cigna Healthcare retains a portion of the savings generated. Client's fee for the additional Cigna DPPO healthcare professionals is equal to 25% of the "gross savings." Gross savings are defined as the difference between the charge that the provider would have made without the savings and the charge made as a result of the savings, Cigna HealthCare pays the applicable vendor fee. • excludes charges for converting a qualified customer of a group plan to an individual plan. • includes Cigna HealthCare's network Shared Savings Fee —Dental. • assumes Cigna HealthCare's standard administrative services only ("ASO") agreement will be used and executed before the effective date of Cigna HealthCare providing administrative services. If modifications to that agreement are required to meet the employer's needs, we are willing to negotiate terms to arrive at a mutually agreed -upon, modified ASO agreement. If a modified ASO agreement is required, but has not been agreed upon by the effective date, Cigna HealthCare will provide administrative services, only if a Letter of Intent as required by Cigna HealthCare has been executed. Such Letter of Intent will reference Cigna HealthCare's standard ASO agreement (or other provisions mutually agreed upon) that will control until execution of the finalized ASO agreement. Notwithstanding anything in the request for proposal or in Cigna HealthCare's Proposal, the terms of the executed ASO agreement or the executed Letter of Intent will control in the event of a conflict between their terms and any terms in the request for proposal or the Proposal. • assumes dental/vision products are excepted. In order to maintain this excepted status, the Plan must ensure that when dental/vision products are offered, they are offered as a separate election for the employee. Cigna HealthCare may have an agreement with your benefit advisor, under which the benefit advisor may be paid for providing marketplace intelligence or for the performance of administrative services. The qualification for and amount of this payment may be based upon overall business growth and/or retention levels. Any such payment is funded through Cigna HealthCare's general overhead. The benefit advisor may qualify for incentive payment (monetary or non -monetary) from Cigna HealthCare. For example, the benefit advisor may receive payment based upon new sales, new customer growth or retention. This incentive payment is funded from Cigna HealthCare's general overhead. Cigna HealthCare sponsors programs to inform benefit advisors about Cigna HealthCare's plan coverage and services (including producer advisory councils). The cost of these events is funded through Cigna HealthCare's general overhead. "Cigna" is registered service mark and the "Tree of Life" logo Is a service mark of Cigna Intellectual Property, Inc., licensed for use by Cigna Corporation and its operating subsidiaries. All products and services are provided by such operating subsidiaries, and not by Cigna Corporation. Such operating subsidiaries include Connecticut General Life Insurance Company, Cigna Health and Life Insurance Company, and HMO or service company subsidiaries of Cigna Health Corporation and Cigna Dental Health, Inc. Copyright 2015 Page 3 of 5 Cigna Citv of Miami Guaranteed Cost Funding Non -Participating January 01, 2016 - December 31, 2017 ° ;fy,,it �°t wt�� p� 4,•.. rr.ht� a�1ut�i le ° , ��lye E. ea<�° . xts�7 e.# °.. t �prefi �ryRates a� � Ratesy�, Dental PPO - Non -Executive DPPO Employee Only 497 $25.39 $32.81 Employee + Spouse 159 $52.28 $67.57 Employee + Child(ren) 139 $51.83 $66.99 Employee + Family 186 $92.45 $119.49 Annual Cost 981 $543,977 $703,052 ° etOtelifiChange (R aoted;. rre, ) . 4 , -;, 129,24%d *The above quoted rates include 3.0% Health Insurance Assessment fees (PPACA): *The above quoted rates do not include any commissions. aj�.e ,fix rqv.r`..w J ?4 t,�.y,�t... _x ,� 1 � �,> jY ,� 't '< P .ie ' �uf � �, .,x.. ,!Y„4 ..ar!x:Fd'WavX_., Si h ec ed: t 5 "a� �y� �c aQYi��N �; C�1rCer)t � � R e 2 b9lw Dental PPO - Executive DPPO Employee Only 3 $25.39 $32.81 Employee + Spouse 4 $52.28 $67.57 Employee + Child(ren) 5 $51.83 $66.99 Employee + Family 9 $92.45 $119.49 Annual Cost 21 $16,518 $21,349 xr . Ms% .mpercent Charlgef;(Quoted;rs3C+ilrrent).,.. . VA, i(40 r ?. ;y25PJdM *The above quoted rates include 3.0% Health Insurance Assessment fees (PPACA). *The above quoted rates do not include any commissions. The 1/1/2018 DPPO renewal increase will not exceed 7.5% above the 2017 rates The 1/1/2019 DPPO renewal increase will not exceed 7.5% above the 2018 rates The 1/1/2020 DPPO renewal increase will not exceed 7.5% above the 2019 rates ;a, R fs shiy.f °. t a'JJ%�j, ;y6, xay, le l�gr�tk,g �x7 4 i'1 i j( el, t..a-xt .%m4x? :X,"n41< �k w�'i ttti+°'� PC' `i,r{. ,'tqj�ry°'ai},i�ppi'}'g'X+{r u7 t tV:1s,i{ iiA.r Curre t, 3 j' iJ.,:L,��V.r1`I�atreS.+Y `\xi5i, iio.:. �12�1 MofitF '.rF''$a � 151n n.R�1 G.]i*has f4;; is Dental HMO FP6XVO1 692 $12.91 $12.91 Employee Only Employee + Spouse 181 $25.92 $25.92 Employee + Child(ren) 202 $26.85 $26.85 Employee + Family 322 $37.29 $37.29 Annual Cost 1,397 $372,676 $372,676 IPeYcet.Ch. ne(Qioted°vslCurrerntR ltnu rd,Xto ai 'QO% n *The above quoted rates include 3.0% Health Insurance Assessment fees (PPACA). *The above quoted rates do not include any commissions. The 1/1/2018 DHMO renewal increase will not exceed 7.0% above the 2017 rates The 1/1/2019 DHMO renewal increase will not exceed 7.0% above the 2018 rates The 1/1/2020 DHMO renewal increase will not exceed 7.0% above the 2019 rates Copyright. 2015 Page 4 of 5 Cigna City of Miami 1/1/2016 ASO Dental Proposal ASO Fees Projected Dental PPO Enrollment: 1,002 Dental PPO Fee Components Administration Fee Network Access Fee Commissions Total ASO Fee *Additional Multi -Year Fee Caps: 1/1/2016 $2.63 $0.70 $0.00 $3.33 1/1/2017 1/1/2018 0.0% 3.5% 1/1/2019 1/1/2020 3.5% 3.5% *ASO fees are shown on a Mature, per Employee per Month basis. 464,0 Cigna. Copyright 2015 Page 5 of 5 Cigna City of Miami RFP Number 495345 Local Preference For Proposers seeking local preference consideration in the evaluation process, the following information must be provided with proposal, pursuant to Section 1.49 of the General Conditions: a) State the Primary Office Location of the Proposer b) Provide location from which the Proposer will be based to perform the work. This is not applicable Copyright 2015 Page 1 of 1 Cigna City of Miami RFP Number 495345 Performance Guarantees Performance Guarantees will be required regarding: a) Implementation; b) Time to Process; c) Processing Accuracy; d) Financial Accuracy; e) Average speed of response; and f) Account management. Cigna has provided Performance Guarantees to include the above criteria as well as additional areas regarding service and implementation. The performance guarantee documents have been provided in this section of the proposal. Copyright 2015 Page 1 of 4 Cigna City of Miami Performance Guarantees — DPPO City of Miami Effective Start Date: January 1, 2016 IMPLEMENTATION Identification Card Delivery Implementation ID Card Timeliness. 98% of the ID cards will be mailed by the agreed upon commitment date in the Implementation Calendar. Results measured at Account Level. Claim Readiness Implementation Claim Readiness. Benefit Profile and eligibility information loaded on claims processing system as of the Commitment Date set forth in the approved Implementation Calendar. Results measured at Account Level. CaII Readiness Implementation Call Readiness. Service Center(s) ready to respond to customer inquiries as of the Commitment Date set forth in the approved Implementation Calendar. Results measured at Account Level. Implementation Satisfaction Implementation Satisfaction. Score of no less than three (3) on Statement 1 of the Cigna HealthCare Implementation Survey. Results measured at Account Level. SERVICE: Claim Time -to -Process Dental Time to Process. Measured for the Term of the Agreement, results will meet or exceed: 98% of Claims processed w/in 20 Business Days. Results measured at the Account Level. Financial Accuracy Dental Financial Accuracy. Measured for the Term of the Agreement, results will meet or exceed: 99% of total audited claim dollars are correctly paid. Results measured at Office Level. Processing Accuracy Dental Processing Accuracy (overall Accuracy). Measured for the Term of the Agreement, results will meet or exceed: 95% of total audited claims are correctly processed. Results measured at Office Level. Average Speed of Answer Dental ASA. Measured for the Term of the Agreement, results will not exceed: 45 seconds to answer a phone call. Results measured at Special Account Queue. Call Abandonment Rate Dental CaII Abandonment Rate. Measured for the Term of the Agreement, results will not exceed: 3% of calls received by Call Center(s) terminated. Results measured at Special Account Queue. RIP Number 495345 gna. Amount At Risk $1,100.00 Amount At Risk $1,100.00 Amount At Risk $1,100.00 Amount At Risk $1,100.00 Amount At Risk $1,100.00 Amount At Risk $1,100.00 Amount At Risk $1,100.00 Amount At Risk $1,100.00 Amount At Risk $1,100.00 Copyright 2015 Page 2 of 4 Cigna City of Miami Call Activity Closure Dental Call Activity Closure. 98% of calls closed in 10 Business Days. Results measured at Book of Business Level. CSA Quality Dental CSA Quality. 95% quality standard. Results measured at Office Level. Automated Maintenance Eligibility Processing Dental Auto Eligibility Processing. Measured for the Term of the Agreement, results will meet or exceed: 99% files processed in 2 Business Days after the receipt of clean eligibility. Results measured at the Account Level. Account Management Dental Account Management. Composite Score (all categories) of 3.0 or better on the Account Management Report Card based on four (4) quarterly scorecards. Results measured at Account Level. RFP Number 495345 Amount At Risk $1,100.00 Amount At Risk $1,100.00 Amount At Risk $1,100.00 Amount At Risk $1,100.00 Copyright 2015 Page 3 of 4 Cigna City of Miami Performance Guarantees - DHMO City of Miami Effective Start Date: January 1, 2016 DENTAL HMO.,: Average Speed of Answer Dental HMO ASA. Measured for the Term of the Agreement, results will not exceed: 45 seconds to answer a phone call. Results measured at Special Account Queue. Call Abandonment Rate Dental HMO Call Abandonment Rate. Measured for the Term of the Agreement, results will not exceed: 3% of calls received by Call Center(s) terminated. Results measured at the Special Account Queue. Member Satisfaction Dental HMO Member Satisfaction. Measured for the Term of the Agreement, results will meet or exceed: a member satisfaction level of 75% or greater with CIGNA Dental overall. Measurement based on national survey results. Post enrollment measure DHMO ID Cards Maintenance. Measured for the Term of the Agreement, results will meet or exceed: 98.5% mailed within 10 business days after the release of, not receipt of, clean and accurate eligibility to the ID card vendor. Results measured at Account Level. Time to Process - Specialty Referral Claims Rate Dental HMO Time to Process. Measured for the Term of the Agreement, result will meet or exceed: 98% within 15 Business Days. Results measured at Office Level. Provider DHMO Network Access, Measured for the Term of the Agreement, Access Standard will meet or exceed: 80% of dental office accepting new patients based on National Results. RFP Number 495345 Ye PSPY $0.88 PSPY $0.88 PSPY $0.88 PSPY $0.88 PSPY $0.88 PSPY $0.88 Total Amount at Risk Per Enrolled Subscriber Total $ Maximum Amount at Risk $5.28 $7,380.00 Copyright 2015 Page 4 of 4 Cigna City of Miami Attachment A RFP Number 495345 Questionnaire for Employee Benefit Dental Plan(s) This Questionnaire must be fully completed, in the order stipulated, and returned with Proposal. Failure to answer all questions and provide with Proposal shall deem Proposal non- responsive. Financial Stability and Experience 1. Please provide the full business name of your company, mailing and physical address, telephone and fax number, email address, and web site address. Legal Name of Firm: Cigna Health and Life Insurance Company (CHLIC), Cigna Dental Health Plan of Arizona, Inc., Cigna Dental Health of Colorado, Inc., Cigna Dental Health of Florida, Inc., Cigna Dental Health of North Carolina, Inc., Cigna Dental Health of Ohio, Inc., Cigna Dental Health of Texas, Inc., and Cigna Dental Health of Virginia, Inc. Company Address: CHLIC Cigna Dental Health Plan of Arizona, Inc., Cigna Dental Health of Colorado, Inc. Cigna Dental Health of Florida, Inc. Cigna Dental Health of North Carolina, Inc. Cigna Dental Health of Ohio, Inc. Cigna Dental Health of Texas, Inc. Cigna Dental Health of Virginia, Inc. Phone Email: 900 Cottage Grove Road, Bloomfield, CT 06002 1571 Sawgrass Corporate Parkway, Suite 140 Sunrise, FL 33323 1571 Sawgrass Corporate Parkway, Suite 140 Sunrise, FL 33323 1571 Sawgrass Corporate Parkway, Suite 140 Sunrise, FL 33323 1571 Sawgrass Corporate Parkway, Suite 140 Sunrise, FL 33323 1571 Sawgrass Corporate Parkway, Suite 140 Sunrise, FL 33323 1640 Dallas Parkway, Plano, TX 75093 1571 Sawgrass Corporate Parkway, Suite 140 Sunrise, FL 33323 860.226.6000 Fax 954.514.6905 dina.d'angelo@cigna.com Website www.cigna.com 2. Which location would be the primary office to service the City's account and what services will be provided through this office? The primary office to service the City of Miami's account will continue to be Sunrise, Florida office located at: 1571 Sawgrass Corporate Pkwy, Suite 140 Sunrise, FL 33323 Copyright 2015 Page 1 of 65 Cigna City of Miami Attachment A RFP Number 495345 Your current Cigna account management team incorporates a global team approach to' effectively coordinate your plan. City of Miami's core account management team includes a client manager, implementation manager, client engagement manager, client service executive, eligibility account specialist, underwriter and on -site health and wellness representatives. This core team is supported by other matrix partners who are specialist in their specific behind the scenes functions. Service representatives from claims, eligibility, billing, local health plans, contracts, compliance, banking, and reporting provide additional support for the account service team. 3. Please list other companies with whom you have financial interest (i.e. insurance companies, PPOs, HMO, MGUs, Brokerage operations, etc.). Cigna companies comprise one of the nation's leading providers of employee benefits, health care coverage, and insurance products to businesses and individuals worldwide. Cigna refers to various operating subsidiaries of Cigna Corporation. Plan coverages and services are provided by these subsidiaries and not by Cigna Corporation. These subsidiaries include, but are not limited to, Connecticut General Life Insurance Company (CGLIC), Cigna Health and Life Insurance Company (CHLIC), Cigna Vision Care, Inc., Cigna Home Delivery Pharmacy and its affiliates, Cigna Behavioral Health, Inc., Cigna Health Management, Inc., HMO or service company subsidiaries of Cigna Health Corporation and Cigna Dental Health, Inc., Kronos Optimal Health Company, and Vanbreda International. In addition, we have joint ventures or business alliances including the following: • Health Alliance Plan of Michigan • HealthPartners, Inc. • MVP Health Plan, Inc. • Tufts Associated Health Plans, Inc. 4. In the last five years, has your business entity ever been involved in a merger or had a change of ownership? If yes, please describe. Yes. On February 28, 2015, Cigna completed the acquisition of New Jersey -based QualCare Alliance Networks, Inc. The agreement combines Cigna's broad, integrated portfolio of health -related plans and services and national scale with QualCare Alliance Networks' expertise and capabilities in working with hospital systems to drive innovation, affordability, and value. Going forward, Cigna and QualCare Alliance Networks will focus on locally tailored innovations to drive member engagement and meet personal needs, as well as offer hospital systems and doctor groups managed care services, such as multitier plan administration, population analytics, performance reporting and management, and clinical benchmarking services. In September 2013, Cigna completed the acquisition of Alegis Care, a multispecialty medical health services organization dedicated to creating a comfortable medical home experience for homebound Medicare and Medicaid patients. The acquisition strengthens Copyright 2015 Page 2 of 65 Cigna City of Miami Attachment A RFP Number 495345 Cigna's ability to provide the chronically ill and elderly, working with their doctor, care coordination in the most appropriate setting for their needs. In November 2012, Cigna finalized our joint venture partnership agreement with Finansbank. With this agreement, Cigna now holds a 51 percent stake of Finansbank's insurance division, Finans Emeklilik, the sixth largest life and pension product provider in Turkey through in -branch banking channels; Cigna can now market life and pension products in the country. This joint venture provides Cigna opportunities to reach and serve a rapidly expanding middle-class market in Turkey through Finansbank's network of over 500 retail banking branches. By leveraging Cigna's direct distribution expertise, the joint venture company will sell life, pension, and other health, life, and accident products in a 15-year exclusive distribution agreement with the bank, providing access to a large branch network and sizeable credit card base. In August 2012, Cigna acquired Great American Supplemental Benefits Group, one of the largest distributors of supplemental health products in the U.S. The new business positions Cigna as one of the largest producers, distributors, and marketers of supplemental health care and related products in the U.S. The acquisition of Great American aligns with Cigna's growth strategy by: • expanding our portfolio of health solutions in the U.S. individual and senior business, while strengthening our member -centricity focus • enabling Cigna to offer greater value throughout every stage of life In January 2012, Cigna completed the acquisition of HealthSpring, expanding Cigna's presence in the senior and Medicare segments. Through this acquisition, Cigna expanded our capabilities and product offerings to better serve our members throughout their life stages. In December 2011, Cigna finalized the acquisition of FirstAssist Insurance Services Limited following regulatory approval from the United Kingdom's Financial Services Authority. This acquisition enhanced Cigna's presence in Europe, and enabled us to offer an expanded range of products and services to our clients across our businesses in Europe and Asia Pacific. FirstAssist Insurance Services and FirstAssist Legal Protection are part of Cigna Global Health Benefits. In August 2010,.Cigna acquired Vanbreda International, based in Antwerp, Belgium, giving Cigna unmatched global reach in expatriate benefits and further accelerating Cigna's global growth strategy. Privately owned, Vanbreda International specializes in the provision of worldwide medical insurance and employee benefits to intergovernmental and nongovernmental organizations, including global humanitarian operations, as well as corporate clients. In February 2010, Cigna acquired Kronos Optimal Health Company, a health and wellness company that specializes in lifestyle management programs, face-to-face coaching, biometric screenings, and health education programs. This acquisition granted Cigna an extensive nationwide network containing approximately 13,000 health coaches, health educators, and screeners. Copyright 2015 Page 3 of 65 Cigna City of Miami Attachment A RFP Number 495345 5. Within the last five years, has your business entity had a change of name, and/or us .. a d.b.a. or is it operating under an assumed name? Our business entity has not had a change of name in the last five years. 6. If an insurance company, what is your current rating with A.M. Best or Standard & Poor's? DHMO Cigna Dental Health of Florida, Inc. has an A.M. Best rating of "A-" (excellent). Our latest rating was on February 13, 2015. The other agencies do not provide ratings for the health plans. DPPO A.M. Best, Moody's, and Standard & Poor's (S&P) currently rate Cigna Health and Life Insurance Company (CHLIC), a Cigna company, and they review these ratings annually. A.M. Best On February 13, 2015, A.M. Best affirmed the financial strength rating of "A" and the outlook of stable. This matches the financial strength ratings of Connecticut General Life Insurance Company (CGLIC) and Life Insurance Company of North America (LINA). A.M. Best has rated CHLIC a financial size "XV." Moody's On December 11, 2014, Moody's upgraded the financial strength rating from "A2" to "Al" and revised the outlook from positive to stable. S&P On May 19, 2014, S&P upgraded the financial strength rating from "A+" to "AA-" and revised the outlook from positive to stable. 7. Describe any previous or pending lawsuits and/or bankruptcies in the last 7 years. In an average year, Cigna Corporation's subsidiaries, including Connecticut General Life Insurance Company (CGLIC) and Cigna Health and Life Insurance Company (CHLIC), process more than 60 million claims and receive approximately 400 claim -related lawsuits. While the outcome of this litigation cannot be determined, we do not expect litigation to result in losses that would be material to results of operations, liquidity, or financial condition. Please refer to Fouii 10-K and Form 10-Q for an updated description of material legal proceedings. These documents are available online: http://www.cigna.com/aboutus/sec-filings Confidentiality concerns, together with the pending nature of a number of lawsuits, preclude further comment or description. c Copyright 2015 Page 4 of 65 Cigna City of Miami Attachment A RFP Number 495345 8. Have any of the principals in your firm or any of your employees (former or current), ever been indicted or convicted of mishandling/misappropriating any insurance company or client funds? If yes, please provide details. To the best of our knowledge and belief, none of Cigna's principals or employees have been indicted or convicted of mishandling/misappropriating any insurance company or client funds. 9. Describe your current procedures for handling client or insured complaints and State Insurance Department complaints. Department of Insurance complaints about products or services are acknowledged and responded to promptly within required regulatory timeframes. Complaints are tracked for trending and reporting purposes. ASO Appeal Process (Post -service) Cigna offers a single level appeal for coverage decisions. The member can submit a verbal or written appeal request within 180 days of the initial denial. Single Level Appeals Someone not involved in the initial claims process reviews appeals. A dental professional will review appeals involving dental necessity or clinical appropriateness. We will respond to: • Post -service clinical denials within 30 calendar days • Post -service administrative denials within 60 calendar days If a claim appeal was submitted to the Department of Insurance, Cigna will follow the national appeals policy. The appeal would be submitted to Cigna, and if the client has elected Cigna's voluntary external review process, the member will receive a form with the letter, and he or she must return it to the appeal address provided. An appeals coordinator will pull together the file and send it to the independent review organization. The independent review organization will send the resolution letter to the member and Cigna. If the decision is to overturnthe denial, the national appeals organization will update the approval, or handle the adjustment, whichever is appropriate. The time frame is 30 calendar days or 45 calendar days, depending upon whether the client is grandfathered or non-grandfathered. Fully Insured Appeal Process Level One Appeal Someone not involved in the initial claims process reviews appeals. A dental professional reviews appeals involving dental necessity or clinical appropriateness. As required by state regulations, we will follow state requirements when responding to concerns about pre -service or post -service denial requests. Cigna notifies the member of the decision in writing, including the specific contractual or clinical reasons for the decision, as applicable. Copyright 2015 Page 5 of 65 Cigna City of Miami Attachment A RFP Number 495345 Only pre -service reviews are eligible for expedited processing. A member may request an expedited review if our standard time frames to respond would seriously jeopardize their life, health, or the ability to regain the dental functionality that existed before the onset of the condition. A dental professional, in consultation with the treating dentist, will decide if an expedited review is necessary, and will communicate an oral response within 72 hours, and then follow up in writing. If a member is not satisfied with our level one appeal decision, he/she may request a level two appeal. Time frames or requirements may vary depending on state law. Level Two Appeal An appeals committee or someone not involved in the level one appeal may conduct appeals. If specialty care is in dispute, we may involve a dentist in the same or similar specialty. As required by state regulations, we will follow state requirements when responding to concerns about pre -service or post -service denial requests. Cigna notifies the member of the decision in writing, including the specific contractual or clinical reasons for the decision, as applicable. Only pre -service reviews are eligible for expedited processing. A member may request an expedited review if our standard time frames to respond would seriously jeopardize their life, health, or the ability to regain the dental functionality that existed before the onset of the condition. A dental professional, in consultation with the treating dentist, will decide if an expedited review is necessary, and will communicate an oral response within 72 hours, and then follow up in writing. Time frames or requirements may vary depending on state law. 10. Has the company Third Party Administrator (TPA) or its principals ever been adjudged bankrupt? If yes, please explain. Cigna has never been adjudged bankrupt. 11. have you ever been involved in an audit by the Department of Labor (DOL)? If yes, please provide details. Several routine Department of Labor investigations of our business practices concerning ERISA-governed plans have been conducted in the past decade and each case resulted in no action being taken. 12. Do you carry a TPA errors & omissions policy? Yes. Copyright 2015 Page 6 of 65 Cigna City of Miami Attachment A RFP Number 495345 • If yes, who is the carrier? • What is the expiration date of the policy? • What are the limits of coverage for the policy? Cigna maintains managed care professional liability E&O insurance coverage for errors and/or omissions that may have (or are alleged to have) occurred during the normal course of Cigna's business, such as account set-up, claim processing, health care professional negotiations, utilization review, health care professional selection, or claims services. The coverage and the extent of coverage depend on the nature of the case, and every case varies. We provide this coverage on a claims -made basis. E&O Coverage Overview ier� '� �frPolicy,',eri Ace American Insurance Company 10/1/14-10/1/15 $15M/Claim and $15M/Aggregate • Is contract a claims made policy? Our contract is a claims made policy. • What is the deductible? We generally refrain from disclosing our deductible. 13. Do you carry a comprehensive general liability policy? Yes. • If yes, who is the carrier? • What is the expiration date of the policy? • What are the limits of coverage for the policy? Cigna's commercial general liability coverage insures Cigna for third -party bodily injury, property damage, and personal and advertising injury allegations made against the company. ,-'kSf�} _ Yi -! k ! ipsurar►a C��ripr §r# £ zy ai i t ti`S ?.�1�� Polioy Periocl�3t�� Y Fes# �y �. i i1 �, $1 million per occurrence ACE American Insurance Company 7/1/14-7/1/15 American Guarantee and Liability Insurance Company(1) 7/1/14-7/1/15 $25 million aggregate (1) A Zurich company • What is the deductible? Due to the confidential nature of our internal business practices, as well as various confidentiality provisions embedded within our insurance programs, Cigna is Copyright 2015 Page 7 of 65 Cigna City of Miami Attachment A RFP Number 495345 contractually prohibited from disclosing insurance deductibles to third parties,, including our clients. 14. Do you carry a fidelity bond? Yes. • If yes, who is the carrier? • What is the expiration date of the policy? • What are the limits of coverage for the policy? • What is the deductible? Cigna maintains a fidelity bond to provide coverage for losses resulting directly from dishonest or fraudulent acts committed by an employee acting alone or in collusion with others. Dishonest or fraudulent acts can cause Cigna to sustain such losses, and provides the employee or another person or entity with financial benefits. The fidelity bond is provided on a claims -made basis. Coverage is afforded on a first -party basis to Cigna. Due to limitations in the insurance marketplace coupled with the type of services provided by Cigna, there is no provision for third -party coverage under the fidelity (crime) bond. ee- Fidelity Bond Coverage Overview aril National Union Fire Insurance Company (AIG) 4/30/14-4/30/15 $20M We generally refrain from disclosing our deductible. • What are the total annual aggregate funds handled for all clients? Because we hold a first -part fidelity bond, the fidelity bond limits are for Cigna only and not our clients. The fidelity bond is provided on a claims -made basis. Coverage is afforded on a first- party basis to Cigna. Due to limitations in the insurance marketplace coupled with the type of services provided by Cigna, there is no provision for third -party coverage under the fidelity (crime) bond. 15. Have claims been made against any of the above policies in the past two (2) years? If yes, please provide details. Because of the inherent confidential nature of the claims data and Cigna's confidential relationship with its insurers, Cigna is unable to release claims history or loss data to third parties or business partners. Copyright 2015 Page 8 of 65 Cigna City of Miami Attachment A RFP Number 495345 Clients can obtain publicly available claims and litigation information directly from SEC filings, or by visiting the investor relations page on our company website at http://www.cigna.com/about-us/investors/ for our recent disclosures. 16. Provide a list of 5 references of clients of similar size. Please include contact name and telephone number. 1) Client Name: Contact Name: Phone Number: 2) Client Name: Contact Name: Phone Number: 3) Client Name: Contact Name: Phone Number: 4) Client Name: Contact Name: Phone Number: 5) Client Name: Contact Name: Phone Number: Palm Beach County Sheriff Bonnie Keeley, Benefits Supervisor (561) 688-3286 University of Miami Jennifer Cohen Human Resources (305) 284-6835 Government of the U.S. Virgin Islands Maureen Venzen, Chief Group Insurance (340) 714-5027 Orlando Health Richard Tunno, Corporate Manager Benefits (321) 841-8641 Shelby County Schools Loretta Poindexter, Benefits Manager (901) 416-3286 Adequacy of Network and Qualifications of Providers 1. Please provide the Geo Access summaries for employees who fall both within and outside the network. The City would like to use 2 providers in 15 miles as the access standard. Provide this report for General Dentists, Endodontists, Periodontists, Oral Surgeons and Orthodontists. We have provided GeoAccess reports in the List of Attachments section of the proposal binder. 2. Complete the following tables regarding your network: DHMO Number of Providers County General Ortho Endo Oral/Max Ped Periodontics Miami -Dade 521 95 57 86 106 56 Broward 352 46 39 45 53 45 Monroe 2 0 0 0 0 0 Palm Beach 214 43 32 33 30 23 Copyright 2015 Page 9 of 65 Cigna City of Miami Attachment A RFP Number 495345 Number of Providers Accepting New Patients County General Ortho Endo Oral/Max Ped Periodontics Miami -Dade 516 95 57 86 106 56 Broward 344 46 39 45 53 45 Monroe 1 0 0 0 0 0 Palm Beach 210 43 32 33 30 23 DPPO Total Number of Providers County General Ortho Endo Oral/Max Ped Periodontics Miami -Dade 1,872 159 84 91 86 90 Broward 1,973 142 97 98 110 116 Monroe 56 1 2 1 2 0 Palm Beach 1,554 103 93 71 77 86 Number of Providers Accepting New Patients County General Ortho Endo Oral/Max Ped Periodontics Miami -Dade 1,872 159 84 91 86 90 Broward 1,973 142 97 98 110 116 Monroe 56 1 2 1 2 0 Palm Beach 1,554 103 93 71 77 86 3. How often are provider contracts renegotiated? Every Cigna dental health care professional agreement expires on December 31 of each year, and is automatically renewed unless Cigna or the dentist ends the contract. The contract may be ended by either party with 60 or 90 days (according to state regulations) written notice anytime throughout the year. 4. Do your contracts include a specific clause which limits the amount of increase? No, We use an office -level approach to fee negotiations with our existing network dentists, These negotiations of network fees have not created an erosion of our national discounts or had a significant impact to our dental care loss ratio. Are there automatic annual increase provisions included in any of your contracts? There are no provisions in network dentist contracts concerning fee increases. The contract does stipulate a 2-year agreement upon initial contracting. Dentists' fees are reviewed at request of the dentist, but no sooner than annually. Copyright 2015 Page 10 of 65 Cigna City of Miami Attachment A RFP Number 495345 5. Are you able to service participants/dependents out of the Miami area through your DMO network? How? DHMO We use the services of non -contracted dentists under the following scenarios: • Emergency Treatment - If an emergency occurs while a member is more than 50 miles away from home or if his or her primary care dentist is unavailable, we will pay the cost of diagnostic and therapeutic dental procedures administered by any licensed dentist during regularly scheduled office hours. The claim will be paid up to a maximum of $50 for each emergency, less applicable patient charges. Slight variations of payment levels are required for regulatory purposes in Texas, Pennsylvania, and New York. • Second Opinions - If a member wants a second opinion, we will arrange for a consultation with a mutually agreed upon dentist at no cost to the member. • Specialty Referral - If a contracted specialist is not available, an out -of -network specialist will be selected on the basis of a referral from the general dentist, with proper payment certification from us. Please note that if a member moves to an area where there are no participating network general dentists, Cigna DHMO coverage is not available. If a member is enrolledin an area where we had maintained a network that subsequently became unavailable or discontinued, we will provide fee -for -service (FFS) coverage for the remainder of the plan year. Before the next dental plan open enrollment, we will send written notification to the member that DHMO plan (including FFS coverage) will no longer be offered. The member would need to choose another dental plan option for the following plan year. DPPO There are no restrictions within the Cigna DPPO plan about the use of noncontracted dentists. Cigna DPPO members always have the choice to receive care from a network dentist at in -network levels and discounts, or from an out -of -network dentist at out -of - network levels. 6. What is your standard process and advance notification timeframe to notify the City and its members of network changes? DHMO National network changes are reported monthly and compared to current client member locations. Depending on the impact, we will notify City of Miami up to 60 days before a network dentist leaves the network. We then transition members to another network dentist through written notification. For the latest information about additions or changes to the network, and for assistance in enrollment or dental office transfers, our automated Dental Office Locator option allows callers to enter their zip code and hear a list of nearby dental offices 24 hours a day, 7 days a week, 365 days a year. The Dental Office Locator can also fax this list. Members can enter a dentist's phone number to see if he/she participates in the Cigna Dental Care Copyright 2015 Page 11 of 65 Cigna City of Miami Attachment A RFP Number 495345 network. If there are multiple dentists with the same telephone number, the system will speak back th.e name of each dentist that can be reached at that office. The list only includes offices currently accepting patients. To use the Dental Office Locator, members can dial our toll -free number, 800.Cigna24. Dental office lists are also available 24 hours a day, 7 days a week, 365 days a year on our website, www.cigna.com. DPPO Since there is no need for members to select a primary care dentist, we do not notify members if a dentist leaves the network. Members can verify the status of a dentist by calling our toll -free number, 800.Cigna24, or visiting our website, www.cigna.com 7. Do you have a system for maintaining credentialing information? How often is each provider re-credentialed? Yes. We maintain the dental provider information in the Provider Workbench Extension system. We re -verify the credentials of network dentists at least every three years, based on the highest accepted industry standards. 8. Please list your 2014.annual network turnover rates (percentages) for both voluntary and involuntary turnover. DHMO Voluntary Involuntary Broward 1.7% 9.6% Dade N/A N/A Monroe 0.0% 0.0% Palm Beach 0.9% 10.6% Total DPPO Voluntary Involuntary Broward 0.1% 5.4% Dade N/A N/A Monroe 0.0% 10.0% Palm Beach 0.5% 4.7% Copyright 2015 Page 12 of 65 Cigna City of Miami Attachment A RFP Number 495345 9. Enter the percentage of providers that are reimbursed by the following methods in the table below: Please note that this is for general dentists and specialists. For DHMO general dentists, 96 percent are paid on a capitation basis and 4 percent paid on a fee schedule. For DHMO specialists, 100 percent are paid on a fee schedule. 'Y#'rmS e�3m +Y1eodin if? 0Reimur, ed3 b hk Salary 0% Discounted Fee for Service w/Withhold 0% Fee for Service w/Bonus 0% Fee Schedule 93% Capitation 0% Capitation w/Withhold 0% Capitation wBonus 0% Percentage Discount 0% Other, please specify Discount off charges 7% 10. Is your plan licensed by the State of Florida? Yes. 11. When physicians are eliminated from the network, what is the timeframe given to allow participants to elect a new dentist? What is done for those that require a transition of care? DHMO City of Miami's employees will generally receive notification of professional terminations 30 days before their general dentist leaves the network. We will refer them to other network general dentists in their area. If none are available, we will initiate a search and., in the meantime, members can visit the dentist of their choice. DPPO Members do not need to select general dentist in our DPPO plan. Cigna DPPO members can visit any network or licensed dentist. 12. Can employees nominate their dentist to become a part of your network? Yes. City of Miami and your members are welcome to call our customer service department to refer specific dental offices to be included in the Cigna dental networks. Once we receive the dentist's information, we contact them to discuss participation in. the Cigna dental networks. We make every effort to contract with any dentist referred to us. Copyright 2015 Page 13 of 65 Cigna. City of Miami Attachment A RFP Number 495345 13. Whenis an area considered a network? What is the minimum number of dentists and specialists required necessary to constitute a network? Cigna contracts directly with individual or group private dental practices for the DHMO and DPPO network. We do not have the minimum number of dentists and specialists required necessary to constitute a network. While specific access standards may vary based on the needs of each of our clients, we have established a target of providing 2 dental offices within 10 miles of a member's home zip code. This may vary based on state or local geographic conditions, such as dentist and member population in the area. We define network access in terms of miles; the targets are further defined based on the nature of the market where our members reside. For example: • Urban areas - 2 dental offices within 5 miles • Suburban areas - 2 dental offices within 15 miles • Rural areas - 2 dental offices within 25 miles Currently, 91.34 percent of DHMO and 95.4 percent of DPPO members had access to 2 dental offices within 10 miles. 14. If a provider leaves the network and doesn't notify the participant, who is responsible for the claim payment? DPPO and DHMO dentists are required to give 60 to. 90 days prior notice unless mandated differently by state regulations. They are required to complete all work in progress. Upon receipt of termination requests, we immediately remove them from the directory, even if we are still trying to negotiate with them to continue to participate. This helps to avoid additional patient disruption. Our online directory is updated at least every 15 days. Within our web directory and printed material, we refer the customer to their dentist and/or Cigna customer service to verify participation, prior to receiving services with their dentist. If the participant did not verify participation, the claim would process as out of network. 15. How will your company interact with the medical provider on claims that are both medical and dental in nature? The claim will be processed as outlined by the dental plan benefits and the medical provider would receive an EOB. 16. Are your network providers prohibited from balance billing the patient for any excess of contracted amount, except for deductibles and coinsurance? Yes. DHMO Network general dentist and specialist contracts contain clauses that prohibit dentists from charging members any additional fee, surcharge, or other cost for services, other than applicable patient charges as defined in the patient charge schedule (PCS) or contract payment schedule for covered procedures. A network dentist will be counseled if he or she Copyright 2015 Page 14 of 65 Cigna City of Miami Attachment A RFP Number 495345 balance bills a member. Failure to comply with corrective action may result in the network dentist's file being referred to our credentialing committee for review of future participation in the network. For services we do not cover, dentists may charge their usual fees. For certain orthodontic procedures, network dentists may charge incremental costs associated with optional/elective materials, including, but not limited to ceramic, clear, lingual brackets, or other cosmetic appliances. DPPO Balance -billing beyond the contract fee is not permitted for any service provided to the member. In the case of Cigna -owned networks, balance billing for covered procedures is strictly prohibited. We will counsel network dentists who do not comply, and continued balance billing may cause the network dentist's file to be referred to our credentialing committee for review of future participation in the network. Cigna's network dentists' contracts include language to ensure that members are only charged in accordance with the contracted fee schedule amounts. They are prohibited from balance billing members. Network fee schedules apply for covered services even after members have reached their annual maximums or exceeded frequency limitations, or if the applicable dental plan imposes missing tooth limitations or other similar limitations. For non -covered services, members are responsible for paying the dentist's usual fee or contracted fee for that procedure. Out -of -network dentists may balance bill the difference between the DPPO plan's payment and their usual charges. 17. Are network directories on-line? Yes. For dentist information, Cigna provides several e-commerce capabilities to allow members to obtain current information on network dentists in their area. Members can conduct network searches through our websites, www.cigna.com and myCigna. Members can locate a network dentist by name, city, state, and zip code. We also provide driving directions. 18. Are printed directories available? At what cost? How often are they updated? Yes. Members can obtain printed directories by calling our customer service department. There is no charge to the member to have one mailed to them. If the group wants printed directories to provide at enrollment, an exception would have to be made. We update printed state directories three times per year (January, May, and August) for the DHMO plan and two times per year (August and January) for the Cigna DPPO plan, unless a state requires different frequency requirements. The system updates our automated dental office locator nightly and our websites weekly. Copyright 2015 Page 15 of 65 Cigna City of Miami Attachment A RFP Number 495345 19. What is the network access fee? Is this included in the administrative services fee or included in claims, or in other? The network access fee is $0.70. It is included in the $3.33 administrative fee. PPO Fee Components 1/1/2016 Administration Fee $2.63 Network Access Fee $0.70 Commissions $0.00 Total ASO Fee $3.33 20. Please explain your In -Network capabilities, is it a single network, is it layered? We are offering a single network for DHMO and DPPO plans. Overall Plan Costs and Discount Arrangements 1. Is a rate/fee guarantee included? For what time period? Yes, a rate/fee guarantee included. It is as follows: 2016 $3.33 2017 $3.33 The 1/1/2018 DPPO ASO renewal fee increase will not exceed 3.5% above the 2017 fee The 1/1/2019 DPPO ASO renewal fee increase will not exceed 3.5% above the 2018 fee The 1/1/2020 DPPO ASO renewal fee increase will not exceed 3.5% above the 2019 fee 1 2. If you are proposing a self -insured plan, will you administer run -out? For how long? At what cost? Our ASO fees include payment of run -out claims. If City of Miami wants Cigna to provide run -out administration, we will keep the account open for a period of 12 months. Run-in and run -out claims are not applicable to the DHMO Cigna Dental Care plan. 4. Confirm you will provide 120 days' notice for rate/fee changes. Confirmed. Copyright 2015 Page 16 of 65 Cigna City of Miami Attachment A RFP Number 495345 5. Describe any programs that you have developed to address special areas of focus, in particular, detection of overcharges and overpayments. • How is criteria developed for these programs? • Are outside dentists/consultants retained to review questionable claims? To maximize our recovery results, Cigna uses a recovery vendor/partner for claim overpayment recovery. We fund the vendor recovery fee and we do not pass it on to our clients. Overpayment Recovery and Refund Process Our vendors use letters, faxes, and phone calls to recover monies owed to Cigna and our clients. When a vendor receives a refund, they remit the entire refund directly to Cigna's claim overpayment recovery unit. The claim overpayment recovery unit processes the entire refund back into the claim system at the member level. At the time that we process the refund, we will credit the client for the recovery of an overpayment. When we recover an overpayment (receive a refund check), the process is to credit the entire amount back into the claim system at the member level. If the client has ASO funding, this process will allow the money to be credited back to the bank account in the form of a refund/credit. 6. Please respond to the following with respect to claim overpayments: • If errors that resulted in overpayments to providers were detected in such samples, would our client be able to recover these overpayments directly from your organization? Yes. • If not, how would such overpayments be recovered? This is not applicable. • How would you keep our client apprised of your efforts to recover overpayments? Cigna uses a recovery vendor/partner for claim overpayment recovery. Our vendor use letters, faxes, and phone calls to recover monies owed to Cigna and our clients. When a vendor receives a refund, they remit the entire refund directly to Cigna's claimoverpayment recovery unit. The claim overpayment recovery unit processes the entire refund back into the claim system at the member level. At the time that we process the refund, we will credit the client for the recovery of an overpayment. When we recover an overpayment (receive a refund check), the process is to credit the entire amount back into the claim system at the member level. If the client has ASO funding, this process will allow the money to be credited back to the bank account in the form of a refund/credit. Copyright 2015 Page 17 of 65 Cigna City of Miami Attachment A RFP Number 495345 7. Please complete the following Claims Administration and Member Services Chart Claim Administration and Member Services Included Additional Cost Amt Toll free telephone access to claim and member services ✓ Cost Containment programs, specify ✓ Claim adjudication ✓ Production and distribution of standard drafts, EOBs Network Access V Multilingual language line ✓ Coordination of benefits ✓ Member satisfaction surveys ✓ Plan Sponsor Services Included Additional Cost Amt Drafting of plan documents Printing /mailing of plan documents to employee homes ✓ Counseling with respect to federal and state regulatory re . uirements V Initial system set up and administration of plan year revisions Consultation with respect to benefits and plan design ✓ Financial underwriting for both new business and ongoing revision ✓ Initial and ongoing eligibility and enrollment services V Production and issuance of standard enrollment forms and ID cards to employee homes Billing/premium collection Provision of expected costs for budgeting purposes V Provision of information for 5500 reporting V Claim fiduciary responsibility Communication/Administrative Materials Included Additional Cost Amt Production and distribution of standard provider directories Productions of standard claim forms ✓ Production of standard employee communication materials ✓ Shi ing of communication materials to employees Banking Included Additional Cost Amt Outgoing wire requests and bank draft handling charge ✓ Bank reconciliation charges ✓ Other banking charges, specify Additional Services Included irAdditional EPP Cost Amt COBRA administration and direct billing V HIPPA certification/compliance ✓ Internet services ✓ Copyright 2015 Page 18 of 65 Cigna City of Miami Attachment A 8. Please complete the appropriate section below: RFP Number 495345 DMO Third Party Administrator Fees Plan Year 2016 Total Fees Plan Year 2017 Total Fees Employee n/a n/a Family n/a n/a Fully Insured Premiums DMO Premiums (monthly) Employee $12.91 $12.91 Employee + Child $25.92 $25.92 Employee + Spouse $26.85 $26.85 Family $37.29 $37.29 The 1/1/2018 DHMO renewal increase will not exceed 7.0% above the 2017 rates The 1/1/2019 DHMO renewal increase will not exceed 7.0% above the 2018 rates The 1/1/2020 DHMO renewal increase will not exceed 7.0% above the 2019 rates Fully Insured Premiums Other (DPPO Non -executive and Executive Plan) Premiums (monthly) Employee $32.81 $32.81 Employee + Child $67.57 $67.57 Employee + Spouse $66.99 $66.99 Family $119.49 $119.49 The 1/1/2018 DPPO renewal increase will not exceed 7.5% above the 2017 rates The 1/1/2019 DPPO renewal increase will not exceed 7.5% above the 2018 rates The 1/1/2020 DPPO renewal increase will not exceed 7.5% above the 2019 rates 9. If you have proposed a self -insured plan, please indicate projected claims: Plan Option Projected Claims Based on Plan Desigr Plan Year 2016 Plan Year 2017 DPPO $625,716 $655,750 DIIMO Not applicable Not Applicable Other 10. Other than those listed on the administrative services chart, are there any other fees or charges that the City would incur if the City accepted your proposal? If so, please indicate here. No additional charges, unless the City has specific requests outside what has been requested in the RFP. 11. Please complete the following in -network Negotiated Fees chart for the designated counties as it applies to the DMO: ADA Code Procedure Description Negotiated Fee (What Patient Pays) by County Broward Dade Palm Beacl Monroe 0120 Adult Exam $0 $0 $0 $0 1110 Adult cleaning $0 $0 $0 $0 2150 Amalgam Restoration $0 $0 $0 $0 7110 Simple Extraction (1) (1) (1) (1) Copyright 2015 Page 19 of 65 Cigna City of Miami Attachment A RFP Number 495345 3310 Anterior Root Canal $90 $90 $90 $90 2750 Porcelain/Gold Crown $230 $230 $230 $230 5110 Complete Upper Denture $185 $185 $185 $185 6240 Porcelain/Gold Bridge Abutment $210 $210 $210 $210 6750 Porcelain/Gold Bridge Pontic $210 $210 $210 $210 (1) This procedure is not covered 12. Please attach any corresponding fee schedules that will apply. We have provided the patient charge schedule in the List of Attachments section of the proposal binder. 13. Is more than one fee schedule utilized on a national basis? If so, please explain. We will continue to offer P6XVO the patient charge schedule (PCS) for City of Miami DHMO plan. We base the Cigna Dental Care managed dental plan on a DHMO model, which may also be called managed dental care, a prepaid dental plan, limited health service plan organization, or a limited health plan, depending upon state regulations. This model provides prepaid dental benefits through a network of dentists. This contracted panel of dentists provides care and services to plan members enrolled at their offices. General dentists generally receive fixed monthly fees and supplemental payments for certain procedures. Members pay the fixed patient charges listed on the PCS for covered procedures, subject to plan limitations and exclusions. Although Cigna does require written precertification for some specialty referrals, one of the main advantages of our managed dental care program is that members will have no claim forms to file. Most of our DHMO plans include fixed patient charges that we publish on the PCS so members know in advance how much they will pay. Our goal is to provide you with a program that fits your budget and provides full coverage for your employees' dental needs. Our PCS options allow you to choose from a complete range of coverage levels and premiums. Each PCS covers a full array of dental procedures (most include orthodontics for both children and adults), without deductibles or annual maximums to potentially limit care. In keeping with our philosophy that preventive care is the key to good dental health; the majority of our plans provide preventive services with no patient charge. 14. Are you willing to offer the executive plans as stand-alone plans? Our PPO offering assumes that both DPPO plans (executive and non -executive) will be selected by the group. If the City would like to offer the executive plan as a standalone plan, Underwriting will need to re -rate the executive plan as a single offering. f Copyright 2015 Page 20 of 65 Cigna City of Miami Attachment A RFP Number 495345 Reporting Capabilities 1. Attach sample copies of your proposed reporting packages. Include proposed reports for financial, claims, utilization, billing, accounting, banking, etc. We have provided sample reporting in the List of Attachments section of the proposal binder. 2. What reporting is available on-line? CignaAccess.com provides tools and information to support clients in the following key areas: • Claim Inquiry — City of Miami can view DPPO paid claim information at the member level. You can also view deductible and lifetime maximum accumulation data at the member level. (City of Miami must be a recipient of PHI per HIPAA) Viewing of DHMO claim information is not available on the employer portal. • Automated Eligibility Management and Reporting Tool — If City of Miami will submit eligibility via our automated eligibility process you can access and download fallout reports. You can review key file processing metrics that provide a historical view of file processing results, including file processing timeliness, member defect rates, and error resolution cycle times. • Eligibility Reports and Statistics — City of Miami can create and download eligibility reports that include member listings and census reports. You can tailor the reports to meet your needs. Data is available in real-time as it appears in our eligibility system at the time of the request. If City of Miami will submit electronic eligibility files, you can also use the automated eligibility management and reporting tool to access and download user-friendly fallout reports and key file processing metrics. • Premium/Fee Invoices and Online Bill Payment - Electronic versions (PDF) of the premium/fee invoices are available: - system generated notification when the invoice is ready - clients retrieve, view, save, or print the invoices at their convenience - ability to pay bills online • Financial Reports — City of Miami can review standard DPPO financial reports, which include monthly experience reports (excluding premium) and lag reports. We post reports to the website by the 1 Oth calendar day of the month. • Banking Reports and Statistics - City of Miami can view current DPPO banking reports based on a preselected request (daily, weekly, or monthly depending on the report type). Reports include worksheets, issued check register, cleared check register, and claim refunds. Monthly reports are available by the 10th business day of the following month; weekly reports are available the first business day of the following week; daily issued reports are available the next business day. Daily cleared reports are available two business days later. Banking reports do not apply to DHMO because it is fully insured. Copyright 2015 Page 21 of 65 Cigna City of Miami Attachment A RFP Number 495345 To tour CignaAccess.com, go to https://CignaAccess.cigna.com and click on the demo located on the upper right hand side or go to: http://www.maier. com/cigna/cigna-access/ A user ID and password are not needed. 3. Is on-line reporting accessible to individuals designated by the City (and approved via HIPAA)? Yes. Communications and Enrollment Capabilities 1. Describe your internet capabilities in regards to the following areas: • Customization to City of Miami plan design information • Enrollment • Forms • Change of status • Employee personal access information (claims, EOBs, dependent information, etc.) • Banking • Employer/consultant reporting • Comparative dental cost information • Other Members' Internet Capabilities The following member information and self-service functions are available through myCigna: • personalized coverage details lookup • DPPO claim status inquiry capabilities • DPPO electronic EOB and explanation of payment (EOP) display • DPPO deductible, out-of-pocket, and lifetime maximum accumulation presentment • network dentist search with maps and directions • DPPO claim forms and submission information • dental prevention and wellness information, including WebMD® articles • glossary of dental terms • DEMO ID card requests • print temporary dental ID cards • dental claim office phone numbers and addresses, and customer service contact information • FAQ • dental treatment cost estimator • information about our Healthy Rewards® discount program Copyright 2015 Page 22 of 65 Cigna City of Miami Attachment A RFP Number 495345 The following provides a brief overview of tools available to members: Treatment Cost Estimator The dental treatment cost estimator is a user-friendly, web -based tool available through the health care professional directory on myCigna that allows members enrolled in any Cigna dental plan to easily estimate and plan for their dental care costs —both on a procedure code level and a treatment level for over 400 treatments and procedures. The dental treatment cost estimator uses a combination of the health care professionals' actual contracted fees and Fair and Independent Research health industry data for market -level estimates. This online tool helps members understand their estimated out-of-pocket costs, view what their savings would be in- and out -of -network with Cigna health care professionals, and display what the treatment or procedure would cost without insurance. The dental treatment cost estimator bases estimates on the member's actual benefit plan design, including coinsurance/copays, maximums, and deductibles. Cigna Dental Cavity Risk Assessment Tool Members can also access the cavity risk assessment tool. This tool, which is available in both English and Spanish, measures the risk of tooth decay for members and their family members, and helps dentists identify their risk of getting a cavity. The assessment consists of 12 questions for adults and 16 questions for children under the age of 12. Periodontal Risk Assessment Tool Our periodontal risk assessment tool allows members to assess their risk for periodontal (gum) disease in minutes by answering 20 simple questions. Available in both English and Spanish, this online quiz provides the user with a score that helps forecast their risk for having gum disease. Users can print the results to share with their dentist at the next visit. Cigna Dental Oral Cancer Awareness Quiz This 10-question quiz is designed to help members test their knowledge about the basics of oral cancer: where it can occur, warning signs, common risk factors, and what members can do to help reduce their own risk, Please note that this quiz does not score members responses or evaluate risk as the periodontal risk assessment and cavity risk assessment do; instead, this quiz is a fast, easy, and fun educational tool. Members can take what they learn and ask questions at their next dental check-up. To take a tour of myCigna, go to www.myCigna.com. The user ID is "userdemo123" and the password is "reviewl" (case sensitive). Please look for the various dental presentations throughout the site, and look at the myCigna tour offered on the footer of each site page. City of Miami' Internet Capabilities CignaAccess.com provides tools and information to support clients in the following key areas: • Claim Inquiry — City of Miami can view DPPO paid claim information at the member level. You can also view deductible and lifetime maximum accumulation data at the member level. (City of Miami must be a recipient of PHI per HIPAA) Viewing of DHMO claim information is not available on the employer portal. Copyright 2015 Page 23 of 65 Cigna City of Miami Attachment A RFP Number 495345 • Eligibility and Coverage Inquiry - City of Miami can view DPPO eligibility and coverage information at the member level. You can also print temporary ID cards. (This .feature does not require City of Miami to be a recipient of PHI.) Viewing of DHMO eligibility and coverage information is not available on the employer portal. • Automated Eligibility Management and Reporting Tool — If City of Miami will submit eligibility via our automated eligibility process you can access and download fallout reports. You can review key file processing metrics that provide a historical view of file processing results, including file processing timeliness, member defect rates, and error resolution cycle times. • Employee Enrollment and Maintenance City of Miami can enroll and maintain coverage elections and demographics for your employees and dependents. Transactions post immediately to the internal eligibility system. City of Miami can: add/delete a dependent end employee coverage reinstate employee/dependent process life status changes • Eligibility Reports and Statistics - City of Miami can create and download eligibility reports that include member listings and census reports. Clients can tailor the reports to meet your needs. Data is available in real-time as it appears in our eligibility system at the time of the request. If you will submit electronic eligibility files, you can also use the automated eligibility management and reporting tool to access and download user-friendly fallout reports and key file processing metrics. • Premium/Fee Invoices and Online Bill Payment - Electronic versions (PDF) of the premium/fee invoices are available: - system generated notification when the invoice is ready - clients retrieve, view, save, or print the invoices at their convenience - ability to pay bills online • Financial Reports - City of Miami can review standard DPPO financial reports, which include monthly experience reports (excluding premium) and lag reports. We post reports to the website by the l0th calendar day of the month. • Banking Reports and Statistics - City of Miami can view current DPPO banking reports based on a preselected request (daily, weekly, or monthly depending on the report type). Reports include worksheets, issued check register, cleared check register, and claim refunds. Monthly reports are available by the l0th business day of the following month; weekly reports are available the first business day of the following week; daily issued reports are available the next business day. Daily cleared reports are available two business days later. Banking reports do not apply to DHMO because it is fully insured. To tour CignaAccess.com, go to https://CignaAccess.cigna.com and click on the demo located on the upper right hand side or go to: http://www.maier. com/cignalcigna-access/ A user ID and password are not needed. Copyright 2015 Page 24 of 65 Cigna City of Miami Attachment A RFP Number 495345 Network Dentists' Internet Capabilities Our dental health professional website, CignaforHCP.com, allows dentists to: • verify patients' network participation and eligibility • review patients' coverage information, including coverage maximums and deductibles • view claim status • enroll in electronic file transfer and receive payment faster • access and download printable reports (DHMO) payment reports office management reports financial reports • print forms —American Dental Association (ADA) claim, referral, and more • download policy manuals, including the general dentist office reference guide • access patient charge schedules (PCS) (DHMO) • take continuing education courses at no charge (contracted health care professionals only) • access information about the Cigna Network Rewards Program® By streamlining access to information for dentists, we are easing the administrative burden for dentists and contributing to a better experience at the dental office for our members. 2. What communication materials/assistance are included in your quoted fees/premiums (include materials, staffing and on-line capabilities)? We are committed to educating members about their dental plans and how to maintain good dental health. Our standard pre -enrollment kit educates employees on dental benefits. This kit generally includes a product brochure, DHMO fee overview, DPPO comparison of patient charges to national average charges summary of benefits, and an enrollment form. Printed state directories are also available upon request. These materials allow benefits managers to conduct informative and educational enrollment meetings. Health fair assistance and materials are also available. For the DHMO plan, after enrollment, members will receive a consolidated booklet that communicates additional plan details, including their plan booklet, patient charge schedule (PCS), and other pertinent information. Members also receive an ID card under separate cover. For the Cigna DPPO plan, certificate booklets are sent to City of Miami to distribute to your employees after they have enrolled in the plan. ID cards for the Cigna DPPO plan can either be sent to the City of Miami's main location or printed through our websites, myCigna or CignaAccess.com. In order for members to make informed decisions about their dental care, they need access to technology, information, and services that provide education and choice, Our website at www.cigna.com provides additional information for members, including: Copyright 2015 Page 25 of 65 Cigna City of Miami Attachment A RFP Number 495345 • network dentist search with maps and directions • articles about oral health for children and adults • glossary of dental terms • treatment cost estimator that enables members to estimate and plan their dental care needs Once enrolled in a Cigna plan, members will have access to a wealth of information through our member website, myCigna, including: • eligibility verification • personalized coverage information • DPPO claim status inquiry and claim forms • DPPO deductible and lifetime maximum accumulation data, dental prevention and wellness information, including access to more than 200 medical and dental articles from WebMD • email form to request DHMO specialty referral status • DHMO dental office transfers • DHMO ID card requests and print temporary DHMO ID cards • dental prevention and wellness information, including access to more than 200 medicaland dental articles from WebMd® • print DPPO Ill cards Members will also have access to our dental treatment cost estimator through the online health care professional directory on myCigna. Our dental treatment cost estimator is a user-friendly, web -based tool that allows members enrolled in any Cigna dental plan to easily estimate and plan for their dental care costs —both on a procedure code level and a treatment level for over 400 procedures and treatments. This online tool helps members understand their estimated out-of-pocket costs, view what their savings would be in- and out -of -network with Cigna health care professionals, and display what the treatment or procedure would cost without insurance. The dental treatment cost estimator bases estimates on the member's actual benefit plan design, including coinsurance/copays, maximums, and deductibles. We staff our customer service center with trained professionals who help solve problems, explain dentists' treatment rationale or charges, and any other questions about the plan's operation. Employees can call 800.Cigna24 with questions about coverage, DHMO dental office transfers, procedures, or any other concerns. In addition, we will conduct open enrollment meetings which are a good opportunity for current and prospective members to learn more about the plancoverage offerings and services provided by the client. In many circumstances, an experienced, knowledgeable Cigna representative is available to attend onsite open enrollment meetings to offer assistance with questions. We have provided communication materials and sample ID cards in the List of Attachments section of the proposal binder. Copyright 2015 Page 26 of 65 Cigna City of Miami Attachment A RFP Number 495345 3. Can the City's logo be included on these materials? Is there an additional charge? We would be happy to discuss customized materials with you. This may include adding your logo or including specific messaging that is important to your employees, or the plans you are offering. Depending on the extent of the customization, or if there are print or mail costs, City of Miami may incur an additional cost. A communications fund has not been built into the rates. 4. Describe your enrollment options (paper, on-line, recorded media, etc.). Three options are available for establishing and maintaining eligibility files: • Internet -Based Enrollment Maintenance Tool (EMT) - Clients submit and view real-time eligibility or reporting information via the EMT on our client website, CignaAccess.com. This method can be used in conjunction with either automated eligibility or manual eligibility. • Automated Eligibility - Clients submit eligibility information by electronic transmission. We publish the reporting results for the automated file processing to our client website for review. • Manual Eligibility - Clients use paper enrollment forms or the standard eligibility spreadsheet for open enrollment and ongoing maintenance updates. 5. Describe the communications that are available, and in what format for: • Enrollment • Network information • Claims information • Team Member attendance for Monthly "Go Before You Know" meetings. • Open Enrollment We are committed to educating members about their dental plans and how to maintain good dental health. Our standard pre -enrollment kit educates employees on dental benefits. This kit generally includes a product brochure, DHMO fee overview, DPPO comparison of patient charges to national average charges summary of benefits, and an enrollment form. Printed state directories are also available upon request. These materials allow benefits managers to conduct informative and educational enrollment meetings. Health fair assistance and materials are also available. For the DHMO plan, after enrollment, members will receive a consolidated booklet that communicates additional plan details, including their plan booklet, patient charge schedule (PCS), and other pertinent information. Members also receive an ID card under separate cover, For the Cigna DPPO plan, certificate booklets are sent to City of Miami to distribute to your employees after they have enrolled in the plan. ID cards for the Cigna DPPO plan can either be sent to the City of Miami's main location or printed through our websites, myCigna. or CignaAccess.com. Copyright 2015 Page 27 of 65 Cigna City of Miami Attachment A RFP Number 495345 In order for members to make informed decisions about their dental care, they need access( to technology, information, and services that provide education and choice. Our website at www.cigna.com provides additional information for members, including: • network dentist search with maps and directions • articles about oral health for children and adults • glossary of dental terms • treatment cost estimator that enables members to estimate and plan their dental care needs Once enrolled in a Cigna plan, members will have access to a wealth of information through our member website, myCigna, including: • eligibility verification • personalized coverage information • DPPO claim status inquiry and claim forms • DPPO deductible and lifetime maximum accumulation data, dental prevention and wellness information, including access to more than 200 medical and dental articles from WebMD • email form to request DHMO specialty referral status • DHMO dental office transfers • DHMO ID card requests and print temporary DHMO ID cards • dental prevention and wellness information, including access to more than 200 medical and dental articles from WebMd® • print DPPO ID cards Members will also have access to our dental treatment cost estimator through the online health care professional directory on myCigna. Our dental treatment cost estimator is a user-friendly, web -based tool that allows members enrolled in any Cigna dental plan to easily estimate and plan for their dental care costs —both on a procedure code level and a treatment level for over 400 procedures and treatments. This online tool helps members understand their estimated out-of-pocket costs, view what their savings would be in- and out -of -network with Cigna health care professionals, and display what the treatment or procedure would cost without insurance. The dental treatment cost estimator bases estimates on the member's actual benefit plan design, including coinsurance/copays, maximums, and deductibles. We staff our customer service center with trained professionals who help solve problems, explain dentists' treatment rationale or charges, and any other questions about the plan's operation. Employees can call 800.Cigna24 with questions about coverage, DHMO dental office transfers, procedures, or any other concerns. In addition, we will conduct open enrollment meetings which are a good opportunity for current and prospective members to learn more about the plan coverage offerings and services provided by the client. In many circumstances, an experienced, knowledgeable Cigna representative is available to attend onsite open enrollment meetings to offer assistance with questions. Copyright 2015 Page 28 of 65 Cigna City of Miami Attachment A RFP Number 495345 6. Please attach samples (including ID card) We have provided sample communication materials and ID cards in the List of Attachments section of the proposal binder Claims Administration Capabilities 1. How many months of historical claim data are stored in your claims system? Claim images are retained and available in the claim imaging system for 10 years. After that time, the images are moved to archival storage for an additional three years, and then destroyed. 2. How far back in time can claims be processed on your system? Existing claim history can only be altered through an adjustment process. We retain original adjusted histories online. Neither claim processors nor any other operators can delete history. Previously processed claims can be accessed online using Cigna IDs, located on ID cards, to pull claim images and other information, such as eligibility. Using a unique Cigna ID prevents using SSNs to retrieve information, or having the SSN on the ID card. 3. Is your system an on-line, direct access system or a plan/claims information storage and retrieval system? Provide a flowchart or brief description of its operation. DHMO Cigna's Webster claim processing system was developed in-house in the early to mid- 1990s, to handle the specific needs of a DHMO plan. In December 2002, we began using Sun hardware and the Solaris operating system. The application provides online access to every service center supporting the DHMO plan coverage. Hardware upgrades are planned as appropriate based on business processing requirements and changes in technology. We also update applications regularly to meet new plan coverage needs and industry changes. Our system consists of every module necessary to administer our plan, including account data, Dental Healthcare Professional files, specialty referrals, encounters, and eligibility. Specialty referrals are processed according to processing guidelines, and referral and encounter processing verifies eligibility. Dental Healthcare Professional payment is accomplished directly by our system. Although we do accept paper eligibility, over 80 percent arrives electronically. This provides for an efficient and timely process, and eliminates errors due to manual data entry. Our claim system automatically: • loads eligibility from CED electronic feed • verifies pertinent employee and dependent information • checks treatment history for tooth number, procedure code, and date of service • identifies any errors occurring during input to the operator for immediate correction • compares encounters against contractual limitations to avoid over utilization Copyright 2015 Page 29 of 65 Cigna City of Miami Attachment A RFP Number 495345 • verifies a match between treatment dates and the employees' and dependents' dates of coverage We offer a single eligibility feed solution and a convenient consolidated bill for clients who have more than one Cigna coverage. DPPO Cigna's DentaCom claim system was developed in-house in the early 1980s based upon our vast experience in the dental industry and the needs of our clients and members. It uses an IBM 9021.900 mainframe computer and is run under CICS (Version 4.1) with both macro and command level using VSAM file access. In 1996, when the Cigna DPPO plan was introduced, enhancements were made to support the processing of a DPPO plan. Major upgrades, since then, include the integration of data entry and auto -adjudication functions into an integrated health care systems environment; a central repository of eligibility and coverage/structure-related data; Cobol II upgrades; automated orthodontia payments; and a new EOB system. Our system is updated annually with new CDT codes as well as HIPAA compliance enhancements. Dental logic prevents payment of duplicate submissions, assists with coding accuracy, and automates plan design features. The logic stores claim -adjusting parameters (guidelines based on dentistry standards), coverage exclusions and limitations, procedure frequencies, and dental plan information. This enables us to detect unbundled procedures and appropriate codes for payment and flags procedures needing further review. Dental history maintains the experience of each member to identify duplicate claims, deductibles, and maximum accumulators, and ensures that the status of the definition is accurate and current. Repetitive orthodontic payments are calculated quarterly and automatically sent without additional adjuster intervention until the maximum benefits are paid. Combined Dental Healthcare Professional checks/itemized EOBs is calculated for payments being made to specific Dental Healthcare Professionals on a given day. Flexible plan designs are administered based on usual and customary charges, percentage off billed charges, or scheduled coverage. The alternate coverage provision allows for consideration of what is commonly performed for that condition whether it is less costly or more costly. Accumulators by plan year, calendar year, and lifetime maximums ensure that the correct amount is paid. Deductibles and out-of-pocket maximums are also tracked. Our claim system automatically: • loads eligibility files from CED electronic feed • tracks unprocessed mail/provides aged -mail reports • verifies pertinent information for each transaction • verifies treatment and coverage dates • protects against payment for prior procedures • checks history for tooth number, procedure code, and date of service • identifies any errors occurring during input • compares claims against contractual limitations to avoid over utilization Copyright 2015 Page 30 of 65 Cigna City of Miami Attachment A RFP Number 495345 • calculates payments according to R&C allowances and/or scheduled benefit amounts • identifies claims where potential COB opportunities exist for follow-up investigation by the processor • generates correspondence • issues checks and EOBs • produces biweekly bulk mailing of dentist checks We have provided claim process flow chart in the List of Attachments section of the proposal binder. 4. How long has your claims payment system been operational? Cigna's Webster claim processing system was developed in-house in the early to mid- 1990s, to handle the specific needs of a DHMO plan. Cigna's DentaCom claim system was developed in-house in the early 1980s based upon our vast experience in the dental industry and the needs of our clients and members. 5. Can eligibility and claims transactions be accessed by the same person? Yes. Customer service advocates (CSAs) work closely with a broad network of business partners, including health care professional services, claims, marketing, network development, health services, client coaching, and sales to assist our members with any inquiries. Our CSAs are advocate for the member. They can respond to member eligibility, claim, coverage, and health care professional -related inquiries 6. Describe enhancements made in the last 12 months and those planned for the next 1.2 months. DHMO We continually update our systems to accommodate changes in the dental insurance market, as well as regulatory requirements. DPPO We have kept the system up-to-date and enhanced it to accommodate changes in the dental insurance market, as well as regulatory requirements. 7. Describe the mechanics/process of screening for duplicate claims. DHMO Our system can apply the appropriate patient charge schedule (PCS), defined network dental health care professional, and identify potential unbundling procedures. Relational database technology enforces constraints at the data level to prevent incorrect entry of claim, dental health care professionals, and member information. Data entered is edited at a claim level against individual and family history tables and against specific plan data to identify suspected fraud and duplicate claims. Copyright 2015 Page 31 of 65 Cigna City of Miami Attachment A RFP Number 495345 Other file edits include duplicate entries based on service date, procedure code, tooth number, and/or quadrant location. DPPO Our claim payment system identifies network dental health care professionals and automatically applies discounts per contractual arrangements. In addition, our system can apply maximum reimbursable charge (MRC) limits, frequency limits, calculate COB, and re -bundle procedures. Data entered is edited at a claim level against individual and family history files and against specific plan data in the policyholder master: • suspected duplicate claims are identified • calendar year maximums have been reached • charges exceeding scheduled amounts are identified 8. Can your system accept and track full eligibility data? Yes. 9. Can your system track each dependent by the dependent's name and social security number? Yes. 10. What is your process for establishing student eligibility? Incapacitated dependent status? Specific non -required data elements for dependents included in the eligibility file will vary depending on your needs. City of Miami will work with the eligibility analyst to understand the data elements needed to support the plans chosen. There are specific elements that are required to be on an eligibility file (noted with * below). Sample data includes: • employee SSN* • employee last name* • employee first name or. initial* • start date* • cancel date • account* • branch* • benopt* • address* • dependent first name* • dependent last name* Copyright 2015 Page 32 of 65 Cigna City of Miami Attachment A RFP Number 495345 • dependent SSN (required if Medical plan coverage and has Medicare or is age 45 and older) • dependent start date* • dependent cancel date • employee gender* • dependent gender* • employee date of birth (DOB)* • dependent DOB* • dependent relationship code* • employee relationship code* • employee dental office selection (DHMO only) • dependent dental office selection (DHMO only) • dental late entrant indicator 11. Under what conditions and by which individuals can your claims system be manually overridden? Upon review and approval by a dental consultant, claim processors can override claim system flags, such as suspected duplicates and charges exceeding U&C or maximum reimbursable charge. 12. How are manual overrides; if any, to your claims system are reviewed by claims managers? Claim center managers receive detailed reports on override transactions to help detect health care professional abuse, or incorrect processing procedures by a claim processor. 13. What are the minimum requirements for claims history transferred to your system(s) on a new account basis? DHMO As the incumbent, this is inapplicable to DHMO since Cigna is current DHMO carrier. DPPO For plans with lifetime maximums, calendar/policy year deductibles, calendar/policy year maximums or out-of-pocket dollars, Cigna is able to accommodate prior financial accumulators, but we request at least 10 days for programming. We will apply an optional service charge. Dollars we can load, but are not limited to: • calendar/policy year maximums • lifetime maximums • carry-over deductibles Copyright 2015 Page 33 of 65 Cigna City of Miami Attachment A RFP Number 495345 • the amount satisfied toward the current year deductible • out-of-pocket dollars The following list identifies the elements we would need for each employee and dependent to facilitate the transfer of dollars: • employee SSN • members name • relationship code • date of birth (DOB) • lifetime maximum paid -to -date • deductible YTD • calendar year maximum paid -to -date • orthodontic maximum paid -to -date • out-of-pocket dollars 14. What system platforms are utilized for plan administration? Please describe. DHMO Cigna's Webster claim processing system was developed in-house in the early to mid- 1990s, to handle the specific needs of a DHMO plan. In December 2002, we began using Sun hardware and the Solaris operating system. The application provides online access to every service center supporting the DHMO plan coverage. Hardware upgrades are planned as appropriate based on business processing requirements and changes in technology. We also update applications regularly to meet new plan coverage needs and industry changes. Our system consists of every module necessary to administer our plan, including account data, Dental Healthcare Professional files, specialty referrals, encounters, and eligibility. Specialty referrals are processed according to processing guidelines, and referral and encounter processing verifies eligibility. Dental Healthcare Professional payment is accomplished directly by our system. Although we do accept paper eligibility, over 80 percent arrives electronically. This provides for an efficient and timely process, and eliminates errors due to manual data entry. Our claim system automatically: • loads eligibility from CED electronic feed • verifies pertinent employee and dependent information • checks treatment history for tooth number, procedure code, and date of service • identifies any errors occurring during input to the operator for immediate correction • compares encounters against contractual limitations to avoid over utilization • verifies a match between treatment dates and the employees' and dependents' dates of coverage We offer a single eligibility feed solution and a convenient consolidated bill for clients who have more than one Cigna coverage. Copyright 2015 Page 34 of 65 Cigna City of Miami Attachment A RFP Number 495345 DPPO Cigna's DentaCom claim system was developed in-house in the early 1980s based upon our vast experience in the dental industry and the needs of our clients and members. It uses an IBM 9021.900 mainframe computer and is run under CICS (Version 4.1) with both macro and command level using VSAM file access. In 1996, when the Cigna DPPO plan was introduced, enhancements were made to support the processing of a DPPO plan. Major upgrades, since then, include the integration of data entry and auto -adjudication functions into an integrated health care systems environment; a central repository of eligibility and coverage/structure-related data; Cobol II upgrades; automated orthodontia payments; and a new EOB system. Our system is updated annually with new CDT codes as well as HIPAA compliance enhancements. Dental logic prevents payment of duplicate submissions, assists with coding accuracy, and automates plan design features. The logic stores claim -adjusting parameters (guidelines based on dentistry standards), coverage exclusions and limitations, procedure frequencies, and dental plan information. This enables us to detect unbundled procedures and appropriate codes for payment and flags procedures needing further review. Dental history maintains the experience of each member to identify duplicate claims, deductibles, and maximum accumulators, and ensures that the status of the definition is accurate and current. Repetitive orthodontic payments are calculated quarterly and automatically sent without additional adjuster intervention until the maximum benefits are paid. Combined. Dental Healthcare Professional checks/itemized EOBs is calculated for payments being made to specific Dental Healthcare Professionals on a given day. Flexible plan designs are administered based on usual and customary charges, percentage off billed charges, or scheduled coverage. The alternate coverage provision allows for consideration of what is commonly perfoitued for that condition whether it is less costly or more costly. Accumulators by plan year, calendar year, and lifetime maximums ensure that the correct amount is paid. Deductibles and out-of-pocket maximums are also tracked. Our claim system automatically: • loads eligibility files from CED electronic feed • tracks unprocessed mail/provides aged -mail reports • verifies pertinent information for each transaction • verifies treatment and coverage dates • protects against payment for prior procedures • checks history for tooth number, procedure code, and date of service • identifies any errors occurring during input • compares claims against contractual limitations to avoid over utilization • calculates payments according to R&C allowances and/or scheduled benefit amounts • identifies claims where potential COB opportunities exist for follow-up investigation by the processor • generates correspondence Copyright 2015 Page 35 of 65 Cigna City of Miami Attachment A RFP Number 495345 • issues checks and EOBs • produces biweekly bulk mailing of dentist checks 15. Will a direct claims payment system be utilized? Yes. 16. How long has the claims payment system been in place? Cigna's Webster claim processing system was developed in-house in the early to mid- 1990s, to handle the specific needs of a DHMO plan. Cigna's DentaCom claim system was developed in-house in the early 1980s based upon our vast experience in the dental industry and the needs of our clients and members. 17. What percentage of claims are automatically adjudicated? DHMO Approximately 80 percent of specialty referrals and network general dentist encounter forms are auto -adjudicated. DPPO Our system automatically processes approximately 80 percent of claims because of the advanced dental logic in our claim system. While other companies may use only dental consultants to process alternate coverage or for less complex claims, our dental claim :. system does it automatically, which saves our clients' money. 18. What are the claims administration standards? We measure claim and call accuracy based upon the following categories/metrics. e 1., andard Processing Accuracy 95% Financial. Accuracy 99,3% Payment Accuracy 97% 10 Day Time to Process (TTP) 90% 15 Day TTP 98.0% 19. How are non -network and out -of -area provider claims identified and paid? Cigna's standard maximum reimbursable charge (MRC) allowance for out -of -network DPPO and indemnity claims payments, except for orthodontic procedures, is the 90th percentile of the amount billed for a given area; however, our system allows for flexibility in adjusting MRC levels ranging from the 50th to the 95th percentile, depending on City of Miami specific needs and cost savings goals. We use data from the Prevailing Healthcare Charges System (PHCS) published by Fair and Independent Research Health to determine the MRC. We consider this data Copyright 2015 Page 36 of 65 Cigna City of Miami Attachment A RFP Number 495345 statistically legitimate if there are nine or more occurrences of a procedure code in a geographical area. If there are fewer than nine, we pay as billed. While most other carriers update only once a year, we keep pace with Fair and Independent Research Health recommendations and update semiannually (April and October). This reduces member's out-of-pocket expenses by increasing the dentist's payment. When determining the MRC, we consider the nature and severity of the condition being treated, as well as to any complications or unusual circumstances that require additional time, skill, or experience. To establish MRC information, we base data on procedure code, zip code, date of service, and charge amount. For out -of -network dentists, Cigna pays the lesser of the dentist's UCR or the account - specific percentile limit (90th percentile) subject to account -specific contractual limitations (coinsurance, deductible, maximum, etc.). The dentist submits the claim form to Cigna for processing and. Cigna sends the payment to the dentist. 20. What are the Eastern Standard Time hours of operation for the claims unit? Claim processing office hours are from 8:00 a.m.. to 6:00 p.m., based upon the local time of the particular service center. 21. How are claims staffing levels established? We normally use a ratio of 1 specialty referral/claim processor for every 115,000 members. Currently we have 130 claim processors in our customer service centers. 22. Is there a dedicated claims unit for the City? We do not have a dedicated dental claims team but we will have a designated claims and service specialist, Ed Boynosky for escalated issues. 23. How many bilingual customer service staff members do you have, and what languages do they speak? How would you handle Creole speaking employees? Customer service advocates (CSAs) can assist non -English-speaking members. Bilingual CSAs service Spanish language calls. Members reach Spanish-speaking CSAs via a Spanish prompt selection on the toll -free customer service number. If a bilingual representative is not available, or a member needs help in another language, a CSA will set up a conference call with an interpreter through LanguageLine Solutions, a nationally recognized and certified foreign language interpretation service. Members access this service through our toll -free customer service number, 800.Cigna24. LanguageLine Solutions offers translation services for more than 200 languages including Creole language. Copyright 2015 Page 37 of 65 Cigna City of Miami Attachment A RFP Number 495345 24. Provide a copy of all certificates, procedures and protocol for HIPAA compliance as required to date and for future scheduled compliance. Cigna entities functioning as a covered entity and/or a business associate comply with applicable requirements of HIPAA and Health Information Technology for Economic and Clinical Health Act (HITECH). This includes: • the appointment of a chief privacy officer who is responsible for overseeing compliance with applicable privacy laws, including HIPAA and HITECH • a privacy council consisting of senior executives to review the existing program and controls, and design and implement a response plan in the event of a breach • the execution of business associate agreements (BAAs) as required by HIPAA and HITECH • the adoption and implementation of privacy policies and procedures designed to ensure compliance with applicable privacy and data protection laws, including HIPAA and HITECH • mandatory workforce training on HIPAA, HITECH, and other applicable privacy and data protection laws and regulations • issuance of required notices of privacy practices • compliance with individuals' requests to exercise their privacy rights, including accessing and amending their PHI and restricting the use or disclosure of their PHI • a privacy complaint, incident, and breach management process As a prerequisite to engagement as a Cigna contractor, both Cigna privacy and Cigna Information Protection review the privacy and information protection standards of vendors receiving, accessing, or using individually identifiable personal information to comply with applicable law and Cigna's privacy and data security standards. Vendors are subject to periodic audits, including on -site, to ensure continued compliance and assess the administrative, physical, and technical safeguards in place to protect the privacy andsecurity of Cigna infoiiiiation. We have provided a copy of our Notice of Privacy Practices in the List of Attachments section of the proposal binder. 25. Do you maintain Performance Standards? If so, please describe. Yes. We measure claim and call accuracy based upon the following categories/metrics. MetreSfandard Processing Accuracy 95% Financial Accuracy 99.3% Payment Accuracy 97% 10 Day Time to Process (TTP) 90% 15 Day TTP 98.0% Ability to Administer Requested Plan Designs/Alternatives Copyright 2015 Page 38 of 65 Cigna City of Miami Attachment A RFP Number 495345 1. Are you able to administer the dental plan designs as designated in this proposal? Yes, we have provided a DHMO plan, a Voluntary DPPO plan and an Executive DPPO as requestedin the RFP. 2. If not, please indicate the deviations per plan. All deviations must be indicated in your response. Cigna is able to administer the requested plan designs. 3. Are there any other plan designs offered by your company not requested in this RFP? No. 4. Regarding Disease Management, do you have the ability to cover members with Chronic Disease (Diabetes/Heart Conditions {not a chronic condition but to include Pregnancies}/etc.) Periodontic cleanings at 100% and/or provide additional cleanings to these identified members from the City? Is there an additional charge for this benefit? We developed the Cigna Dental Oral Health Integration Program® to reinforce the importance of good oral health in relation to overall health. Research has shown an association between periodontal (gum) disease —a bacterial infection to complications for heart disease, stroke, diabetes, preterm birth, preeclampsia, and other health issues. This made us the first carrier in the dental insurance industry to offer enhanced coverage for members who have cardiovascular disease, diabetes or who are pregnant. We continue to stay abreast of new clinical research showing associations between oral health and certain medical conditions and as a result, we have enhanced the program to reflect the latest medical and dental research. The new program includes the following list of clinical conditions: • cardiovascular disease • cerebrovascular (stroke) • maternity • diabetes • chronic kidney disease • head and neck cancer radiation • organ transplants The Cigna Dental Oral Health Integration Program was first to use improved oral health to reduce risks related to pregnancy, diabetes, and heart disease. Studies show that patients with the following conditions are frequently prone to dry mouth, a condition associated with a higher risk of dental cavities: head and neck cancer radiation, organ transplants and chronic kidney disease. As a result, we have enhanced our program. Dental members can Copyright 2015 Page 39 of 65 Cigna City of Miami Attachment A RFP Number 495345 get l00 percent reimbursement of their out-of-pocket costs for certain dental services if they have any of the following medical conditions: maternity, diabetes, heart disease, stroke, head, and neck cancer radiation, organ transplants and chronic kidney disease. Members participating in the Cigna Dental Oral Health Integration Program are also eligible for the following additional coverage: • discounts of up to 50 percent off retail prices for chlorhexidine, fluoride toothpaste, and other dental prescription plan product's targeted at patients with a high risk for oral health problems through Cigna Home Delivery PharmacysM • behavioral guidance on subjects such as fear of going to the dentist, tobacco cessation, and stress and its impact on oral health Additionally, employees may access discounts of 25-50 percent off Xylitol gum through the Cigna Healthy Rewards® program. The enhancements made to the oral health integration program truly demonstrate Cigna's total integration capabilities as a health service company. Fully Insured There is no additional cost for the oral health integration program. ASO We estimate the incremental claim cost PMPM is approximately $0.05 or just $0.60 PMPY. We base the foundation of the oral health integration program on published research showing an association between dental disease and overall health —including the conditions covered in this program. Members may experience medical cost savings too as there is evidence showing that people with gum disease and certain medical conditions who receive dental treatment may reach a better state of oral health and may actually experience substantial medical cost savings. 5. Are there any additional services provided to assist Members with covered services if the Annual Maximum is reached within a policy period? Yes, members will still have access to the online tools and resources to assist them in evaluating and finding providers. As well as, continued access to resources like Cigna's Healthy Rewards®. This program is available to our dental members. It provides discounts on services like acupuncture, chiropractic services, massage therapy, laser vision correction, vitamins, herbal supplements, and nonprescription health and beauty products. There are no added fees or limits to the number of services members can use. Copyright 2015 Page 40 of 65 Cigna City of Miami Attachment A RFP Number 495345 Account Management Staff 1. Complete the following chart with information on the management and service team you propose for our clients. Role Name Title Percent of Time Commitment to City of Miami Through Implementation After Implementation Account Manager Dina D'Angelo Client Manager 50% 50% Day to Day Liaison Ed Boynosky Jennifer Miles Client Service Executive 10% 10% Implementation Coordinator Diane Buchman Implementation Manager 100% 60% Customer Service Supervisor Carrie Cortese Director — Client Implementation and Service 10% 10% Claim Administration Supervisor Please contact Customer Service Executive, Ed Boynosky or Jennifer Miles for any escalated claims administration inquiries. Network Management Liaison Please contact Customer Service Executive, Ed Boynosky or Jennifer Miles for any escalated network management inquiries. Other Melissa Menendez Client Engagement Manager 10% 10% 2. Include the resumes of the above proposed team members. Included. Cigna has provided resumes in Section 4 of this proposal submission. 3. Is designated staff expected to maintain measurable client satisfaction standards? If so, please describe. Yes. Cigna uses an account management report card to determine the effectiveness of our account management process. We conduct an account management satisfaction survey quarterly to ensure that we are meeting our client's needs. The survey asks clients to rate their level of satisfaction, from dissatisfied to completely satisfied, with their account management team in various topics. Clients send the report card back to Cigna where we compile the results. If there is an unfavorable response, we conduct a meeting with the client to discuss the concerns. If necessary, we complete a root cause analysis and put measures in place to ensure continued satisfaction. Satisfaction surveys are an integral part of our post -implementation process. Cigna conducts an implementation satisfaction survey after implementation is complete. We use voice of the client surveys and internal feedback loops to continuously improve upon our case installation process. We ask clients to provide feedback on a variety of topics related to their specific implementation experience. Copyright 2015 Page 41 of 65 Cigna City of Miami Attachment A RFP Number 495345 Banking 1. What are your billing and premium payment procedures? Monthly invoices are automatically generated based on eligibility data provided by City of Miami and maintained in our central eligibility database. Our Cigna accounts receivable and billing system is fully integrated with our eligibility system. As eligibility -related changes are processed, they are systematically generated to the accounts receivable and billing system throughout the business day. City of Miami's billing representative will be able to view a pending version of your next invoice containing these changes to effectively respond to any billing questions you may have. Rate and structure changes are updated using the same approach. Our clients are able to receive a single, system -generated, eligibility -based invoice for each plan coverage Cigna offers on an insured, minimum premium, and/or ASO basis. There is flexibility in the date that bills can be produced and mailed. Dates available for bill production are determined on a client -specific basis, based on the plan coverages selected and City of Miami's timing preference. Bill timing options include: • Prior Bill produce bills before the month of service (standard) • Current Bill - produce bills during the month of service - Client must agree to retrieve invoices and ad hoc reporting, if applicable, from CignaAccess.com (PDF version). Client must agree to remit payment via automated clearing house (ACII) or federal wire transfer. Client must agree to pay as billed. - The print date of invoice must be no later than the seventh of the month. City of Miami may select one of the following calendar dates for bill production: • Prior Bill - recommended calendar date is between the 16th and 28th • Current Bill recommended calendar date, if above requirements are met, is between the first and the seventh A case installation specialist will work with City of Miami to determine the billing date and timing that meets City of Miami's needs. The bill will be produced each month on the calendar date that is selected. The bill reflects eligibility data in our system as of the close of business on the day the bill is produced. Additions, changes, and terminations processed through that date will be reflected on the bill. Eligibility changes processed after the bill is produced will be reflected on the next month's bill. The monthly billing package provides a summary page detailing the total amount to be remitted. The total amount includes charges for current month of service, retroactive adjustments, and any unpaid amounts from prior bills. Eligibility updates that were not processed in time for the current month's bill will be reflected on the next bill. Premiums and fees are due as of the first day of the coverage month and are considered delinquent if payment is not received by the last day of the month. Copyright 2015 Page 42 of 65 Cigna City of Miami Attachment A RFP Number 495345 2. What financial reporting is included? The monthly billing package provides a summary page detailing the total amount to be remitted. The total amount includes charges for current month of service, retroactive adjustments, and any unpaid amounts from prior bills. Eligibility updates that were not processed in time for the current month's bill will be reflected on the next bill. 3. What are the funding requirements (i.e., checks issued, checks cleared?) The preferred method of funding is based on checks cleared (cashed). 4. Is bank reconciliation included in your fees/premiums? Yes. 5. Please give the following information for your principal banking relationship (to be used as reference): • Bank name Citibank National Association • Address One Penn's Way, New Castle, DE 19720 • Phone number 303.729.7185 • Contact name and title Fernando Martins — Financial Services Specialist Dental Management Capabilities 1. During the dentist selection/credentialing process, please confirm that the following items are checked and the frequency with which the items are checked: a. Graduation from an accredited US college of dentistry b. Valid state license c. Board certification/eligibility appropriate to practice area d. Federal and state DEA controlled substance registration and unrestricted prescribing privileges e. Malpractice coverage f. Detailed malpractice history g. Detailed history of disciplinary action or litigation h. Membership in professional organization i. Detailed history of general health j. Detailed history of chemical dependency k. Detailed history of mental health 1. Detailed history of conviction for fraud or felony Confirmed. 2. Please confirm the following: a. All participating primary dentists are personally visited by a network staff at least once annually in order to reassess the dental office environment and interview the dentist b. The network management information systems routinely collects information on the following items and this information is communicated to the participating dentists at least two times per year i. Adherence to community standards Copyright 2015 Page 43 of 65 Cigna City of Miami Attachment A RFP Number 495345 ii. Appropriate use of services iii. Billing accuracy iv. Member satisfaction surveys are routinely conducted and results are shared with the dentists at least once per year c. Indicate those utilization issues your management information system monitors to evaluate the amount and quality of dental care provided: i. Identifies statistical data on members according to employer group ii. Identifies the number of member visits by employer group iii. Maintains patient complaints Confirmed. 3. Please confirm the rate of re-credentialing primary dentists. We re -verify the credentials of all network dentists at least every three years, based on the highest accepted industry standards. During the re-credentialing process, we ensure that network dentists continue to meet the standards of initial credentialing. In addition, we review complaint tracking reports, and facility and patient records (DHMO only). The re- credentialing process is finished when there are no unfavorable findings and the credentials are current. If findings are unfavorable, our dental directors review the information and make recommendations to the credentialing subcommittee for approval or denial of the dentist's continued participation in the network. 4. Please confirm the rate of re-credentialing for specialist. We re -verify the credentials of all network specialists at least every three years, based on the highest accepted industry standards. During the re-credentialing process, we ensure that network dentists continue to meet the standards of initial credentialing. In addition, we review complaint tracking reports, and facility and patient records (DHMO only). The re-credentialing process is finished when there are no unfavorable findings and the credentials are current. If findings are unfavorable, our dental directors review the information and make recommendations to the credentialing subcommittee for approval or denial of the dentist's continued participation in the network. Other Dental Information 1. Please attach a copy of plan experience report that you feel would be of assistance to the City of Miami in evaluating your program. We have provided sample reporting package in the List of Attachments section of the proposal binder. 2. Please attach a dental implementation schedule. We have provided sample implementation calendar in the List of Attachments section of the proposal binder. Copyright 2015 Page 44 of 65 Cigna City of Miami Attachment A RFP Number 495345 3. Please attach a copy of your Reasonable and Customary charges. We have provided patient charge schedule in the List of Attachments section of the proposal binder. 4. Please confirm the right of the City of Miami to audit claims at any time. ASO Claim Audit: City of Miami may, in accordance with the following requirements and at no additional charge while this agreement is in effect, audit Cigna Health and Life Insurance Company's (CHLIC's) payment of plan coverage subject to the following conditions: i. City of Miami shall provide to CHLIC a scope of audit letter and the fully executed Claim Audit Agreement, together with a 45-day advance written request for audit. City of Miami will designate with CHLIC 's consent, such consent not to be unreasonably withheld, an independent, third party auditor to conduct the audit (the "auditor"). In addition, City of Miami and CHLIC will agree upon the date for the audit during regular business hours at CHLIC's office(s). City of Miami shall be responsible for its auditor's costs. The audit shall be conducted in accordance with the terms of CHLIC 's Claim Audit Agreement, which is hereby agreed to by City of Miami and which shall be signed by the Auditor before the start of the audit. ii. City of Miami may conduct one such audit every 2-plan years (but not within 18 months of a prior audit). iii. Auditor will review payment documents (subject to any contrary terms in participating health care professional agreements) relating to a random, statistically valid sample of 225 claims paid during the two prior plan years and not previously audited. If the audit identifies any claim adjustments, any such adjustments will be made in accordance with this agreement and based upon the actual claims reviewed and not upon statistical projections or extrapolations. Fully Insured Under a fully insured arrangement, Cigna is fully responsible for claims administration and carries every risk associated with such processes; therefore, we cannot permit an external audit; however, Cigna has an internal claim quality assurance program to monitor internal performance standards to ensure the accuracy of claims payment. 5. Please include a copy of a sample employer contract that includes all exclusions and limitations that the vendor expects will apply to the City of Miami. As the incumbent carrier, Cigna has included a copy of the current, in -force, insurance policy. The policy, along with a sample copy of our ASO agreement, in the List of Attachments section of the proposal binder. Copyright 2015 Page 45 of 65 Cigna City of Miami Attachment A Service and Quality RFP Number 495345 1. Provide the most recent two years' patient satisfaction results for the network you are offering. 2013 and 2014 member satisfaction survey results are as follows: r'33'.w-' t.-"i#i yi k 5€ g �+'�, - S mSPS' fA "5 7 W3�� � 24 ! ta5=w78 � If a e tienS i s on�` pyb ,ez, S�`� •} � y, 5 Af 'S�� ��D} > �� ���� � 4'C R`i {i ate, 4 xg- Y;. ,� � �tl � `' Product: DI-IMO Summary Level: National Completed Surveys: 7,011 Survey Period: 01/01/2013 —12/31/2013 Question Favorable Response Unfavorable Response Q1—Overall Experience Q3 — Likelihood to Recommend Q4—Overall Dental Care Q4—Overall Dental Care From Hygienist Q4 — Dentist/Staff Explaining Treat/Prot Q4 — Discussing Treatment Options With You Q4—Amount Of Time Waiting In Office Q10 — CIGNA Dental Benefits Plan 94.25% 89.46% 95.70% 97.10% 94.78% 92.58% 92.38% 90.20% 5.75% 10.54% 4.30% 2.90% 5.22% 7.42% 7.62% 9.80% <4weeks >4 weeks Q6 — Days From Appointment To Visit 88.27% 11.73% Survey Period: 01/01/2013 —12/31/2013 Copyright 2015 Page 46 of 65 Cigna City of Miami Attachment A RFP Number 495345 Question Favorable Response Unfavorable Response Q1- Overall Experience 99.29% 0.71% Q3 - Likelihood to Recommend 98.41% 1.59% Q4 - Overall Dental Care 99.36% 0.64% Q4 - Overall Dental Care From Hygienist 100.00% 0.00% Q4 - Dentist/Staff Explaining Treat/Proc 99.13% 0.87% Q4 - Discussing Treatment Options With You 98.82% 1.18% Q4 -Amount Of Time Waiting In Office 98.69% 1.31% Q8 - CIGNA's Handling of Dental Claims 96.37% 3,63% Q10-CIGNA Dental Benefits Plan 94.44% 5.56% <4weeks >4 weeks Q6 - Days From Appointment To Visit 92.25% 7.75% afierritSas a �t"5};-:f<f_� 4"�' ,n"f �i u"3t�. ���p'��r'V. i'$�d "4.. z�i-a'7Y�2����fiav �`t-`�Y�s"L''���� �"b`'zC i��4�. l �. � �j 41. `Sy��'£ �� ?,'my. C tea' i'�,�� ,�+�+y 1`� ,�1� �ler�k d ,€i s P 1;' •7 �j�^�{"�!i, �'.K.nR�. ., &�{�� -. .f NS _.ni _y�y"-?���a• gy �i4 � i �' ,.��#•� t M�� � } S ems'"' v��v'��'�,:Gk t'. � �, Product: DHMO Summary Level: National Completed Surveys: 6,973 Survey Period: 01/01/2014 - 12/31/2014 Question Favorable Response Unfavorable Response Q1-Overall Experience Q3 - Likelihood to Recommend Q4-Overall Dental Care Q4-Overall Dental Care From Hygienist Q4 - Dentist/Staff Explaining Treat/Proc Q4 - Discussing Treatment Options With You Q4-Amount Of Time Waiting In Office Q10- CIGNA Dental Benefits Plan 94.34% 89.34% 95.92% 97.75% 95.06% 92.87% 92.70% 90.73% 5.66% 10.66% 4.08% 2.25% 4.94% 7.13% 7.30% 9.27% Copyright 2015 Page 47 of 65 Cigna City of Miami Attachment A RFP Number 495345 <4weeks >4 weeks Q6 — Days From Appointment To Visit 85.71% 14,29% e� �1 e a reo ,s.ar actio Repo r�k �,. �w'�.hu �,.t•..'i, "4.,«i£�,a.,.�'.§';,a, �, :s- ��� ^-•'`;+f`�.., "@k�'�.A„ ,a,.�J�,.?. ,. � "`•�F -,< ?����d ,a _;.�� *~��`.�: ie,,,t-�,"�,a,,..fdx Product: DPPO Summary Level: National Completed Surveys: 6,683 Survey Period: 01/01/2014 —12/31/2014 Favorable Unfavorable Response Question Response Q1—Overall Experience 99.31% 0.69% Q3— Likelihood to Recommend 98.70% 1.30% Q4—Overall Dental Care 99.50% 0.50% Q4—Overall Dental Care From Hygienist 99.81% 0.19% Q4 — Dentist/Staff Explaining Treat/Proc 99.27% 0.73% Q4 — Discussing Treatment Options With You 98.95% 1.05% Q4 — Amount Of Time Waiting In Office 98.88% 1.12% Q8 — CIGNA's Handling of Dental Claims 96.45% 3.55% Q10 — CIGNA Dental Benefits Plan 94.83% 5.17% <4weeks >4 weeks Q6 — Days From Appointment To Visit 83.98% 16.02% 2. What member service factors make you uniquely qualified to administer the City of Miami's dental plan? Cigna combines cost savings, flexible plan designs, knowledgeable and caring customer service, and a focus on prevention and wellness. We take pride in being a health service company —not just another insurance carrier. Our Healthy Rewards® program offers discounts on health and wellness programs and services outside the realm of dental care. • We Are Nationwide - The DI--IMO plan is operational in 37 states, and the Cigna DPPO plan is operational in 50 states. We are one of only two carriers to offer dental indemnity, DPPO, DEPO, and DHMO plans nationwide. Our DHMO network is one of the largest in the nation, with more than 19,000 unique dentists and nearly 87,000 Copyright 2015 Page 48 of 65 Cigna City of Miami Attachment A RFP Number 495345 access points. Our DPPO network has the largest network of dentists contracted to discounted fee arrangements, with over 134,000 unique dentists and 350,000 access points. • We Are an Industry Leader - Our member satisfaction programs, best -in -class quality and utilization management programs, and award -winning website help to ensure that we continue to enhance service to our members. • We Have a Solid Foundation For more than 125 years, the Cigna Companies have been helping people lead healthier, more secure lives. Cigna Corporation's subsidiaries are leading providers of employee plans in the U.S. Plans and services include managed and indemnity health and dental coverage, as well as group life, accident, and disability insurance. • We Are Innovative - If there is a better way, we will find it. Key areas of focus include network development, plan coverage research and enhancement, system and service capabilities, and people development. We have implemented Six Sigma methodology with a dedicated focus on claims processing, customer service calls, and billing reconciliation. Over 100 of our employees have certified Six Sigma belt status, ranging from black belt to yellow belt. • National Health Care Anti -Fraud Association (NHCAA) We are also a founding member of the NHCAA Institute for Health Care Fraud Prevention translating saved fraud dollars to lower rates for our clients and members. • We Are Dedicated to Our Clients - We offer focused account management, cost- effective and flexible plans, and exceptional service. Your designated account service team is committed to making City of Miami's experience with Cigna positive and highly satisfying. From implementation through renewal —from executive sponsorship to day-to-day service —we will exceed your expectations. • We Are Committed to Helping the Communities in Which We Operate - We believe that being a good corporate citizen means channeling our resources into programs that improve the quality of life for everyone —not just our members. That is something we take very seriously at Cigna; it embodies our mission of helping the people we serve improve their health, well-being, and sense of security. Cigna and the Cigna Foundation offer help in a number of ways, such as providing grants and funds to qualified organizations, sponsoring charitable causes and events, and simply contributing our time and energy, wherever and whenever possible. • We Look Forward to Working With City of Miami - Nationwide networks, flexible plan designs, and designated account management teams create a solid and unique foundation for Cigna to service City of Miami's needs. We want to make sure that each of City of Miami's employees understand and are satisfied with their dental coverage options. • We Invest in Our Employees, Plans, Networks, and Clients - Cigna focuses on continuous improvement and sharing best practices in every aspect of our business. We encourage employees to take advantage of our extensive training courses and tuition payment programs. We routinely monitor the health care marketplace, and invest people and financial resources to keep pace with plan coverage and network growth trends. We believe these investments contribute to our ability to attract, service, and retain our valuable employees, dentists, and clients. Copyright 2015 Page 49 of 65 Cigna City of Miami Attachment A RFP Number 495345 We Are Dedicated to Helping City of Miami can achieve its cost -saving goals, while offering your employees quality dental coverage at affordable prices. When choosing Cigna, you do not sacrifice choice, service, or reliability to ensure employee satisfaction and promote oral health. 3. How is work in progress treated for a patient who elects to participate in the dental plan? In the state of Texas, inlays, onlays, crowns, bridges, partial and full dentures, and root canals initiated before changing to Cigna must be completed under the terms of the previous carrier. In all other states, inlays and onlays initiated before changing to Cigna must be completed under the terms of the previous carrier. DHMO There may be a contribution toward orthodontic benefits in progress. The contribution, if any, isa predetermined amount based on the coverage and number of months (excluding the months for retention) remaining at the start date to complete the interceptive or comprehensive treatment. It is important to note that enrollment in our plans does not modify any obligation that the member has to their original contract with their orthodontist, even if the dentist participates in the Cigna Dental network. DPPO Orthodontia In -Network If a member chooses an in -network orthodontist, we will initiate payments for the number of months remaining in the member's orthodontic case based on the DPPO contracted amount. We will pay up to the coverage maximum for the member's plan for the number of months remaining, and retention if any maximum dollars are left. Orthodontia Out -of -Network If a member chooses an out -of -network dentist, we will initiate payments for the number of months remaining in the member's orthodontic case based the member's coverage plan and the dentist's charges. We will pay up to the coverage maximum for the number of months remaining and retention if any maximum dollars are left. History Data Transfer To arrange for coverage for orthodontic treatment -in -progress, a history tape transferred to us from the previous carrier may eliminate delay. Based on the complexity of the data transfer, there may be an optional service charge. 4. What happens to work in progress when coverage is terminated? Coverage for a dental procedure that was started before disenrollment from the plan (crowns, root canal treatment, bridges, dentures, and partials if the teeth were fully prepared or the final impressions), will be extended for 90 days after disenrollment, unless it was due to nonpayment of premiums. Copyright 2015 Page 50 of 65 Cigna City of Miami Attachment A RFP Number 495345 Coverage for orthodontic treatment started before disenrollment from the dental plan will be extended to the end of the quarter or for. 60 days after disenrollment, unless it was due to nonpayment of premiums. 5. Do you require pre -authorization prior to service for any dental procedures or for any treatment exceeding a specified dollar amount? Yes. DHMO Predetermination for general dentistry is not required because we provide network general dentists with coverage guidelines for the completion of the range of services that they perform. These include diagnostic services, preventive services, restorative dentistry, crowns and bridges, partial and complete dentures, root canal therapy, minor oral surgery, and preliminary periodontal therapy. The network general dentist directs most referrals for specialty care (with the exception of pediatric care since children under age seven may select a network pediatric dentist as their primary care dentist without a referral; and orthodontic care, which can be accessed directly by the member without a referral). Referrals to obtain care with a network specialist do not require precertification. The network specialist is responsible for obtaining any necessary predeterminations for the actual treatment he or she will be performing. Patient charges listed on the patient charge schedule (PCS) may apply at the specialist's office based upon the specialty care coverage for the specific PCS. If a member elects to have treatment not covered on the PCS, they are responsible for paying the dentist's normal fee. Specialty referrals are valid for 90 days from the date of issuance. After the expiration date, the system automatically purges the specialty referral. We send notifications of predetermination of coverage decisions to dentists by mail, and make them available to members through myCigna, a secure website. We send notification of claims payment decisions to members and dentists in writing by mail. We only make telephone calls to the dentist when there is a need for additional information or clarification that we can obtain verbally to make a decision about the predetermination. DPPO We do not require predetermination of coverage, but recommend it for any claim over $200. Predetermination of coverage is a voluntary review of a dentist's proposed treatment plan and expected. charges. The treatment plan should include supporting preoperative x-rays and other diagnostic materials, as requested by a Cigna dental consultant. If there is a change in the treatment plan, the dentist should submit a revised plan. We determine covered dental expenses for the proposed treatment plan. If there is no predetermination of coverage, we determine covered dental expenses when we receive a claim. Copyright 2015 Page 51 of 65 Cigna City of Miami Attachment A RFP Number 495345 Predetermination of coverage is not a guarantee of a set payment. We base payment on the actual services delivered and the coverage in force at the time services are completed. Pretreatment reviews take 5 to 10 days. Predeterminations are valid for 12 months from the date of issuance. After the expiration date, the system automatically purges the predetermination. Administrative Capabilities 1. Please detail the performance guarantees included in your proposal, which include at a minimum guarantees for claim processing, member services and patient satisfaction. We have provided performance guarantees in Section 9, the Performance Guarantees section of the proposal submission. 2. Include a complete list of standard reports you can provide to the City of Miami to demonstrate you are meeting the administrative standards as well as your 2014 results for each: a. Accurate claims processing i. Accuracy ii. Timeliness b. Member services i. Waiting period to speak to a representative ii. Call abandonment rate c. Patient satisfaction We have provided sample reporting in the List of Attachments section of the proposal binder. 3. Describe your system security processes for protecting member information. Every staff member has a unique sign on ID. The employee's manager provides the security database administrator with the employee's name, employee ID, hire date, and system access required for set-up. The employee's ID is created in three layers: • Unix - opens account and assigns ID and password. • Database - creates account at the database level from the Unix ID so the employee can access the database. • Application - assigns the system security (role -based access code) based on the employee's job function. Multiple roles exist within job function based on the employee level and any lead or supervisory responsibilities. Security codes are set-up in the system based on job title and function. Employees with the same security role codes can access and modify the same information in the system. These roles are audited and reviewed every six months for accuracy. Copyright 2015 Page 52 of 65 Cigna City of Miami Attachment A RFP Number 495345 Once an employee is terminated, the ID is deactivated in the system. Inactive IDs are eliminated every six months from the Unix and database tables, but are never removed from the personnel tables because of long-term audit purposes. Employees are not allowed to share IDs. If an employee is found violating this rule, it is a serious offence and can be grounds for termination. Our system requires periodic password changes as another way to ensure security. Additionally, if a computer is left unattended for 18 minutes, it will automatically log off and the operator must re-enter the ID and password to regain access. IDs are tied to role -based access codes and as such, determine whether an employee has access to inquiry only, claim processing, or eligibility updates. If an employee attempts to gain unauthorized access due to their level of identification, the system will automatically shut down. 4. What steps do you take in the event of provider fraud? Once potential fraud has been identified or suspected, the dentist is flagged in our claim system so that future claim submissions are reviewed by the fraud coordinator and/or the SIU before payment is issued. If we substantiate fraud, we may request payment of overpayments, and we will refer evidence to law enforcement or the state's Department of Insurance, as required. If we substantiate member fraud, the SIU will contact the Cigna sales team for notification to the client. 5. What is your process of financial recovery to the City of Miami in the event of provider or member fraud? Health care fraud impacts both the cost and quality of dental coverage, and endangers members by exposing them to unnecessary treatments or creating false dental records that may impact the payment of future health services. Cigna's Special Investigations Unit (SIU) is committed to protecting our clients and members from fraud and abuse. The SIU has more than 60 staff members located across the U.S. and in Europe. The SIU investigators work closely with claim, legal, and clinical personnel to establish new guidelines and system enhancements that will assist in the fight against fraud. The SIU's responsibilities include: • conducting investigations of suspected fraud and analyzing cases to determine the potential fraud's scope • mitigating the potential fraud's financial impact by flagging dentists in our claim systems, preventing potentially fraudulent claims from being processed, and alerting claim processors of an investigation • gathering evidence of potential fraud for referral to law enforcement, regulatory bodies, and industry associations • pursuing civil recovery against those who have submitted false claims • using technology and data mining techniques to identify suspect behavior patterns of possible fraudulent health care professionals/facilities Copyright 2015 Page 53 of 65 Cigna City of Miami Attachment A RFP Number 495345 • working closely with Cigna claim, legal, and clinical management teams to establish, guidelines and system enhancements • delivering antifraud training and current fraud scheme communications to key Cigna employees Three examples of potential fraud situations are: • a dentist submitting fraudulent claims • fraud involving a member • internal fraud by Cigna employees (handled by our internal investigations team) Identifying Potential Dentist or Member Fraud Cigna requires that dental claims state the actual services the member received. When reasonable evidence reveals that this is not the case, we ensure that payment is based on the actual services the member received. Cigna's claim system controls reduce the risk of loss through rebundling of fragmented claims, R&C guidelines, and duplicate payment edits, and allows for prepayment audits of specific procedure codes. Claim processors and customer service advocates (CSAs) are trained to identify the red flags of potential fraud. We have a formal, focused review program, antifraud training, and specific referral guidelines for claim processors to ensure that potential suspect claims are surfaced and forwarded to the SIU. Published guidelines list circumstances under which a dental claim should be audited before payment, in order to verify that services were provided. Claims meeting specific fraud criteria are referred directly to the SIU staff for investigation. Investigations consist of both retrospective and prospective reviews of paid claims and current claim submissions. Retrospective reviews may entail requesting supporting documents from the dentist and verification from the members that the dentist actually provided the services billed. Prospective reviews involve flagging dentists in the claim systems. Flagging a dentist can have many protocols, such as requesting additional documentation from the dentist or sending a survey to the member. The flagging field within the .claim systemis protected, and only SIU and dental data control representatives have certification to access the flag field. Identifying Potential Employee Fraud Our internal investigations team is responsible for investigating allegations of possible fraud or violations of Cigna's code of ethics and principles of conduct committed by Cigna employees, contracted workers, and vendors. We have a dedicated fraud manager and investigators for this function. Technology An important component of our antifraud program includes using technology to data mine for suspicious or unusual billing activity. Cigna's SIU uses computer -assisted audit tools and techniques to facilitate an effective and sustainable data mining program. The data Copyright 2015 Page 54 of 65 Cigna City of Miami Attachment A RFP Number 495345 mining strategy focuses on peer group analysis to score and rank dentists' billing patterns. IBM's fraud and abuse management system (FAMS) is an example of one tool we use to perform such analysis. In addition, the SIU uses link analysis and social networking software to identify and visualize connections between entities within the claim data. Various technologies and techniques are continuously tested and used to enable Cigna's data mining program to adapt to ever -changing billing schemes. Associations Cigna is a founding member of the National Health Care Anti -Fraud Association (NHCAA), comprised of health care fraud experts from the public and private sectors. NHCAA developed and implemented many specialized training programs and other important initiatives to address health care fraud. The SIU actively participates in these initiatives and uses the NHCAA to satisfy annual investigator training requirements. Client Involvement To be successful, our antifraud program must be a partnership between Cigna and our clients. Although training, claim system controls, computerized detection, data analysis, and involvement with industry association and law enforcement initiatives are important parts of the program, we rely on clients and members to inform us of discrepancies that may reveal potential fraud. The Cigna website, www.cigna.com, provides more information on health care fraud and includes our SIU fraud hotline phone number, SIU fax number, SIU email address, and the SIU mailing address in Hartford, Connecticut. Copyright 2015 Page 55 of 65 Cigna City of Miami Attachment A RFP Number 495345 This page intentionally left blank. Copyright 2015 Page 56 of 65 Cigna City of Miami Attachment A RFP Number 495345 This page intentionally left blank. Copyright 2015 Page 57 of 65 Cigna City of Miami Attachment A RFP Number 495345 This page intentionally left blank. Copyright 2015 Page 58 of 65 Cigna City of Miami Attachment A This page intentionally left blank. RFP Number 495345 Copyright 2015 Page 59 of 65 Cigna City of Miami Attachment A RFP Number 495345 This page intentionally left blank. Copyright 2015 Page 60 of 65 Cigna City of Miami Attachment A RFP Number 495345 This page intentionally left blank. Copyright 2015 Page 61 of 65 Cigna City of Miami Attachment A RFP Number 495345 This page intentionally left blank. Copyright 2015 Page 62 of 65 Cigna City of Miami Attachment A RFP Number 495345 This page intentionally left blank. Copyright 2015 Page 63 of 65 Cigna City of Miami Attachment A This page intentionally left blank. RFP Number 495345 Copyright 2015 Page 64 of 65 Cigna City of Miami Attachment A RFP Number 495345 This page intentionally left blank. Copyright 2015 Page 65 of 65 Cigna Under your plan, you have coverage for hundreds of dental procedures. This overview shows you a small sampling of covered services and what you will pay compared to your estimated cost without coverage. See savings below! Review your plan materials to understand how your plan works. For questions on the plan before enrollment, call 1.800.Cigna24 (1.800.244.6224) and select the"Enrollment Information" prompt. Regular dental visits may do more than brighten your smile. Receiving regular dental care often catches minor problems before they become major and more expensive to treat. And there's an association between gum disease and other conditions, such as preterm birth, heart disease, stroke, diabetes and other health issues. So taking good care of your teeth and gums may help you live a healthier life. Get the most value from your plan Take advantage of your plan's preventive care services - certain services may be covered at no additional cost to you (see below for details). Your plan also covers many other dental services that can help you achieve and maintain a healthy mouth. Samplingof covered procedures`{ What You'll , ,y Cotwitt Ci naD°enta C e Pay' Estimated cost without dental coverage Adult cleaning (two per calendar year each at $0) (additional cleanings available at $50 each) �a $70—$136 each Child cleaning (two per calendar year each at $0) (additional cleanings available at $40 each) es 0F $53—$102 each Periodic oral evaluation $0 u $40-$76 Comprehensive oral evaluation � � `� �� �$�r ���� � y4 �; $62-$118 Topical fluoride (two per calendar year each at $0) (additional topical fluoride available at $15 each) Y rz $28—$53 X—rays — (bitewings) 2 films - $33-$63 X—rays — panoramic film ;_t$Ohf $84—$161 Sealant — per tooth ; t$ $42—$80 Amalgam filling (silver colored) —2 surfaces {; $118-$226 Composite filling (tooth —colored) —1 surface, Anteriory $p t T $120—$231 Molar root canal (excluding final restoration) 275 . ¢ $852—$1,640 Comprehensive orthodontics — child (up to 19th birthday) — Banding $1 042—$2 005 Periodontal (gum) scaling & root planing —1 quadrant F $179—$344 $109—$209 Periodontal (gum) maintenance 535 Removal/extraction of erupted tooth Removal/extraction of impacted tooth $370-$712 Crown — porcelain fused to high noble metal � �� $�30 f{�=u �� � $849—$1,634 Implant supported retainer forporcelain fused to metal fixedpartial denture P Pp .�.._,.�a���.� ��00 $1,097—$2,112 Occlusal appliance by report (for treatment ofTMJ) $640—$1,233 Offered by: Connecticut General Life Insurance Company, Cigna Health and Li DFO STANDARD VACO 09 nsurance Company, or their affiliates 6bp®® %)Te Cigna. 856819 11/13 67 Know what's important to you You can save money on a wide range of services, including: • Preventive care - cleanings, fluoride, sealants, bitewing X-rays, full mouth X-rays, and more • Basic care - tooth -colored fillings (called resin or composite) and silver - colored fillings (called amalgam) • Major services - crowns, bridges, and dentures (including those placed over implants), root canals, oral surgery, extractions, treatment for (gum) disease, specialty care (with an approved referral), and more • Orthodontic care - braces for children and adults • General anesthesia - when medically necessary • Teeth whitening - using take-home bleaching trays and gel Finding a network dentist is easy. There are several ways to choose your network general dentist: • Find a dentist at Cigna.com. Our online dental directory is updated weekly. • Call 1.800.Cigna24 (1.800.244.6224) to speak with a customer service representative. Our representatives can send you a customized dental directory listing via email. Key plan features • There is a $5 office visit fee associated with your plan. • No deductibles - you don't have to reach a certain level of out-of-pocket expenses before your insurance kicks in. • No dollar maximums - you don't have to worry about your coverage running out after your covered expenses reach a certain dollar amount. • Easy to understand plan - the fees you pay your dentist are clearly listed on your Patient Charge Schedule (PCS). • There are no claim forms to file and no waiting periods for coverage. • The network general dentist you choose will manage your overall dental care. • Covered family members can choose their own network general dentists - near home, work or school. • You don't need a referral for children under seven to visit a network pediatric dentist. And you don't need a referral to see a network orthodontist. • There's no age limit on sealants, which help prevent tooth decay. • Your plan covers certain procedures to help detect oral cancer in its early stages. • 24/7 access to the Dental Information Line -this line is staffed by trained professionals who can help if you have questions about dental treatment and clinical symptoms. gowns a'n Dentures and partii-s RelineS,sebases Adjustments Prpsthesis over impf Temporomandibular Joint (TM)) treatment Athletic mouth guard. mouth 1 every3calendaryears__ eplaceme t eveYy 5,years if unse7viceable and cannot be repairer Ietic mouth guard per 12 mohths when listed'on your P 67 68 Listed below are the servicesor expenses Which awe NOT covere responsibility'atthe.dentist's usual.fees;..There Is_no'cove age o • Or in,connection'with ininjary'arising'out:of,-oiin'tf--ea;`` course of, any employmentfor wage or profit • Charges which would not,have been made any facility, other hospital_or a cortectional- institutionowned or operated bythe'united states -government or bya state; or municipal government if .the person had • To the extent that payment.is=unlawful_whereth e person resides when_the expenses are incurred Or the services are received • The charges whiich'the:person islnot,ieg`allyrequired to� • Charges.whiich would not have been made if the' _.person had no insurance.: Due to in'uies which are in e "t`ioria i "elf-"nfli � _ .t n alys i. icted • Services.`not listed on the:- . Services`'providedRb'y a non-netWork dentist without ,Cigna Dental's prior approval(except emergencies,`as described in your plan docu`ments)3".', •"-Services related' to aninjury:orillness;paidunder' `... p workers compensation, occu ational disease, or similar' . saws - • Serv'c s p rovid d : r pa i::;_' i e p edo „d_byorthrougha'federal:, or state_ govern mental agency or autho rity, political subdivision or a public_program, Other than;med`ical • -Services required while serving in the,armed forces of any, country or_ international authority or' relating to a declared or._undeclared war oracts of war,: Services performed primahil 'for_ cosmetic reasons" �unle`ss specificall`a'isteo Y- • General ..', e al arc sthesis; sedation and nitrous oxide; unless specifically listed"on yourPCS' r 'Presc tion nnedi atii.. rip e cat ors Replacement offixed=and/Or rernovable_applianceS;t ' (including fixed and removable.: orthodontic appl,ia)ces) that have been'loststolen, or damaged due tompatient abuse, misuse or neglect'` `-• ur ica .n __,.,.-, �_ .,,: ---- - __ I im la t of an t unle'ss's ecificall g_ p. Y YPe p y t n your'PCS 'Services considered to`beu• nnece$s r� -ei e' . rnon ° u e„sa yor.xpenmentai in nature or do' not Ineet:cornrtnonlyaccepted dental standards_ The corrtpletion ofcrowr)s -canal:treatment already in ptogress on the effet dotE. our` Cigna Dental torte iation of- pipiar tsu`p which areyou e coin including crowns,brtdges an >rog°ress on theeffective cis'`' overrage, unless specifically orsultattor) oreval_ua' ervicesthat--are not covered dodontic.trea ont;pri r" erio ° ontai ind'su`pport ng bone) surgery oftee;rh'exh bifin �ooror hopeless periodontal prognosis one grafting and/oridedtis`sue're eretafior )erformed at the site a tooth extraction unles pet ficallyfiisted .or.g uided .,._. i, erformed In conjunctionwi ieriradicufa`r surgery ntention;a:l',root canal treatment gin theabserice if ur ordisease;to_solel'facilitate.a restorative Vrees `�"'rformed er e pe e by;'a p =o thod t ocalized delivery f antimicro.b-al.�agents�w en - performed alohe orin the absence of traditional. ieriO Oita stilers`` \ny localized delivery of antimicrobial agent ifoce du'resiwhen r o`re than _eight;($) ofthese iroceduresare re ported on fh date'of sery n ec oh ont of an orst riliation;'` f ti d/ _ erg z i i e-r te" entat on.�;f. ' on la e_ e em i o ,an y;,mlay, ore or fied bridge Within 180 da hereceme tation:of' n i'm' lani includingcrowns, bnc lays;of iiitial,placerrei h eryices`to correct,con heieplacerfent_of coif fi_e;re "=lacementof 'n ;occlusal " p_ One-per=ai%y24consecu e same lost ano s of,initial placement s'u "v or`ted prosthesis itures)_witfin,180: Igeiand/o:rin plant sU;pport'ed profit{ esis or splinting d..retanet`s"=and`s`socated Should any law require coverage for any particular service(s) noted above, the exclusion or limitation for that service(s) shall not apply. , This document outlines the highlights of your plan. For a complete list of both covered and not -covered services, including benefits required by your state, see your insurance certificate or plan description. If there are any differences between the information contained here and the plan documents, the information in the plan documents takes precedence. 68 69 �0®B� oz,ver r Cigna® 1. Theterm'DHMO"is used to referto product designs that may differ by state of residence of enrollee, including but not limited to, prepaid plans, managed care plans, and plans with open access features. 2. Costs listed for the Cigna Dental Care plan do not vary. Estimated costs without dental coverage may vary based on location and dentists' actual charges. These estimated costs are based on charges submitted to Cigna in 2012 and are intended to reflect national average charges as of January 2015 assuming an annual cost increase ofthree percent. Estimates have been adjusted to reflect the 2011 Cigna DHMO geographical membership distribution. 3. Minnesota residents: You must visit your selected network dentist in order for the charges on the Patient Charge Schedule to apply. You may also visit other dentists that participate In our network or you may visit dentists outside the Cigna Dental Care network. If you do, the fees listed on the Patient Charge Schedule will not apply. You will be responsible for the dentistis usual fee, We will pay 50% of the value of your network benefit for those services. 0f course, youill pay less if you visit your selected Cigna Dental Care network dentist. Call Customer Services for more information. Oklahoma residents: DHMO for Oklahoma is an Employer Group Pre -Paid Dental Plan. You may also visit dentists outside the Cigna Dental Care network. If you do, the fees listed on the Patient Charge Schedule will not apply. You will be responsible for the dentistis usual fee. We pay non -network dentists the same amount weld pay network dentists for covered services. 0f course, youlll pay less if you visit a network dentist in the Cigna Dental Care network. Call Customer Services for more information. 4, California and Texas residents:Treatment for conditions already in progress on the effective date of your coverage are not excluded if otherwise covered under you PCS. Dentists who participate in Cigna's network are independent contractors solely responsible for the treatment provided and are not agents of Cigna. DHMO insurance coverage is set forth on the following policy form numbers: CO, DE, FL, KS, NE, OH, PA, and VA: PB09. AR: HP-POL120; CA: CAPB09, CAVP/A09, or 91994D3; CT: PBO9CT; IL: CG—CDC—ILL—POLICY; LA: HP-POL118; MA: HP-POL134; MI: HP-P0L179; M0: PBO9M0; MS: HP-POL117; NC: PB09.NC; NV: HP-P0L132; NY: HP-POL130; OK: HP-POL115 (CHLIC) and GM6000 DEN201 V1(CGLIC); OR: HP-POL121; SC: HP-P0L128; TN: HP-P0L134;1X: PB091X; UT: HP-P0L129; WA: WAPOL05/11; and WI: HP=POL122. "Cigna,"the"Tree of Life" logo,"GO YOU"and"Cigna Dental Care"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, Cigna Health and Life Insurance Company, Cigna HealthCare of Connecticut, Inc., and Cigna Dental Health, Inc. and its subsidiaries. Cigna Dental Care plans are provided by Cigna Dental Health Plan of Arizona, Inc, Cigna Dental Health of California, Inc., Cigna Dental Health of Colorado, Inc„ Cigna Dental Health of Delaware, Inc., Cigna Dental Health of Florida, Inc., a Prepaid Limited Health Services Organization licensed under Chapter 636, Florida Statutes, Cigna Dental Health of Kansas, Inc. (Kansas and Nebraska), Cigna Dental Health of Kentucky, Inc., Cigna Dental Health of Maryland, Inc., Cigna Dental Health of Missouri, Inc., Cigna Dental Health of New Jersey, Inc., Cigna Dental Health of North Carolina, Inc., Cigna Dental Health of Ohio, Inc., Cigna Dental Health of Pennsylvania, Inc., Cigna Dental Health ofTexas, Inc., and Cigna Dental Health of Virginia, Inc. In other states, Cigna Dental Care coinsurance plans are underwritten by Connecticut General Life Insurance Company, Cigna Health and Life Insurance Company or Cigna HealthCare of Connecticut, Inc., and administered by Cigna Dental Health, Inc, 856819 11/13 © 2013 Cigna. Some content provided under license. 69 „.„, Ligna. 595894 d 10/11 71 know what's important to you Regular dental visits may do more than brighten your smile. Research shows receiving regular dental care often catches minor problems before they become major and expensive to treat. Every $1 you spend on preventive dental care could save you $8 to $50 in restorative and emergency treatment' Review your plan materials to understand how your plan works. We are here if you have questions or need more information call 1.800.Cigna24 (1.800.244.6224). • Take advantage of your plan's preventive care services — most are covered at low cost or no cost to you. • Enjoy discounts on health -related products and services with Cigna Healthy Rewards®.3 Get smarter about ways to stay healthy Did you know that healthy gums may: • Help reduce the risk of pre -term birth. Pregnant women with chronic gum disease may be more likely to give birth prematurely.4,5 • Lead to a healthier heart.Those with gum disease may be at greater risk for heart disease and stroke.' • Help control blood sugar. One study' found that when diabetic patients' gum infections were treated, it was easier to manage their blood sugar. Studies also show that patients with the following conditions are frequently prone to dry mouth, a condition associated with a higher risk of dental cavities: head and neck cancer radiation, organ transplants and chronic kidney disease. As a result, we've enhanced the Cigna Dental Oral Health Integration Program° to reflect the latest medical and dental research. If you have any of the. following medical conditions, you qualify for 100% reimbursement of your out of pocket costs for certain related dental procedures: pregnancy, heart disease, stroke, diabetes, head and neck cancer radiation, organ transplants and chronic kidney disease. There's no additional charge for the Program — if you qualify, you get reimbursed! To (earn more, visit myCigna.com or call the number on your ID card or 1.8O0.Cigna24 (1.800.244.6224). 1. "OHMO"is used to refer to product designs that may differ by state of residence of enrollee, including but not limited to, prepaid plans, managed care plans and plans with open access features. 2. www.adha.org (American Dental Hygienist Association). 3. Healthy Rewards discounts and services are not available in all states. A discount program is NOT insurance, and you must pay the entire discounted charge 4. American Dental Association News Releases, Sept. 2001. 5. Journal of the American Dental Association, July 2001 "Oral Health During Pregnancy: An Analysis of Information." 6. American Academy of Periodontology (www.perio.org), Feb. 2002. 7. Journal of the American Dental Association, 0ct.2003, 72 4;10V14-0 o U zu ,a417'.p.a; o _ 0100 Cigna. make sure you read this important information What's covered You can save money on a wide range of services, including: Preventive care — cleanings, fluoride, sealants, bitewing X-rays, full mouth X-rays and more. • Basic care — tooth -colored fillings (called resin or composite) and silver -colored fillings (called amalgam). • Major services — crowns, bridges, dentures (including those placed over implants), root canals, oral surgery, extractions, treatment for periodontal (gum) disease and more. • Specialty care — many plans include specialty care with an approved referral. Check your plan materials to see how specialty care is handled. • Orthodontic care — some plans include braces for children and adults. Check your plan materials. • General anesthesia — when medically necessary. Age and frequency limitations apply to some covered services. Alternate benefit provisions may apply for covered services if noted on your PCS.' Review the rest of your enrollment materials for more details. What's not covered* Your dental plan covers services that can help you maintain a healthy mouth and treat or manage dental conditions. But no plan covers everything. Here are some examples of services not covered: • Services provided by a non -network dentist without prior approval from Cigna Dental (except emergencies). • Replacement of fixed or removable bridges, dentures and orthodontic retainers that are lost, stolen, or damaged due to patient abuse, misuse or neglect. Cosmetic dentistry unless specifically listed on your PCS. Dental implant surgery or services associated with placement, repair, removal or restoration of a dental implant. *This is not a complete list. For a complete list of services not covered, refer to the rest of your enrollment materials or call 1.800.Cigna24 (1.800.244.6224) if you have questions or need more information. • 9. Covered services may cost less than alternative services suggested by the dentist. You can receive the dental procedure of your choice; however, if you choose the higher cost procedure, you will be responsible for paying the Patient Charge for the covered procedure plus the difference in cost between the dentist's usual charges for the less costly procedure and higher cost procedure. "Cigna"is a registered service mark, and the"Tree of Life"logo and "Cigna Dental"are service marks of Cigna Intellectual Property, Inc., licensed for use by Cigna Corporation and its operating subsidiaries. All products and services are provided exclusively by such operating subsidiaries, including Connecticut General Life Insurance Company and Cigna Health and Life Insurance Company, and not by Cigna Corporation. Cigna Dental refers to the following operating subsidiaries of Cigna Corporation: Connecticut General Life Insurance Company, Cigna Health and Life Insurance Company and Cigna Dental Health, Inc., and its operating subsidiaries and affiliates, The Cigna Dental Care plan is provided by Cigna Dental Health Plan of Arizona, Inc., Cigna Dental Health of California, Inc., Cigna Dental Health of Colorado, Inc„ Cigna Dental Health of Delaware, Inc., Cigna Dental Health of Florida, Inc., a Prepaid Limited Health Services Organization licensed under Chapter 636, Florida Statutes, Cigna Dental Health of Kansas, Inc. (Kansas and Nebraska), Cigna Dental Health of Kentucky, Inc., Cigna Dental Health of Maryland, Inc., Cigna Dental Health of Missouri, Inc., Cigna Dental Health of New Jersey, Inc., Cigna Dental Health of North Carolina, Inc., Cigna Dental Health of 0hio, Inc., Cigna Dental Health of Pennsylvania, Inc., Cigna Dental Health of Texas, Inc., and Cigna Dental Health of Virginia, Inc. In other states, the Cigna Dental Care plan is underwritten by Connecticut General Life Insurance Company, Cigna Health and l.ife Insurance Company or Cigna HealthCare of Connecticut, Inc. and administered by Cigna Dental Health, Inc. All models are used for illustrative purposes only. 595894 d 10/11 © 2011 Cigna. Some content provid 'u under license. 877438 08/14 (Cigna Total DPPO) 440, °°®Cigna® Offered by Connecticut General Life Insurance Company, Cigna Health and Life Insurance Company or their affiliates. This brochure is not intended for residents of Nev Aexico. 76 Cigna's Total Dental PPO (DPPO) network makes it easy to protect your health - and your smile - with the right dental care at the right price. You can choose a dental provider from one large network. directory that is easily accessible and searchable online. In addition, we offer online tools that allow you to make more informed decisions about your dentist and your dental care. Understand how your plan works When you choose a network dentist, your coverage includes a wide range of eligible services after you satisfy any waiting period and meet your deductible:* Preventive care (cleanings, x-rays and more) Basic care (fillings, basic restorative work) • Major services (bridges, crowns and more) • Orthodontics (some plans may include orthodontic coverage for children and adults) *AII group dental policies and benefit plans contain exclusions and limitations. For costs and complete details of coverage, see your employer's plan documents. Additional considerations: • Many diagnostic and preventive care procedures are covered at no cost or a reduced cost to you. • For other services, you will usually pay a percentage of the cost - or coinsurance amount - to the dentist at the time of service • You don't need an ID card to receive dental care. • If you visit a dentist or specialist for a second opinion, we will reimburse you according to your plan coverage. You don't need to select a primary care dentist. You don't need a referral to receive care frorn a specialist. Your access - Thousands of dentists, one directory Cigna Total IDPPO Network provides access to the largest network of dentists contracted to discounted fee arrangements.3 As of 2015, we expect to have a total of 139,0004 unique dentists available at34750os office locations. This means more convenience and greater savings for you. Within Cigna Total DPPO, we offer two levels: Cigna DPPO Advantage g5,000 dentists 237,50o locations Average savings of 35%6 Cigna DPPO 44,00o dentists 110,000 locations Average savings of 15%6 All participating dentists are consolidated into one directory; which you can easily search online at Cigna.com and myCigna.com. ADDED BENEFITS FOR OUR DPPO CUSTOMERS • Enjoy discounts on health -related products and services through Cigna Healthy Rewards®, • The Cigna Dental Oral Health Integration Program° offers enhanced dental coverage and more for dental customers with any of the following medical conditions: diabetes, heart disease, stroke, maternity, head and neck cancer radiation, organ transplants and chronic kidney disease. There's no additional charge for the program - those who qualify get reimbursed 10o percent of coinsurance for certain related dental procedures* and are eligible for other perks! * Deductible does not apply. Reimbursement counts towardmaximum for DPPO plans. Restrictions and limitations apply. 76 77 THE BENEFITS OF IN -NETWORK CARE Select a dentist or specialist from the in -network Cigna Total. DPPO list Pay less for covered services because in -network dentists have agreed to offer services at lower negotiated rates, approximately 35% off average area charges with DPPO Advantage and 15with DPPO, You may save on out-of-pocket costs for many services not covered under your plan. In -network dentists have agreed to offer our customers discounted fees for all procedures on their fee schedules. (Not available in all states.) • In -network dentists will submit claims for you. • All in -network dentists have been screened through a process modeled after the highest national quality standards, and we repeat the process every three years. Customer tools — Knowledge is power As you choose your dental provider, cost is an important factor to consider, as is experience and location. Cigna gives you personalized tools to help you make informed decisions about your dental health. These tools provide information about dentist care and cost savings, allowing transparent information sharing that saves you time and money. • Cost-effectiveness designation: Within the myCigna.com directory, customers can research dentists using Cigna's star rating system to determine the level of potential savings. A dentist receives one, two or three stars from Cigna, The more stars, the greater the potential savings. • Dental care distinction: Cigna helps you make dental care decisions by adding information within the online network directory to identify dentists who meet certain practice criteria. • Dental treatment cost estimator: Customers can obtain personalized out-of-pocket cost estimates for over 400 common dental procedures and treatments. Dental procedure estimates will be specific to the dentist's contract and product with Cigna. Estimates are calculated in "real-time" and personalized using your specific plan benefits, deductibles, and applicable co -pay or coinsurance fees. Select any dentist or specialist Your out-of-pocket expenses will generally be higher because out -of -network dentists have not agreed to offer Cigna plan customers negotiated rates. Depending on your plan design, out -of -network dentists may bill you for the difference between the payment they receive from Cigna and their usual fees. You may have to file your own claims. Please refer to your Summary of Benefits for specific plan details and any age and frequency limitations, and a complete list of exclusions and limitations. Enroll today Make sure that you don't miss your opportunity to enroll for this important benefit. All you need to do is: 1. Review your plan materials and consider your family's needs. z. Complete and sign the enrollment form and return it to your employer If your employer has a different process, follow those instructions. After you enroll We're there for you - when and how you need us, Visit myCigna.com for: • • Oral Health assessments and quizzes • Out-of-pocket dental cost estimates • ID Card info • Claim information • Plan information Network directory of dentists • Discounts on a variety of health and wellness products and services Always on the go? You can also utilize many of the above services with our mobile app. We are dedicated to providing better savings, better health, and a better experience. Our goal is to support you and your health, With Cigna, you benefit from a large network of dentists, discounted prices on quality dental care, and the tools you need to help you make informed decisions about your dental health. Enroll today and say yes to plans designed to provide better savings, better health, and a better customer experience. 77 Visit myCigna.com or call customer service at 800.Cigna24 (800.244.6224) for information about dental coverage, claim status, dental office locations, eligibility and plan verification, and much more. aeo Cigna® 1. www.adha.org (American Dental Hygienist Association), 2. Academy of General Dentistry. The Importance of Oral Health to Overall Health, January 2012. 3. NetMinder. DPPO data as of March 2014, including combined reported Cigna Dental Radius Network@ and Dental Network Savings Program counts of unique dentists. Data is subjectto change.The Ignition Group makes no warranty regarding the performance of the data and the results that will be obtained by using. 4. January 2015 projection, as of April 2014. 5. January 2015 projection, as of April 2014. 6.2015 industry projection based on actual 2012 Ruark Discount Study national industry results projected to 2015. Cigna projects to have higher net effective discounts than the industry average based on Industry projections for 2015 assuming an average 2% effective discount industry growth, based on historical industry trends, and an average 4% effective discount Cigna DPPO growth from 2012-2015. "Cigna"and the"Tree of Life"logo are registered service marks and"Cigna Dental"is a service marks of Cigna Intellectual Property, Inc., licensed for use by Cigna Corporation and its operatin. subsidiaries. All products and services are provided exclusively by and through such operating subsidiaries, including Connecticut General Life Insurance Company, Cigna Health and Life Insurance Company, Cigna HealthCare of Connecticut, Inc., and Cigna Dental Health, Inc. and its subsidiaries, and not by Cigna Corporation. 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. All models are used for illustrative purposes only. 877438 08/14 (Cigna Total DPPO) 02014 Cigna. 78 Cigna ,g. al Enrollment Form Employer: Complete Section A Employee: Complete Sections B, C & D Insured and/or Administered by Cigna Health and Life Insurance Company Please print and thank you for providing this information Cigna. ''' ,k,', ',,, 0j-.1.80.1'0611P sirrixi- - - - ,,,,;1,.,6iiko:Er4orroottoitroo.,-- ' ' "'. ' " fsidtt' ,, 5743SegtfttAt'',4**-44Z ''''''•e' , - ?0 '",4,,e4-%14%*,..4144._Vd&,1 ,4", ''EMOLOYEitt4AM ' " .,..0,-*.....st....„.,...A,- ' ''-"' ; ",,-; -,,71,., q.6...,-4,. .# "..g...-,,F.Not. k ,,, ..-'r r!,.., ' ' '-'6 .5W.AbotitsS7 - - ,. .1: ...' - ?I V 3 '4"•,,,,,, '' 4. • ,, . , --.•,,.• ,,, -,0,!. , ..!g ..,t.l. ...• .a., ,.., .. NE- ENROLL , ,RIEINSI A `.•!•,, - ' - '-' 'ko'''' r dgoc cpu N,-F,,. . . ,i , ,, ,%,',':., ,., ',' -,S,,,,,. "'itiiVi&ibilidiWietilifilc ,. •''AlloNrceAss. , :. . ., '6.1,,,tz.00,0.,,,,,,,'" ,,;. ,',.,., 4 ',,,- '',..„ ' .: ..„ _ ,,,'„: . . ..... „.„ . • ..• •, • •-,-. --• ,•:. 4 b-HIRE .i.(.. • , - ..,91,0979) ,,,, ,,,,,, • ,,,..,,.,. ' ,,,,,,,,,,,r 4...„--. • . , . dkjob• , , E'.4 .':.:,',A.,7k -,:,,,,,, 1, -,, ,4`:.,,,,,,,47;• , .. _ ge ...',nkre.„.1-)A,00 ',,, ..-Ccifiertotia: , ,.,," ..„..„,,,,,,,„0,,,,, • - „„,,,,,,,,,,,,,,,,,--, ,.,4,-., , ,..t, i.oeutNtatfiEFWOrillo0 ...i..,....p..i,....,*r.4.,..ao.,...v1Eza. -.,,,,,,,,,:,,4 --, : ,...s. ,...., - • 4 ' -0 ' 'i.,,• 1-.6--.--'0,E0,-,E',sevrAv :.t _ -,. . .,. .... ,.., ''' ,"'" , • A,' ''''''' ' — ,..... 4 , fb- 'iii . ,„ -6 •Ei sferAo.‘00 .. . 444 ,. , . ,.. , ,. - rw, - , , :. . ErnPI -o- 0 pndent e n an ;r sVNaM V. „ t.5111, - ' - d' 4r . , ra&1tir4:4,,4....sti4f,144,3:44,45411t,i06441,i44,,,t, ,. '..-., M. m • !Ill 1..,,,a m -..,....-.,:. 1 .... - .--e-v.:.. .....ir... e rnpl m n r- Dentala anotherpla .ri, '''' ., k,;,.....:At,,, .? ,v ,,0- - , .. .,, ., • ra - ..‘-, %., - i r, ' •,'", 4. , ',. — , .,,. ...., Tiansfet 114 ., , ',.,.. _,.. EMPLOYEE NAME (Last) (First) (Mi.) I I SOCIAL SECURITY NO. • 1 1 1 I I I I I EMPLOYEE DATE OF BIRTH (MM/DD/CCYY) HOME PHONE • ( ) WORK PHONE ( ) HOME E-MAIL ADDRESS EMPLOYEE IDENTIFICATION NUMBER . .. ,, " ADDRESS (Street) (City) (State) (Zip Code) I 1 1 WHAT IS YOUR PRIMARY LANGUAGE? (optiona0 DO YOU HAVE A DISABILITY AFFECTING YOUR ABILITY TO COMMUNICATE OR READ? (optiona0 . Yes II No SELECT PLAN: r--! Cigna Li Dental Care° g Cigna Dental EPO 0 Cigna Dental PPO 0 Cigna Traditional Xnifq 001110te tromyours) L,o,,'.4a0im.9'i,0ONvgg,'-,mwt*g-4mF.;waa'4iV15te,41.k0-m'4- w-V-rA,,,v4IgA&ig:W..'p-9O,.-,`,§,,1- N v SOCIAL?- A,.cupSap.NyeEM1l9,iet2'140, le V4 4IRTI1 ,. pi%AVTiia-k2,O0.F.,.'. I I 0*,VO;.,-444u pEqJpKovp007 • M E F iAVad.ZtOraEoI,. lo N., g4TpO.tlaFwaP4tg74vcs%aEtctoE.0em5.' - (for'PigpeiCare IY ist Choice - irX,,.;•, i, 5-IPi..iAtat4-,e„lse,.eidp,Vp,.,i.i.-tiyii,‘oipiYtg tirAt:COatKoWai IXgffi14 M M .,..-.. Add Cancel .7t •?,s, el, r Employee 2nd Choice - ..,.. Spouse .. I I 111 M • F 1st Choice - M II Add Cancel 2nd Choice - Dependent Relationship I I II M • F 0 1st Choice - D . Add Cancel 2nd Choice - ...-- Dependent Relationship • M • F 0 E. ist Choice - • 0 Add Cancel 2nd Choice - Dependent Relationship 111 M El F . . 1st Choice - DAdd 0 Cancel 2nd Choice - f6 A, Proof of student or handicapped status for overage dependents may be required. The original effective date must be completed for each member in order for continuous coverage credit to be applied toward waiting period. _ g:Du -44,-4-- SIGNATURE - The information provided above is true and correct to the best of my knowledge, and I accept the provisions on the reverse side of this form which I have read and understand. EMPLOYEE'S SIGNATURE/ DATE NOTE: Not all products are available for all clients or all states. Check your enrollment materials carefully to see what is offered for your group. DISTRIBUTION: White - Cigna Canary - Member Pink - Employer HC-ENR12 Generic Cat. #720000c Rev. 11-13 (OVER) PROVISIONS • The Cigna Dental Care (DHMO) plan is underwritten or administered by Cigna Dental Health Plan of Arizona, Inc., Cigna Dental Health of California, Inc., Cigna Dental Health of Colorado, Inc., Cigna Dental Health of Delaware, Inc., Cigna Dental Health of Florida, Inc., a Prepaid Limited Health Services Organization licensed under Chapter 636, Florida Statutes, Cigna Dental Health of Kansas, Inc. (Kansas and Nebraska), Cigna Dental Health of Kentucky, Inc. (Kentucky and Illinois), Cigna Dental Health of Maryland, Inc., Cigna Dental Health of Missouri, Inc., Cigna Dental Health of New Jersey, Inc., Cigna Dental Health of North Carolina, Inc., Cigna Dental Health of Ohio, Inc., Cigna Dental Health of Pennsylvania, Inc., Cigna Dental Health of Texas, Inc., and Cigna Dental Health of Virginia, Inc. In other states, the Cigna Dental Care plan is underwritten by Cigna Health and Life Insurance Company or Cigna HealthCare of Connecticut, Inc. and administered by Cigna Dental Health, Inc. • The term "DHMO" is used to refer to product designs that may differ by state of residence of enrollee, including but not limited to, prepaid plans, managed care plans, and plans with open access features. • The Cigna Dental PPO and EPO plans are underwritten or administered by Cigna Health and Life Insurance Company with network management services provided by Cigna Dental Health, Inc. and certain of its operating subsidiaries. The Cigna Traditional (Indemnity) plan is underwritten and/or administered by Cigna Health and Life Insurance Company. • I accept the coverage/insurance benefits provided by this group plan and authorize the processing of my enrollment in the coverage as indicated on this form. i authorize deduction from my earnings of the required contributions, if any, toward the cost of the coverage. • I authorize payment of benefits to the participating provider. • oauthorize any participating office to release records and billing information concerning me or my covered dependents to Cigna Health and Life Insurance Company and/or Cigna Dental Health, Inc. and its subsidiaries and affiliates for purposes of plan administration or for the purpose of validating and determining benefits payable. I further authorize Cigna Health and Life Insurance Company and/or Cigna Dental Health, Inc. and its subsidiaries and affiliates to release any records or information concerning me or my covered dependents to its designee, for purposes of plan administration and customer service. • California law prohibits an HIV test from being required or used by health insurance companies as a condition of obtaining health insurance coverage. Cigna Health and Life Insurance Company and/or Cigna Dental Health, Inc. and its subsidiaries and affiliates do not require such tests in any state as a condition of obtaining dental coverage. FRAUD WARNING Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information, or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which *is a crime, and shall also be subject to a civil penalty not to exceed five thousand dollars and the stated value of the claim for each such violation. (In Florida, this is a felony of the third degree. In New York, the civil penalty is not to exceed five thousand dollars and the stated value of the claim for each such violation. *In Nebraska, "is" is changed to "may be"). "Cigna" and "Cigna Dental Care" are registered service marks, and the "Tree of Life" logo is a service mark, 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 Cigna Health and Life Insurance Company, Cigna HealthCare of Connecticut, Inc., and Cigna Dental Health, Inc. and its subsidiaries. ©2013 Cigna �� I/ii • Ig na Dental DHMO (Front) ID CARD FEATURES escript on of ID card fi l Ggn'a.Dental'loga `.; I entrlogo(if_appl cable),, lient naiii`e(ifappl,'tabiej !' Dental Care Network(DHMO) Is.;CustomerlD';'_ ental0ffi�e ThisisaGeargia,requirementto:displayth tholDcatd WILL`IMPLEMENTONLY_ON'6A'Idcari [an'Contact Information ustom erand%or;Dependerit Names. 7ycignaaom;`websiteiniormation CLIENT NAME . 006 DENTAL CARE NETWORK (DHMO) Cigna O Dental Office: HEALTHY SMILES Call this number to schedule an appointment: 555.551.5511 0 Plan information, benefits and to locate a network dentist Call toll -free: 1.800.Cigna24 (1.800.244.6224) OD Account Website: www.accountwebsite.com T93122847 01 GREEN, GERALD T93122847 GREEN, ALISSA T93122847 GREEN, NICHOLAS T93122847 GREEN, KARSON i-§t1 fiend caw!fsize: 6f0D`c'ag 863XXX 04/13 Dental DHMO (Back) ID CARD FEATURES mThis card does not guarantee eligibility for benefits ® If required, mail referral forms to the following Cigna Dental location: Cigna Dental P.O. Box 188037 Chattanooga, TN 37422-8037 ® Cigna Dental refers to the following operating subsidiaries of Cigna Corporation: Connecticut General Life Insurance Company, Cigna Health and Life Insurance Company and Cigna Dental Health, Inc. and its operating subsidiaries and aff!iates. The Cigna Dental Care plan is provided by Cigna Dental Health plan of Arizona, Inc., Cigna Dental Health of California, Inc., Cigna Dental Health of Colorado, Inc., Cigna Dental Health of Delaware, inc., Cigna Dental Health of Florida, Inc., a Prepaid Limited Health Services Organization licensed under Chapter 636, Florida Statutes, Cigna Dental Health of Kansas, Inc., (Kansas and Nebraska). Cigna Dental Health nfKentucky, Inc., Cigna Dental Health of Maryland, Inc., Cigna Dental Health of Missouri, Inc., Cigna Dental Health of New Jersey, Inc., Cigna Dental Health of North Carolina, Inc., Cigna Dental Health of Ohio, Inc., Cigna Dental Health of Pennsylvania, Inc., Cigna Dental Health of Texas, Inc., and Cigna Dental Health of Virginia, Inc. In other states, the Cigna Dental Care plan is underwritten by Connecticut General Life Insurance Company, Cigna Health and Life insurance Company or Cigna Healthcare of Connecticut, Inc. and administered by Cigna Dental Health, Inc. m Catalog number m EDI Submitter No: 62308 Other;features: Fontsizecannot.be altered(madesmaller) "$taticlabels--except'product disdaimer,to be in 61ue coloras shown'on-ID:card-depictiion.' "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 exclusively by such operating subsidiaries and not by Cigna Corporation. Such operating subsidiaries include Connecticut General Life Insurance Company (CGLIC), Cigna Health and Life Insurance Company (CHLIC), and HMO -or service company subsidiaries of Cigna Health Corporation and Cigna Dental Health, Inc. In Arizona, HMO plans are offered by Cigna HealthCare of Arizona, Inc. In California, HMO plans are offered by Cigna HealthCare of California, Inc. In Connecticut, HMO plans are offered by Cigna HealthCare of Connecticut, Inc. In North Carolina, HMO plans are offered by Cigna HealthCare of Nora arolina, Inc All other medical plans in these states are insured or administered by CGLIC or CHLIC. 863XXX 04/13 V= 'ttigna_ Some content provided under license. 83 • - mIUMNI 8NNVMNIiINIM =mum NNEHIMIl NoN ENNIO MIN 'me INC MIN --• miwijimm Not Aso =man! — ism imen ENE am A A, Dental Claim Form HEAD@ri INFOF MATIC?W Cigna•17en1ad t40# Insured and/or Administered by `s`r"r Connecticut General Life Insurance Company and 'it's. 4:igna'Healtfit and L1te Insurance tvlyipany Formailing address, tali Ct6tome(5enuke at 1=800-24482 4 Cigna, 1. Type III D al Transecllon (Mark if applicable bortes) Statement of Actual Servares EP8DTf Th6)0% i♦ Requoal for PradeletmtnahonlPreauihortzatton ,'tjredeterminetionIPresutttorlaalbnNumbgr POLICYHOLDBW3UBSCHtOEI INFORMATION Pat InsufanceCompanyNea lir1,N3). k: Poiloineliler/Siebsaibefr'Wsme (Lasi,'FItat Middle l i5al, 'Stalk, Address, city, State; 2kp Cede. tNSURAWGE COMPANY/[DENTAL EENEFrr PLAN INPOriMATION ....__ - _... 3, Compariy/PlanNarrre:,Addrass. Ctty; Slala, Zip CUde 13,•Ra1e6i'13(1ll M!OP/CCYY} i4,.G¢nd9' OM 0 t 1.,iii,10 I%THER 0f VERAGE' ie, Plari/Group 14tenter 7: mployee Name 4.0t0er Daniel ar 4 dic i Cr?ovita8et e.,($101, 11 ). QYet (1 ompte1e :5°11} 19; Nana of PofwyhcldeiinubscrlberIn #4 (last; Firet:'M'aidfe initial: Sulfa) PATIENT INFORMATION 18, Relailonsbip ®S;e41 to' Po{icyhdlderl5upscober01 #t2 /il ova • 1.9pdttie. El .pependan(Clild El Oilier 13, S,tudent 5takig Ohl 0 Pis 6...D"alenf6lrthOAMIDDiCCYY) 't.r,an4#r M F 9;PNwyboldier/gtihacnberID(.5,81n(it4) 20.Name heel,First,Mldelt lhltlslf,Suffix),;ArldreeS;Clfy;State,f2lp'4toila 3. Ptanharbup Pt timber 111 Pttileiil .# IieFdllunotito it, Pert+uii t4amau in PO. 1J .sou n. $p0u8e ® Dependent 0 S]lher 11,ttiher theurattee Cri(npaii0' tal'Benefit plaii4erne Address ity(G.121e,2(PCode 1.Oats elRidh'(MMf0bi. CYY) 22,:GentieE �M ®F 23 kalalitIDlpcbsunt#{AsetgnedtiyDentist}: FtECOItD OF SEI 11OES PR YIOE13 24, Procedure Date ihiMr-PlOri . Q5,¢a`ea of OYat CaWty 2F3 ..' Toaih System 2T 'T VII1' fief(%) ortetten s) •28Tbot(i $t dace 29. (roGHti(re Ct?'de 3(F,17esctti?tlon $l.1 de 2' @'. 4 6 7 9. 1Q: MIS.SiNG TEETH IN1'ORMATION Permanent ,primary 32. pthor Fda(s} 34. (Plate an X' on each missing tooth) 3 4 1 4 G 7 8 3 10 11 12 13 14 15 16 A 5 C D E F G N, 1' 4 32 31' 311 29 28 27 26 25 24 23 22 2:1 20 19 19 '17 T 8: R Ci P 0N M L l 33,Tgtnt Fne 35. Rergar5§ AUTHORIZATIONS ANCILLARY OLJ !1REATMENT mewl `N[ATOM 39 1 have been tnfortired of the 1reetn ant plan and associated tees, l apnee lobo responsible (or` all alrarges for deital servfnas and materials not paid by my denlal1 benefit plan, unlase prphl Ay.by lav,,or• `the beeline decker 11 dpnlat praciioeJ es a rontradual agreelrient With rhyplan protehlti or portion of sU0I diarges;'To Ure akt4ntperantttedby taw i cahsent toy.out ties and disolosuae of my ptotenled h'aallh infurrnalWotocarryotdpayment atvUI $J8conneoUonw111h.Uiis'lairn, 38,-Plate o} Treatment- Provtder'a, 0f• ooe f 1Ho8pilsl •6CF � {`'tber 30, Number.o(6ridasur0S' 00`to 9'Hl . ,. atada r phla} o rl Imaye��} ricder(. i J P 4n,.1.,TtO4tntegt,7or0rtlwAun(i l' 014506rp41-*2) ErYes (Caanp10e4142) .41,pattAppilenee:Pledoel(MWerttOC,YY) 42,'Manlh5 fTte tnent IRemalniny 43,;Repto*ttonlo0PreaQtasis7 - .®1' .Yes (Campleie44) .. ...,... 44.:DateP$O. Pta4emenr(MM/DD/C'CYY} . ,__..... P tlenLJGuardiansignaturo Dale r�ny autlnrxfze a+id �rrect WiSI,N- v7.the drys tlr)hed0Pltat-bettyirte Mhptw'Ine payait,k,(otn, 4ane4y 61110ki viwnarned ' deMistIardentalenlIty. x 4$:treatmentResutbn fOni g fkcdpa 4i)al dlneselinlury 1J Auto:i:e0klelil CI Gtberacpident 46 `Dale r6iAc4kfeni (MM1oD CCVYj 47 A1to Angdenl State ,. $ubecra1er slgrialiira pats BaLt;INODENTi$T:OR DENTALENTiTY(1.eavoWank ifdenilsIor'denialentity(anot aubrnfiitng palm oo botintf of the patlenl orinsuredisubscebet) TREATItJO_DEPkTIST1,NG-114. ,1.111,4 LO0716N.i3F1RMd'i'ION,,., 53,1 ieteby certify lhaliha procedures asliid haled bjiifale'are (n progress ((tr pracedurtis Ihet neguird mUglpte visits)bilhavattaen camptnted. 4o,/Nalm,Aaarees,ttiy"'State ZipGette .Sn E ng;l74nhst 84td(Xreail j. pate 54. TIn 4 l6e644 N0060e 5E.Addre4s, City, Stara 21 C6d4 p : WA. Provider: SpeclaltyCtidi' • 49. NPt 5O.Ucensa Number $1 $SN oti1N 522.. Phone 5A Addillonal Prov/der. ID 57,Nuroi� r-{' .1 58AuhlnfabPer 2OO6 American Deritall. Association J400 (.Sams a"sADADsntal Clain Rani— J401, J402, J403, J4041 Ca%:ff5501154d Rev, 03/2012 AV& American Dental Association www:ada.org Comprehensive completion instructions for the ADA Dental Claim Form arc found in Section 4 of the ADA Publication titled CDT 2007/2008, Five relevant extracts from that section follow: GENERAL, INSTRUCTIONS A. The forrn,is designed so that the name and address (Item 3) of thethird-party payer receiving the claim (insurance company/dental benefit plan) is visible in a standard #10 window envelope, Please fold the form. using the `tick -marks' printed in the margin. B. In the :tipper-righr of the form, a blank space is provided for the convenience of the payer or insurance company, io allow the assignment of a claim or contt✓ol number. C. All items in the fonts must be completed unless it is noted on; the form or in the following instructions, that completion is not required. D. When a name and address field is required,the: full name of an individual or a full business name, address and zip code must be entered. E. All dates must include;thefour-digit. Year, F. if the number of procedures reported:exceeds• the number of lines available on one claim form, the remaining procedures must be listed an a separate, fully completed claim. form. COORbINATIONOF BENEFITS (COB) When a claim is being submitted to the secondary payer, complete the form in itsentirety and attach the primary payer's Explanation of Benefits OW showing the amount paid by the primary payer. • You may indicate the amount the primary carrier paid in the "Remarks" fiend (item # 35), NATIONAL PROVIPER:IDENTWIEIR (NPI) 49 and. 54 NPI (National Provider I'ndentifer): This iaan.identifier assigned by the Federal government to all providers considered to be HIPAA covered eatltras. Dentists.' who are not covered entities may elect to obtain an NPI at their discretion, or may be enumerated if required by a participating provider agreement with a third -party payer or applicablestate: law/regulation. An NPI is tinigtle to art individual dentist (Type 1 NPI.) or dental entity (Type 2 NPI), and has no intrinsic 'meaning. Additional information on MI and enumeration can be. obtained from theADA's Internet Web Site: www.ada.arg/goto/npi 52Aand58 Additional.Ivider D; Arint rlcrrtai, Put?ail/ Provider IIZ, This is anidentifier assigned to the trilling dentist or dental entity other than a Social Security Number (SSN)orTax Identification Number (TIN): It is not the provider's NPI. The additional identifier is sometimes referre to as a Legacy Identifier (LID). LTDs may notbe unique as they are assigned by different entities (e.g., third -party payer; Fede government). Some Legacy IDs have in intrinsic. meaning. PROVIDER SPECIALTY ,C:ODES 56A Provider Specialty Code: Enter the. code that indicates the type of dental professional who delivered the treatment. Available codes desei'ibin 'treating dentists are listed below. The general cede; listed as 'Dentist' may be usedinstead.. of any other dental pracli:tioner code. category / Description Code Code ....... ... Dentist A dentist is a. person qualified by a.doctorate. in dental surget°y (D.D.S) or dental r'rredieine (D.M D.) licensed by the: state to practice dentistry, and 'practicing within the scope of that .license. 122300000X General Practice 1223G0001X Dental Specialty (sce following list) Various Dental Public Health 1223D0001X Erdodontics 1223E0200X Orthodontics 1223X0400X Pediatric Dentistry 1223P0221X Periodontics 1223P0300X Prosthodontics 1223P0700X Oral & Maxillofacial Pathology 1223P0106X Oral & Maxillofacial Radiology 1223D0008X Oral & Maxillofacial Surgery 1223S0112X Denta ,provider taxonomy codes listed above are a subset of the full code set that is posted at: www.wpc-edi,coanlcodesltaxonamy Should there be any updates to ADA Dental Claim Form completion instructions, the updates will be posted on the ADA's web site at: www.ada,org/goto/dentalcode Caution: Any person who, knowingly and with intent todefraud any insurance company or other person: (1) files an application for insurance or statement of claim containing any materially false information; or (2) conceals for the purpose of misleading, information concerning any material fact thereto, commits a fraudulent insurance act. IMPORTANT CLAIM NOTICE Alaska Residents: A person who •knowingly and with intent to injure, defraud or deceive an insurance company or files a claim containing false, incomplete or misleading information -may be prosecuted understatelaw. Arizona Residents: For your protection, Arizona law requires the following statement to appear on/with this form. Any person who knowingly presents a false or fraudulent cairn far payment of loss is subject to criminal and civil penalties. The authorization shall remain ineffectforthe termofyour (overage. You Or Our designated representative is entitled to receive a copy of this claim form.. California Residents: Tor your protection, California law requires the following to appear on/with this form Any person Who knowingly preSentsa, false orfraudulent claim for the payment of a Toss is guilty of -a crime and may be subjectto fines andconfinerrment n state priso n, Colorado Residents, It is unlawful to knowingly -provide false, incomplete or misleading facts or Information to an insurance companyforte purpose of defrauding or attempting to defraud the company. Penalties may include imprisonment, fines, denial of 'insurance, and civil damages Any insurance company or agent of an insurance Company who knowingly provides false, incomplete or misleading facts or information to a policyholder or daintant for the purpose of defrauding: or attempting to defraud the policyholder or claimant with regard toi settlement or award payable from insurance proceeds shall bereported to the Colorado Division of Insura, cewithinthe Department of Regulatory Agencies. District of Columbia Residents•: WARNING It is a crime.to provide false or misleading Information to an:'insurer for. the purpose of defraiudingthe insurer or any other person. Penalties include imprisonment and/orfines, in addition, an insurer may deny insurance benefits if faise information materially related to a claim was provided by the applicant. Florida Residents: Any person who knowingly and with intent to injure, defraud or deceive any insurer files a statement of claim or an application. containing any false, incomplete or Misleading information is guilty of`a felony Oldie third degree, Kentucky Nesidents: Any person who knowingly and with intent to defraud any insurance company or other person files a statement of claim containing any materially false information or conceals, for the purpose of misleading,. information concerning any fact material thereto commits a fraudulent insurance act, Which is a crime, Mane Residents, it is a Crime to knowingly provide false; incomplete or misleading information to an insurance company for the purpose of defrauding the Company. P:gnalties relay include Imprisonment, fines or a denial -of insurance benefits. • Maryland Resii tents: Any person who knowingly and willfully presents false information in an.:application for insurance is guilty of a crime and may subject to fines and confinement in prison. Minnesota. Residents: A person who files a daim with intent to defraud or helps commit a fraud against an insurer is: guiltyof acrime,, New Hampshire Residents: Any person who, with a purpose to injure, defraud, or deceive any' insurance company,, files a statement of dairn containing any false, incomplete, or misleading information lssubjectto prosecution and punishment forinsurancefraud, as provided in. RSA 638..20, New Jersiey Residents.: Any person Who knowingly files a statement of claim containing any false or niisieading information is subject to criminal and tivi) penalties: NewYo•gic Residents: Any person who knowingly and with intent to defraud any insurance company orother person files atiapplication for Insurance or statement of claim containing any materlaliy false information., or conceals forthe.purpose of rn,isleading, information concerning any immaterial thereto, commits ar fraudulent insurance. act, which is a crime and shall also be subject, to a civil penalty. not to exceed $5000 and the stated value of the claim for each suchviolation. Ohio Residentsc Any person wh'p, with intent to defraud or knowing that he is facilitating a fraud against an insurer, submits an application or file's claim containing afalse or deceptive statement is guilty of insurancefraud.. Oregon Residents: Anyperson who knowingly and with intent to defraud any insurance company or other person: (1) files an application for insurance or statement of el:aim containing any .materially false information; or, (2) conceals for the purpose .of misleading; information concerning any ;material fact, may have committed a fraudulent Insurance act. . Pennsylv'anla Residents: Any person Who, knowingly and with intent to defraud any insurance company or other person, files an application for insurance or statement.of claim containing any Materially false information, or conceals for the purpose of misleading, Inforrnatlon concerting anyfa t material thereto, commits a fraudulent insurance act which is acrirrie and sribjeitssuch person tti criminal and civil penalties, Rhode Island. Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly presents false information in an application for insurance is guilty of a crime and maybe subject to fines and confinement in prison. Tennessee Residents:it is a crime' to knowingly provide. false, incomplete or misleading information to an insurance compa•ny'fQr the purpose of defrauding the Company,. Penalties in CItfde:iftiprisnnmeiit, fines -and denial of insurance beiieef s. Texas Residents: Any person who knowingly presents a false or fraudulent claim for. the payment of:a loss is guilty of a crime and maybe subject to fines and confinement in stateprison. Virginia Residents: Any person who, with :the intent to defraud or knowing that he isfacilltating a fraud against an insurer; suubmits;an application:arfiles a claim containing a false* deceptive statement may have violated state.law, Washington Residents: it is a crime to: knowingly provide false, incomplete, or misleading information to an insurance company for the purpose of defrauding the company. Penalties include imprisonment, fines, and denial of insurance benefits. Tipp.' is a registered service mark, and the. "Tree of Lire" logo and "Cigna Dental" are service marks, of Cigna intellectual Property, inc.; licensed for. use' by Cigna Corporation and;ita operating riPlipkiieripe. All prGduct., and orvlaei. are provided l y br'through eUch operating suboidic rieo grid not by Ogee C.orporotroni, Such operating; subsidiaries include Connecticut General Life insurance Company„ Cigrie health a:nd Lrf .Insurance Company, end HMO or service corrSpaiiy subsidiarleof Cigna Health Corporation and Crgna Dental H s.ealth, Inc. socisat1 Rev.03/2612 863865 03/13 Introducing the simple, personalized myCigna Mobile App. You're busier than ever. At Cigna, we get that. While we can't wave a magic wand and make all the frustrating, time-consuming aspects of your life go away, we can give you a tool to help make your life easier. And healthier. The all -new myCigna Mobile App gives you a simple way to personalize, organize and access your important dental information - on the go. It puts you in control of your health, so you can get more out of life. os°Q0a 61 °°�°Cigna. Offered by: Cigna 1ealth and Life Insurance Company, Connecticut General Life Insurance Company, or their affiliates. 88 fir® BIG FEATURES. Health care professional directory • Search for a dentist from the Cigna national network • Access maps for instant driving directions Coverage • Get important details on your plan, like what you'll pay in- and out -of -network • Track and manage plan deductibles and coinsurance ID cards • Quickly view dental ID cards (front and back) for everyone on your plan • Easily print, email or scan right from smartphone Claims • View and search recent and past dental claims • Bookmark and group dental claims for easy reference Health wallet • Store and organize all important contact info for dentists and dental facilities • Add dentists to contact list right from a claim or directory search Get the myCigna Mobile App from the App StoresM or Google PIayTM. Available on the App Store 00 ANDROID APP ON Goo*Ie play ®y Cigna° The Apple logo isla trademark ofApple Inc., registered in the U.S. and othercountries. App Store is a service mark of Apple Inc. Android and Google Play are trademarks of Google Inc. The downloading and use of the App is subject to the terms and conditions of the App and the online stores from which It is downloaded. Standard mobile phone carrier and data usage charges apply. Actual Mobile App features available may vary depending on your plan. The listing of a health care professional or facility in the mobile directories available through the myCigna Mobile App does not guarantee that the services rendered by that professional or facility are covered under your specific dental plan. Check your official plan documents, or call the number listed on your ID card, for information about the services covered under your plan benefits. "Cigna"and the"Tree of Life" logo are registered service marks, and "GO YOU"and "Your Health Has Met Its App" are service marks, of Cigna Intellectual Property, Inc., licensed for use by Cigna Corporation and its operating subsidiaries. All products and services are provided by orthrough such operating subsidiaries and not by Cigna Corporation. Such operating subsidiaries include Connecticut General Life Insurance Company, Cigna Health and Life Insurance Company, Cigna HealthCare of Connecticut, Inc., and Cigna Dental Health, Inc. and its subsidiaries. 88 863865 03/13 © 20'13 Cigna. Some content provided under license. The newly designed, customized site makes it easier to quickly find exactly what you're looking for: • Find a dentist or specialist • View your dental coverage details • Use the Dental Treatment Cost Estimator to estimate costs ■ Learn about your oral health risks with the Gum Disease Assessment and other interactive tools Registering for myCigna.com is easy: 1. Visit www.myCigna.com 2. Click on the "Register Now" button 3. Complete the following four steps: "Enter Personal Details," "Confirm Your Identity," "Create User ID" and "Review & Submit." Important dental information is waiting for you on www.myCigna.com 4t4.9 6 4. Cigna "Cigna" and "Cigna Dental Care" are registered service marks, and the "Tree of Life" logo and "GO YOU" are 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 Cigna Health and Life Insurance Company (CHLIC), Connecticut General Life Insurance Company (CGLIC), and HMO or service company subsidiaries of Cigna Health Corporation and Cigna Dental Health, Inc, All models are used for illustrative purposes only. © 2012 Cigna. Some content provided under license. 89 We invite you to call us during your enrollment period. We look forward to hea ri nc from you. o®�®d10d lizoto r go' op 1 r Cigna. Caring that you make the right choice. Need help deciding if Cigna coverage is right for you? The information you're looking for is just a phone call away! A helpful, friendly resource. Learn more about the features and advantages of Cigna coverage. Call today and speak with a knowledgeable enrollment specialist for: • Information on specific plans. • Help finding participating dentists. • Comparisons of all Cigna products and resources available to you. This service is limited to providing information only. Enrollment cannot be completed through this line. Please contact your employer for enrollment instructions. "Cigna"the "Tree of Life" logo and"Cigna Dental Care" 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 Company (CHLIC), Cigna HealthCare of Connecticut, Inc., and Cigna Dental Health, Inc. and its subsidiaries. Cigna Dental PPO plans are underwritten or administered by CGLIC or CHLIC, with network management services provided by Cigna Dental Health, Inc. and certain of its subsidiaries. In Arizona and Louisiana, the insured Dental PPO plan offered by CGLIC is known as the "CG Dental PPO". In Texas, the insured dental product is referred to as the Cigna Dental Choice Plan. Cigna Dental Care (DHMO) plans are underwritten or administered by Cigna Dental Health Plan of Arizona, Inc., Cigna Dental Health of California, Inc,, Cigna Dental Health of Colorado, Inc., Cigna Dental Health of Delaware, Inc., Cigna Dental Health of Florida, Inc., a Prepaid Limited Health Services Organization licensed under Chapter 636, Florida Statutes, Cigna Dental Health of Kansas, Inc. (Kansas and Nebraska), Cigna Dental Health of Kentucky, Inc. (Kentucky and Illinois), Cigna Dental Health of Maryland, Inc., Cigna Dental Health of Missouri, Inc., Cigna Dental Health of New Jersey, Inc., Cigna Dental Health of North Carolina, Inc., Cigna Dental Health of Ohio, Inc., Cigna Dental Health of Pennsylvania, Inc., Cigna Dental Health ofTexas, Inc„ and Cigna Dental Health ofVirginia, Inc. In other states, Cigna Dental Care plans are underwritten by CGLIC, CHLIC, or Cigna HealthCare of Connecticut, Inc. and administered by Cigna Dental Health, Inc. In Illinois, Cigna Dental Care plans are considered Prepaid Dental plans, All models are used for illustrative purposes only. 878158 07/14 © 2014 Cigna. Some content provided under license. Learn more Nothing is more important than your health. That's why there's myCigna.com -• your online home for assessment tools, plan management, dental health information and much more. Once you've enrolled in a Cigna dental plan, you can use myCigna.com to: • Choose dentists and create, download and print a personal directory • Verify plan details such as coverage, coinsurance/ copays, and deductibles (the amount you pay before your plan starts to pay). • Print a dental ID card. • Get the forms you need. • Access dental health information through WebMD° Dental Health Resource Center. • Estimate your dental costs before your next visit. Get to know your oral health Are you at risk for gum disease? Knowing the answer to this question could help your overall health. That's because research shows an association between gum disease and other health conditions like diabetes, heart disease and stroke. Pregnant women with untreated gum disease may be at an increased risk for delivering preterm and/or low birth weight babies. Think cavities are just for kids? Think again. Many adults have untreated cavities (25% of those 20-44 years, 21% of those 45-64 years, and 20% of those 65 years and older).' And tooth decay (cavities) is the single most common chronic childhood disease four times more common than asthma? Assess your risks The Periodontal (gum) Disease and Cavity Risk Assessment Tools are designed to help you and your dentist identify factors that might increase your risks for gum disease and cavities. The quizzes are quick and easy. The Periodontal Disease Risk Assessment is just 20 questions. The Cavity Risk Assessment is just 12 questions for adults and 16 questions for children under age 12. And when you complete the quizzes, you'll get detailed score sheets that tell you whether you are low risk, low to moderate, moderate risk or high risk for gum disease or tooth decay, depending on which quiz you've taken. Take the quizzes today and share the results with your dentist at your next dental checkup. Please note that these tools serve as a guideline to assess your risks for cavities and gum disease. It's important to visit your dentist on a regular basis to discuss your oral health. 1. www.cdc.gov/oralhealth/factsheets/dental° caries American Dental Association; May 31, 2012, CDC report: Selected Oral Health Indicators in the United States, 2005-2008, 2. Surgeon General's Report on Oral Health in America Centers for Disease Control and Prevention, July, 10 2013, Preventing Dental Caries With Cornmunity Programs. GO YOU® °0 .®0' �� Cigna® 592684 k 04/14 Offered by: Connecticut General Life Insurance CompRrhy or Cigna Health and Life Insurance Company. Prevention is key Regular dental visits may do more than brighten your smile. Research shows receiving regular dental care often catches minor problems before they become major and expensive to treat. Practice prevention and take advantage of your plan's preventive care services - certain services may be covered at low cost or no cost to you when you visit a network dentist. Covered services* may include, but are not limited to: Oral exams Cleanings Fluoride treatments X-rays Oral cancer screening *The following is not an exhaustive list of exclusions and limitations. See your plan documents for additional details. Exams, cleanings and fluoride treatments are limited to 2 per calendar year, Routine x-Rays are limited to: Bitewings: 2 per calendar year, non -routine x-rays are limited to: Full mouth:1 every 3 calendar years; Panorex: 1 every 3 calendar years. The frequency limitations of certain other covered services are set forth on your plan benefit schedule. We're here when you need us We know that sometimes you need us at odd hours - late at night, on the weekend or during a national holiday. Sometimes your questions just can't wait for "normal business hours." • "My son is away at college. Can you help me find a network dentist close to his school?" • "My dentist told me I need a root canal. Does my dental plan cover this?" • "My husband has a painful toothache, but he's in Phoenix on a business trip. Can you help me find a dentist?" That's why our Custorner Service hours include weekdays, Saturdays, Sundays and holidays. Call us at 8OO.Cigna24 any time you need us - we'll be there. We're on the clock for you 24 hours a day, 7 days a week, 365 days a year. Health and wellness discounts Save money when you purchase health and wellness products and services through the Cigna Healthy Rewards° program.3 Programs include: Weight and nutrition management Fitness Tobacco cessation. Vision and hearing care Vitamins, health and wellness products • ' Alternative medicine • Anti -cavity products • Healthy lifestyle products 3. Healthy Rewards is a discount program. If your plan includes coverage for any of these services, this program is in addition to, not instead of your plan benefits. Healthy Rewards programs are separate from your benefits. A discount program is NOT insurance, and you must pay the entire discounted charge. Some Healthy Rewards programs are not available in all states and programs may be discontinued at any time. rCigna. "Cigna, "Healthy Rewards", the "Tree of Life" logo and "GO YOU" are registered service marks, and "Cigna Dental," is a service mark, of Cigna Intellectual Property, Inc., licensed for use by Cigr} Corporation and its operating subsidiaries. All products and services are provided exclusively by such operating subsidiaries, including Connecticut General Life Insurance Company, Cigna Healt and Life Insurance Company, Cigna HealthCare of Connecticut, Inc., and Cigna Dental Health, Inc. and its subsidiaries, and not by Cigna Corporation. 592684 k 04/14 © 2014 Cigna. Some content provided under license. 92 SMILE! It's easy to find a network dentist or specialist. Finding a Cigna Dental PPO (DPPO) network dentist or specialist is quick and easy - whether you prefer searching online or speaking to a customer service representative. Let us show you how: You can find a DPPO network dentist from the online directory on Cigna.com ) Go to Cigna.com, click on "Find a Doctor". at the top of the screen. ) Then, choose a Directory by clicking on the "If Your Insurance Plan is Offered through Work or School" option. Next, click on "Find a...Dentist." F040 A boa'TC , DENTIST OR FACILITY wnwnto.4.1%tdwwisodorettmtvme.Mfir ttMeivell.v fiik. amrtaa-.ariii,th_,au+rmac '1•W07.4rVry.0.1e.ftCat48etkdtkH+vtt5M,41,11 irals taa.alicattli f:.a xJ Js L. xnr..r•rr�tm�a�f%iV,iVc Vinci a... ) Enter SEARCH LOCATION - city, state or zip code. ) SELECT A PLAN by clicking on the Pick drop down icon and selecting "Cigna Dental PPO or EPO" under the Dental Plans section. Then press choose. SER'EC'i A PLAN FOR YOUR RRAROPil IP YCU A#,RFAIiY HANK ACIONA PLAN. ,a...t... r,hu.a,.mAray..R.A.nakamtva.arenaraomvPanain.f.a.komlVwtSvr..nlafMMAIfmmmfnsel�.te IF YGu A1:14. LOCKING FOR ACrANA P}.AN... sOtOn Naio yrw HNdr bSnanohVtex[grok6?4,a,”11... 11 TNiii Mi T11. PUNSAVANMLI HI YOUR 4dA110140L04A110N261I0..A00,IL YiotCAi ILANf ubAaA t MYP.AAA:Ct)Ytf Y.VMEM, CCdiueiHPIA,t ,kika:keFUMC,APUi NfrilCi!oLLNe tertvfits n PPS raa .C#¢.uAAk !44I.. MK4.P.= kYkl;aNelNgentCil IX/?. Mnaxx,t:tuu MnrfznC.eeWArvh.5ie 1[MU ofnTAtn.nit e kow .aeui.r f' [gm1,..1 nMU �rg'u-aCmVIPFVE.. r CaikajV11,0P004 nmalim14.@n muttMnxr;Yl�+MtMNweMn,44, kk amt.'Aa!OJ (continued on next page) ith1l 9 it the search results, you'll 5eeabe als 5 � hel j�ou identify potential savings Totall Cigna_ DPPO When searching undo a DPPO plan, all in network dentists are labeled as Participates in Total°Cigna ` `i DPPb?' These dentists have all agreed to offer services at lower negotiated rates Within this network we ofger two discoun ®�,,Cigna. el.� Offered by: Cigna Health and Life Insurance Company, Connecticut General Life Insurance Company or their affiliates. This brochure is not intended for residents of New Mexico. 877496 09/14 © 2014 Cigna. Some content provided under license. 93 If you want to narrow your search, you can also type in key words, like dentist name, specialist type or office name. Then, click "Search." From the Search Results page, you can further refine your search results - by distance, specialty, years in practice and additional languages. Click on a dentist's name for more details, including multiple location listings with map view. Go to myCigna.com - the easiest way! MyCigna.com automatically knows which Cigna dental plan you belong to. Your home zip code will be entered automatically, but you can change the zip if you are looking for a dentist in another area. Once you're enrolled, you can search for a network dentist by name, specialty or location at myCigna.com (registration is required). After logging in to myCigna.com, click on "Find a Doctor" or "Service" at the top of the page. ) Enter your search criteria and click "Search", OR ) Click on "Dentist" under the "Find a Person" heading and double-click a specialty dentist by category. This information is also available on the myCigna mobile app. Call us at 800.Cigna24 (800.244.6224) For assistance locating a Cigna network dentist or specialist, use the automated Dental Office Locator or speak to a customer service representative. You can also request a customized directory based on the type of dentist you are looking for in your area, Call yourcurrent dentist to see if he or she participates • When you call, be sure to ask if your dentist participates in the Cigna dental network for your plan. Call or click to find a network provider that's right for you At Cigna, we are dedicated to providing better savings, better health and a better customer experience. Our goal is to support you and your dental health. From full -service to self-service, Cigna has your provider search covered. 1)6 ( Cigna. 1 Dentists who participate in Cigna's network are independent contractors solely responsible for the treatment provided and are not agents of Cigna. All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company, Connecticut General Life( Insurance Company, Cigna HealthCare of Connecticut, Inc., and Cigna Dental Health, Inc. and its subsidiaries, and not by Cigna Corporation. 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. All models are used for illustrative purposes only, The Cigna name logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. 94 877496 09/14 CD201'4 Cigna. Some content provided under license. Cigna provides customized mobile access to dental benefits h'Cigna's ew'clental mobile �nreb page, emp i access enrollment and Mani nlormatiori an= rb� � dis he ing diem stay connecter on, evce w iakrs somefl ing ta; snide Customized information - just for you Cigna's mobile site provides custom plan -specific content. Features include: • Customized enrollment information Plan details, including patient charge schedules and benefit summaries • Claim information via myCigna.com • "Find a Dentist" search function • Educational videos • Risk -assessment tools Access to 24/7 customer service center This content is customized to provide employees with information that fits their plan - and their on -the -go lifestyle. Easy to access, easy to use Employees can easily access the mobile web page using a QR code or a custom web address through most smart phone devices. The QR code and custom web URL can be included on printed and electronic communication materials. Check out a sample by scanning the QR code! (Best viewed on a smart phone). You can also access by going to http://abccompany.dentalbenefits.mobi. Welcome, ABC Company Employees! Explore yourdental beneille by clicking the buttons below: myCi jna irear=swo'For benefit and claim information after you enroll Your destination for dental information Our new mobile web page gives customers a single destination for dental information. From enrollment and beyond, Cigna makes dental benefits easier. One site. One stop. Give us a click and check us out. ArCigna. Offered by: Cigna Health and Life Insurance Company, Connecticut General Life Insurance Company or their affiliates. "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, Cigna Health and Life Insurance Company, and HMO or service company subsidiaries of Cigna Health Corporation and Cigna Dental Health, Inc. 877435 07/14 © 2014 Cigna. Some content provided under license. 95 Cigna Dental You can estimate and plan for your dental care costs using the treatment cost estimator on myCigna.com. This user-friendly, web -based tool allows you to get dental estimates based on your specific plan design and geographic location. This tool is flexible, enabling you to get estimates at a procedure or treatment level. A treatment level estimate is usually more accurate because it represents a group of procedures used to treat or resolve a specific dental condition or disease. This gives you a better understanding of what you may pay when you visit the dentist. Benefits and features* With the treatment cost estimator tool, you can; Estimate the approximate cost of treatment prior to the actual treatment. Compare the financial impact if you visit an in -network vs. an out -of -network dentist. Understand how much money you are saving as a result of your plan membership. Search by key words, procedure codes, treatments, dental categories and much more. • Access the dental glossary where you can find descriptions of key dental terms. View (DPPO and Dental Indemnity) your specific plan information such as annual maximums, annual deductibles and much more. View (DHMO) your specific plan information such as patient charge schedule, age and frequency limitations and much more. Our treatment cost estimator tool makes it easier and more,convenient for you and your family to learn about your oral health, dental benefits and the costs associated with receiving dental care. 0,004 '.� VOlb061: fir' g e�®gym na. Offered by: Cigna Health and Life Insurance Company, Connecticut General Life Insurance Company or their affiliates. *The availability of certain features may vary depending on your plan. The Treatment Cost Estimator is for informational purposes and provides rough calculations only, based on the treatment or procedure you choose. It does NOT guarantee the exact amount ofyour out -of pocket costs and it does NOT guarantee coverage for any treatment or procedure or any dental benefit plan payment. Your actual out-of-pocket cost for dental care will depend on the specific terms of your dental benefit plan. The term "DHMO"is used to refer to product designs that may differ by state of residence of enrollee, including but not limited to, prepaid plans, managed care plans, and plans with open access features. "Cigna,"the "Tree of Life"logo and "GOYOU"are registered service marks, and"Cigna Dental" is a service mark, 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 Company (CHLIC), Cigna HealthCare of Connecticut, Inc., and Cigna Dental Health, Inc. and its subsidiaries. Cigna Dental PPO plans are underwritten or administered by CGLIC or CHLIC, with network management services provided by Cigna Dental Health, Inc. and certain of its subsidiaries. In Arizona and Louisiana, the insured Dental PPO plan offered by CGLIC is known as the"CG Dental PPO'. In Texas, the insured dental product is referred to as the Cigna Dental Choice Plan. Cigna Dental Care (DHMO) plans are underwritten or administered by Cigna Dental Health Plan of Arizona, Inc., Cigna Dental Health of California, Inc., Cigna Dental Health of Colorado, Inc Cigna Dental Health of Delaware, Inc., Cigna Dental Health of Florida, Inc., a Prepaid Limited Health Services Organization licensed under Chapter 636, Florida Statutes, Cigna Dental Health of Kansas, Inc. (Kansas and Nebraska), Cigna Dental Health of Kentucky, Inc., Cigna Dental Health of Maryland, Inc, Cigna Dental Health of Missouri, Inc„ Cigna Dental Health of New Jersey, Inc., Cigna Dental Health of North Carolina, Inc., Cigna Dental Health of Ohio, Inc„ Cigna Dental Health of Pennsylvania, Inc., Cigna Dental Health of Texas, Inc., and Cigna Dental Health of Virginia, Inc9W other states, Cigna Dental Care plans are underwritten by CGLIC, CHLIC, or Cigna HealthCare of Connecticut, Inc, and administered by Cigna Dental Health, Inc. All models are use for illustrative purposes only. 868431 05/13 © 2013 Cigna. Some content provided under license. Cigna Dental Oral Health Integration Program° Get the dental services you need for your medical condition. And get your money back too. What is the Cigna Dental Oral Health Integration Program? It's a program that reimburses out-of-pocket costs for specific dental services used to treat or help prevent gum disease and tooth decay. The program is for people with certain medical conditions that research shows maybe impacted by dental care. There are other perks to the program too, like discounts on prescription and non-prescription dental products and information about behaviors that can affect oral health, There's no additional cost for the program - if you qualify, you get reimbursed!' Do I qualify? If you have a Cigna dental plan, you're eligible for the program. It doesn't matter if you have a Cigna medical plan or not. The only requirement is that you have one of the following medical conditions: Diabetes • Heart disease • Pregnancy • Stroke • Organ transplants • Chronic kidney disease • Head and neck cancer radiation *You do not need to meet your plan's deductible to receive reimbursement for these services. However, any reimbursement you receive will apply to and is subject to your plan's annual maximum. If my dental coverage has a plan maximum or deductible, how do procedures covered under the program get applied? Any procedures covered under the program are not applied toward your plan's annual deductible; however, do count towards your plan's annual maximum. If I go out -of -network, will the services covered under this program still apply? If your plan does not include coverage for out -of -network services, then you must use a dentist in your plan's network for coverage under this program to apply. If your plan includes out -of -network coverage, you will be reimbursed for your covered expenses whether you choose to use an in -network or out -of -network dentist, However, if you use an out -of -network dentist you may have out-of-pocket costs because the dentist may choose to bill you for charges that are in excess of what your plan reimburses for covered expenses. Offered by: Cigna Health and Life Insurance Company, Connecticut General Life Insurance Company, and/or Cigna Dental Health, Inc. and its subsidiaries. 830527f 05/14 97 toe m°�OAo® gna. What dental services are covered under the Cigna Dental Oral Health Integration Program? Check the chart below to see which dental services are covered for each qualifying medical condition. WOO '1074 Head and neck cancer racliation Organ transplants 1. D4910: Four times per year. 2. D0120, D0140, and D0150: One additional evaluation. 3. D1110: One additional cleaning. What other perks does the Oral Health Integration Program include? Dental care doesn't just happen at the dentist's office. So when you submit a Registration Form, you'llget up to 50 percent off average retail prices on the following prescription dental products through Cigna Home Delivery PharmacySM* - no matter who your pharmacy carrier is: • Chlorhexidine prescription anti -bacterial rinses • Fluoride prescription toothpaste • Fluoride prescription rinses • Fluoride prescription gels You can also ask for free samples and other discounts on non-prescription dental products. When you submit a Registration Form, you can also choose to get information on how stress, fear of going to the dentist and tobacco use can affect your oral and overall health. But more importantly, we'll tell you what you can do to overcome these destructive behaviors. *You should check any insurance or other benefits you have before using these discounts, as those benefits may result in lower costs to you. 4. D9110: No limitations. 5, D1206, D1208 and D1351: All other limitations apply. How does it work? If you have a medical condition that qualifies to get any of the covered dental procedures in the table above, you'll get reimbursed for 100% of your copays (the fixed amount you pay at your dental visit) or coinsurance (a percentage of the cost that you owe). . Here's how to get reimbursed: 1. Fill out the Registration Form. This is required only one time per qualifying medical condition. You can find it on myeigna.com, Cigna.com or by calling the number on your ID card. Remember to check off any additional information you may want about Cigna Home Delivery Pharmacy discounts and/or behaviors that can affect oral health. 2. Mail in your completed form to Cigna at the address listed on the Registration Form. 3. Visit your dentist and pay your usual copay or coinsurance amount for the covered service. We'll send your reimbursement within 30 days. °ede 4,4t°oCigna. The Cigna Dental Oral Health Integration Program may not be available under your specific plan. Check your plan documents or call the number on your Cigna ID card for information about your plan. "Cigna," the "Tree of Life" logo, "GO YOU" and "Cigna Dental Oral Health Integration Program" are registered service marks, and "Cigna Dental," and "Cigna Home Delivery Pharmacy" are service marks, of Cigna Intellectual Property, Inc., licensed for use by Cigna Corporation and its operating subsidiaries. All products or services are provided by or through such operating subsidiaries and not by Cigna Corporation, Such operating subsidiaries include Connecticut General Life Insurance Company, Cigna Health and Life Insurance Company, Cigna HealthCare of Connecticut, Inc., Tel -Drug, Inc., Tel -Drug of Pennsylvania, LLC, and Cigna Dental Health, Inc., and its subsidiaries, including Cigna Dental Health Plan of Arizona, Inc,, Cigna Dental Health of California, Inc., Cigna Dental Health of Colorado, Inc„ Cigna Dental Health of Delaware, Inc., Cigna Dental Health of Florida, Inc., a Prepaid Limited Health Services Organization licensed under Chapter 636, Florida Statutes, Cigna Dental Health of Kansas, Inc. (Kansas and Nebraska), Cigna Dental Health of Kentucky, Inc., Cigna Dental Health of Maryland, Inc., Cigna Dental Health of Missouri, Inc., Cigna Dental Health of New Jersey, Inc., Cigna Dental Health of North Carolina, Inc., Cigna Dental Health of Ohio, Inc., Cigna Dental Health of Pennsylvania, Inc., Cigna Dental Health of Texas, Inc., and Cigna Dental Health of Virginia, Inc.. "Cigna Home Delivery Pharmacy" refers to Tel -Drug, Inc, and Tel -Drug of Pennsylvania, LLC. 830527 f 05/14 © 2014 Cigna. Some content provided under license. 98 life of a Claim a fully integrated approach to processing claims Claim received and scanned into electronic format -0111=== Mit • - • Value-added clinical review of claims • Claim system automatically flags more than 200 procedures for higher review • 3-tier review approach (Benefit Analysts; Dental Reviewers; Licensed Dental Consultants) Electronic Gateway Image Repository Claims Review Check, EOB or Correspondence EXIAlicifkliCiti Istotillt • 54rver.arirctIOdos. biliticasee 1MSS. p4g f'DoS) .5.-crnt Applications Cigna. 99 Cigna Network Analysis Cigna DHMO Created for... City of Miami June 2015 Created with the Quest Analytics Suite Copyright © 2003-15 QuestAnalytics, LLC. 100 Cigna Network Analysis Access Summary for All Employees With Access 2 June 2015 Created for... City of Miami Access Analysis All Accessibility - Cigna DHMO - All Employees - Dental Providers Employee Group All Employees Provider Group Cigna DHMO - Open General Dentists Cigna DHMO -Endodontists Cigna DHMO - Periodontists Cigna DHMO - Oral Surgeons Cigna DHMO - Orthodontists Employee Name All Eniptoyees, e. Employees With Access Provider Name Standard ;Cigna DHMO Open General Dentists. , ,,, , ; Cigna DHMO - Endodontists Cigna,DHMO„ Periodontists Cigna DHMO - Oral Surgeons i. na-DHMO -Orthodontists 21n' 5 miles, 2 in 15 miles 2 in15 miles 2 in 15 miles 2 in 15 miles ;99`1' 3,437 3;368 6,133 With Access Average Distance 1 2 985 97.9 977 98.2 985 State City Miami Gardens Employee Key Geographic Areas Provider Name Cigna,DHMO 'Endodontisfs„� ,x,`" Cigna DHMO Open General Dentists Cigna'DHMO Oral.Siirgeons Cigna DHMO Orthodontists Cigna DHMO ;Periodontists , , Cigna DHMO Endodontists Cigna; DHMO - Open Genetal'Dentists Cigna DHMO -Oral Surgeons Cigna DHMO ' Orthodontists. Cigna DHMO - Periodontists Cigna DHMO. ,°Endodontists. , Cigna DHMO -Open General Dentists Cigna DHMO =Ora! Surgeons „ '4 Cigna DHMO - Orthodontists Cigna DHMO` Periodontists ; .• Cigna DHMO - Endodontists Cigna DHMO Open General Den#fists Cigna DHMO - Oral Surgeons Cigna DHMO ::Orthodontists. Cigna DHMO - Periodontists Cigna DHMO - Endodontists - Cigna DHMO - Open General Dentists Cigna DHMO='Oral •Surgeons=: Cigna DHMO -Orthodontists Cigna DHMO .Periodontists Cigna DHMO - Endodontists Cigna DHMO - Open General Dentists Cigna DHMO - Oral Surgeons Cigna DHMO - Orthodontists Cigna DHMO - Periodontists Cigna DHMO -'Endodontists Standard 2 in 15miles_,- 2 in 15 miles 2 in 15 miles, ,: , 2 in 15 miles 2 in 15_miles . , 2 in 15 miles 2 in154miies 2 in 15 miles 2 in 15'miles , . " 2 in 15 miles 2 in 15.'miles. 2in15miles_ 21n,15miles ;: 2 in 15 miles 2'in 15miles 2 in 15 miles 21n.S5miles': 2 in 15 miles 2 in;15 miles 2 in 15 miles 2 in 15 Miles, 2 in 15 miles tin 15miles 2 in 15 miles 2 in 15 miles 2 in 15 miles 2 in 15 miles 2 in 15 miles 2 in 15 miles 2 in 15 miles 2 in 15 miles h_,27 129 52 60 27 18 21 35 11 8 28 36 32 26 2 0 0 0 1 6 4 3 3 With. Access Average Distance A % 0 1 2 .1578 1,578 1.578 1,578 1,578 208 208 208 208 208 137 137 �137 137 137. 76 76 76 76 76 62 62 62 62 62 57 57 57 57 57 50 1000' 100.0 100A. 100.0 100:0. 100.0 100.0 100t0: 100.0 100:R: 100.0 1000' 100.0 100.0 100.0 100.0 100.0 10o.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 23 0.8 1„8 1.3 0.5 1.7 1.8 1.9 20 1.0 1.9 1.7 2.0 3.2 1.5 2.4 3.1 3.1 1.3 30. 1.2 2.4. 2.1 23 1.5 12 1.8 17 1.7 1.8 2.9 1.6 2.3 2.1 2.5 4.1 1.7 3.3 1.9 3.2 9.1 2.2 3.4 3.1 3.2 3.7 © 2015 QuestMalylics, LLC Cigna Network Analysis Access Summary for All Employees Without Access 3 June 2015 Created for... City of Miami Access Analysis All Accessibility - Cigna DHMO -All Employees - Dental Providers Employee Group All Employees Provider Group Cigna DHMO - Open General Dentists Cigna DHMO - Endodontists Cigna DHMO - Periodontists Cigna DHMO - Oral Surgeons Cigna DHMO - Orthodontists Employee Name 2,399 Employees Without Access Provider Name Cigna DHMO - Open General: Dentists, Cigna DHMO - Endodontists Cigna DHMO - Periodontists; Cigna DHMO - Oral Surgeons Ci na DHMO - Orthodontists Standard 2 in 15`miles 2 in 15 miles 2 in 15 miles 2in15miles 2 in 15-miles : 6991 3,437 3,368 6,133 7,914 Without Access Average Distance % 1 2 36 51 55 42 37 1.5 2.1 2.3 1.8 1.5 28.5 41.1 55.6 36.8 34.3 37.8 56.6 60.8 41.3 44.7 State City Employee Key Geographic Areas Provider Name Standard Without Access Average Distance 1 2 Florida North Carolina Florida North Carolina Ftorldt: North Carolina Florida North Carolina Florida, North Carolina Florida.. Alabama Arizona Colorado Florida 02015 QuestAnalylics. LLC Key Largo =5 Sebring 3 Naples 3 Sebring 3 Marathon- - 2 Franklin 2 Marathon.' . 2 Franklin 2 Marathon ? 2 Franklin 2 Marathon . _ _ 2 Franklin 2 Invemess.. ''2 Marathon 2 Port Orange 2 Franklin 2 Lehigh Acres2 Phenix City 1 Flagstaff • . 1 Montrose 1 CedarKey .1 East Palatka 1 Englewood . 1 Fort White 1 Greenwood 1 Cigna DHMO- Endodontists . Cigna DHMO - Open General Dentists Cigna DHMO - Oral Surgeons Cigna DHMO - Orthodontists Cigna DHMO- Periodontists Cigna DHMO - Endodontists Cigna DHMO Oral Surgeons Cigna DHMO - Periodontists Cigna DHMO-Endodontists: . . Cigna DHMO - Endodontists Cigna DHMO=,Open General Dentists`;. Cigna DHMO - Open General Dentists Cigna DHMO - Orai" Surgeons Cigna DHMO - Oral Surgeons Cigna:DHMO - Orthodont sts Cigna DHMO - Orthodontists Cigna DHMO - Periodontists; Cigna DHMO - Periodontists CignaDHMO-Periodontists, .. Cigna DHMO - Periodontists Cigna DHMO - Endodontists.° Cigna DHMO - Oral Surgeons Cigna;DHMO=Orthodontists Cigna DHMO - Endodontists CignaDHMO - Endodontists Cigna DHMO Endodontists Cigna DHMO - Endodontists: Cigna DHMO - Endodontists CignaDHMO - Endodontists Cigna DHMO - Endodontists Cigna DHMO Ehdodontists 2• in l5 miles 2 in 15 miles 2in15miles 2 in 15 miles 2 in .15°miles 2 in 15 miles 2 in:l5tniles 2 in 15 miles 2 in15 miles•_ 2 in 15 miles tin 15 miles „x 2Yin 15 miles 2 in 15 miles 2 in 15 miles 2 m 15 miles 2 in 15 miles 2m 15;'miles . 2 in 15 miles 2 in 15miles .. 2 in 15 miles 2 in 15-miles 2 in 15 miles 2 in 15 irides , , 2 in 15 miles 2 in 15'iniles. 2 in 15 miles 2 in-15miles 2 in 15 miles 2 m 15 miles 2in15miles 2-in .15 miles '.-5. 4 :4 4 4 3 3 3 2 2 2 2. 2 2 2 2 2 2 2 100.0 80.0 80.0 80.0 80.0 100.0 100.0 100.0 100.0 100.0 :100.6 100.0 100.0 100.0 100.0 100.0 100:0 100.0 1100.0 100.0 5010 50.0 ..50.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 • 20.4 1.1 22.1 22.1 22.1 35.8 26.8 46.6 643 63.7 48.8 63.4 49.1 64.3. 52.9 25.6 64.3 6.7 84.0 12.9 12.9 5,2 72.9 69.5 165.4 39.0 21.0 14.4 15.6 60.1 27.6 22.1 22.1 22.1 22.1 47.3 27.5 47.7 73.9 66.0 63 2 53.5 64.3 49.1 64.3 61.4 25.9 64.3 165 85.9 163 16.3 16.0 85.9 69.5 165.4 39.0 31.1 25.9 15.6 60.3 102 Accessibility Overview Cigna Newyork Analysis - Open General Dentists Access Overview for All Employees With Access 5 June 2015 Created for... City of Miami Access Analysis Cigna DHMO -All Employees - Open General Dentists Employee Group All Employees Office Group Cigna DHMO - Open General Dentists Comparison Graph Percent of employees with access to a choice of offices over miles D 1st closest 8 2nd closest 3rd closest 4th closest 5th closest 1 The Access Standard is defined as (All Employees) employees accessing: 2 (Cigna DHMO - Open General Dentists) offices in 15 miles Overall Access' 2,399 Employees 6,991 offices at6,880:locations '{Cigna DHMO - Open General Dentists); :IN 2,36 (98.5%); Employees with.access Distance to 1st closest office Distance to 2nd closest. office`.. Distance to 3rd closest office'., Distance to 4th closest Distance to 5th closest office: ., 0.0 mile 1.0 mile 0.0 mile 0.1 mile 0.3 mile 0.3 mile 1 a miles 1.7 miles 2.1 miles 2.3 miles 13.7 miles 4.3 miles 18.9 miles 63.7 miles 64.1 miles Access Standard Comparison Percentage of employees 100 80 50 40 20 r„,,,J,„,,,•s,�, - '''''''''''''r''.. _____. :mot/ F `1 • iy 1,:">' ,,,„,„... IF x,,,,, t,:r,i J. 2 4 5 6 7 8 Miles to a choice of offices 9 10 11 12 13 14 15 ©2015 QuestAnalyfics, UC. 104 Cigna Network Analysis - Open General Dentists Access Overview for All Employees Without Access 6 June 2015 Created for... City of Miami Access Analysis Cigna DHMO -All Employees - Open General Dentists Employee Group All Employees Office Group Cigna DHMO - Open General Dentists Comparison Graph Percent of employees with access to a choice of offices over miles 1st closest 2nd closest 3rd closest it 4th closest II 5th closest 1 The Access Standard is defined as (All Employees) employees accessing: 2 (Cigna DHMO - Open General Dentists) offices in 15 miles 5%) Employees withoutaec Distances Mmrmum Average '"Maximum': Disfanee to 1st closest x office, 0.3 mile 28.5 miles 107.6 miles Distance f 2nd closest roffice 7k 15.3 miles 37.8 miles 113.0 miles Distanceto 3rd closest office 17.0 miles 42.2 miles 159.4 miles liistanceto 4th closest office 4.'fftr'Cwi 18.6miles 46.1 miles 165.4 miles D�is;taneetba 5th closest 18.7 miles 50.7 miles 165.4 miles Percentage of employees 0 0 0 0Do 0 Access Standard Comparison / / 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Miles to a choice of offices 02015 Quest Analy5cs, LLC. Cigna Network Analysis - Endodontists Access Overview for All Employees With Access 7 June 2015 Created for... City of Miami Access Analysis Cigna DHMO -All Employees - Endodontists Employee Group All Employees Office Group Cigna DHMO - Endodontists Comparison Graph Percent of employees with access to a choice of offices over miles 1st closest LA 2ndclosest 3rd closest it 4th closest ME 5th closest The Access Standard is defined as (All Employees) employees accessing: 2 (Cigna DHMO - Endodontists) offices in 15 miles Overall Access' 2,399 Employees 3,437 offices at 1;944locations (Cigna DHMO-Endodontists) 2;348197.9%) Employeesw'ith`access Distance to 1st closest office; Distance to 2nd closest. office :.. Distance to 3rd closest - office Minimu n 0.1 mile 0.1 mile Average 2.2 miles 3.0 miles 3.8 miles Maximune';. 14.1 miles 14.9 miles 39.0 miles Distance to 4th closest office 0.3 mile 4.3 miles 78.4 miles Distance to 5th closest': offices. 0.3 mile 5.1 miles 85.7 miles Access Standard Comparison Percentage of employees 100 80 60 40 20 6 MIMPI rr �A w F , ..::,7::r:4H-::':"':::'''';' , ". ‚5/ r' r him" /r - 1 2 3 4 5 6 7 8 Miles to a choice of offices 9 10 11 12 13 14 15 © 2015 QuestMalyucs, LLC. 106 Cigna Network Analysis - Endodontists Access Overview for All Employees Without Access 8 June 2015 Created for... City of Miami Access Analysis Cigna DHMO -All Employees - Endodontists Employee Group All Employees Office Group Cigna DHMO - Endodontists Comparison Graph Percent of employees with access to a choice of offices over miles ❑ 1st closest f 2nd closest 3rd closest 4th closest 5fh closest - The Access Standard is defined as (All Employees) employees accessing: 2 (Cigna DHMO - Endodontists) offices in 15 miles 2 399 Employees 3 437 offices at 19441ocations'(C ■ `51(21%) Employees wltnou 5 Distances inimum `Average Maxinsur l- Distance to 1st closest ' office a 3.1 miles 41.1 miles 165.4 miles Distance to 2nd closest ` •office' 15.6 miles 56.6 miles - 186.4 miles Distance to 3rd closest +i' office. � w1�NY 15.8 miles 58.6 miles 186.8 miles Distance' to 4thclosest office"`~ 15.9 miles 63.7 miles 186.8 miles Distance to 5th ciosest office'As 15.9 miles 66.3 miles 187.1 miles Percentage of employees 1.5 O Access Standard Comparison / i / 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Miles to a choice of offices 02015 Quest Analyecs, LLC. Cigna Network Analysis - Periodontists Access Overview for All Employees With Access 9 June 2015 Created for... City of Miami Access Analysis Cigna DHMO -All Employees - Periodontists Employee Group All Employees Office Group Cigna DHMO - Periodontists Comparison Graph Percent of employees with access to a choice of offices over miles ❑ 1st closest 133 2nd closest 3rd closest 4th closest 111 5th closest The Access Standard is defined as (All Employees) employees accessing: 2 (Cigna DHMO - Periodontists) offices in 15 miles Overall Access'' 2,399 Employees 3368`offices at 2,112 locations (Cigna DHMO Periodontists) 2,344 (97,7°%) Eiriployees with -access Distance to 1st closest office`,: Distance to 2nd closest office Distance to 3rd closest office' Distance to 4tti'closest office; Distance to 5th closest., office`: 0.1 mile 0.2 mile 0.2 mile 2.4 miles 3.0 miles 3.6 miles 4.1 miles 13.7 miles 14.8 miles 100.2 miles- 147.2 miles 150.5 miles Access Standard Comparison Percentage of employees 100 80 60 40 20 4 5 6 7 8 Miles to a choice of offices 9 10 11 12 13 14 15 © 2015Quest Analytcs, LLC. 108 Cigna Network Analysis - Periodontists Access Overview for All Employees Without Access 10 June 2015 Created for... City of Miami Access Analysis Cigna DHMO - All Employees - Periodontists Employee Group All Employees Office Group Cigna DHMO - Periodontists Comparison Graph Percent of employees with access to a choice of offices over miles 0 1st closest 88 2nd closest 3rd closest * 4th closest 5th closest The Access Standard is defined as (All Employees) employees accessing: 2 (Cigna DHMO - Periodontists) offices in 15 miles Overall Access' `2,399 Employees 3;368 offices)'at 55 (2 3%0) Employees wit E kc ,fi Distances Minimum Average MaxrmuiTi Distance to 1st closest 6.2 miles 55.6 miles 180.5 miles Distance to 2nd ciosesti fps offices 15.7 miles 60.8 miles 181.3 miles Disfanee to 3rd closest offic 15.7 miles 66.3 miles 181.3 miles Distan a to 4th closest offices < ws 18.7 miles 71.7 miles 181.3 miles Distance ta tli-closest ' office4 .. 1 :r: 18.7 miles 74.1 miles 182.1 miles Access Standard Comparison Percentage of employees 0 o a o 0 / / 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Miles to a choice of offices ©2015 QuestAnalytcs, LLC. Cigna Network Analysis - Oral Surgeons Access Overview for All Employees With Access 11 June 2015 Created for... City of Miami Access Analysis Cigna DHMO - All Employees - Oral Surgeons Employee Group All Employees Office Group Cigna DHMO - Oral Surgeons Comparison Graph Percent of employees with access to a choice of offices over miles 0 1st closest 2nd closest E 3rd closest 4th closest II 5th closest The Access Standard is defined as (All Employees) employees accessing: 2 (Cigna DHMO - Oral Surgeons) offices in 15 miles Overall Access' 2,399 Employees 6,133 offices at 3,104 locations (Cigna DHMO - Oral Surgeons) :... 2,357(982%) Employees' with' access' Distance to 1st closest Office, Distance to 2iidciesest Distance to 3rd closest cifice'. Distance to 4thclosest' office,. Distance to 5th cl'osest office.. 0.0 mile 0.1 mile 0.1 mile 0.1 mile 0.2 mile 1.8 miles 2.5 miles 2.9 miles 3.3 miles 3.7 miles 13.7 miles 14.9 miles 48.2 miles 56.4 miles 60.0 miles Access Standard Comparison Percentage of employees 100 80 60 40 20 2 3 4 5 6 7 8 Miles to a choice of offices 10 11 12 13 14 15 O 2015 QuestAnalytics, LLC. 110 Cigna Network Analysis - Oral Surgeons Access Overview for All Employees Without Access 12 June 2015 Created for... City of Miami Access Analysis Cigna DHMO - All Employees - Oral Surgeons Employee Group Alt Employees Office Group Cigna DHMO - Oral Surgeons Comparison Graph Percent of employees with access to a choice of offices over miles o ist closest Ell 2nd closest 3rd closest if 4th closest * 5th closest The Access Standard is defined as (All Employees) employees accessing: 2 (Cigna DHMO - Oral Surgeons) offices in 15 miles ri::43005•41440g6,2:Wi5iciiiMe. Distances AverageI..e giOdiiiiirc, j3tifaiigq aii40041, $ftlelf,,ai,`,- • - - M4g2.--Ai "' f 10.0 miles 36.8 miles 142.5 miles titel4n Closest office 7A1-.7- 15.8 miles ' 41.3 miles 142.5 miles bl dr566-ler Closest..', 16.1 miles 43.2 miles 142.5 miles 61Sitifigi' 4th c1osdsL. .'14' 6ffid 16:1miles .., 46.8 miles 142.5 miles 1?Yt 51111- .;, is apce,9 ,..coses office • 17.4miles 51.6 miles 142.5 miles Access Access Standard Comparison . ,. , 100 / /-/ / / 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Miles to a choice of offices Percentage of employees T.) ..p. 0, co 000 0 00 ©2015 Quest Analylics, LLC. Cigna NetvvarkAnalysis - Orthodontists Access Overview for All Employees With Access 13 June 2015 Created for... City of Miami Access Analysis Cigna DHMO -All Employees - Orthodontists Employee Group All Employees Office Group Cigna DHMO - Orthodontists Comparison Graph Percent of employees with access to a choice of offices over miles Q 1st closest rfi 2nd closest 3rd closest NI 4th closest it 5th closest 1 The Access Standard is defined as (All Employees) employees accessing: 2 (Cigna DHMO - Orthodontists) offices in 15 miles Overall Access' 2,399 Employees 7,914 offices at3,658locations (Cigna DHMO -Orthodontists) ® 2,312(98.5%)Employees With access Distances Minimum Average Maximum: Distancetolst closest office- 0.0 mile 1.6 miles 13.7 miles Distance to 2nd closest 0.0 mile 2.2 miles 14.6 miles Distance to 3rd closest officeP: 0.0 mile 2.6 miles 38.7 miles Distance to-4th closest office 0.2 mile 3.1 miles 73.9 miles Distance to 5th closest office 0.3 mile 3.5 miles 81.1 miles Access Standard Comparison Percentage of employees 100 80 60 40 20 2 4 5 7 8 Miles to a choice of offices 9 10 11 12 13 14 15 © 2015 QuestAnalytics, LLC. 112 Cigna Network Analysis - Orthodontists Access Overview for All Employees Without Access 14 June 2015 Created for... City of Miami Access Analysis Cigna DHMO -All Employees - Orthodontists Employee Group All Employees Office Group Cigna DHMO - Orthodontists Comparison Graph Percent of employees with access to a choice of offices over miles o 1st closest 0 2nd closest 3rd closest 4th closest it 5th closest 1 The Access Standard is defined as (All Employees) employees accessing: 2 (Cigna DHMO - Orthodontists) offices in 15 miles 7,914Yitiffiadabtl,658',14110,1a, gna DFfMO Ort6ddiWs Distances ..unimum,, Minimum ,,v, AVIaximum , .biggilO41ir afo1oia's1 Office 4.0 miles 34.3 miles 76.1 miles -3466ei.celligic,, est ros pffi 16.0 miles 44,7 miles 99.8 miles Pistaridele'3rdcosest iffiere''' 16.0 miles 48.1 miles 130.0 miles itiLita:OCe'te osest ''''ii ,.. office 17.2 miles 50.3 miles 130.0 miles aDialaiipt 0.6f 'ClOs' es -,,,' office 17.2 miles 54.7 miles 130.0 miles Percentage of employees 0 Access Standard Comparison . , / 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Miles to a choice of offices ©2015 Quest Analytics, LLC. Cigna. Accessibility Detail Cigna Network Analysis Access Detail for All Employees With Access 16 June 2015 Created for... City of Miami All Accessibility - Cigna DHMO -All Employees - Dental Providers The Access Standard is defined as (All Employees) employees accessing: 2 (Cigna DHMO - Open General Dentists) offices in 15 miles, 2 (Cigna DHMO - Endodontists) offices in 15 miles, 2 (Cigna DHMO - Periodontists) offices in 15 miles, 2 (Cigna DHMO - Oral Surgeons) offices in 15 miles, 2 (Cigna DHMO - Orthodontists) offices in 15 miles State City Employees With Access Employee Zip Code #1 Name Provider With Access' Average Distance # % 1 2 Florida- - „- - 33142 33169 ,31165'. 33186 •,- 33145 33133 64 64 • 62 59 59 - * 55 54 Cigria,OHMDIpi5.0.000400fti06:0,4*tktfitMS Cigna DHMO - Endodontists Cigna DHMO -Periodntist Cigna DHMO - Oral surg ops Cigna DHMO -Orthodontists Cigna DHMO - Open General Dentists Cigna DHMO - Periodontists Cilia bfigObrai:Sarg Cigna DHMO - Orthodontists Cigna DHMO -OpenGeneral Ientists Cigna DHMO - Endodontists Cigna DHMO - Pthiod'ordisfs Cigna DHMO - Oral Surgeons Cigna DHMO---Oxthodont Cigna DHMO - Open General Dentists Cigna DHMO - Periodontists Cigna DHMO- Oral Surgeons - Cigna DHMO - Orthodontists Cigna DHMO - Open General Deritists Cigna DHMO - Endodontists Cigna DHMO - Oral Surgeons Cigna DHMO- Orthodontists' Cigna DHMO - Open General Dentists Ciglia DHMO Endodontists - „-. , •••; -..• • Cigna DHMO Periodontists Cigna DHMO-Oral Surgeons Cigna DHMO - Orthodontists Cigna DHMO Open Gen&al Dentists- ' -• Cigna DHMO - Endodontists Cigna DHMO* Periodontists Cigna DHMO - Oral Surgeons Cigna DHMO ,-; Orthodontists Cigna DHMO - Open General Dentists Cigna DHMO Endodontists • Cigna DHMO - Periodontists CignaDHMO - Oral Surgeons Cigna DHMO - Orthodontists ONS510. 0 0 0 0 0 0 7 16 -8 o . 0 0 3 3 2 3 2 7 0 0 0 0 0 66 66 66 64 6464 64 64 64 64. 64 64 62 6622; 62 rr-i,66 59. 9 59 59 59 59 59 59 55 55 55 55 55 54 54 54 54 54 100.0 00,0 100.0 100.0 100.0 100.0 1°0.0 1100.0 -fold 100.0 fOO:o' 100.0 100.0 1000 100.0 100.o 100.0 !Al 100.0 100.0 100.0 100.0 100.0 ,100.0 100.0 oo.o 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 1.9 2.5 • 1*.2 1.5 „Z:- 13 1.2 1.3 0.8 1.8 1.8 0.6 2.9 1.2 1.0 0.9 0.9 2.8 1.9 1.4 1.1 0.4 0.9 0.5 1.7 1.6 0.8 1.3 1.1 2.3 1.9 3.0 23 2.2 1.7 1.9 2.1 2:1 2.8 2.4 1.4 1.6 1.5 2.2 2.4 2.1 0.8 3.3 1.9 2.1 1.3 1.4 4.5 2.1 1.4 2.0 0.7 0.9 0.7 26 1.8 1.1 1.3 1.2 3.1 2.3 2015 Quest Analytics, LLC. Continued on next page_ Cigna NGrvvorkAnalysis Access Detail for All Employees With Access 17 June 2015 Created for.._ City of Miami All Accessibility - Cigna DHMO - All Employees - Dental Providers t The Access Standard is defined as (All Employees) employees accessing: 2 (Cigna DHMO - Open General Dentists) offices in 15 miles, 2 (Cigna DI-IMO - Endodontists) offices in 15 miles, 2 (Cigna DHMO Periodontists) offices in 15 miles, 2 (Cigna DHMO - Oral Surgeons) offices in 15 miles, 2 (Cigna DHMO - Orthodontists) offices in 15 miles State City Employee Zip Code # Employees With Access Provider Name With. Access' Average Distance # %. 1 2 Florida ©2015 Quest Anaiy5cs, LLC. Hollywood; 50 Cigna DHMO =,Open,General`Dentists, Cigna DHMO - Endodontists Cigna DHMO '--Periodontists Cigna DHMO - Oral Surgeons Cigna DHMO Orthodontists,'- . Cigna DHMO - Open General Dentists Cigna. DHMO - Endodontists Cigna DHMO - Periodontists Cigna DHMO ,Oral.,Surgeons Cigna DHMO - Orthodontists Cigna DHMO - Open General Dentists Cigna DHMO -Endodontists Cigna DHMO Periodontists -+;' Cigna DHMO - Oral Surgeons CignaDHMO 'Orthodontists Cigna DHMO - Open General Dentists Cigna:DHMO, .Endodontists Cigna DHMO - Periodontists Cigna DHMO ,OraISurgeons Cigna DHMO - Orthodontists Cigna,DI-IMO _Open Generaf'De`ntists, Cigna DHMO - Endodontists Cigna DHMO -Periodontists .. Cigna DHMO - Oral Surgeons Cigna DHMO , O thodontists Cigna DHMO - Open General Dentists Cigna DHMO : Endodontists Cigna DHMO - Periodontists Cigna DHMO Oral Surgeons Cigna DHMO - Orthodontists Cigna DHMj -Open General Dentists;, Cigna DHMO - Endodontists Cigna)OMO_ Periodontists Cigna DHMO -pre! Surgeons Cigna DHMO^ wOithodontists Cigna DHMO - Open General Dentists Cigna DHMO Endodontistst w Cigna DHMO - Periodontists Cigna-DHMO - Oral Surgeons'...; Cigna DHMO - Orthodontists :•53 53 53 53 53 50 50 50 50 50 50 :50 50 50 46 -46 46 '46 46 45 45 45 45 43 43 43 42 42 42 1000. 100.0 100.0 100.0 100. i 100.0 1000 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0: 100.0 1000, 100.0 10(3 0 100.0 1000 100.0 loom 100.0 100�0 100.0 too:o 100.0 100":0 100.0 100,0 100.0 100 0' 100.0 100.0 100.0 1.1 4.1 .37 2.6 2:5 0.5 2.7 1.7 1.8 1.1 12 1.3 1.3 1.3 •.1.3 0.8 0.9. 1.5 1.4 0.4 1.1 _ 0• 9 1.2 0.6 4A0 1.4 1.0 1.2 1!.4 1.1 0.7 2.0 --2.0 18 4.1 .41 3.6 .3.0 0.8 2.8 2.5 2.6 1.9 -2.1. 3.7 35 3.0 13 1.0 4.4 15 1.5 0.6 1.1 1.4 20 1.0 54 1.5 3?.6 1.6 1.2 1.4 1.4 2.9 3.8 Continued on nextpage... 116 Cigna Network Analysis Access Detail for All Employees With Access 18 June 2015 Created for... City of Miami All Accessibility - Cigna DHMO -All Employees -Dental Providers TheAccess Standard is defined as (Alf Employees) employees accessing: 2 (Cigna DHMO - Open General Dentists) offices in 15 miles, 2 (Cigna DHMO - Endodontists) offices in 15 miles, 2 (Cigna DHMO - Periodontists) offices in 15 miles, 2 (Cigna DHMO - Oral Surgeons) offices in 15 miles, 2 (Cigna DHMO - Orthodontists) offices in 15 miles ©2015 Quest Analytics, LLC. 33150 33126 38 36 5 Employees With. Access Provider Name igna';DHMO OpenGeneralSentis, Cigna DHMO,- Endodontists Cigna'DHMO Penodontisfs ,w Cigna DHMO - Oral Surgeons Cigna DHMO- Orthodontists '.ti . Cigna DHMO.- Open General Dentists Cigna DHMO Endodontists Cigna DHMO - Periodontists. Cigna DHMO Oral Surgeons Cigna.DHMO - Orthodontists 'Cigna DHMb Open General Dentists Cigna DHMO - Endodontists `Cigna_DHMO Periodontists ,3,; Cigna DHMO - Oral Surgeons Cigna DHMO; Orthodontists s "• Cigna DHMO - Open General Dentists Cigna DHMO - Endodontists Cigna DHMO - Periodontists Cigna DHMO x. Oral Surgeons ; Cigna DHMO - Orthodontists Cigna,DHMO - Open General Dentists • ; Cigna DHMO; Endodontists Cigna DHMO Periodontists ,?- Cigna DHMO,- Oral. Surgeons ,CignaDHMO Orthodontists,.:' , 35 Cigna DHMO Open General Dentists Cigna DHMO, Endodontists,.: Cigna DHMO - Periodontists Cigna DHMO.Oral,Surgeons Cigna DHMO,-, Orthodontists 34 Crgna DHMO Open General Dentists Cigna DHMO - Endodontists Cigna DHMO Periodontists Cigna DHMO - Oral Surgeons Cigna'DHMO .Orthodontists 33 Cigna DHMO - Open General Dentists Cigna DHMO Endodontists " ,' Cigna DHMO - Periodontists Cigna DHMO - Oral Surgeons Cigna DHMO - Orthodontists 0 0 0, 0 0 2. 10 0 0 0 0 0 With Access' Average Distance: # %p. 1 2 41 38 38 38 38 37 37 37 Z. 36 i36 36 36 35 35 .35 35 35 35 :-35 35 35 35 34 34 34 34 34 33 r33, 33 33 33 1000 100.0 100.0' 100.0 1000. 100.0 100.0 100;0, 100.0 1000'. 100.0 100i0; 100.0 :19Q;QI. 100.0 1000 0.7 1.0 0.5 100.0 2.1 100.6: i oo.0 100 0. 100.0 100 6. •_" 100.0 100`.0 100.0 100.0: 100.0 100 0, 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 • 1.9 13 1.6 2.2 1.8 1.5: 0.4 2,1 0.8 11: 0.6 1'.3 4.9 2.8 3.3 0.6 1.9 1.9 1.3 Continued on ne ;07 1.7 ;1:.3 1.2 14, 1.5 ' 31; 4.4 32, 3.3 1.7 18 2.1 2.0 1.2 33, 2.1 3.6 21 1.6 1.6 3.0 2.3 -1.9 0.6 2.1: 0.9 3.3 1.1 1.9 7.0 2.8 3.3 2.6 0.9 4.0 2.3 3.2 1.8 Page-. Cigna Nezwork Analysis Access Detail for All Employees With Access 19 June 2015 Created for... City of Miami At Accessibility- Cigna DHMO -All Employees - Dental Providers The Access Standard is defined as (All Employees) employees accessing: 2 (Cigna DHMO- Open General Dentists) offices in 15 miles, 2 (Cigna DHMO - Endodontists) offices in 15 miles, 2 (Cigna DHMO - Periodontists) offices in 15 miles, 2 (Cigna DHMO - Oral Surgeons) offices in 15 miles, 2 (Cigna DHMO - Orthodontists) offices in 15 miles State City • © 2015 Quest Analylics, LLC. Miam • jr:f Opa Locka ; • • - Hollywood.: Miami • ,*1-2 Employee Zip Code ''.•33135 33054 .33027' 33136 -;•„ 33156 33162 • :33055 33179 . 33 33 32 31 29 29 Employees With Access Provider Name Cigna DHMO Gghpfal Dentists - Cigna DHMO - Endodontists Cigna DHMO - Cigna DFIMO - Oral Surgeons Cigna DHMO - Orthodontist Cigna DHMO - Open General Dentists CignDOMO,.-i'Endedontists. Cigna DHMO - Periodontists Cigna DHM0,.:. Oral Snrgerin.s-. • . Cigna DHMO - Orthodontists Cigna DHM07.,.-000-n:Geheral Dentists-, Cigna DHMO - Endodontists Cigna DHMO-'-.kPeriddonflits Cigna DHMO - Oral Surgeons Cigna DHM0.-OrthOdentists Cigna DHMO - Open General Dentists Cigna:DENO-it Endodontists- . • Cigna DHMO - Periodontists Cigna DHMO - Orthodontists Cigna DHMO - Endodontists Cigna DHMO Oral Surgeons Cigna DHMO-'Orth�dontists Cigna DHMO - Open General Dentists Cigna DHMO Endodorttista - Cigna DHMO - Periodontists Cigna DHMO - Orthodontists Cigna DHMO - Endodontists Cigna DHMO- Peiiodontists -, Cigna DHMO - Oral Surgeons Pr66Attf01.0000fiitiCg.Stgg-VitittligiggkitB Cigna DHMO •-• Open General Dentists 044)34.002004iiii401iSigt Cigna DHMO - Periodontists Cigna DHMO -'Oral Surgeons Cigna DFIMO - Orthodontists 0 0 0 0 0 0 03 11 5 0 3 5 1 0 5 4 80 0 0 0 .2;ftgr'' 3 2 2 With Ac essAverage Distance # % 1 2 •33 33 33 33 33 33 33 33 33' 33 ,32 32 32 32 32 31 31 31 31 31 29 29 29 29 29 29 29 29 29 29` 29 29 28 28 28 -- 28 28 100.0 100.0 10(10' 100.0 :too.° 100.0 loo.o 100.0 1,00.0 100.0 :mob 100.0 10010 100.0 100.0 100.0 100.0 1000 100.0 loo,o 100.0 100.0 100.0 oolo 100.0 100-10 100.0 lix(o• 100.0 1000 100.0 100.0 100.0 ioo`.0 100.0 064 100.0 100.0 100.0 1.3 1.2 0.9 .18 1.8 1.7 1.8 1.1 1.6 0.7 0.8 1.5 1.2 0.4 2.0 2.1 1.3 1.2 2.2 2.1 2.2 1.6 0.7 0.9 1.0 0.9 1.8 3.6 2.8 1.8 1.4 17.5 2.2 2.0 0.8 1.2 3.6 0.5 2.3 2.1 1.5 4.0 2.8 3.9 2.0 0.9 Continued on nextpage... 118 Cigna Network Analysis Access Detail for All Employees With Access 20 June 2015 Created for... City of Miami All Accessibility - Cigna DHMO -All Employees - Dental Providers 1 The Access Standard is defined as (All Employees) employees accessing: 2 (Cigna DHMO - Open General Dentists) offices in 15 miles, 2 (Cigna DHMO-Endodontists) offices in 15 miles, 2 (Cigna DHMO - Periodontists) offices in 15 miles, 2 (Cigna DHMO - Oral Surgeons) offices in 15 miles, 2 (Cigna DHMO - Orthodontists) offices in 15 miles State City Employee Zip Code # Employees With Access Provider Name With Access" # a/o Average Distance 1 2 02015 Quest Analylics, LLC. Cigna DHMO„-Open`Generai DentistsV,„ Cigna DHMO - Endodontists Cigna DHMO_ Penodonhsts; Cigna DHMO - Oral Surgeons Cigna DHMO,,, Orthodontists Cigna DHMO Open General Dentists Clgna,DHMO " Endodontists" Cigna DHMO - Periodontists Cigna DllMO OratSurgeons'_ uf" Cigna DHMO - Orthodontists Cigna DHMO. openyGenerallDentists Cigna DHMO - Endodontists 'Cigna DHMO Periodontists: Cigna DHMO - Oral Surgeons Cigna DHMO - Orthodontists , K. Cigna DHMO.,- Open General Dentists Cign&DHMO__, Endodontists Cigna DHMO - Periodontists Cigna DHMO oral Surgeons . ;! Cigna DHMO - Orthodontists Cigna.DHMO, OpentGeneral Dentists:: Cigna DHMO - Endodontists Cigna DHMO Perjodontists: Cigna DHMO - Oral Surgeons Cigna DHMO.Orthodontists"x Cigna DHMO Open General peOsts Cigna,DHMO . Endodontists Cigna DHMO - Periodontists Cigna DHMO _Oral Srgeo uns Cigna DHMO - Orthodontists Cigna; DHMO Open 4General;Dentists - Cigna DHMO - Endodontists CignaDHMO Periodontists " Cigna DHMO Oral Surgeons Cigna DHMO ,Orthodontists ", . Cigna DHMO :Open General Dentists -Cigna DHMO ,Endodontists Cigna DHMO - Periodontists Cigna DHMO - Oral Surgeons Cigna DHMO - Orthodontists 0 0 0 -28 28 28 28 27 27 27 27 27 27 27 27 '27 26 26 26 26 26 .26 26 26 26 6 25 25 25 25 23 23 23 23 23 23 23 23 100 0 100.0 1000 100.0 100 0 100.0 1000 100.0 1000 100.0 100 0 ,y 100.0 100.0 , 100.0 :ioo.o 100.0 1000, 100.0 1. 100.0 100.0 100 0 100.0 1000 100.0 1D00 =-i, 100.0 0.8 100.0 2.0 100.0 100 0 100.0 100.0 100.0 100 0 100.0 . 100.0 ` 100.0 100.0 4.2 100.0 2.6 100.0 3.4 100.0 2.2 2.1 2.1 0.6 2.7 1.0 4.0 3.6 1.1 2.8 0.8 1.3 0.7 1.5 1.0 1.5 1.1 4.3 1.3 2.5 13 1.2 28 4.4 2Z 2.7 1.2 6.4 17 3.7 '16 2.0 2.2 3.6 2.8 2.8 1.0 4.1 4.0 1.3. 1.2 "2.0 1.8 -2.1 3.0 1.0 1.5 1.2 1.5 13 1.8 49. 4.0 4.0 2.5 Continued on next page. Cigna Net. ork Analysis Access Detail for All Employees With Access 21 June 2015 Created for_. City of Miami All Accessibility - Cigna DHMO -All Employees - Dental Providers t The Access Standard is defined as (All Employees) employees accessing: 2 (Cigna DHMO - Open Genera/ Dentists) offices in 15 miles, 2 (Cigna DHMO - Endodontists) offices in 15 miles, 2 (Cigna DHMO - Periodontists) offices in 15 miles, 2 (Cigna DHMO - Oral Surgeons) offices in 15 miles, 2 (Cigna DHMO - Orthodontists) offices in 15 miles State Employee City Zip Code Employees With Access Provider Name With Access' Average Distance # %. 1 2 I9orida © 2015 Quest Analytics, LLC. Cigna;DHMO Open Gene al Dentists Cigna DHMO -Endodontists Cigna DHMO - Periodontists Cigna DHMO - Oral Surgeons Cigna DHMO "Orthodontists., >" Cigna DHMO - Open General Dentists Cigna ®HMO - Endodontists Cigna DHMO - Periodontists Cigna DHMO -Oral Surgeons Cigna DHMO - Orthodontists Cigna.DHN10-OpenGenera( Dentists , Cigna DHMO - Endodontists Cigna DHMO Periodontists Cigna DHMO - Oral Surgeons Cigna DHMO` Orthodontists := Cigna DHMO - Open General Dentists CignaDHMO Endodontists; Cigna DHMO - Periodontists Cigna DHMO Oral:Surgeon's Cigna DHMO - Orthodontists Cigna DHMO _Operi`General ,Dentists Cigna DHMO -Endodontists Cigna DHMO Periodontists Cigna DHMO - Oral Surgeons Cigna DHMO ,Orthodontists Cigna DHMO - Open General Dentists Cigna DHMO Endodontists Cigna DHMO - Periodontists Cigna DHMO Oral:Surgeons .r Cigna DHMO - Orthodontists Cigna DHMO OperGeneral .Dentists Cigna DHMO - Endodontists Cigna D11M0 Periodontists Cigna DHMO Oral Surgeons Cigna,DHMO Orthod_ ontists Cigna DHMO - Open General Dentists Cigna DHMO y- Endodontists . .g Cigna DHMO - Periodontists Cigna.DHMO AYa1:Surgeons m Cigna DHMO - Orthodontists _22 22 22 22 22 22 ;..22 22 22 22 22 22 22 22 22 22 22 22 N22 22 22 22 22 22 20 ..20 20 .20 20 20. 20 20 20 19 19 19 1000 100.0 100.0 100.0 .100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 1000 100.0 100:0 100.0 100:0 100.0 100.0 100.0 100.0 100.0 1000 100.0 100.0 100.0 100.0 100.0 00.0 100.0 v1:00.0 100.0 =100A 100.0 100 0 100.0 100.0 100:0 100.0 2.3 0.7. 0.6 0.6_ 0.5 :2 0.8 12 1.5 1.0 2.8 25' 2.5 2.5. 0.8 0:8 0.8 0.8 3.5 1:3 1.3 '1.4 1.1 1.9 '19 1.9 • 3.0 1.1 0.6 0:5 2.3 -1.0 0.8 0.9 0.7 1:2 1.4 1.6 1:2 2.8 2.9. 2.5 =3;3 0.9 1.0 0.9 1.1 4.9 2.0 18 1.5 1.9 1.9 '09 5.9 25 2.8 0.7 2.0 2.9 -.2.0' 73.2 1.3 2.3 Continued on next page._ 120 Cigna Network Analysis Access Detail for All Employees With Access 22 June 2015 Created for... City of Miami All Accessibility - Cigna DHMO -All Employees - Dental Providers 1 The Access Standard is defined as (Al Employees) employees accessing: 2 (Cigna DHMO - Open General Dentists) offices in 15 miles, 2 (Cigna DHMO - Endodontists) offices in 15 miles, 2 (Cigna DHMO - Periodontists) offices in 15 miles, 2 (Cigna DHMO - Oral Surgeons) offices in 15 miles, 2 (Cigna DHMO - Orthodontists) offices in 15 miles State City Employee Zip Code # Employees With Access Provider Name With AccessAverage Distance 1 2 Florida Hollywood f , ; ,:_ Cigna DHMO _.Open;General Dentls Cigna DI-IMO - Endodontists Cigna DHMO` Perindontisls! Cigna DHMO -.Orel Surgeons Cigna,DHMO Orthodontistsa -' Cigna DHMO -,Open General Dentists Cigna DHMO .,Endodontists, '_,.,, , Cigna DHMO - Periodontists CignaDHMO - Oral Surgeons - v' Cigna DHMO - Orthodontists Cigna DHMO , Open General pentisx Cigna DHMO - Endodontists Cigna DHMO-Penodontists Cigna DHMO - Oral Surgeons 'Cigna DH,MO Orthodontists.,.-' Cigna DHMO - Open General Dentists {Cigna DHMO_ Endodonfists , Cigna DHMO - Periodontists Cigna DHMO_ Oral Surgeons Cigna DHMO - Orthodontists Cigna DHMO„: open;Gener0LDentists " . Cigna DHMO - Endodontists Cigna DHMO Periodontists Cigna DHMO - Oral Surgeons Clgna.DHMO Orthodontists Cigna DHMO - Open General Dentists CignaspHMO Endodontists r„ Cigna DHMO Periodontists Cigna.DHMO Oral Surgeons,: Cigna DHMO - Orthodontists. ,Cigna DHMO Open`GeneralDentists • Cigna DHMO - Endodontists Cigna DHMO , Periodontists Cigna DHMO - Oral Surgeons :Cigna DHM_0, Orthodontists , Cigna DHMO - Open General Dentists Cigna'DI-MO, Endodontists , Cigna DHMO - Periodontists Cigna DHMO - Oral Surgeons- Cigna DHMO - Orthodontists 0 0 1 18 18 18 :'18 18 18 7 17 17 17 I7 17 17 17 17 17 16 :16 16 16 16 -15 15 °15 15 5 15 15 15 15 ooi 100.0 100.0: 100.0 100A 100.0 9000 100.0 100 0. 100.0 100.0' 100.0 100:0' 100.0 4001 100.0 100 0 100.0 100 0 100.0 100 0 100.0 100 0 100.0 100:0 100.0 1(00' 100.0 100.0 100.0 100:0 100.0 100.0 100.0 100 0 100.0 Joao 100.0 100.0 100.0 • 0.8 1.3 1.6 2:4 1.8 0.8 0:7 0.7 0.9 1.9 1.4 1.1 10 1.1 1.6 1.8 5.9 1.6 =30 2.3 08` 1.0 �08 0.8 08. 0.9 1.7 1 6 1,6' 0.8 3.3 1.3 .2.0 5.0 7.2 3.2 •;3.2 3.8 5.2 0:7 1.6 0.6 1.3 2.1; 2.1 1.9 2.1 2.2 2.2 2.6 2.7 "1'2 1.4 1.9 4.6 3.2 3.3 2.4 3.4 11' 1g 0.5 0.8 2,0 " :2.1 2.2 4.7 2.0 2.0 1.1 2.1 Continued on next page_ ©2015 QuestAnalylics,. LLC. Cigna N&.;;orkAnalysis Access Detail for All Employees With Access 23 June 2015 Created for... City of Miami All Accessibility- Cigna DHMO -All Employees - Dental Providers Tne Access Standard is defined as (AII Employees) employees accessing: 2 (Cigna DHMO - Open General Dentists) offices in 15 miles, 2 (Cigna DI-IMO - Endodontists) offices in 15 miles, 2 (Cigna DHMO - Periodontists) offices in 15 miles, 2 (Cigna DHMO - 0ral Surgeons) offices in 15 miles, 2 (Cigna DHMO - Orlhodontsts) offices in 15 miles ©2015 Quest Analyfirs, LLC. Miami Hollywood» `.; Miami Beach' Fort Lauderdale Homestead'' Miami Employees With Access Employee Zip Code `33167 33181 33020 33024 33331 33101 F, 3f 14 Cigna DH, MO .OpenGeneral-Dentists Cigna DHMO - Endodontists Cigna,DHMO Periodontists Cigna DHMO - Oral Surgeons Cigna DHMO Orthodontists; 14 Cigna DHMO - Open General Dentists Cigna•DHMO - Endodontists Cigna DHMO - Periodontists Cigna'DI MO -Oral Surgeons~-' Cigna DHMO - Orthodontists 12 Cigna DHMO- -Open General Dentists Cigna DHMO - Endodontists .Cigna DHMO Periodontists Cigna DHMO - Oral Surgeons C)gna DHMO Orthodontists 12 Cigna DHMO - Open General Dentists CignapHMO ;Endodontists Cigna DHMO - Periodontists Cigna DHMO Oral'. Surgeons. ; „ ;' Cigna DHMO - Orthodontists Cigna DHMO Open GenerarDenhsts Cigna DHMO - Endodontists Cigna DHli O Periodontists Cigna DHMO - Oral Surgeons Cigna'DHMO, Orthodontists,.;;• , 11 Cigna DHMO - Open General Dentists Cigna:DHMO Endodontists „;, Cigna DHMO - Periodontists Cigna DHMO ,Oral;Surgeoiis Cigna DHMO - Orthodontists 11 Cigna•DHMO Opengeneral_Dentists, ..: Cigna DHMO - Endodontists igna DHMO Periodontists sFh Cigna DHMO - Oral Surgeons Cigna DEMO Orthodontists= Cigna DHMO Open General Dentists Cigna DHMO Endodontists, xs ,_y Cigna DHMO - Periodontists Cigna DHMO `Oral Surgeons' Cigna DHMO - Orthodontists 2 0 0 1 0 2 2 0 0 8 4 4 6 2 2 • 0 0 With Access'Average Distance % 1 2 ;14 14 14 14 14' 14 14 14 ,14' 14 12 12, 12 12 12 12 12 12 12 12 12 12 11 100:10 100.0 10`0.0 100.0 100.0 100.0 900.0! 100.0 100.0 100.0 100.0 100.0 100.0 :100.0 100.0 100 0• 100.0 100 0_ 100.0 1oao; 100.0 100:0 100.0 10o a 100.0 1000: 11 100.0 11 :Nog 11 100.0 11 ,100 0 11 100.0 100.0 100.0 100.0 100:0 100.0 0:9 1.8 3.2 3.5 3.2 . 4.0 1.0 3.2 2.8 3.2 1.0 1.1 1.2 1.5" 1.3 3.8 1;3 13 1.3 1.3 0.5 0.8. 2.7 2.7 2:1 2.3 2.7 2.7 0.7 14 1.7 0.5 11 1.3 0.9 0.6 0.7 07. 1.6 3.4. 1.7 2.0 1.8 3.9 1.1 1.2 1.1 0.7 • 0.7 08. 2.1 :4 2.2 2.0 33 6.2 4.8 1.1 1.7 1c2 . -.1.2 0.9 3.7 Continued on nextpage_ 122 Cigna Network Analysis Access Detail for All Employees With Access 24 June 2015 Created for... City of Miami All Accessibility - Cigna DHMO - All Employees - Dental Providers The Access Standard is defined as (All Employees) employees accessing: 2 (Cigna DHMO - Open General Dentists) offices in 15 miles, 2 (Cigna DHMO - Endodontists) offices in 15 miles, 2 (Cigna DHMO - Periodontists) offices in 15 miles, 2 (Cigna DHMO - Oral Surgeons) offices in 15 miles, 2 (Cigna DHMO - Orthodontists) offices in 15 miles State Florida , , i ,- e2015 QuestAnaiytics, LLC. City - Zip Code lam 33141 =33010 33013 33131 Employee 11 10 9 9 Employees With Access Provider Name ;Cigna DHMO zOper} eneral Dentist: Cigna DHMO - Endodontists 'Cigna DHMO ,Periodontists t Cigna DHMO - Oral Surgeons Cigna DHMO , Orthodontists _;;_,, Cigna. DHMO - Open General Dentists Cigna1DHMO Endodontists ma`,, Cigna DHMO - Periodontists Cigna,DHNiOwOral Surgeon? Cigna DHMO - Orthodontists Cigna DHMO `Open; General Dentists; Cigna DHMO - Endodontists Cigna DHMO Periodontists Cigna DHMO,-, Oral Surgeons Cigna.DHMO,, Orthodontist" Cigna DHMO - Open General Dentists Cigna DHMO Endodontists . Cigna DHMO -. Periodontists Cigna DHMO. Oral,.$urgeons . Cigna DHMO - Orthodontists Cigna�DHMO. , Opeo General Dentists Cigna DHMO - Endodontists Cigna DHMO Periodontists,;` Cigna DHMO Oral Surgeons Cigna,DHMO Orthodontists ,_ ?: Cigna DHMO - Open General Dentists Cigna DHMO. Ehdodontists, Cigna DHMO - Periodontists Cigna DHMO Oral Surgeons Cigna DHMO - Orthodontists Cigna DHMO. Open Generai`Dentists Cigna DHMO - Endodontists Cigna.DHMO -Periodontists N, Cigna DHMO Oral Surgeons CignaDHMO OiEtiodontists, E Cigna DHMO - Open General Dentists Cigna DHMO Endodontists-' Cigna DHMO - Periodontists Cigna DHMO - Oral Surgeons- Cigna DHMO - Orthodontists 0 0 1 With Access'Average Distance 1 2 11 100.0 100 0 100.0 100{0 =, 100.0 100 0 100.0 100 0 ,,. 100.0 100:0, 100.0 1000' 100.0 1000 31' 100.0 0.7 11 11 �10 10 0 10 10 < 10 0 10 10 9 9 9 9 9 9 9 9 9 9 9 9 9 100.0. 100.0 100.0: 100.0 10Q9, 100.0 100:0, 100.0 100E0 100.0 10o 0, 100.0 iod.o 100.0 100.0 100.0 100.0 100 0 4664 100.0 1000 100.0 100.0 100.0 5.4 2.6 0.6 0.8 2.7 0.6 3.1 0.8 1.2 1.2 3.4 26. 1.5 0.8 0.5 2.1 1.8, 1.2 3.0 6.0 60 3.6 .0 60 1.6 2.5 1.9 2.1 2.1 0.3 3.4 Continued on next page._ 6.2 :2 3.1 26 0.6 27 3.2 27 2.7 09 10.7 11, • 3.1 3" 1: 0.9 "13 1.3 1.2 0.7, 4.1 2.8 2.7 1.4 0.8 : 3.9 2.9 21` 1.9 3.6 11.0 6.0 6.0 1.6 2.5 2.3 Cigna Nr...JrkAnalysis Access Detail for All Employees With Access 25 June 2015 Created for... City of Miami Al Accessibility -Cigna DHMO -All Employees - Dental Providers The Access Standard is defined as (Ali Employees) employees accessing: 2 (Cigna DHMO-Open General Dentists) offices in 15 miles, 2 (Cigna DHMO - Endodontists) offices in 15 miles, 2 (Cigna DHMO - Periodontists) offices in 15 miles, 2 (Cigna DHMO - Oral Surgeons) offices in 15 miles, 2 (Cigna DHMO - Orttiodonfists) offices in 15 miles State Florida ©2015 QuestMalyfics, LLC. City Mlafril Fort Lauderdale Hallandale J-u r r 33178 33146 33312 33009 Employee Zip Code_ # Employees With Access Provider Name 33132 9 Cigna DHMO. Open General Dentists.: . Cigna DHMO - Endodontists Cigna DHMO=•Periodonfisfs ;,._, Cigna DHMO - Oral Surgeons Cigna DiMO--Orttodontists , 9 Cigna DHMO - Open General Dentists ;Cigna,DHMO Endodontists ;; Cigna DHMO - Periodontists Cigna DHMO Oral''Surgeons . Cigna DHMO - Orthodontists 9 Cigna DHMO Opeti Genera( Dentists Cigna DHMO Endodontists CignaDHMO - Penodonhsts , Cigna DHMO - Oral Surgeons Cigna DHMO Orthodontists 8 Cigna DHMO - Open General Dentists " Cigna DHMO - Endodontist ';' Cigna DHMO - Periodontists Cigna DHMO Oral_Surgeons Cigna DHMO - Orthodontists 8 Cigna DHMO Ope General`Dentlsfs Cigna DHMO - Endodontists Cigna DHMO Periodontists? Cigna DHMO - Oral Surgeons Cigna DHMO Orthocl ntists„ 6 Cigna DHMO - Open General Dentists Cigna DHMO Endodontists Cigna DHMO - Periodontists Cigna DHMO Oral Surgeons Cigna DHMO - Orthodontists Cigna DHMO Opeh l eneral Dentists Cigna DHMO - Endodontists Cigna DHMO Penodontisfs Cigna DHMO - Oral Surgeons Cigna DHMO Orthodontists _„ 6 Cigna DHMO- Open'General Dentists IfifTOKV1614.COR460.t Cigna DHMO - Periodontists Cigna•DHMO - Oral Surgeons ,. .' Cigna DHMO - Orthodontists 124 With Ac essl Average Distance % 1 2 -,9 9 9 9 9 9. 9 9 9 9 9 �00;0 100.0 100.0 100.0 1000 100.0 100.0 100.0 100,0 100.0 1000, 100.0 100.0. 100.0 100.0 100.0 1000 100.0 100A 100.0 1000 100.0 =f 00;0 100.0 100.0 100.0 100 0 100.0 100• 0 100.0 100.0 000 100.0 100 0` 100.0 100.0 100.0 2.2 1.7 1.1 2.3 2.9 2.7 1.1 3,2 7.4 5.4 4:9 1.0 1.6 1..1`. 1.1 1.4 1.4 1.6 3.7`. 3.1 2.1 0.7` 0.9 0.8 2.2 2.2 1.7 3.5 2.6 4.8 4.1 25 4.6 8.0 64 5.4 5.3 1.5 17. 1.7 1.7 1.6 5.0 20 5.0 1.9' 1.8 4.1 38 3.2 2.1 1.1 1.2 1;3 -1s3 1.8 1.8 Continued on nextpage... Cigna Network Analysis Access Detail for All Employees With Access 26 June 2015 Created for... City of Miami All Accessibility - Cigna DHMO -All Employees - Dental Providers 1 The Access Standard is defined as (All Employees) employees accessing: 2 (Cigna DHMO - Open General Dentists) offices in 15 miles, 2 (Cigna DHMO - Endodontists) offices in 15 miles, 2 (Cigna DHMO - Periodontists) offices in 15 miles, 2 (Cigna DHMO - Oral Surgeons) offices in 15 miles, 2 (Cigna DHMO - OrthodonUsis) offices in 15 miles ©2015 QuestAnatyfics, LLC. Pembroke,Pines _; Wellington Fort Lauderdale Fort Lauderdale 33414 33325 33317 Employees With Access Provider Name igna DHMO. Open General Dentists_ Cigna DHMO- Endodontists Cigna DHMO{ yPeriiodontists,_,;t Cigna DHMO - Oral Surgeons "Cigna DHMO Orthodontists , ; 6 Cigna DHMO Open. General Dentists Cigna.DHMO Endodontisfs_ _"_ Cigna DHMO 7 Periodontists Cigna DHMO _Oral Surgeons Cigna DHMO - Orthodontists Cigna DHMO .Open General Dentists „ Cigna DHMO - Endodontists igna DHMO Periodontists Cigna DHMO - Oral Surgeons Cigna DHMO Ortfiodontists `N, 5 5 '4. 4 Cigna DHMO - Open General Dentists Cigna DHMO . Endodontists Cigna DHMO - Periodontists 'Cigna,DHMO , Oral Surgeons Cigna DHMO: Orthodontists Cigna DHMO , Open`;General D ntists Cigna DHMO -Endodontists Cigna DHv1O "Penddontlsts._. ,, Cigna DHMO Oral Surgeons Cigna DHMO Orthodontists s " Cigna DHMO Open General Dentists Cigna,DHMO- Endodontists zr Cigna DHMO - Periodontists Cigna DHMO Oral Surgeons;: Cigna DHMO - Orthodontists CignaDHMO ,_Open General Dentists. ". Cigna DHMO - Endodontists Cigna,D-IM0 Periodontists , ; Cigna DHMO Oral Surgeons„ Cigna:DHMO Ort bdontists Cigna DHMO -.Open General Dentists Cigna,DHMO .Endodontists Cigna DHMO - Periodontists Cigna DHMO - Oral' Surgeons Cigna DHMO - Orthodontists 3 2 With Access' Average Distance # % 1 2 6 6 6 6 6 6 5 5 5 5 5 5 5 5 5 5 5 5 5 4 4 4 4 4 4 4 4 100.0 100.0 100,0 100 0 100.0 100:Q 100.0 i o:o 100.0 100;t) 100.0 100 0; 100.0 100.0 100;0 100.0 100 0. 100.0 .100.0: -too.0 1000 100.0 100.0 100.0 100 0. 100.0 100.0 100.0 100.0 100.0 100. 100.0 100A' 100.0 100:0 100.0 100.0 100.0 1.0 1.0 2.5 0.6 0.8 :1:6 3.2 3'i9: 2.3 3.3 21 218 1.8 2.2 37 2.4 24; 1.3 6.1 2.6 1.5 ,1I8; 2.8 <35 3.3 3.2 2.8 1.6 3.1 2.8 3.1 31 0.9 09 1.1 1.1 1.4 0.8 0.8 2.6 2.3 2.2 1.3 0.9 3.6 1,5 0.7 1.7 1.7 2.9 29 2.7 0.7 3.1 1-9 3.1 0.9 Continued on next page... Cigna NeczorkAnalysis Access Detail forAllEmployees With Access 27 June2015 Created for... City of Miami Al Accessibility- Cigna DHMO -Al Employees - Dental Providers 1 The Access Standard is defined as (All Employees) employees accessing: 2 (Cigna DHMO - Open General Dentists) offices in 15 miles, 2 (Cigna DHMO - Endodontists) offices in 15 miles, 2 (Cigna DHMO - Periodontists) offices in 15 miles, 2 (Cigna DHMO - Oral Surgeons) offices in 15 miles, 2 (Cigna DHMO - Orthodontists) offices in 15 miles Florida C 2015 QuestAnalytics, LLC. HDmestead' Jupiter Ldkahatchee Miami Miami Beach aim City'; Port Saint Lucie .::ic Nfy i '33035 33458 33470 33170 ,33233 .. 33154 34990 34953 Employees With Access Provider Name 4 CignacigritEIHMQ4.TOpettGenerali)entlsis t`> Cigna DHMO - Endodontists Cigna DHMO Periodontists. Cigna DHMO - Oral Surgeons Cigna DHMO .Orthodontists 4 Cigna DHMO - Open General Dentists Cigna DHMO,- Endodontists -t:• Cigna DHMO - Periodontists Cig'naDHMO OraiSurgeons" Cigna DHMO - Orthodontists CignaDHMO Open; General: Dentists Cigna DHMO - Endodontists Cigna DHMO Periodontists z Cigna DHMO - Oral Surgeons Cigna'DHMO, Orthodontists 4 Cigna DHMO - Open General Dentists Cigna DHMO Endodontists Cigna DHMO - Periodontists Cigna DHMO Oral,Surgeons Cigna DHMO - Orthodontists CignaDHMO Open'; Genera1Dentisfs s Cigna DHMO Endodontists Cigna DHMO Periodontists . Cigna DHMO - Oral Surgeons Cigna DHMO Oritrodontists Cigna DHMO - Open General Dentists. Cigna DHMO Endodontists Cigna DHMO - Periodontists Cigna DHMO OralASurgeons Cigna DHMO - Orthodontists Cigna"DHMO OpensGenera4 Dentists" Cigna DHMO - Endodontists Cgna.DHMO Periodontists " Cigna DHMO - Oral Surgeons Cigna DHMO`- Orthodontisiitt , v , 4 4 Cigna DHMO - Open General Dentists CignarDliMO - Endodontasts ry , Cigna DHMO - Periodontists Cigna'DHMO Oral Surgeons Cigna DHMO - Orthodontists With Access?Average Distance 4 % 1 2 4 4 4 4 4 4 4 4 4 4 4 4 4 4 `4 4 • 4 4 4 4 4 4 4 4 4 4 i00.0 100.0 300.0' 100.0 100.0 100.0 10a.d 100.0 100:0 100.0 100.0 100.0 100:0. 100.0 100.0 100.0 100.0 100.0 foo 0 100.0 100.0 100.0 1000 100.0 100.0 100.0 100.0 100.0 100.0 100.0 400 0' 100.0 1000 100.0 100.0 100.0 100.0 100.0 13 1.3 1.3 1.3 1.3 1.3 1.9 1°3 1.3 6.7 7.1 7.1, 7.1 7.7 2.7 3.8 4.2 3.8 11. 1.4 1.3 2.6 2.0 20 2.5 2.0 1.9 4.4 1.8 10.8 1.3 1.3 1.3 2.0 1.9 1.9 1.4 71 7.1 71, 7.8 7.8 3.6 68. 4.8 61' 3.8 1.4 2.8 26, 2.1 25: 4.6 2i5 2.5 4• 5 4.7 1.9 ' 4.4 D4,i0: 4.0 4.0 4.0 4.7 16 1.6 3.0 4.2 Continued on nextpage... 126 Cigna Network Analysis Access Detail for All Employees With Access 28 June 2015 Created for... City of Miami All Accessibility - Cigna DHMO - All Employees - Dental Providers The Access Standard is defined as (Ali Employees) employees accessing: 2 (Cigna DHMO - Open General Dentists) offices in 15 miles, 2 (Cigna DHMO - Endodontists) offices in 15 miles, 2 (Cigna DHMO - Periodontists) offices in 15 miles, 2 (Cigna DHMO - Oral Surgeons) offices in 15 miles, 2 (Cigna DHMO - Orthodontists) offices in 15 miles State Florida District of Columbia Florida © 2015 QuestAnalyfics, LLC. City iiferdale Palm Beach Gardens Washington Fort Lauderdale Employee Zip Code # 33324 33418 33316 ,..,.... ems. 3 3 3 2 Employees With Access Provider Name Cigna DHMO Open General Dentist ' Cigna DHMO Endodontists Cigna DHMO Periodontis Cigna DHMO Oral Surgeons Cigna DHMO Orthodontists Cigna DHMO Open General Dentists .Cigna DHMO yEndod nhsts :t . Cigna DHMO - Periodontists .Cigna DHMO Orali� - Surgeons_; Cigna DHMO - Orthodontists Cigna DHMO Open General;,D_ entists Cigna DHMO - Endodontists igna DHMO - Periodontists Cigna DHMO Oral Surgeons 'Cigna DHMO Orthodontists : ,_ Cigna DHMO - Open General Dentists Cigna DHMO Endoiontisfs Cigna DHMO - Periodontists Cigna`DHMO Oral Surgeons ''' Cigna DHMO - Orthodontists Cigna DHMO Ope, General;Hentists„ Cigna DHMO -,Endodontists Cigna DHMO Periodontists=' Cigna DHMO - Oral Surgeons Cigna DHMO •Orthodontists Cigna DHMO - Open General Dentists Cigna DHMO Endodontists_ ,F . _ Cigna DHMO Periodontists Cigna DHMO Oral Surgeons' Cigna DHMO :Orthodontists Cigna`DHMO Open General: Dentists Cigna DHMO - Endodontists Cigna-DHMO Periiodontists Cigna DHMO Oral Surgeons Cigna;DHMO.- Orthodontists ,, Cigna DHMO Open General Dentists Cigna'DHMO' Endodontists .. Cigna DHMO - Periodontists Cigna DHMO - Oral Surgeons - Cigna DHMO - Orthodontists With Accessl Average Distance # % 1 2 1 QO 0 100.0 100`:0` 100.0 100,Q 100.0 100 0. 100.0 100:0 100.0 100`0: 100.0 100"0 100.0 100.0 100:0 100.0 1000 100.0 100 0' 100.0 1.00.0 100.0 100.0 100.0 00._0 100.0 100 0. 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 0.6 -rx> 0.3 0.5 1.0 0.6 2.3 1.8 0.9 1.2 13 2.4 1.1 23 2.3 2.3 22. 3.2 3.4 3.6 0.9 5.1 5.9 3.6 4.6 4.4 4.8 5.2 Continued on next page_. 0.7 0.5 to 0.6 10. 1.0 0:9 1.0 22 2.3 18. 2.3 21 1.0 1.2 1;e' 3.2 24. 2.3 4.6 2.3 2.9 3.1 3,3 3.5 4.2 3.7 2.1 5.1 6.9 3.6 21.. 0.8 5.2 4.8 4.6 Cigna Mork Analysis Access Detail for All Employees With Access 29 June 2015 Created for... City of Miami All Accessibility- Cigna DHMO -All Employees - Dental Providers The Access Standard is defined as (All Employees) employees accessing: 2 (Cigna DHMO - Open General Dentists) offices in 15 miles, 2 (Cigna DHMO - Endodontists) offices in 15 miles, 2 (Cigna DHMO - Periodontists) offices in 15 miles, 2 (Cigna DHMO - Oral Surgeons) offices in 15 miles, 2 (Cigna DHMO - Orthodontists) offices in 15 miles State Floricla 02015 Quest Anarytics, LLC. City Fort Lauderdale • FortMyers Homestead iivemess Lak Worth Lehigh Acres . , Employee Zip Code 33321. 33322 33327 33334 •P33908';',:;14 33034 34453 33449 33936 2 2 2 2 Employees With Access. Provider Name Cigna.pOrvic-.),:.,.0req[G006tatDentists• ' Cigna DI-IMO - Endodontists CigriaDHM0.- Periodontists Cigna DHMO - Oral Surgeons Cigna.ptimo.-:oitiriodpf,tists' Cigna DHMO - Open General Dentists Cigna DHMO - Endodontists Cigna DHMO - Periodontists Cigna DHMO Oral Cigna DHMO - Orthodontists Cigna OHMO.:pperiateneral. Dentists • Cigna DHMO DHMO - Endodontists . Ciia DHMO - Periodontists Cigna DHMO - Oral Surgeons Cigna DHMO ..• Cigna DHMO - Open General Dentists Cigna DNMO-Endodontists Cigna DHMO - Periodontists Cigna DHMO - Orthodontists Cigna DFIMO - Endodontists Cigna DH!IO -Periodontists Cigna DHMO - Oral Surgeons CigneDHMODiffiOdentiStr.:.- Cigna DHMO - Open General Dentists Cigna DHMO - Endodontits Cigna DHMO - Periodontists Cigna DHMO -OrafSurgeons - Cigna DHMO - Orthodontists Cigna DHMO Open Generat Dentists Cigna DHMO - Endodontists Cigna DMO - Oral Surgeons Cigna DHMO : Orthodontists LrdNi*Pi*.fAi30iiteillir:#04051irdigtZPV. Cigna DHMO - Endodontists .-.6144150610XitOn76116Witt.015352530itanit Cigna DHMO - Oral Surgeons Cigna DHM0'.2-.Orthedantists‘,:ii-77.7:f--7-, Cigna DHMO - Open General Dentists -:1 2 0 2 1 6 4 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 With Access' Average Distance * % 1 2 2 2 2 2 2 2 • :••••-••••''''•••2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 100.a 100.0 100.0 100.0 100.0 100.0 100.0 100.0 too° 100.0 100.0 ) ob:o 100.0 loo.o 100.0 100.0 .)60, 100.0 1:00.0 100.0 )od.o 100.0 100.0 100.0 )otlo 100.0 ,1601Y 100.0 )140.6. 100.0 466:0- 100.0 10010; 100.0 100.0 100.0 100.0 - 1.2 0.5 1.7 1.2 1.3 0.2 0.4 0.5 1.4 5.8 - 2.9 2_8 2.9 1.2 3.6 3.4 4.2 2.8 4.2 4.2 2.9 4.2 1.7 7.4 10.3 1.7 ttr: 1.6 4.5 - 4.4 3.5 15 1.3 ..1.8 1.2 2.4 0.6 0.5 0.5 OA: 1.9 2.9 7.4 2.9 30 1.2 1.8 1.8 3.6 6.0 3.6 4.2 2.8 13.5 4.2 4.2 4.2 13.0 7.4 13.9 7.5 tigigka 4.5 5.2 • 4.4 10.5 Continued on nextpage... 128 Cigna Network Analysis Access Detail for All Employees With Access 30 June 2015 Created for... City of Miami All Accessibility - Cigna DHMO -All Employees- Dental Providers 1 The Access Standard is defined as (All Employees) employees accessing: 2 (Cigna DHMO - Open General Dentists) offices in 15 miles, 2 (Cigna DHMO - Endodontists) offices in 15 miles, 2 (Cigna DHMO - Periodontists) offices in 15 miles, 2 (Cigna DHMO - Oral Surgeons) offices in 15 miles, 2 (Cigna DHMO - Orthodontists) offices in 15 miles State Florida _ ... City Lehigh Acres �,; Employee Zip Code # :33936 2' 2 Employees With Access Provider Name CignaDHMO Periodontists u _ , Cigna DHMO Open General Dentists Cigna DHMQ -Endodontists , Cigna DHMO - Periodontists Cigna DHMO , Oral Surgeons, Cigna DHMO - Orthodontists Cigna,DHMO Open General°;Dentists, Cigna DHMQ - Endodontists Cigna DHMQ Periodontists , Cigna DHMQ - Oral Surgeons Cigna DHMO-O,rthodonttsts,,„„.W Cigna DHMO - Open General Dentists Cigna'DHMO - Endodonh`sts Cigna DHMQ - Periodontists Cigna DHMO Oral',Surgeons Cigna DHMQ-Orthodontists Cigna DH:MO , Open General Dentists .! Cigna DHMO -Endodontists Cigna DHMQ Periodontists Cigna DHMO-,Oral Surgeons Cigna DHMQ Orthodontists Cigna DHMO- Open General Dentists Cigna;DHMO Endodontists _-, ., Cigna DHMQ - Periodontists CignaDHMO Oral'Surgeons°:~ Cigna DHMQ - Orthodontists Cigna,DHMO _,OperGeneralDentists Cigna DHMO - Endodontists Cigna DHMQ Periodontists Cigna DHMO - Oral Surgeons Cigna DHMQ - Orthodontists: Cigna DHMO - Open General Dentists Cigna DHMO -Endodontists' Cigna DHMO - Periodontists Cigna DHMQ Orthodontists., __. Cigna DHMO Open General Dentists Cigna DHMO?"?.0801ists F? Cigna DHMO - Periodontists Cigna DHMO - Surgeons Cigna DHMO - Orthodontists 0 With Access, Average Distance # % 1: 2 2 100E 100.E 1000' 1.1 1.1 ©2015 QuestAnalytics, LLC. ,33261 0 2 2 2 2 2 2 2 2 2 2 2 2 2, 2 2 2 2 2 2 2 2 2 2 2 100.0 100.0, 100.0 100 0 100.0 100 0, 100.0 1.0E 0 100.E 100.0 100,E 100.0 100.Q. 100.E 106.E 100.0 100.E 100.0 100.E 100.0 100.E 100.0 100.E 100.0 100.E 100.0 l0o.0 100.0 100.E 100.0 100 0 100.0 100.E 100.0 100.0 100.0 2.0 2.0 0.5 1.3 1.0 1.0 1.1 1.5 6.4 4.2 1.4 1.5 6:6 0.6 1.5 1.5 1.5 3.7 7.5 8.4 0.7 1.1 1.1 1.1 2.6 2.9 2.0 2.0 0.5 1.3 13, 1.0 1.3 1.8 18. 1.1. :2 8.1 3.8 5.3 2.2, 1.8 3.1 3:1 2.8 { 0.9 0.6 4.5 1.5 1.5 7.5 8.8 8.4 109 1.0 19 1.9 1.9 2.6 Continued on next page_. Cigna Nr;,-..orkAnalysis Access Detail for All Employees With Access 31 June 2015 Created for... City of Miami All Accessibility -Cigna DHMO -All Employees - Dental Providers 1 The Access Standard is defined as (All Employees) employees accessing: 2 (Cigna DHMO - Open General Dentists) offices in 15 miles, 2 (Cigna DHMO- Endodontists) offices in 15 miles, 2 (Cigna DHMO - Periodontists) offices in 15 miles, 2 (Cigna DHMO - Oral Surgeons) offices in 15 miles, 2 (Cigna DHMO -Orthodontists) offices in 15 miles Florida Arizona Colorado @ 2015 Quest Analytics, LLG. Pompano Beach Port Orange Port Saint Lucie Sebring Stuart ;Tarpon Springs The Villages henucCity` Littleton 32128 34986 34997 32162 80129 Employees With Access Provider Name 2 CignaDHMQ, Open'GeneralDentists Cigna DHMO - Endodontists Cigna DHMO -: Periodontists Cigna DHMO - Oral Surgeons Cigna DHMO-Orthodontists ;_::, ,, 2 Cigna DHMO - Open General Dentists Cigna DHMO - Eridodontists. ; _ , Cigna DHMO - Oral Surgeons Cigna DHMO' Orthodontists: 2 Cigna DHMO - Open General Dentists CignaDHMO - Endodontists: ; Cigna DHMO - Periodontists Cigna: DHMO -Oral Surgeons.; Cigna DHMO - Orthodontists Cigna DHMO 0pen_;General Dentists Cigna DHMO - Oral Surgeons CignaIJHMO Orthodontists ,t' 2 Cigna DHMO - Open General Dentists Cigna DHMO Endodontists :;; Cigna DHMO - Periodontists Cigna DHMO Oral Surgeons? Cigna DHMO - Orthodontists :Cigna DHMO Open` General, Dentist Cigna DHMO - Endodontists Cigna DHMO Periodontists, ` Cigna DHMO - Oral Surgeons Cigna,DHMQ Orthodontists 2 Cigna DHMO - Open General Dentists Cigna DEMO, ,Endodontists, x, . Cigna DHMO - Periodontists ,Cigna DHMO "Oral;Surgeons'`` Cigna DHMO - Orthodontists Cigna DHMO Open`;General Dentists Cigna DHMO - Orthodontists Cigna DHMO - Oper General Dentin 1 Cigna DHMO - Endodontists. Cigna DHMO Periodontists Cigna DHMO -Oral Surgeons Cigna'DHMO Orthodontists Cigna DHMO - Open General Dentists With Ac ess' Average Distance ' % 1' 2. 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 1 1 1 1 Ioo;o 100.0 1000 100.0 100.0 100:0 100.0 100;0 100.0 100.0 100.0 .100.0' 100.0 100.0 100.0 100:0 100.0 100 0 100.0 igo:o; 100.0 100,0' 100.0 100.0- 100.0 1000E 100.0 • 00.Q_ 100.0 100:0` 100.0 100.0? 100.0 100.0 100.0' 100.0 0.4 0.4 :0.4 4.2 4.6 4.6 4'2 0.6 0.7 1.1 3:6 0.9 • 3.5 2.3 • 3.6 4.5 3.7 8.6 8:6 '1::1 0.4 1.1 0.4 11. 4.3 4.6 4.6 6.7 1.0 0.7 1.1 0.7 2.7 4.2 4.3 70 2.3 6.0 4.2 5.6 36° 5.6 8.6 8.6 8.6 53. 5.3 2.4 1.4 2.4 0.7 2.5 Continued on next page-. 130 Cigna Network Analysis Access Detail for All Employees With Access 32 June 2015 Created for... City of Miami All Accessibility - Cigna DHMO -All Employees- Dental Providers 1 The Access Standard is defined as (Alt Employees) employees accessing: 2 (Cigna DHMO - Open General Dentists) offices in 15 miles, 2 (Cigna DHMO - Endodontists) offices in 15 miles, 2 (Cigna DHMO - Periodontists) offices in 15 miles, 2 (Cigna DHMO - Oral Surgeons) offices in 15 miles, 2 (Cigna DHMO - Orthodontists) offices in 15 miles State Cofo`rado '.` Florida e 2015 Quest Analytics, LLC. City Littleton w Bokeelia .. Employee Zip Code # Employees With Access Provider Name ;Cigna DHMO _Endoodontistsop, „ Cigna DHMO - Periodontists Cigna DHMO Oral Surgeons . Cigna DHMO - Orthodontists Cigna DHMO Open; General; Dentists°`'; Cigna DHMO -Endodontists Cigna DHMO OralSurgeons ,. Cigna DHMO - Open -General Dentists Cigna,DHMO Endodontists . Cigna DHMO - Periodontists Cigna DHMO OrarSurgeons ..; Cigna DHMO - Orthodontists ;Cigna DHMO _ Open General: Dentists Cigna DHMO - Endodontists Cigna DHMO - Periodontists Cigna DHMO - Orthodontists Cigna DHMO OpenGeneralDenhsts s Cigna DHMO - Endodontists Cigna DHMO Periodontists Cigna DHMO -Oral Surgeons Cigna DHMO ``Orthodontists Cigna DHMO Open General Dentists Cigna DHMO :Endodontists _. Cigna DHMO - Periodontists. Cigna DEMO Oral Surgeons Cigna DHMO -.Orthodontists ;Cigna DHNIO Open General`, Dentists' Cigna DHMO - Endodontists Cigna,DHMO Penodontistss; . Cigna DHMO Oral Surgeons Cigna DHMO Orthodontists, Cigna DHMO - Open General Dentists Cigna DHMO -Endodontists Cigna DHMO Periodontists Cigna DHMO Oral Surgeons ; , Cigna DHMO Orthodontists Cigna DHMO OpenGeneral,Dentists`. Cigna DHMO Endodontists Cigna DHMO - Periodontists •' Cigna DHMO- Oral Surgeons With AccesslAverage Distance #- %; 1 2 100.0 100.0 100 0: 100.0 1000: 100.0 100 0 100.0 100:0 100.0 100.0' 100.0 100.0 100,1), 100.0 100.0 100.0 1000, 100.0 1000 100.0 100..0 100.0 1000 100.0 ;100'.0 100.0 100.0 100.0 100.0- 100.0 100.0' 100.0 100:0 100.0 100.0 100.0 0.7 0.7 9.4 01i 0.9 1.3 1;3 0.9 1013` 10.3 10.3 0.7 0.7 0:7 0.2 1.1 0.6 3.4 3.4 3:4 34 3.4 0.3 1.4 0.3 0.4 1r3 2.2 1.6 1.4 4. 4�6 1.7 0;7: 0.7 101 9.4 10A 1.3 • 13 3.1 ;13.` 1.3 10.4. 14.4 121` 12.1 0. 0.7 -19. 0.7 Dz 1.0 1.4 1.1 11`. 1.0 4.9 3.4 4.7. 3.4 4.3 0.3 1.4 0.3 1.1 6 2.2 2.2 2.2 Continued on next page._ Cigna Nt•,_.orkAnalysis Access Detail for All Employees With Access 33 June 2015 Created for... City of Miami All Accessibility - Cigna DHMO - All Employees - Dental Providers The Access Standard is defined as (All Employees) employees accessing: 2 (Cigna DHMO - Open General Dentists) offices in 15 miles, 2 (Cigna DHMO - Endodontists) offices in 15 miles, 2 (Cigna DHMO - Periodontists) offices in 15 miles, 2 (Cigna DHMO - Oral Surgeons) offices in 15 miles, 2 (Cigna DHMO - Orthodontists) offices in 15 miles Florida ©2015 QuestAnalytics, LLC. Delray Be -sett..., East Palatka Englewood Estero Fort Lauderdale ::33445 .,LL 33484 "32131 .' 34223 33928 33301 33304 -e 33309 33313 MEN 33319 ttlata Employees. With Access Provider Name Cigna DHMO , Oittiod ntists Cigna DHMO - Open General Dentists Cigna.DHMO Endodontists Cigna DHMO Periodontists CignaDHMO Oral Surgeons :; Cigna DHMO -Orthodontists Cigna ,Orthodontists. Cigna DHMO-Open General Dentists Cigna DHMO Periodontists Cigna DHMO - Orthodontists Cigna DHMO, Open General: Dentists.,.; Cigna DHMO -Endodontists Cigna DHMO Periodontists Cigna DHMO - Oral Surgeons ;Cigna DHMO Orthodontists Cigna DHMO - Open General Dentists Cigna DI-IMO Endodontists '„ Cigna DHMO - Periodontists Cigna DHMO Oral'Surgeons; :. Cigna DHMO - Orthodontists Cigna D}IMO -Open General Dentists Cigna DHMO -Endodontists Cigna DHMO -Periodontists__ : Cigna DHMO - Oral Surgeons Cgna,DHMO Orthodontists. Cigna DHMO - Open General Dentists Cigna'DHMO Endodontists. , Cigna DHMO - Periodontists Cigna DHMO OralSurgeons. ,;; Cigna DHMO - Orthodontists Cigna DHiv10r Open General Dentists Cigna DHMO - Endodontists Cigna. DHMO Periodontists Cigna DHMO --Oral Surgeons :Cign&DH 10 Ohhodontists "' Cigna DHMO - Open General Dentists Cigna DHMO Endodonti Cigna DHMO - Periodontists Cigna°DHMO Oral Surgeons n Cigna DHMO - Orthodontists 2 0 With Access'Average Distance # % 1: 2 00( 100.0 100.0 100.0 11000 1 100.0 , 100:0 100.0 100.0 1 100.0 1 1:00.0 1 100.0 1 100.0 1 100.0 1000 1 100.0 1000 1 100.0 100.0'. 1 100.0 000 1 100.0 1 1 1 1 100.0 100:0. 100.0 100.0 1000 100.0 100:0' 100.0 10010 100.0 100.0 100.0 100a: 100.0 22 0.3 6.4 10.0 2:6 2.6 4;6 7.7 2.9 0.4 3.6 4.1 1.7 2.1 34 1.0 3.7 3.0 0.7 22 0.6 1.3 1.0 1:;3 4.1 6.2 7.9 10.0 14.6 46 4.6 •4.6 8.7 0.6 .41_ 4.9 3.6 4.6 3.0 3;7 2.3 40 1.6 =3.5 3.7 3.4 2.4 1.2 1.7 1.8 2.3 3.0 2.1 3.2 Continued on next page_ 132 Cigna Network Analysis Access Detail for All Employees With Access 34 June 2015 Created for... City of Miami At Accessibility - Cigna DHMO -All Employees - Dental Providers 1 The Access Standard is defined as (Ali Employees) employees accessing: 2 (Cigna DHMO - Open General Dentists) offices in 15 miles, 2 (Cigna DHMO - Endodontists) offices in 15 miles, 2 (Cigna DHMO - Periodontists) offices in 15 miles, 2 (Cigna DHMO - Oral Surgeons) offices in 15 miles, 2 (Cigna DHMO - Orthodontists) offices in 15 miles State Florida_ ©2015 Quest Analytics, LLC. City eft Lauderdale' . , ,. Fort Myers Gainesville s- Greenwood :Hollywood Homestead Employee Zip Code # 234.:. 33329 33913 32606.. 32443 33019 33083 33092 1 1 1 1 Employees With Access Provider Name Cigna DHMO Open General_Dentists, Cigna DHMO -_Endodontists _Cigna DHMO Periodontists m Cigna DHMO - Oral Surgeons Cigna DHMO Oithodontists. ,_ Cigna DHMO- Open General Dentists Cigna:DHMO - Endodontists _, __ Cigna DHMO - Periodontists Cigna DHMO ,Oral;Surgeons ,;.1 Cigna DHMO - Orthodontists Cigna DHMO OpenGeneral Dentists`:; Cigna DHMO - Endodontists Cigna DHMO Periodontists , Cigna DHMO - Oral Surgeons ;Cigna DHMO Orthodontists w Cigna DHMO - Open.General Dentists CignaeDHMO - Endodontists Cigna DHMO - Periodontists - Cigna DHMO ,Oral"Surgeons Cigna DHMO - Orthodontists Cigna DHMO w.Open GenerafDentists Cigna DHMO - Endodontists CignaDHMO Oral_Surgeons_`s Cigna DHMO - Oral Surgeons Cigna DHMO- Opeh General.Denbsts Cigna DHMO - Endodontists Cigna DHMO Periodontists,_ ,a Cigna DHMO Oral Surgeons CignaDHMO Orthodontists, Cigna DHMO - Open General Dentists - Cigna DHMO Endodontists <_ Cigna DHMO - Periodontists Cigna:DHMO- Ora(Surgeons- Cigna DHMO - Orthodontists Cigna DHMO Open°;General Dentists Cigna DHMO Endodontists `Cigna DHMO Periodontists =' Cigna DHMO - Oral Surgeons Cigna DHMO - Orthodontists Cigna DHMO - Open General Dentists With Access'Average Distance 1 1 ;1 1 1 1 1 0%u 100.0` 100.0 100:0; 100.0 100:o: 100.0 100.0. 100.0 100.0 100.0 100.0 100.0 r000 100.0 100 0 100.0 100 0 100.o 100 0 100.0 1 o0.0 100.0 too 0 100,0 100.0' 100.0 1000 loo,o 100:0 100.0 100.0 100.0 100.0 100.0 100:0 100.0 100.6 100.0 100.0 100.0 11; 1.1 2.8 ;11 1.3 1.3; 0.9 1.1 1.3 c 1.3 1.3 1.3 1.3 : i13 1.3 1.3 2.9 2.5 4.7 2.5 1.5 4.4 6,4 3.9 6.4 5.5 6.2 1.3 _.. :15 1.3 1.3 1.3 1.5 9.1 9.1 1.7, 22 3.7 3.7 2.3 2.3 3.7 3.7 4.2 1.4 1.4 2,0 2.5 2.4 0.3 1.5 1.5 1.5 1.8 0.6 1.5 1.3 1.3 2.2 3.9 1..2 1.2 3.9 4:4 3.9 ,44 1.1 AAA 1.0 1.4 1.4 2.3 0.7 Continued on next page_ Cigna NeLworkAnalysis Access Detail for All Employees With Access 35 June 2015 Created for... City of Miami All Accessibility- Cigna DHMO -All Employees- Dental Providers 1 The Access Standard is defined as. (All Employees) employees accessing: 2 (Cigna DHMO - Open General Dentists) offices in 15 miles, 2 (Cigna DHMO - Endodontists) offices in 15 miles, 2 (Cigna DHMO - Periodontists) offices in 15 miles, 2 (Cigna DHMO - Oral Surgeons) offices in 15 miles, 2 (Cigna DHMO -Orthodontists) offices in 15 miles State Florida © 2015 Quest Analytics, LLC. City Homestead. Jensen Beach Lakeland Employee Zip Code # 1'33092 Employees With Access Provider Name Cigna DHMO'= Endodontists Cigna DHMO - Periodontists Cigna DHMO, Oral Surgeons Cigna DHMO - Orthodontists Cigna DHMO - Open General Dentists Cigna DHMO - Endodontists Cigna DHMO Periodontists.,: • Cigna DHMO -Oral Surgeons Cigna DHMO Orthodontists . Cigna DHMO - Open General Dentists Cigna DHMO Endodontists -: , Cigna DHMO - Periodontists Cigna;DHMO Oral` Surgeons,::.; Cigna DHMO - Orthodontists Cigna DHMO _ Open'General Dentists Cigna DHMO - Endodontists Cigna Penodontlstaz Cigna DHMO - Oral Surgeons Cigna DHN(0 Orthodontists Cigna DHMO - Open General Dentists Cigna.DHMO„,D'ndodonhsts - „E, , , Cigna DHMO - Periodontists Cigna DHMO Oral Surgeons;' Cigna DHMO - Orthodontists Cigna DH'MO Open; General; Dentists,_;' Cigna DHMO - Periodontists CignaDHMO OralSurgeons ;;" Cigna DHMO - Orthodontists CignaDHMO OperiGeneral"Dentists,=,' Cigna DHMO - Endodontists Cigna:DHMO Periodontists .r Cigna DHMO - Oral Surgeons Cigna DHMO Orthodontists ; _ Cigna DHMO - Open General Dentists CignaDHMO Endodontiats5 ,,_ _r Cigna DHMO Periodontists Cigni DNMO -OmI, Surgeons, x N : Cigna DHMO - Orthodontists Cigna OpenGeneral_Dentists Cigna DHMO - Endodontists With Access' Average Distance # % 1 2 • 1 1 1 1 .11)14 100.0 1000 100.0 100.0 100.0 .1000 100.0 1000 100.0 100:0 100.0 i00.6 100.0 100.0 100.0 1000 100.0 100,0 100.0 100:d.; 100.0 100 0 100.0 20.0 20.0 19919 100.0 1000 100.0 100.0 100.0 100.0 f000 100.0 3.9 4.9 3.9 2.8 3.2 3i 2.3 2.4 2:4 2.4 2.4 09 2.8 2.3 4.8 7.0 4.8 13.7 13.7 13.7 1.8 1.8 1'8 3.5 3.5 5.3 4.9 49 3.9 3.2 3.2 3.5 2.4 2.9 2.4 2.4 2.4 2.4 2.4 23 2.8 28 2.8 6.7 7`0 7.0 68 5.2 "14.3 13.7 13:7 13-.7 0.9 3.3 r1.8 3.0 33' 11.0 3.5 3.5 2:7 2.7 2.7 2.7 Confined on next page... 134 Cigna Network Analysis Access Detail for All Employees With Access 36 June 2015 Created for... City of Miami All Accessibility - Cigna DHMO -All Employees - Dental Providers The Access Standard is defined as (All Employees) employees accessing: 2 (Cigna DHMO - Open General Dentists) offices in 15 miles, 2 (Cigna DHMO - Endodontists) offices in 15 miles, 2 (Cigna DHMO - Periodontists) offices in 15 miles, 2 (Cigna DHMO - Oral Surgeons) offices in 15 miles, 2 (Cigna DHMO .Orthodontists) offices in 15 miles State. © 2015 Quest Analylics, LLC. City Employees With Access Employee Provider Zip Code # Name CignaDHMO Oral Surgeonsl F Cigna DHMO - Orthodontists Cigna DHfMO Open_General Dentists Cigna DHMO - Endodontists Cigna DHMO Periodontists: Cigna DHMO - Oral Surgeons Cigna DHMO Orthodontists ` Cigna DHMO - Open General Dentists Cigna,DHMO Endodontists>; Cigna DHMO - Periodontists Cigna DHMO ,Ora(SGrgeonsw^' Cigna DHMO - Orthodontists ;Cigna DHMO Endodontists: Cigna DHMO - Oral Surgeons Cigna DHMO_ Orthodontists ,. z f Cigna DHMO - Open General Dentists Cigna DHMO Endodontists Cigna DHMO - Periodontists ;Cigna DHMO OralSurgeons Cigna DHMO - Orthodontists CignaDHMO Open General°D`entists Cigna DHMO - Endodontists Cigna DHMO Periodontists „ i Cigna DHMO - Oral Surgeons Cigna DHMO Orthodontists Cigna DHMO Open General Dentists Cigna DHMO, Endodontists Cigna DHMO -.Periodontists Cigna DHMO Oral, Surgeons , r.=`. Cigna DHMO,- Orthodontists Cigna DHMO, Open:General :Dentists Cigna DHMO - Endodontists. Cigna DHMO - Periodontists .. Cigna DHMO Oral Surgeons C,gna=DHMO Orthodontists- Cigna DHMO - Open General Dentists Cigna;DHMO , Ehdodonttsts .-':..; . Cigna DHMO - Periodontists Cigna DHMO - Oral Surgeons Cigna DHMO - Orthodontists With AccessAverage Distance 2 1 1 1 1 1 1 1 i1 1 1 1 1 1 1 1 1 100.D: 100.0 ioo:o 100.0 100.0 100.0 100 D 100.0 100 0 100.0 '100.0,, 100.0 50 0 50.0 50 0 100.0 100 0 100.0 100.0 100.0 100 0 100.0 100.0 1DD.0 100 0 100.0 .loco 100.0 10.6 100.0 100.0 100.0 100.0 100.0 1000' 100.0 100.0 100.0 100.0 100.0 1.8 1; 5.7 6c8 3.2 5.6 11.6 11.6 3.3 3.6 3.3 3' 3.3 5.2 4.4 5.2. 5.2 -35 1.1 11 1.1 10 0.6 2.2 1.3 3.5 3.5 0.6 20_ 2.1 2.1 0.6 Continue 1.8 18 6.8 68 6.8 3:2: 5.6 149, 14.9 _146' 4.9 61 6.2 3:4 3.9 7,9. 7.9 8.0 5.2 4.7 1.2 2.3. 2.3 1.2 1.0 2.2 5.6 3.8 3.8 on next page... Cigna Network Analysis Access Detail for All Employees With Access 37 June 2015 Created for... City of Miami All Accessibility - Cigna DHMO -All Employees - Dental Providers 1 The Access Standard is defined as (All Employees) employees accessing: 2 (Cigna DHMO - Open General Dentists) offices in 15 miles, 2 (Cigna DHMO - Endodontists) offices in 15 miles, 2 (Cigna DHMO - Periodontists) offices in 15 miles, 2 (Cigna DHMO - Orai Surgeons) offices in 15 miles, 2 (Cigna DHMO - Orthodontists) offices in 15 miles State City Employee Zip Code # Employees With Access Provider Name With Access' 'Average Distance el 1 2 ©2015 QuestAnaiytics, LLC. Cigna.DHMO ;.Open•General Dentists Cigna DHMO - Endodontists CignaDHMO -.Periodontists Cigna DHMO - Oral Surgeons .Cigna.DHMO LLOrthodontists Cigna DHMO - Open General Dentists Cigna,DHMO. Endodontists• Cigna DHMO - Periodontists Cigna DHMO--Oral.Surgeons< Cigna DHMO - Orthodontists Cigna Open General;Dentist© • Cigna DHMO - Endodontists Cigna DHMO Periodontists t, •_ Cigna DHMO - Oral Surgeons Cigna DHMO O"rfhodontists ;<< Cigna DHMO - Open General Dentists Cigna DFIMO ,Endodontists Cigna DHMO - Periodontists ,Cigna DHMO OralSurgeons Cigna DHMO - Orthodontists Cigna DHMO Open General; Dentists . Cigna DHMO - Endodontists Cigna DHMO Periodontists Cigna DHMO - Oral Surgeons Cigna,DHMO Orthodontists Cigna DHMO - Open General Dentists CignailDH'MO Endodontists Cigna DHMO - Periodontists Cigna,DHMO OralSurgeons' Cigna DHMO - Orthodontists Cigna.DHMO Open,General'Dentists` Cigna DHMO - Endodontists Cigna DHMO Periodontists; Cigna DHMO - Oral Surgeons CignaDHMO Orthodontists _ Cigna DHMO - Open General Dentists Cigna<DHMO , Endodontis sVg, y i- _ Cigna DHMO - Periodontists Cigna DHMO-'O"ral'Surgeons Cigna DHMO - Orthodontists 2 1 1 1` 1 1 1 1 1000 100.0 100.0 100.0 100.0 100.0 100 0 100.0 ,100.0 100.0 100.0` 100.0 1000 100.0 100:0; 100.0 100• 0'. 100.0 100.0,'. 100.0 100;6 100.0 100.0 1000 100.0 -"bolo` 100.0 100.0 100.0 106.6 100.0 100,0 100.0 100.0 100.0 100.0 100.0 0.1.. 0:2 0.1 0.1 01 0.6 0.1 0.1 0.1 0.1,. 1.2 1.3 13 1.3 1.3 1.4 1.4 14 3.1 3.3 0.3 •0.4 0.3 0.3 .0.3 0 5: 0.3 0.3 0:3 0.4 0.4 0.8 0.8 26 2.4 -1.0 2.2 25 2.2 21 0.6 -1.9 0.6 1.9 18 1.8 2.9 10' 1.3 4 3.6 2i 11.0 14.8 09i 0.4 2.2 2.2 22 2.2 .1.1, 0.1 0.8 0.5 0.8 -20 0.9 2.2 Continued on next page_ 136 Cigna Network Analysis Access Detail for All Employees With Access 38 June 2015 Created for... City of Miami All Accessibility - Cigna DHMO -All Employees - Dental Providers The Access Standard is defined as (All Employees) employees accessing: 2 (Cigna DHMO - Open General Dentists) offices in 15 miles, 2 (Cigna DHMO - Endodontists) offices in 15 miles, 2 (Cigna DHMO - Periodontists) offices in 15 miles, 2 (Cigna DHMO - Oral Surgeons) offices in 15 miles, 2 (Cigna DHMO - Orthodontists) offices in 15 miles State City Employee Zip Code # Employees With Access. Provider Name With Access'r Average Distance # % 1 2 ulberry, s New Smyrna Beach North Port ClgnaDHMO , Open_ General`_Dentisfs ,: -' i+ Cigna DHMO -Endodontists ClgnaOFlMO'-Periodonfisfs w. Cigna DHMO - Oral Surgeons Cigna DHMO Orthodontists•, k Cigna DHMO - Open General Dentists Cigna DHMO Endodontists Cigna DHMO - Periodontists CignaOHMO Orthodontists ._u.z Cigna DHMO Open General Dentists ClgnaDHMO `Endodontists 4;k _ " , . Cigna DHMO Oral Surgeons ;Cigna DHMO Orthodontists Cigna DHMO - Open General Dentists 'CignaDHMO,YPeriodontists „.'_ , 4, Cigna DHMO -Orthodontists Cigna DHMO -Endodontists Cigna DHMO 7 Oral Surgeons Cigna DHMO OpeitGenera1 Dentists Cigna DHMO - Endodontists Cigna DHMO Penodontistsr. Cigna DHMO Oral Surgeons CignaDHMO yOrtjodontists `r. Cigna DHMO Open General Dentists Cigna DHMO - Endodontists„ f Cigna DHMO - Periodontists ,Cigna DHMO OralzSurgeona Cigna DHMO Orthodontists Cigna DHMO Open General Dentists Cigna DHMO -,Endodontists Cigna DHMO Periodontists Cigna DHMO - Oral Surgeons Cigna DHMO Orthodontists Cigna DHMO Open General Dentists, Cigna DHMO "Endodontists Cigna DHMO - Periodontists Cigna DHMO Oral Surgeons' Cigna DHMO - Orthodontists Cigna DHMO- Open Genial Dentists Cigna DHMO - Endodontists 100.0 100.0. 100.0 100 0, 100.0 00.0 100.0 100 0 100 0 1000 100.0 100 0 100.0 1 O,, 100.0 100 0 100.0 100 0 100.0 1000� 100.0 1000 100.0 1000 100.0 100.0 100.0 100.0 100.0 100,0 100,0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 6A: , . ;Z S 7.5 7.5 13.2; 6.0 7.5 '6.3 3.0 4.2 5.6 5.7 14; 1:4, 3.7 6.2 7.3 7.3 7.3 -10.6 5.2 9.4 136 .14--3,. 5.5 5.5 141 143 10.7 11.2 0.1f 0.9 1.4 1.4 1.4. 14.. 1.4 1.4 .114 1.4. 1.0 _ 2.5 i 2.8 4.5 2.8 4,5 '2.5. 2.5 2.3 2.3 94 2.0 3.0 3.0 2:4 3.0 3.0 3.3 .3.9 3.9 1.8 3.8 4.8 4.8 5.5 3.9. 2.2 5.1 2.0 2.6 1.2 7.8 5.2 3. Continued on next page_ © 2015 Quest Analytics, LLC. Cigna Network Analysis Access Detail for All Employees With Access 39 June 2015 Created for... City of Miami All Accessibility - Cigna DHMO -AII Employees - Dental Providers s The Access Standard is defined as (AO Employees) employees accessing: 2 (Cigna DHMO - Open General Dentists) offices in 15 miles, 2 (Cigna DHMO- Endodontists) offices in 15 miles, 2 (Cigna DHMO - Periodontists) offices in 15 mites, 2 (Cigna DHMO - Oral Surgeons) offices in 15 miles, 2 (Cigna DHMO - Orthodontists) offices in 15 miles State City Employee Zip Code # Employees With Access Provider Name With Access' Average, Distance # %: 1 2 Fierida. 02015 Quest Analytics, LLC. Ormond Beach Oviedo Palm Bay Palm Beach Gardens i Pembroke Pines . Pensacola Pompano Beach • 32174, 32907 33060 1 1 1 Cigna DHMO Oral°Surgeons Cigna DHMO - Orthodontists ,Cigna DHMO ,OpenGeneral Dentists Cigna DHMO - Endodontists CignaDHMO Periodontists :: Cigna DHMO - Oral Surgeons Cigna DHMO .Orthodontists Cigna DHMO - Open General Dentists Cigna: DHMO = Endodontists Cigna DHMO Periodontists Cigna DHMO Oral:Surgeons , Cigna DHMO - Orthodontists Cigna DHMO Operi'General Dentists Cigna DHMO - Endodontists ;Cigna DHMO'- Periodontists: Cigna DHMO - Oral Surgeons CignaDHMO„Orthodontists Cigna DHMO - Open General Dentists Cigna,DHMO AEndodontists Cigna DHMO - Periodontists Cigna,DHMO .Oral Surgeons .`_: Cigna DHMO - Orthodontists Cigna DHMO Endodontists , . _ Cigna DHMO - Oral Surgeons Cigna DHMQ Orthodontists Cigna DHMO - Open General Dentists Cigna,DHMO •Endodonbsts Cigna DHMO - Periodontists Cigna DHMO Oral Surgeons _ '< Cigna DHMO -_Orthodontists Cigna DHMO - Open`General Dentists Cigna DHMO - Endodontists Cigna DHMO Penodontists ;i Cigna DHMO - Oral Surgeons " Cigna DHMO Oithodontists u u = Cigna DHMO - Open General Dentists `Cj,. igna DHMO Endodontists,,=, - . '' Cigna DHMO - Periodontists Cigna DHMO -Graf Surgeons Cigna DHMO - Orthodontists 100�0` 2.0' 2.0 100.0 2.6 6.9 100.0 .03 1.6 100.0 0.3 6.3 1000' 0.3 03 100.0 0.3 0.3 100:0' -0.3 0.3 100.0 2.0 2.0 100.0 2.0' `21 1 100.0 2.0 2.0 1 100.0 .2.0 '2.0 1 100.0 2.0 2.0 1 1000 1.44 - 1.9 - 1 100.0 1.1 1.1 '1' 100.0 .07 .0.7 1 100.0 0.9 1.9 0•0 ': -1.1 11 1 100.0 0.7 1.0 100.0 07 .0.7 100.0 0.7 1.7 1000 07: 1.5 1 100.0 0.7 0.7 100 0 3.3 3.3. 100.0 2.8 2.8 100 0 :2.9 ,2.9 1 100.0 0.4 1.0 100 0 ;; 10, '10 1 100.0 1.0 1.0 100 0 1.P 100.0 1.6 1.9 100 0 0.5" -0.6 1 100.0 1.3 1.3 1000 1.3 13` 100.0 0.1 0.6 1000 0.8 1.3 • 1 100.0 0.8 1.5 =1 100.0 -17 1.7 1 100.0 2.3 2.4 Continued on nextpage_ 138 Cigna Network Analysis Access Detail for All Employees With Access 40 June 2015 Created for... City of Miami All Accessibility - Cigna DHMO -All Employees - Dental Providers The Access Standard is defined as (All Employees) employees accessing: 2 (Cigna DHMO - Open General Dentists) offices in 15 miles, 2 (Cigna DHMO - Endodontists) offices in 15 miles, 2 (Cigna DHMO - Periodontists) offices in 15 miles, 2 (Cigna DHMO - Oral Surgeons) offices in 15 miles, 2 (Cigna DHMO - Orthodontists) offices in 15 miles State Florida ©2015 QuestAnaiytics, LLC. City ompano°Beach Rockledge Sebring Employee Zip Code # 33071 34983 32955 33701 33870 1 1 1 1 1 Employees With Access Provider Name .gna DHMO Oper{General Dentists . T <_i Cigna plimo,7 Endodontists CignapHMO Periodontists. Cigna DHMO - Oral Surgeons Cigna DHMQ , Oritiodontists, Cigna DHMO - open General Dentists Cigna DH.,MO . Endodontists Cigna DHMO - Periodontists Cigna DHMO Oral„Surgeons Cigna DHMO Orthodontists Cigna DHMO Open'General Dentists Cigna DHMO - Endodontists gra DHMO .Periodontists; Cigna DHMO - Oral Surgeons Cigna DHMO Orthodontists Cigna DHMO - Open General Dentists ;Cigna DHMO Endodontists s , ' , , , Cigna DHMO ;Periodontists ,Cigna DHMO. Oral; Surgeons Cigna DHMO - Orthodontists ;Cigna DHMO- OpenvGeneral, Dentists =: Cigna DHMO - Endodontists Cigna DHMO Periodontists g Ci na DHMO Oral Surgeons Cigna DHMO,Orthodontists Cigna DHMO Open General Dentists Cigna DHMO Periodontists Cigna DHMO - Oral Surgeons Cigna DHMQ Orthodontists , `,, Cigna DHMO - Open General Dentists ;Cigna DHMO Endodontists Cigna DHMO - Periodontists Cigna DHMO oral;Surgeons. Cigna DHMO - Orthodontists Cigna DHMO open'General Dentists -- Cigna pi -No: Endodontists Cigna DHMO Periodontists Cigna DHMO - Oral Surgeons Cigna:DHMO -Orthodontists Cigna DHMO- Open General Dentists With. Access' Average Distance # # % 1 2 0 0 3 1 1 1 1 1 .1 1 1 100'0 100.0 1000` 100.0 100.0 100,0' 100.0 1000' 100.0 100.0 1000 100.0 100`;0 100.0 00:0 100.0 1000 100.0 11,01 100.0 1000 100.0 100 0 100.0 ,16614 100.0 10Q 0, 100.0 100 0, 100.0 ioo:o 100.0 100.0 100 0, 100.0 100.0 100.0 1.8 1.8 0.5 0.5 0.5 2.5 2.5 0.5 • 0.5 0.5 2.5 25 2.5 1.4 2.1 3 2, 32 3.2 3.3 211. 1.6 3.3 3.4 3.5 34 ? 4,0 3.2 3.2 3A 5.0. 4.5 5.6 12:4. 1.0 1.0 56 3.2 5.1 4.0 - . 4.0 5.7 4.2 4.0 9.6' 9.6 14.6 13.4 13.7 14.6 9.6 12.5 0.6 2.5 123. 5.7 3.1 4.0 Continued on next page_ Cigna Newark Analysis Access Detail for All Employees With Access 41 June 2015 Created for... City of Miami All Accessibility - Cigna DHMO -All Employees - Dental Providers 1 The Access Standard is defined as (All Employees) employees accessing: 2 (Cigna DHMO - Open General Dentists) offices in 15 miles, 2 (Cigna DHMO - Endodontists) offices in 15 miles, 2 (Cigna DHMO - Periodontists) offices in 15 miles, 2 (Cigna DHMO - Oral Surgeons) offices in 15 miles, 2 (Cigna DHMO - Orthodontists) offices in 15 miles State City Employee: Zip Code Employees With Access Provider Name With AccessAverage Distance # % 1 2 © 2015 QuestAnalylics; LLC. Sebring >-= Stockbridge Cigna`DHMO-:OralSurgeons.;; Cigna DHMO - Orthodontists Cigna DHMO - Open; General Dentists: Cigna DHMO - Endodontists Cigna; DHMO - Periodontists .:,,;; Cigna DHMO - Oral Surgeons .CignayDHMO --Orthodontists-..-, Cigna DHMO- Open General Dentists Cigna:DHMO Endodontists Cigna DHMO - Oral Surgeons Cigna DHMO Orthodontists ; Cigna DHMO - Open General Dentists Cigna DHMO �Endodontists Cigna DHMO - Periodontists Cigna DHMO OrahSurgeons Cigna DHMO Orthodontists CignaDHMO open; General Dentists . Cigna DHMO - Endodontists CignaDHMO Periodontists Cigna DHMO- Oral Surgeons Cigna DHMO :Orthodontists :; Cigna DHMO - Open General Dentists Clgna:DHMO Orthodontists j: Cigna DHMO - Open General Dentists Cigna.DHMO Endodontists• . '_ , Cigna DHMO - Periodontists Cigna DHMO.,'OralSurgeons , Cigna DHMO -Orthodontists ClgnapDHMO Open;General Dentists; Cigna DHMO - Periodontists Cigna DHMO Orat_Surgeons Cigna DHMO - Orthodontists Cigna DHMO Open'General.Dentists Cigna DHMO Endodontists Cr na DHf 1Q Periodonbsts" 6 w • r Cigna DHMO:, Oral Surgeons Cigna DHWIO Ortf bdonJsts Cigna DHMO - Open General Dentists Cigna.DHMO='Perodontsts Cigna DHMO - Oral Surgeons 100.0 100.0 100.0 100.0 100.0 100.0 1000 100.0 100.0. 100.0 100.0 100.0 100.0 100.0 100:0 100.0 100;0 100.0 1000 100.0 1000 100.0 100.0 100.0 1000 100.0 1,000 100.0 1000 100.0 100 0 100.0 100.0 100.0 100 100.0 100.0 100.0 100.0 ;2.5. 2.3 3.5 4.2 4.2 ;; 3.9 1.6 ;40 4.0 0.5 1.7 0.6 0.6 25 13.1 77; 1.0 1.5 4.9 13.5 9.1 1.4 3.1 3.1 2.7 2.1 2.8 4.9 -3.9 4.2 4:3 4.2 4.1 1.9 7.2. 4.0 1.9 1.7 1.7 1.7 17 2.7 14.1 131 1.0 52 2.2 -2.7 5.4 -147 10.1 1.4 50' 5.0 66 3.2 18 5.4 2.1 1.0 1.1 -3.2 32 3.2 3.2 Continued on nextpage.. 140 Cigna Network Analysis Access Detail for All Employees With Access 42 June 2015 Created for... City of Miami All Accessibility- Cigna DHMO -All Employees- Dental Providers 1 The Access Standard is defined as (All Employees) employees accessing: 2 (Cigna DHMO - Open General Dentists) offices in 15 miles, 2 (Cigna DHMO - Endodontsts) offices in 15 miles, 2 (Cigna DHMO - Periodontists) offices in 15 miles, 2 (Cigna DHMO - Oral Surgeons) offices in 15 miles, 2 (Cigna DHMO - Orthodontists) offices in 15 miles State City Employee Zip Code # Employees With Access Provider Name With Access"' Average Distance # % 1 2 Georgia - Mississippi Nevada North Carolina Ohio Tennessee Virginia Grand Totals SleOibildged„.301141V.S.g. Picayune LasVegas Durham Gamer ClevelandCotumbia Knoxville Fredericksburg NewportNews • 1,-A-54,1„gii,F1-221ZA.414 30281 39466 89'1- t 27705 27529 45315 37323 #4010 37918 22406 id23608.. 0134110 1 Cigna DFTMO - Orthodontists Cigna DHMO Endodontists Cigna DHMO' Peribdontists Cigna DFIMO;OralSurgeons - Cigna DHMO 'Orthodontists -- 1 Cigna DHMO - Open General Dentists Cigna DHMO' Orthodontists igna DHMO- Periodontists Cigna DHMO - Orthodontists Dentists - Cigna D.1-1MO;peiTiOdOntiStS, _2,367 2,349 2,348 2,362 2,367 Cigna DHMO-Oral Surgeons Cigna' DHMQ Oral Surgeons. Cigna DHMO - Open General Dentists Cigna DHMO - Endodontists Cigna DHIVIOLOra!SurgeonsCigna DHM - Orthodontists Cigna DHMO Open General Dentists Cigna DHMO - Oral Surgons Cigna DHMO - Orthodontists Cigna HMO Open General Dentists Cigna DHM0 Cigna DHMO Orthodontists- Cigrta DHMO- Open General Dentists Cigna DHMO- Endodontists Cigna DI-IMO- Oral Surgeons Cigna DHMO - brt 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 1 415 169 158 255 243 2;363. 2,348 2,344 2,357 2,362 100,0 '160.4 100.0 106.6 :19°4? T1 100.0 j00:61 100.0 1000 100.0 190,,9 100.0 100.0 aO::P 'too.° 100.0 166:o 100.0 1000 100.0 0610 663, 99.9 99.8 99.8 2.8 1.3 1.9 2.4 2.4 2.8 1.9 5.2 10.4 10.4 3.5 3.5 3.5 3.9 ":„...:"-• 1.5 1.5 9:4 5.9 5.8 6.3 6.4 6.4 3.2 1.3 2.4 2.4 5.4 2.8 7.7 3.9 11.0 11.6 12.1 12..1 3.9 2.2 14.9 1.5 13.0 8.58.5 6.5 6.9 10.7 1.4 3.0 2.4 2.5 2.2 e2015 Quest Analytics, ILO. Cigna Network Analysis Access Detail for All Employees Without Access 43 June 2015 Created for... City of Miami All Accessibility- Cigna DHMO -All Employees - Dental Providers 1 The Access Standard is defined as (All Employees) employees accessing: 2 (Cigna DHMO - Open General Dentists) offices in 15 miles, 2 (Cigna DHMO - Endodontists) offices in 15 miles, 2 (Cigna DHMO - Periodontists) offices in 15 miles, 2 (Cigna DHMO - Oral Surgeons) offices in 15 miles, 2 (Cigna DHMO - Orthodontists) offices in 15 miles Florida North Carolina Alabama Arizona Colorada, , Florida ©2015 QuestAnalytics, LLC. Employees Without Access Employee Provider City Zip Code # Name Key Largo . Inverness Marathon Naples Port Orange' Sebring Franklin Phenix City° ;; Flagstaff Montrose" .:;`. Alachua Bokeelia CedarFfev . ;33037 34453 33050 • 34113 32128 33875 28734 36867 86004 32615 33922 5 2 2 2 2 Cigna.DHMO - Endodontists Cigna DI-IMO - Open General Dentists Cigna DHMO _ Periodontists: Cigna DHMO - Oral Surgeons Cigna DHMO Orthodontists Cigna DHMO - Periodontists Cigna DHMOCigna DFIMO-'Opert General Dentists Cigna DHMO - Endodontists Cigna DHMO'- Periodontists Cigna DHMO - Oral Surgeons Cigna.DHMO ;Orthodontists, Cigna DHMO - Oral Surgeons Cigna DHMO -.Periodontists Cigna DHMO - Endodontists Cigna DHMO °-Periodontists Cigna DHMO - Open General Dentists Cigna DHMO = Endodontists Cigna DHMO - Periodontists Cigna.DHMO -Oral Surgeons Cigna DHMO -Orthodontists Cigna DHMO ,Endodontists• Cigna DHMO :Periodontists Cigna DHMO , Oral Surgeons ,;: Cigna DHMO - Open General Dentists Cigna_DHMO -Endodontists Cigna DHMO - Periodontists Cigna DHMO Oral Surgeons ": Cigna DHMO - Orthodontists Cigna DHMO• ,Open General Dentists Cigna DHMO - Endodontists Cigna:DHMO ; Periodontists 'i Cigna DHMO Oral Surgeons Cigna,DHMO Orthodontists Cigna DHMO - Periodontists ,Cigna DHMO Orthodontists ` ,,' Cigna DHMO - Oral Surgeons Cigna DEIMO„-Open General Dentists; Cigna DHMO - Endodontists Cigna DHMO= Periodontists Cigna DHMO - Oral Surgeons Without Access' Average Distance %, 1 2 4 4 4 2 2 2 2 2 2 2 2 2 2 1 100.0 80.0 F 80.0 80.0 80`.0 100.0 100.0 100.0 100.0. 100.0 ion 100.0 100.0 100.0 100A• 100.0 100.0 100.0 1000 100.0 100.6 100.0 100.0 100.0 100 0 100.0 100d• 100.0 100.0 100.0 1000 100.0 100.0' 100.0 100.0 100.0 100.0 100.0 20.4 1.1 22.1 22.1 22.1 25.6 49.7. 64.3 64.3 63.4 64.3 31.5 6:7 36.9 47.5 48.8 :63.7 84.0 52.9 :72.9 72.9 • 64.1i 62.3 69 5 69.6 43.1 43.1 1076 165.4 1654 142.5 J`t:J 47.5 27.6 22.1 22.1 22.1 22.1 25.9 63.2 73.9 643 64.3 64.3 32.3 16.5 48.6 487. 53.5 66.0 85.9 -49`1' 61.4 85.9 73.6 '641, 69.2 69.5 101:7 .6.17 43.1 113:0 165.4 1654 142.5 549 48.4 16.3 39.0 39.0 53.7 • -54>1. 34.9 36.0 Continued on next page.. 142 Cigna Network Analysis Access Detail for All Employees Without Access 44 June 2015 Created for... City of Miami All Accessibility - Cigna DHMO -Ali Employees - Dental Providers 1 The Access Standard is defined as (All Employees) employees accessing: 2 (Cigna DHMO - Open General Dentists) offices in 15 miles, 2 (Cigna DHMO - Endodontfsts) offices in 15 miles, 2 (Cigna DHMO - Periodontists) offices in 15 miles, 2 (Cigna DHMO - Oral Surgeons) offices in 15 miles, 2 (Cigna DHMO - Orthodontists) offices in 15 miles State Florid City OptiatKer-!ftVQ0.3 East Palatka Englewood Fort White Gairiesvifle Hih Springs Indian Lake Estates Keystone Heghts Lakeland [ehigh Acre Marco Island Employees Without Access Employee Provider Zip Code # Name 32625 32131 34223 32038 -32606 - 32443- 32643 33855 33810 33936T-.; 34145 :crgkopti.„.golookkr000gottg,woitatittitt Cigna DHMO OperGeneral„Dentists Cigna DHMO7 Periodontists Cigna DHMO'- Oral Surgeons Cigna DHMO - Endodontists 6166:1-51#.11 Cigna DHMO - Open General Dentists 0664'1; oilmoigeircologfsivAt0,?::-..:,,,i2.:.,3;,--v'.A Cigna DHMO - Periodontists Cigna DEVIC- Orthodontists Cigna DHMO - Orthodontists Cigna DHMO - Open General Dentist - Cigna DHMO - Endodontists Cigna DHMO Periodontists - Cigna DEIMO - Orthodontists, Cigna DHMO- Oiien General Dentists - Cigna DHMO - Endodontists Cigna DHMO Oral Surgeons Cigna DHMO - Orthodontists- - Cigna p!-ylo79per,i General Dentists Cigna pi:imp:PeriodontistsCigna DHMO -Oral -Surgeons , - Cigna DHMO- Orthodontists Cigna DHMO.- - Endodontists Cigna DI-IMO..7:PerkidtintiSt8.!: Cigna DHMO - Oral Surgeons _ Cigna DHM�- Orthodontists Cigna DHMO - Periodontists - - 0064000.2;04460*E-01M"-E. Cigna DHMO Surgeons Cigna DHMO - Open General Dentists Cigna DI-1M0 - Endodontists - • Cigna DHMO - Periodontists Without Access' Average Distance # # % 1 2 0 0 0 0 0 0 0 0 0 00 0 0 00 0 0 0 0 0 0 0 0 1. 1 1 .1 1 1 1 1 1 1 1 1 1 1 1 •1 106,0. 100.0 100.0 100-0 100.0 J64:6„ 100.0 ioao 100.0 100.0 100.0 100.0 1004 100.0 100'4 100.0 1000. 100.0 160:Oi• 100.0 100.0 0�0- 100.0 100.0 100.0 100.0; 100.0 -100.0 100.0 .100.0 100.0 50.0 50.0 100.0 100.0 100.0 19.6 32.8 19.5 14.4 10.0 16.0 A5.6 55.4 25.8 4.0 60.1 180.5 28.7 15.7 15.8 53,3 15.7 17.0 16.4 19:6 24.6 22:0 15.7 21 21.8 26.0 26.0 21.4 9.8 ,,,f,Trfft!'•12,9 12.9 13.7 - '16.7 18.6 38.9 21.0 32,8 21.0 • 25.9 226 25.2 60.5 55.4 39.2 31.1 60.3 181.3 58.6 „,.. 15.8 16.1 52.7 19.6 24.6 31.3. 22.4 16.4 22.2 22.5 30.9 •-• 26.0 -• 21:4 • .. 19.5 18.3 16.3 16.0 16.7 • 18.9 18.6 0 2015 Quest Analytics, LLC. Continued on next page.. Cigna Network Analysis Access Detail for All Employees Without Access 45 June 2015 Created for:.. City of Miami All Accessibility- Cigna DHMO -All Employees - Dental Providers The Access Standard is defined as (All Employees) employees accessing: 2 (Cigna DHMO - Open General Dentists) offices in 15 miles, 2 (Cigna DHMO - Endodontists) offices in 15 miles, 2 (Cigna DHMO - Periodontists) offices in 15 miles, 2 (Cigna DHMO - Oral Surgeons) offices in 15 miles, 2 (Cigna DHMO - Orthodontists) offices in 15 miles State Employee City Zip Code # Employees Without Access Provider Name Without Access;' Average Distance % 1 2 Florida ©2015 Quest Analytics, LLC. Marco;lsland , McAlpin Monticello 34145 32012 • ,;; 32344 - Naples,_ - '.34110 New Smyma Beach 32168 North Port . 34286 C'cklawaha .,:i; 32179 Ormond Beach 32174 Palm Coast; 32164 Pensacola Rockledge SeBnng, Spring Columbus Hiawassee "32524 32955 33870 - '34609 31904 30546 .1; 1 1 1 1 Cigna.DHMO .Oral;Surgeons Cigna DHMO - Orthodontists Cigna.DHMO - Open General Dentists Cigna DHMO - Endodontists Cigna DHMO Periodontists Cigna DHMO - Oral Surgeons Cigna.DHMO .Orthodontists .=.: Cigna DHMO - Open General Dentists Cigna DHMO - Endodontists • Cigna DHMO - Periodontists Cigna DHMO'- Oral Surgeons: Cigna DHMO - Orthodontists Cigna DHMO Oral,Surgeons. Cigna DHMO - Periodontists Cigna DHMO Endodonhsts Cigna DHMO - Oral Surgeons Cigna DHMO Open General Dentists Cigna DHMO - Periodontists Cigna DHMO Orihor ontlsfs Cigna DHMO - Periodontists Cigna DHMO Open;General Dentists, Cigna DHMO - Endodontists Cigna DHMO Periodontists,;: Cigna DHMO - Oral Surgeons Cigna DHMO Orthodontists Cigna DHMO - Open General Dentists Cigna DHMO Periodontists_ „ }; Cigna DHMO - Endodontists Cigna DHMO Endodontists Cigna DHMO - Periodontists Cigna DHMO Periodontists.:! Cigna DHMO - Endodontists Cigna DHMO Periodontists - Cigna DHMO - Oral Surgeons Cigna DHMO Open General Den_fsts Cigna DHMO -, Endodontists Cigna DHMO Periodontists A, ,; Cigna DHMO - Oral Surgeons Cigna DHMO Orthodontists Cigna DHMO - Open General Dentists 100.0 100.0 100.0 100.0 00.0` 100.0 1 oo.o 100.0 100.0 100.0 i oo.0 100.0 100.0 100.0 100;0 100.0 • 100.0 100.0 1000 100.0 j 00,0 100.0 100:0 100.0 100.0 100.0 100:0 100.0 100.0' 100.0 100.0' 100.0 1000 100.0 100.0 100.0 100.0` 100.0 417; 20.1 19.8 19.7 70.1 46.8 47.5 19.8 20.8 128.7 19.1 20.0 173 10.6 1'.e. 14.3 15.9 1 9.1 17.5 18.1 18:2 3.0 1516. 3.1 •33.7 44.7 69.7 42.4 21.1 46.8 19.7 74.7 47.2 701 20.1 217 130.5 19.1 20.8 18A 19.6 26.9 23.4 15.3 16.3 18'6 24.7 18.1; 24.1 35.9 18.1 -22.6 27.0 165.5 19.1 44.7 45.8 16.6 83.2 704 61.3 65.5 62.6 62.6 631 42.0 42.8 Continued on next page_ 144 Cigna Network Analysis Access Detail for All Employees Without Access 46 June 2015 Created for... City of Miami All Accessibility - Cigna DHMO -All Employees - Dental Providers The Access Standard is defined as (All Employees) employees accessing: 2 (Cigna DHMO - Open General Dentists) offices in 15 miles, 2 (Cigna DHMO - Endodontists) offices in 15 miles, 2 (Cigna DHMO - Periodontists) offices in 15 miles, 2 (Cigna DHMO - Oral Surgeons) offices in 15 miles, 2 (Cigna DHMO - Orthodontists) offices in 15 miles State South Carolina 2015 Quest Analytics, LLC. City Jonesboro Stockbridge Vidalia Hendersonville Employee Zip Code # Employees Without Access Provider Name igna DHMQ Endodontists-, Cigna DHMO Periodontists "Cigna DHl O Oral,Surgeons Cigna DHMO,-.Orthodontists Cigna DHMq Endodontlstg, Cigna DHMO - Endodontists 064 DHMO .OpenGenera1Dentists . . Cigna DHMO -Endodontists Cigna DHMQ" Periodontist Cigna DHMO - Oral Surgeons .Cigna DHMQ. Orthodontists Cigna DHMO - Open General Dentists Cigna DHMO Erid`odontistsa, ; Cigna DHMO - Periodontists Cigna DHMo Oral Surgeons Cigna DHMO - Orthodontists Cigna DNMO Open!GeneraWe tists,..=. Cigna DHMO - Endodontists Cigna DHMQ Periodontists _,. Cigna DHMO Oral Surgeons Cigna DHMO Endodontists , . Cigna DHMO - Periodontists Cigna DHMO OraGSiirgeons Cigna DHMO - Endodontists Cigna DHMQ OralrSurgeons . 3. Cigna DHMQ Open General Dentists Cigna DHMQ ,Endodontists} Cigna DHMQ Periodontists Cigna DHMQ Oral Surgeons Cigna DHMO -Orthodontists Cigna DHMO, Endodontists Cigna DHMO - Orthodontists Cigna DHMO Open General Dentists Cigna DHMO - Endodontists Cigna DHMO Periodontists Cigna DHMQ - Oral Surgeons Cigna DHMO Orthodontists Cigna DHMO - Open General Dentists Cigna DHMO- Endodontists' Cigna DHMO - Periodontists 0 0 0 Without Access' Average Distance. # %. 1 2 1 1 1 1 1 :1 1 1 1 1 1 100:0` 100.0 1000 100.0 100 0 100.0 100 0 100.0 100 0 100.0 100.0, 100.0 100.0. 100.0 100p 100.0 100.0 100.0 100 0, 100.0 100:6 100.0 100.0 100.0 100.0 100.0 1000. 100.0 100.0. 100.0 100.0 100.0 100.0 100.0 100.0`. 100.0 100.0 100.0 100.0 100.0 62.9 42.1 42.1 12.7 74:5. 121.0 ; 74.5 38.2 ,750 38.1 '109.4 97.1 53.6 58.2 259 50.5 19f0 17.9 20.5 12.5 10.4 131: 18.2 73.6 123.2 301 31.9 38.6 10.7 25.9 49.7 1;15.0 108.4 43.9 26.3 68.8 66.9 670 63.8 42;1' 42.1 16.9 16.5 77.8. 121.0 74.5 68.1 87.5 59.0 186.4 97.1 96.1 59.8 277 145.7 26.0 25.9 115.0 21.7 17.3 130.4 15.8 20.2 76.9 125.9 62.6 89.6 51.0 16.3 43.5 108.5 1`150 113.2 44.6 44.1 69.4 68.8 Continued on nextpage... Cigna Nervvork Analysis Access Detail for All Employees Without Access 47 June 2015 Created for._ City of Miami All Accessibility- Cigna DHMO -All Employees - Dental Providers The Access Standard is defined as (All Employees) employees accessing: 2 (Cigna DHMO - Open General Dentists) offices in 15 miles, 2 (Cigna DEMO-Endodontists) offices in 15 miles, 2 (Cigna DHMO - Periodontists) offices in 15 miles, 2 (Cigna DHMO - Orai Surgeons) offices in 15 miles, 2 (Cigna DHMO - Orthodontists) offices in 15 miles State South Carolina' Tennessee Texas Virginia Grand Totals City Westminster Cleveland Columbia. Knoxville. Rockwood Summertowrs Nacogdoches Fredericksburg NewportNews ;: Employee Zip Code 29693 37323 38401. 37918 37854 38483 75964 22406 ` 23608 1 1 Employees Without Access Provider Name Cigna'DHMO- Oral.`Surgeons Cigna DHMO - Orthodontists Cigna DHMO- Open General Dentists Cigna DHMO - Endodontists Cigna DHMO - Periodontists Cigna DHMO - Orthodontists Cigna DHMO = Open General Dentists Cigna DHMO - Endodontists Cigna DHMO -'Periodontists Cigna DHMO - Orthodontists Cigna DHMO - Periodontists Cigna DHMO Open General Dentists Cigna DHMO -'Endodontists Cigna DHMO - Periodontists Cigna DHMO - Oral Surgeons Cigna DHMO - Orthodontists Cigna DHMO - Open General Dentists Cigna DHMO - Endodontists Cigna DHMO . Periodontists Cigna DHMO - Oral Surgeons Cigna DHMO =.Orthodontists Cigna DHMO - Open General Dentists Cigna DHMO Endodontists .. ._ Cigna DHMO - Periodontists Cigna DHMO .Oral Surgeons Cigna DHMO - Orthodontists Cigna DHMO ,Endodontists Cigna DHMO - Periodontists Cigna DHMQ - Endodontists " Cigna DHMO Periodontists 52 Cigna DHMO - Endodontists 37 Cigna DHM6. Open General Dentists` 56 Cigna DHMO Periodontists I. 44 Cigna DHMO =.Oral'Surgeons 39 Cigna DHMO - Orthodontists 0 0 0' 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Without ^ Access'Average Distance # % 1 2 1 1 1 1: 1 1 1 1 1 1 1 1 1 1 51 36' 55 42 37 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 98.1 97:3 98.2 `. 95.5 94.9 45.3 45.9 5.3 5.3 71.1 22.9 2.0 22.3 392 22.8 88.8 32.3 32.7, 49.6 17.2 33.9 182 40.2 57.0 18.2 413 60.1 99.8' 99.8 601 76.1 22.5 8.5 362 27.8 41.1 28.5 55.6 368 34.3 45.6 45.9 18.2 22.9 73.0 63.0 19.0 26.0 40.5 23.3 133.5 32.7 39.3 94.6 24.6 39.2 29.3 44.1 60.1 18.3 42.4 64.2 . ,108.8 109.7 64.7 99.8 32.9 22.5 95.5 27.8 56.6 37.8 60.8 41.4 44.7 ©2015 Quest Anafyfics, LLC. 146 Cigna. Cigna Network Analysis Total Cigna DPPO Created for... City of Miami June 2015 Created with the QuestAnalytics Suite Copyright © 2003-15 QuestAnalytics,- LLC. 147 Cigna Network Analysis Access Summary for All Employees With Access 2 June 2015 Created for... City of Miami Access Analysis All Accessibility - Total Cigna DPPO - All Employees - Dental Providers Employee Group All Employees Provider Group Total Cigna DPPO - General Dentists Total Cigna DPPO - Endodontists Total Cigna DPPO - Periodontists Total Cigna DPPO - Oral Surgeons Total Cigna DPPO - Orthodontists Employee Name Ali -Employees Name Employees With Access Provider Standard 'rTotal•Cigna,DPPO .General'Dentists Total Cigna DPPO - Endodontists Total Cigna DPPO-:P'enodontists Total Cigna DPPO Oral Surgeons Total Ciina DPP..O. Orthodontists, 21n l5 miles r, k,. 21n 15 miles 2in15miles 2 in 15 miles 2in15miles ...r. 295 287 13,431 11,984. 22,296 25,241 With Access Average Distance Locations # °Io 99.8 98.5 98.4 98.8 990 12 State Fiorid"a.. Miami City Miami Gardens ©2015 QuestAnaiytics, LLC Employee 57 50 Key Geographic Areas Provider Name Total: CignaDPPO Endodonnsts,...._ ;.;, Total Cigna DPPO General Dentists Total Cigna DPPO „Oral Surgeons ,. Total Cigna DPPO - Orthodontists TotalClgna DPP,O . Periodontists , Total Cigna DPPO Endodontists Total Cigna DPPO`, General• Dentists;;:.... _ Total Cigna DPPO Oral Surgeons Total Cigna DPPO.•Orthodontists Total Cigna DPPO - Periodontists Total Cigna DPPO ,•Endodontists „. ,' Total Cigna DPPO - General Dentists Tiitar.c6ifa-Dppa'i.othlOifgeane Total Cigna DPPO - Orthodontists Total'Cigna DPPO • Periodontists Total Cigna DPPO - Endodontists Total Cigna,DPPO General Dentists r;. Total Cigna DPPO -.Oral Surgeons Total Cigna DPPO Orthodontists Total Cigna DPPO- Periodontists Total Cigna'DPPO'-'Endodontists: Total Cigna DPPO - General Dentists Total Cigna DPPO - Oral Surgeons s: Total Cigna DPPO - Orthodontists Total Cigna DPPO ;Periodontists Total Cigna DPPO - Endodontists Total Cigna DPPO - General Dentists Total Cigna DPPO - Oral Surgeons Total Cigna DPPO - Orthodontists Total Cigna DPPO - Periodontists Total Cigna DPPO - Endodontists Standard 2 in 15m11es" ;OrZ`' 2 in 15 miles 2m 15miles . .<` 2 in 15 miles 2.in 15miles , ,., 2 in 15 miles 2 in 15 miles 2 in.15`miles 2 in 15 miles 21n 15.miles .., 2 in 15 miles 21n15iniles_ 2 in 15 miles 2 in 15 miles 2 in-15 miles 2 in;15',`miles 2in15miles 2 iii 15''miles 2 in 15 miles 2 in '15'm11es 2in15miles 2 in 15 miles. 2 in 15 miles 2in15miles 2 in 15 miles 2in15miles 2 in 15 miles 2 in15 miles 2 in 15 miles 2 in 15 miles With Access Average Distance # % 1 2 92' ,1,678 100 0 1,685 173 121 58 7,15 50 72 88 .1,060 93 88 100 0 7 0 0 0 5 118 11 7 5 1,578 100.0 „1,578'; 1000 1,578 100.0 1,578 106,0 208 100.0 '208 100.0 208 100.0 208 100.0 208 100.0 137 100,0 137 100.0 137 100.0 137 100.0 137 100.0 76 100.0 76 100.0 76 100.0 76 100.0 76 100.0 62 100.0 62 100.0 62 100.0 62 100.0 62 100.0 57 100.0 57 100.0 57 100.0 57 100.0 57 100.0 50 100.0 0.5 1.0 1.1 0:6 1.2 1.0 1.0 0.3 0.8 1.3 1.4 0.7 1.4 1.3 1.5 1.9 0.6 1.9 1.8 2.0 2.2 1.0 2.4 2.0 2.3 1.2 0.6 1.3 1.3 06 1.4 .13 1.2 1.9 0.5 1.1 1.4 1.7 0.8 1.7 1.6 1.7 2.5 0.8 1.9 1.8 3.0 3.2 1.2 2.7 2.9 3.2 2.0 Cigna N,,,vorkAnalysis Access Summary for All Employees Without Access 3 June 2015 Created for... Gaya Miami Access Analysis All Accessibility- Total Cigna DPPO - All Employees - Dental Providers Employee Group All Employees Provider Group Total Cigna DPPO - General Dentists Total Cigna DPPO Endodontists Total Cigna DPPO - Periodontists Total Cigna DPPO - Oral Surgeons Total Cigna DPPO - Orthodontists Employee Name All Employees 2,399 Name Employees Without Access Provider Standard Total Cigna DPPO L' General Dentists • Total Cigna DPPO - Endodontists Total Cigna DPPO = Periodontists Total Cigna DPPO - Oral Surgeons Total Cis na DPPO-;Ortliodantists• 2 in' 15 miles" 2 in 15 miles 2 in15 miles 2 in 15 miles 211115'miles 295,287 13,431 11,984 22,296 25241 Without. Access Average Distance Locations # %. 1 2 70;951: 6,054 6,284 9,106 11,016 35 39 29 25 0.2 1.5 1.6 1.2 1.0 19.6 38.3 43.0 32.7 31.1. State City Employee Key Geographic Areas Provider Name. Standard Without Access Average Distance # % 1 2 Florda North Carolina Florida North Carolina. Florida. North Carolina Florida, North Carolina Alabama Arizona Colorado Florida Georgia Key -Largo :::.;• Sebring Marathon" Franklin Marathon " Franklin Marathon Franklin Marathon Franklin PhenncCity • Flagstaff Montrose Cedar Key Foif White- Greenwood High Springs Indian Lake Estates Keystone Heights Mc Alpin Monticello Columbus Hahira Hiawassee Vidalia. Louisiana Lafayette Mississippi Picayune'-" © 2015 QuestMalyfics, LLC. 5 3 Total Cigna DPPO Endodontists . Total Cigna DPPO - Oral Surgeons TotalCigna.DPPO- Orthodontists Total Cigna DPPO - Periodontists Total. Cigna DPPO`- Endodontists Total Cigna DPPO - Periodontists 2 Total Cigna•DPPO - Endodonbsts 2 Total Cigna DPPO - Endodontists 2 Total.Cigna DPPO'- Oral Surgeons " 2 Total Cigna DPPO - Oral Surgeons 2 Total,CignaDPPO-Orthodontists 2 Total Cigna DPPO - Orthodontists 2 Total'Cgna DPPO .Periodontists 2 Total Cigna DPPO - Periodontists 1 Total Cigna DPPO` Endodontists, 1 Total Cigna DPPO - Endodontists 1 TotalCigna DPPO -Endodontists 1 Total Cigna DPPO - Endodontists 1 Total Cigna DPPO; End`odonfists • 1 Total Cigna DPPO - Endodontists • 1 Total Cigna•DPPO Endodontists 1 Total Cigna DPPO Endodontists 1 Total Cigna DPPO Endodontists ;' 1 Total Cigna DPPO - Endodontists z 1 Total;Cigna•DPPO' Endodantits. 1 Total Cigna DPPO - Endodontists °1 Total Cigna`DPPO-Endodontists. 1 Total Cigna DPPO - Endodontists 1 Total.Cigna DPPO; Endodontists, _ 1 Total Cigna DPPO - Endodontists -1 Total Cigna DPPO'=Endodontists 2 in 15 miles . 2 in 15 miles 2 ih 15miles 2 in 15 miles 2 in 15miles 2 in 15 miles - 2in 15°miles 2 in 15 miles 2 to :15miles 2 in 15 miles 2rn 15 infes_4 _ _.,. 2 in 15 miles 2 m,15 miles 2 in 15 miles 2 in 15 miles 2 in 15 miles 2m�15miles 2 in 15 miles 2inl5°miles .., 2 in 15 miles 2 in 15'miles 2 in 15 miles 2 in 15'miles " , 2 in 15 miles 2 in 15miles 2 in 15 miles 21n.l5 "miles 2in15miles 2ir 15mlles 2 in 15 miles 2 iri 15'miles 80:0 80.0 80.0 80.0 100:0 100.0 1'00.0 100.0 100.0 100.0 100.0 100.0 100.0 1000 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0: 100.0 1oo.0 100.0 100.0 100.0 100 6 221 22.1 3.5 22.1 35.8, 2.9 443 37.3 631r 35.5 2.6 53.0 43.1 148.5. 33.9 15.6 31.1 15.8 19.6 218 19.7 .`19:7 1.0 10.9 53.9 ._ 40.5 58.4 16.8 22.1 22.1 22.1 22.1 35.8 40.6 45.5 37.3 63.4 48.8 63.4 48.9 54.3 337.3' 69.5 157.1 34.5 15.6 33.1 15.8 19.6 22.8 19.7 19.7 35.3 63.2 54.3 405' 60.7 18.0 149 agna. Accessibility Overview Cigna Necwork Analysis - General Dentists Access Overview for All Employees With Access 5 June 2015 Created for... City of Miami Access Analysis Total Cigna DPPO - All Employees - General Dentists Employee Group All Employees Dentist Group Total Cigna DPPO - General Dentists Comparison Graph Percent of employees with access to a choice of dentists over miles o 1st closest 2nd closest 3rd closest II 4th closest II 5th closest The Access Standard is defined as (All Employees) employees accessing: 2 (Total Cigna DPPO - General Dentists) dentists in 15 miles Overall Access' 2,399 Employees 295,287 dentists at 70,951 locations (Total Cigna DPPO General Dentists) 2,394;(99.8%)'Employees with access Distances Minimum Average ' Maximum` Distance to 1st closest dentist 0.0 mile 0.6 mile 13.5 miles Distance to 2nd closest dentist 0.0 mile 0.7 mile 14.0 miles Distance to 3rd closest dentist 0.0 mile 0.8 mile 22.4 miles Distance to 4th closest dentist 0.0 mile 0.9 mile 22.4 miles Distance to 5th closest dentist 0.0 mile 0.9 mile 22.4 miles Access Standard Comparison Percentage of employees 100 80 60 40 20 1 2 3 5 6 7 8 Miles to a choice of dentists 9 10 11 12 13 14 15 © 2015 Quest Analytics, LLC. 151 Cigna Network Analysis - General Dentists Access Overview for All Employees Without Access 6 June 2015 Created for_. City of Miami Access Analysis Total Cigna DPPO - All Employees - General Dentists Employee Group All Employees Dentist Group Total Cigna DPPO - General Dentists Comparison Graph Percent of employees with access to a choice of dentists over miles 1st closest 2n2nd closest Id 3rd closest • 4th closest It 5th closest 1 The Access Standard is defined as (All Employees) employees accessing: 2 (Total Cigna DPPO - General Dentists) dentists in 15 miles Overall Access' 2 399 Emptoyees • 295287 dentists at7095 Penerar Dentists} locations, 5 (0.2%) tmployees wl f�ou access Distances imum ver'age aximum?, 1.6 miles 12.7 miles 21.5 miles Dlstance,to 2nd cfosest 15.4 miles 15.4 miles 15.4 miles 15.5 miles 19.6 miles 21.4 miles 21.5 miles 22.5 miles 27.7 miles 30.6 miles 30.8 miles 30.8 miles Access Standard Comparison Percentage of employees 100 80 60 40 20 2 3 4 5 6 7 8 Miles to a choice of dentists 10 11 12 13 14 15 © 2015 Quest Analylics, LLC. Cigna NeLvrork Analysis - Endodontists Access Overview for All Employees With Access 7 June 2015 Created for... City of Miami Access Analysis Total Cigna DPPO - All Employees - Endodontists Employee Group All Employees Dentist Group Total Cigna DPPO - Endodontists Comparison Graph Percent of employees with access to a choice of dentists over miles 0 1st closest M 2nd closest IN 3rd closest NE 4th closest 5th closest TheAccess Standard is defined as (All Employees) employees accessing: 2 (Total Cigna DPPO - Endodontists) dentists in 15 miles Overall Access' 2,399 Employees 13,431 dentists at 6,054 locafions (Total Cigna DPPO - Endodontists) IN 2,364 (98.5%) Employees with access Distances Minimum Average ' . Maximum Distance to lst closest dentist 0.0 mile 1.6 miles 13.7 miles Distance to 2nd closest dentist 0.1 mile 2.1 miles 13.7 miles Distance to 3rd closest dentist 0.1 mile 2.5 miles 29.8 miles Distance to 4th closest dentist 0.1 mile 2.7 miles 29.8 miles Distance to 5th closest dentist 0.1 mile 2.9 miles 46.3 miles Access Standard Comparison Percentage of employees 100 80 60 40 20 1 2 3 4 5 6 7 8 Miles to a choice of dentists 10 11 12 13 14 15 © 2015 Quest Analytics, LLC. 153 Cigna Network Analysis - Endodontists Access Overview for All Employees Without Access 8 June 2015 Created for... City of Miami Access Analysis Total Cigna DPPO - All Employees - Endodontists Employee Group All Employees Dentist Group Total Cigna DPPO - Endodontists Comparison Graph Percent of employees with access to a choice of dentists over miles 0 1st closest 2nd closest 3rd closest 4th closest 5th closest 1 The Access Standard is defined as (All Employees) employees accessing: 2 (Total Cigna DPPO - Endodontists) dentists in 15 miles 2,399 Employees 13,431 dentists at 6,054 l(cati Endodontists) 35(t5%) Employeeswithoutacci Distances ximum Distance to 1stclosest= dentist Dtstance,to.3rd"clooses dentist 1.0 mile 15.6 miles 31.8 miles 38.3 miles. 148.5 miles 157.1 miles 15.8 miles 15.8 miles 15.9 miles 41.4 miles 46.4 miles 47.9 miles 157.1 miles 165.4 miles 165.4 miles Access Standard Comparison Percentage of employees 100 80 60 40 20 2 3 4 7 8 Miles to a choice of dentists 10 11 12 13 14 15 0 2015 Quest Analytics, LLC. Cigna Nb....ork Analysis - Periodontists Access Overview for All Employees With Access 9 June 2015 Created for... City of Miami Access Analysis Total Cigna DPPO - All Employees - Periodontists Employee Group All Employees Dentist Group Total Cigna DPPO - Periodontists Comparison Graph Percent of employees with access to a choice of dentists over miles D 1st closest 2nd closest 3rd closest 4th closest It 5th closest 1 The Access Standard is defined as (All Ernployees) employees accessing: 2 (Total Cigna DPPO - Periodontists) dentists in 15 miles 2,399 Employees 11,984 dentists at 6,284 locations (Total Cigna DPPO - Periodentists) 2,360 (98.4%) Employees with access Distance to 1st closest dentist Distance to 2nd closest dentist Distance to 3rd closest dentist Minimum 0.0 mile 0.0 mile Average •Maximum 1.4 miles 1.8 miles 2.0 miles 14.1 miles 14.9 miles 17.6 miles Distance to 4th closest dentist 0.1 mile 2.3 miles 40.4 miles Distance to 5th closest dentist 0.1 mile 2.5 miles 44.2 miles Access Standard Comparison Percentage of employees 100 80 60 40 20 2 3 4 5 6 7 8 Miles to a choice of dentists 9 10 11 12 13 14 15 @ 2915 Quest Analrics, LLC. 155 Cigna Network Analysis - Periodontists Access Overview for All Employees Without Access 10 June 2015 Created for... City of Miami Access Analysis Total Cigna DPPO - All Employees - Periodontists Employee Group All Employees Dentist Group Total Cigna DPPO - Periodontists Comparison Graph Percent of employees with access to a choice of dentists over miles 0 1st closest Eli 2nd closest 16 3rd closest If 4th closest II 5th closest 1 The Access Standard is defined as (All Employees) employees accessing: 2 (Total Cigna DPPO - Periodontists) dentists in 15 miles 2399 Employee 11984 dentists otaliCibribP Distance fo2MdIosest klentEst RdiVP.47. Distances 1.6 miles 15.1 miles 33.9 miles 43.0 miles 73.2 miles 85.3 miles 16.8 miles 16.8 miles 21.6 miles 47.3 miles 54.2 miles 55.8 miles 120.3 miles 165.4 miles 165.4 miles Access Standard Comparison Percentage of employees 100 80 60 40 20 2 3 4 5 6 7 8 Miles to a choice of dentists 9 10 11 12 13 14 15 02015 Quest Analybcs, LLC. Cigna Ne.iorkAnalysis - Oral Surgeons Access Overview for All Employees With Access 11 June2015 Created far... City of Miami Access Analysis Total Cigna DPPO - All Employees - Oral Surgeons Employee Group All Employees Dentist Group Total Cigna DPPO - Oral Surgeons Comparison Graph Percent of employees with access to a choice of dentists over miles G 1st closest 2nd closest 3rd closest 4th closest 5th closest The Access Standard is defined as (All Employees) employees accessing: 2 (Total Cigna DPPO - Oral Surgeons) dentists in 15 miles Overall Access" 2,399 Employees 22,296 dentists at 9,106 iodations (Total Cigna DPPO - Oral Surgeons) 2,370 (98.8%) Employees with access a istan ces Minimum Average Maximum Distance to 1st closest dentist 0.0 mile 1.4 miles 13.7 miles Distance to 2nd closest dentist 0.0 mile 1.8 miles 13.7 miles Distance to 3rd closest dentist 0.0 mile 2.1 miles 55.9 miles Distance to 4th closest dentist ; ° 0.0 mile 2.4 miles 121.2 miles Distance to 5th closest dentist 0.0 mile 2.5 miles 125.4 miles Access Standard Comparison Percentage of employees 100 80 60 40 20 1 2 3 4 5 6 7 8 Miles to a choice of dentists 10 11 12 13 14 15 ©2015 Quest Ana ytcs, LLC. 157 Cigna Network Analysis - Oral Surgeons Access Overview for All Employees Without Access 12 June 2015 Created for... City of Miami Access Analysis Total Cigna DPPO - All Employees - Oral Surgeons Employee Group All Employees Dentist Group Total Cigna DPPO - Oral Surgeons Comparison Graph Percent of employees with access to a choice of dentists over miles 0 1st closest 2nd closest 3rd closest • 4th closest 5th closest The Access Standard is defined as (All Employees) employees accessing: 2 (Total Cigna DPPO - Oral Surgeons) dentists in 15 miles Overall Access'' 2,399 Employees 22 296'dentists at 9"106 Iocatlons' Surgeons)`" Employeeswlfhout acce Distances aximum 2.5 miles 15.6 miles 26.3 miles 32.7-miles 63.6 miles 63.9 miles Distance fo 3rd closest' dentist 16.1 miles 33.7 miles 64.8 miles 16.1 miles 16.1 miles 34.4 miles 35.6 miles 64.8 miles 65.0 miles Percentage of employees 0 0 0 0 0 Access Standard Comparison / r 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Miles to a choice of dentists © 2015 Quest Analytics, LLC. Cigna Ne >orkAnalysis - Orthodontists Access Overview for All Employees With Access 13 June 2015 Created for... City of Miami Access Analysis Total Cigna DPPO - All Employees - Orthodontists Employee Group All Employees Dentist Group Total Cigna DPPO - Orthodontists Comparison Graph Percent of employees with access to a choice of dentists over miles ❑ 1st closest a 2nd closest 3rd closest 4th closest X 5th closest The Access Standard is defined as (All Employees) employees accessing: 2 (Total Cigna DPPO - Orthodontists) dentists in 15 miles Overall Access' 2,399Employees 25,241 dentists at 11,016 locations (Total Cigna DPPO - Orthodontists) 2,374' (99.0%) Employees with Distance to 1st closest dentist 0.0 mile 1.1 miles 13.7 miles Distance to 2nd closest dentist 0.0 mile 1.5 miles 13.7 miles Distance to 3rd closest dentist 0.0 mile 1.8 miles 43.1 miles Distance to 4th closest dentist 0.0 mile 2.0 miles 43.1 miles Distance to 5th closest dentist 0.0 mile 2.1 miles 43.1 miles Access Standard Comparison 100 80 a) 60 a E CD m 40 iu a 20 2 3 4 7 8 Miles to a choice of dentists 10 11 12 13 14 15 ©2015 Quest Analytics, LLC. 159 Cigna Network Analysis - Orthodontists Access Overview for All Employees Without Access 14 June 2015 Created for... City of Miami Access Analysis Total Cigna DPPO-All Employees - Orthodontists Employee Group All Employees Dentist Group Total Cigna DPPO - Orthodontists Comparison Graph Percent of employees with access to a choice of dentists over miles 0 1st closest El 2nd closest gi 3rd closest ft 4th closest I. 5th closest 1 The Access Standard is defined as (All Employees) employees accessing: 2 (Total Cigna DPPO - Orthodontists) dentists in 15 miles Overall Access' 2,399 Employees 25 241 dentists at`110 Orthodontists) 25 (1.0%) Employees without acres Distances fmmum Overage' aximum Dlsfance to 2nd cFos"e idehtfst 0.5 mile 15.7 miles 15:7 miles 16.1 miles 16.1 miles 19.8 miles 31.1 miles 35.8 miles 38.9 miles 40.1 miles 54.9 miles 63.9 miles 64.8 miles 67.0 miles 68.2 miles Access Standard Comparison Percentage of employees 100 80 60 40 20 / / / 2 / 3 4 / / 5 6 7 8 Miles to a choice of dentists 9 10 11 12 13 14 15 © 2015 Quest Analytics, LLC. na. Accessibility Detail Cigna Network Analysis Access Detail for All Employees With Access 16 June 2015 Created for... City of Miami All Accessibility - Total Cigna DPPO - All Employees - Dental Providers 1 The Access Standard is defined as (All Employees) employees accessing: 2 (Total Cigna DPPO General Dentists) dentists in 15 miles, 2 (Total Cigna DPPO - Endodontists) dentists in 15 miles, 2 (Total Cigna DPPO - Periodontists) dentists in 15 miles, 2 (Total Cigna DPPO - Oral Surgeons) dentists in 15 miles, 2 (Total Cigna DPPO - Orthodontists) dentists in 15 miles State City Employee Zip Code # Employees With Access Provider Name With Access?' Average Distance %. 1 2 Florida © 2015 Quest.Analy0cs, LLC. Miami . 331'57 33142 33176, 33169 33186 • 66 64 64 62 59 59 55 54 Total Cigna°DPPO.`- General. Dentists , Total Cigna DPPO - Endodontists Total Cigna, DPPO Periodontists Total Cigna DPPO - Oral Surgeons Total DPPO'- Orthodontists . Total Cigna DPPO - General Dentists Total 'Ciigna,DPPO - Endodontists . ` . Total Cigna DPPO - Periodontists Total Cigna DPPO - Oral Surgeons Total Cigna DPPO - Orthodontists Total Cigna DPPO"=General'Dentists Total Cigna DPPO - Endodontists Total Cigna DPPO Periodontists.. Total Cigna DPPO - Oral Surgeons Total CignaDPPO- Orthodontists Total Cigna DPPO - General Dentists Total Cigna DPPO - Endodontists. , Total Cigna DPPO - Periodontists Total Cigna DPPO'- Oral Surgeons Total Cigna DPPO - Orthodontists Total' Cigna DPPO -,General Dentists Total Cigna DPPO - Endodontists Total Cigna DPPO -.Periodontists " Total Cigna DPPO -Oral Surgeons Total Cigna DPPO - Orthodontists Total Cigna DPPO - General Dentists Total Cigna DPPO - Endodontists Total Cigna DPPO - Periodontists Total Cigna DPPO -Oral Surgeons , Total Cigna DPPO - Orthodontists Total Cigna DPPO -:General Dentists Total Cigna DPPO - Endodontists Total Cigna DPPO -Periodontists Total Cigna DPPO - Oral Surgeons Total Cigna DPPO - Orthodontists Total Cigna DPPO - General Dentists Total Cigna DPPO-`Pndodontists Total Cigna DPPO - Periodontists Total Cigna DPPO -Oral Surgeons Total Cigna DPPO - Orthodontists 66 66 66 66 -66 64 64` 64 64 64 64, 64 64 64 64 62 62 62 62 62 59 59 59 59 59 59 59 59 59 59 55 55 55 55 55 54 54 54 54 54 100:0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100A 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100,0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 0:6 1.6 1.6 0.8 0.6 2.7 2.0 1.9 1.5 0.8 1.4 1.2 1.1 1.6 1.2 0.9 0.7 0.5 2.1 1.9 1.1 0.8 0.3 0.8 0.4 0.7 0.6 0.5 1.5 0.8 0.9 1.3 0.6 2.2 1.9 2.2 0.9 0.7 3.4 2.1 2.0 2.3 0.9 1.5 1.6 1.3 1.2 0.5 1.7 1.8 1.8 1.7 0.4 2.0 1.7 1.2 0.9 0.6 2.6 2.0 1.2 1.1 0.3 0.8 0.5 1.3 0.7 0.6 1.6 1.0 1.1 1.3 Continued on next page_. Cigna Analysis Access Detail for All Employees With Access 17 June 2015 Created for... City of Miami All Accessibility - Total Cigna DPPO - All Employees - Dental Providers 1 The Access Standard is defined as (All Employees) employees accessing: 2 (Total Cigna DPPO - General Dentists) dentists in 15 miles, 2 (Total Cigna DPPO - Endodontists) dentists in 15mites, 2 (total Cigna DPPO - Periodontists) dentists in 15 miles, 2 (Total Cigna DPPO - Oral Surgeons) dentists in 15 miles, 2 (Total Cigna DPPO -Orthodontists) dentists in 15 miles State ©2015 Quest Anaiyacs, LLC. 33155 33161 33175 33025 33127 Employees With Access Provider Name 53 Total Cigna DPPO -;General Dentists Total Cigna DPPO - Endodontists Total. Cigna DPPO - Periodontists Total Cigna DPPO - Oral Surgeons Total Cigna DPPO -Orthodontists 50 Total Cigna DPPO - General Dentists Total Cigna DPPO - Endodontists Total Cigna DPPO -Periodontists Total Cigna DPPO - Surgeons Total Cigna DPPO -Orthodontists 50 Total Cigna DPPO -:General. Dentists Total Cigna DPPO - Endodontists Total Cigna DPPO - Periodontists Total Cigna DPPO - Oral Surgeons Total Cigna DPPO Orthodontists 46 Total Cigna DPPO - General Dentists Total Cigna DPPO Endodontists Total Cigna DPPO - Periodontists Total, Cigna DPPO - Oral Surgeons Total Cigna DPPO - Orthodontists 45. Total Cigna DPPO ,General Dentists Total Cigna DPPO - Endodontists Total Cigna DPPO - Periodontists" Total Cigna DPPO - Oral Surgeons Total CignaDPPO Orthodontists 43 Total Cigna DPPO - General Dentists Total Cigna DPPO - Endodontists Total Cigna DPPO - Periodontists Total Cigna DPPO -Oral Surgeons Total Cigna DPPO - Orthodontists 42 Total Cigna DPPO- General Dentists Total Cigna DPPO - Endodontists Total Cigna DPPO- Periodontists Total Cigna DPPO - Oral Surgeons Total Cigna DPPO Orthodontists 41 Total Cigna DPPO General Dentists Total Cigna DPPO Endodofltists Total Cigna DPPO - Periodontists Total Cigna DPPO - Oral Surgeons Total Cigna DPPO - Orthodontists 0 0 45 6 1 3 3 31 2 14 2 0 0 32 0 0 0 70 3 9 52 3 0 With Ac ess" Average Distance % 1 2 53 53 53 53 53 50 50 50 50 50 50 50 50 50 46 46 46 46 46 45 45 `45 45 45 43 43 43 43 43 42 42 42 42 42 41 41 41 41 41 100.0' 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 1000 100.0 100 0 100.0 100.0 100.0 0.8. 2.7 32 2.5 1.0 0.3 1.1 1.1 0.9 0.7 0.7 1.2 1.2 1.3 1.3 0.6 0.9 1.3 0.9 1.3 0.3 1.7 1.1 1.2 1.9 0.4 1.6 1.2 1.3 0.7 0.5 1.1 1.0, 1.1 0.9 4.0 3.7 2.6 2.1 0.4 1.2 1.9 1.0 1.1 1.0 2.0 2.8 1.3 1.3 0.6 1.1 1.4 1.4 1.3 0.3 1.7 1.2 1.2 14 0.4 2.8 1.3 1.6 0.8 0.6 1.2 1.2 1.3 ".1 1.2 0.4 0.6 3.9 41 1.8 2.0 1.1 1.8 0.8 2.7 Continued on next page- 163 Cigna Network Analysis Access Detail for All Employees With Access 18 June 2015 Created for... City of Miami All Accessibility - Total Cigna DPPO - All Employees - Dental Providers 1 The Access Standard is defined as (All Employees) employees accessing: 2 (Total Cigna DPPO - General Dentists) dentists in 15 miles, 2 (Total Cigna DPPO - Endodontists) dentists in 15 miles, 2 (Total Cigna DPPO - Periodontists) dentists in 15 miles, 2 (Total Cigna DPPO - Oral Surgeons) dentists in 15 miles, 2 (Total Cigna DPPO - Orthodontists) dentists in 15 miles State City Employee Zip Code Employees With Access Provider Name With AccessAverage Distance 1 2 i„ •;. " © 2015 Quest Analylics, LLC. Hollywood Hialeah Hollywood ,7,,,-7777 :77i Miami 33173 33150 ' 33023 33015 33029 33134 33196 33126 41 Total Cigna DPPO General Dentists Total Cigna DPPO Endodontists Total • ' • Total Cigna DPPO - Oral Surgeons Totat--CigOaDPFP•,,Orthodpfitists, Total Cigna DPPO - General Dentists Total Cign ••••;OhciPCibiiti§t:,t - Total Cigna DPPO - Periodontists Total Cigna DPPO - Oral Surgeons Total Cigna DPPO - Orthodontists Total Cigna DPPO - General Dentists Total Cigna DPPO7,Endodontists Total Cigra DPPO -Periodontists Total Cigna DPPO - Oral Surgeons Total Cigna DPPO- Orthodontists Total Cigna DPPO - General Dentists Total Cigna"-DI:'PQ-,7:.EndddontistS7:-.-:. 7- , Total Cigna DPPO - Periodontists Total Cigna DPPO - Oral Surgeons Total Cigna DPPO - Orthodontists Total Cigna DPPO - General Dentists Total Cigna DPPO - Endodontists Total Cigna DPPO - Periodontists Total Cigna DPPO 7 Oral Surgeons Total.Cigna DPPO- Orthodontists 35 Total Cigna DPPO - General Dentists Total,Cignaf:DPPOEnclOciontiSte.'„ Total Cigna DPPO - Periodontists Total Cigna DPPO -Oral Surgeons Total Cigna DPPO - Orthodontists Total digna DP,PO7-.Generat Dentists Total Cigna DPPO - Endodontists Total Cigna.DPPO.- Periodontists Total Cigna DPP07,0ralSurgeons Totaf Cigna DPPO - Orthodontists 33 Total Cigna DPPO - General Dentists Total Cigna DPPO Endodontists Total Cigna DPPO - Periodontists Total Cigna DPPO - Oral Surgeons Total Cigna DPPO - Orthodontists 38 36 35 34 38 4 7.6 2 2 1 0 0 19 1 63 4 4 1 113 7 7 6 6 27 1 29 0 0 0 '-„417 41 41 41 41 38 38 38 38 37 37 37 37 36 36 36 36 36 35 35 35 35 35 35 35 35 35 35 34 34 34 33 33 33 33 100.0 100.0 100.0 100.0 000: 100.0 00,0 100.0 Dio 100.0 :106,b; 100.0 100.0, Oo.o, 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 too:o 100.0 100.0 100.0 100:0 100.0 ob:o 100.0 foo.o 100.0 100.0 100.0 100:0 100.0 100.0 100.0 0.2 0.7 I -7 107 0.6 0.5 0.7 3.2 1.6 1.5 1.4 -..' 0.7 1.8 1.6 0.3 0.5 0.7 0.6 0.6 • 0.8 1.3 2.8 2.6 1.0 0.4 1.2 1.6 1.0 0.7 0.8 0.9 3.3 3.2 2.0 1.6 0,8 1.5 1.1 1.7 1,7 0.6 --: 2.5 2.1 3.1 1.6 0.8 1.6 1.6 2.1 1.6 0.4 0.8 0.9 0.7 0.9 0.8 3.3 2.8 2.7 1.8 0.4 Continued on next page_ 1f5"7-% Cigna N&,..orkAnalysis Access Detail for All Employees With Access 19 June 2015 Created for... City of Miami All Accessibility - Total Cigna DPPO - All Employees - Dental Providers 1 The Access Standard is defined as (All Employees) employees accessing: 2 (Total Cigna DPPO - General Dentists) dentists in 15 miles, 2 (Total Cigna DPPO - Endodontists) dentists in 15miles, 2 (Total Cigna DPPO- Periodontists) dentists in 15 miles, 2 (Total Cigna DPPO - Oral Surgeons) dentists in 15 miles, 2 (Total Cigna DPPO - Orthodontists) dentists in 15 miles State Employee City Zip Code # Employees With Access Provider Name With Access' Average Distance 1 2 ©2015 Quest Analytics, LLC. Total Cigna DPPO-General Dentists Total Cigna DPPO - Endodontists Total Cigna DPPO - Periodontists Total Cigna DPPO - Oral Surgeons Total Cigna DPPO - Orthodontists Total Cigna DPPO - General Dentists Total Cigna DPPO:-Endodontists Total Cigna DPPO -Periodontists Total Cigna DPPO -Oral Surgeons Total Cigna DPPO - Orthodontists Total Cigna'DPPO -General Dentists Total Cigna DPPO - Endodontists Total Cigna DPPO -Periodontists Total Cigna DPPO - Oral Surgeons Total Cigna DPPO - Orthodontists Total Cigna DPPO - General Dentists Total Cigna DPPO - Endodontists Total Cigna DPPO - Periodontists Total Cigna DPPO - Oral Surgeons Total Cigna DPPO - Orthodontists Total. Cigna_DPPQ General, Dentists Total Cigna DPPO - Endodontists Total Cigna DPPO = Periodontists Total Cigna DPPO Oral Surgeons Total Cigna DPPO Orthodontists Total Cigna DPPO - General Dentists Total Cigna DPPO -Endodontists Total Cigna DPPO - Periodontists Total Cigna DPPO - Oral Surgeons Total Cigna. DPPO - Orthodontists Total Cigna DPPO - General Dentists Total Cigna DPPO - Endodontists Total Cigna DPPO, Periodontists, Total Cigna DPPO - Oral Surgeons `Total CignaLLDPPO "Orhodontists Total Cigna DPPO - General Dentists Total Cigna DPPO - Endodontists Total Cigna DPPO - Periodontists Total Cigna^DPPO - Oral Surgeons Total Cigna DPPO Orthodontists 27 0 4 2 0 122 15 13 15 4 2 1,1 0 77'. 9 6 11 53 6 0 118 9 8 33 33 33 33 33 33 33 33 33. 33 32 32 32 32 32 31 31'' 31 31 31 29 29 29 29 29 29 29 29 29 29 29 29 29 28 28 28 28 100,0 100.0 100.0' 100.0 100.0 100.0 ,100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 .100.0 100.0 100.0 100.0 100.0E 100.0 100.0 100.0 100,0' 100.0 100,0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.E 100.0 1 o0:0 100.0 100.E 100.0 0.2 1.1 0.5 1.0 0.4 0.7 1.7 1.8 1.7, 1.7 0.7 2.6 0.8 0.7 1.2 1.0 1.1 1.2. 1.3 0.3 0.7 0.6 2.0 0,5 2.2 2.2 0.5 0.3. 1.1 0.6 1.2 09 0.7 2.1 3.3 17 1.8 0.8 1.1 1.2 1.3 10 0.6 2.6 0.8 0;8 1.4 1;2 1.3 0.4 1.3 0.6 0.6 0.8 2.9 2.7 2.2 0.6 0.8 0.9 09 1.0 0.8 0.9 Continued on next page.. 165 Cigna Network Analysis Access Detail for All Employees With Access 20 June 2015 Created for... City of Miami All Accessibility - Total Cigna DPPO - All Employees - Dental Providers The Access Standard is defined as (All Employees) employees accessing: 2 (Total Cigna DPPO - General Dentists) dentists in 15 miles, 2 (Total Cigna DPPO - Endodontists) dentists in 15 miles, 2 (Total Cigna DPPO - Periodontists) dentists in 15 miles, 2 (Total Cigna DPPO - Oral Surgeons) dentists in 15 miles, 2 (Total Cigna DPPO - Orthodontists) dentists in 15 miles State City Employee Zip Code # Employees With. Access Provider Name With Access' Average Distance # % 1 2 © 2015 Quest Analytics, LLC. 33193 Total CignaDPPOy eneral Dentists Total Cigna DPPO - Endodontists Total. Cigna DPPD Periodontists_ Total Cigna DPPO - Oral Surgeons Total Cigna DPPD orthodontists , .' Total Cigna DPPO - General Dentists Total Cigna,DPPO 'Entlodontists Total Cigna DPPO. :Periodontists Total Cigna DPPOa- Oral Surgeons...!': Total Cigna DPPO - Orthodontists Total Cigna DPPD r ,General Dentists Total Cigna DPPO - Endodontists Total Cigna DPPD . Periodontists Total Cigna DPPO :Oral Surgeons Total Cigna DPPOj 'Orthodontists. Total Cigna DPPO - General Dentists Total Cigna DPPD 'Endodontists„ Total Cigna DPPO Periodontists Total Cigna DPPD ,,.Oral Surgeons , , , Total Cigna DPPO - Orthodontists Total Cigna DPPD ;General Dentists Total Cigna DPPO -Endodontists Total Cigna DPPO - periodontists s Total Cigna DPPO - Oral Surgeons Total Cigna DPPD - Orthodontists': Total Cigna DPPO -General Dentists Total Cigna DPPD -Endodontists Total Cigna,DPPO - Periodontists Total Cigna DPP-0-?,Drat Surgeons: . Total Cigna DPPO - Orthodontists Total Cigna DPPD - Generai Dentists Total Cigna DPPO - Endodontists Total Cigna DPPO'- Periodontists Total Cigna DPPO - Oral Surgeons Total Cigna DPPO -;Orthodontists _ . Total Cigna DPPO -General Dentists Total Cigna DO-PC-Endodontists Total Cigna DPPO - Periodontists Total Cigna DPPO Oral Surgeons Total Cigna DPPO - Orthodontists 0 0 28 28 28 28 28 27 27 27 -27 27 27 27 27 27 27 26 26 26 26 26 26 26 26 26 26 25 25 25 25 -'23 23 23 23 23 23 ;23 23 23 23 100.0 100.0 101 100.0 local 100.0 1000 100.0 10o-.0 100.0 1,001 100.0 100.0 100.0 100:0' 100.0 100 0 100.0 100.0 100.0 100.0. 100.0 1oo.o 100 0 100 0 100.0 100.0. 100.0 '100.0 100.0 100.0 100.0 100:0 100.0 1000 100.0 100.0 100.0 100.0 100.0 0.5 1.4 0.9 0.4 1.0 0.6 2.0 2.3 1.2. 2.3 0.5 1.1 0.7. 1.1 0.7 0.4 0.8. 0.7 1.5 0.8 0.4 1.0 0.7 1.2 0.6 1.0 2.6 3.4 1.4 :5. 1.8 11:. 1.2 0.7 0.6 - 2.7 2.6 2.1 1.0 3.1 2.6 1.2 2.4 0,5 3.9 1.2 4.0 0.7 0.5 0.8. 1.0 1.9 1.1 0.5 1.3 0.7 1.5 07 1.1 45. 4.0 4.0 1.7 Continued on next page... Cigna Ne,:.orkAnalysis Access Detail for All Employees With Access 21 June 2015 Created for... City of Miami All Accessibility -Total Cigna DPPO - All Employees - Dental Providers The Access Standard is defined as (All Employees) employees accessing: 2 (Total Cigna DPPO - General Dentists) dentists in 15 miles, 2 (Total Cigna DPPO - Endodontists) dentists in 15 miles, 2 (Total Cigna DPPO - Periodontists) dentists in 15 miles, 2 (Total Cigna DPPO - Oral Surgeons) dentists in 15 miles, 2 (Total Cigna DPPO - Orthodontists) dentists in 15 miles State City Employee Zip Code # Employees With Access Provider Name With Access' Average Distance # % 1 2 ©2015 Quest Analytics, LLC. Total Cigna DPPO - General, Dentists Total Cigna DPPO - Endodontists Total Cigna DPPO= Periodontists, Total Cigna DPPO - Oral Surgeons Total Cigna DPPO - Orthodontists Total Cigna DPPO - General Dentists Total Cigna DPPO - Endodontists Total Cigna DPPO - Periodontists Total Cigna DPPO -'Oral Surgeons Total Cigna DPPO - Orthodontists Total Cigna DPPO General- Dentists Total Cigna DPPO - Endodontists Total Cigna DPPO Periodontists ; - Total Cigna DPPO - Oral Surgeons Total Cigna DPPO. Orthodontists Total Cigna DPPO - General Dentists Total Cigna DPPO -;Endodontists Total Cigna DPPO - Periodontists Total. Cigna DPPO .Oral Surgeons" Total Cigna DPPO Orthodontists Total. Cigna DPPO_-.- General Dentists , Total Cigna DPPO -Endodontists Total Cigna DPPO -Periodontists - Total Cigna DPPO - Oral Surgeons Total"Cigna DPPO 'Orthoodontsts Total Cigna DPPO - General Dentists Total.Cigna„DPPO -Endodontists Total Cigna DPPO - Periodontists Total Cigna DPPO - Oral; Surgeons Total Cigna DPPO - Orthodontists *al Cigna DPPO GeneralDentists" Total Cigna DPPO - Endodontists Total Cigna DPPO -Periodontists Total Cigna DPPO - Oral Surgeons Total Cigna DPPO--Orthodontists Total Cigna DPPO - General Dentists Total CtgiaDPPO yEndodonists Total Cigna DPPO - Periodontists Total Cigna DPPO _ Oral Surgeons Total Cigna DPPO - Orthodontists ' 184 1 15. 8 14 45 6 8 9 6 12 0 0 51 4 4 9 0 0 5 ?58 1 3 0 2 22 22 22 22 22 22 22 22 22 22 22 22 22 `22 22 22 22 ;22 22 22 22 '22 22 20 20 20 20 20 20 20 20' 20 rQ 19 19 -19 19 19 _100.0 100.0 '100A 100.0 100.0 100.0 100.0 100:o. 100.0 00.0 100.0 100.0; 100.0 i00.0 100.0 100,0 100.0 100.0 100.0 100:0 100.0 100.0. 100.0 100.0 100.0 100:0 100.0 1000 100.0 100;0 100.0 106;0 100.0 100.0 100.0 100,0'. 100.0 1000 100.0 0.2. 0.8 0`6 0.5 0.4 0.3 0.8 0.7 0.8 0.5 0.3 3.5 21 0.7 0.5 0.8 0.7 07 0.6 02 0.7 08 1.4 07 0.7 ,1:3 1.9 19 1.3 0.4' 0.6 1.7 2.0 0.6 0.7 0.6 0.4 1i 0.8 1.2 0.7 0.3 3.5 2.1 216= 0.5 0.8 0.8 0.8 0.7 03c 0.9 1.2; 2.2 1 2 0.9 1.9 1.9 1.9 0.5 1.0 1.1 2.0 0.2 0.3 1.1 1.0 1.3 1.6 - 18 0.8 1.1 Continued on next page_. 167 Cigna Network Analysis Access Detail for All Employees With Access 22 June 2015 Created for... City of Miami All Accessibility - Total Cigna DPPO - All Employees - Dental Providers 1 The Access Standard is defined as (All Employees) employees accessing: 2 (Total Cigna DPPO - General Dentists) dentists in 15 miles, 2 (Total Cigna DPPO - Endodontists) dentists in 15 miles, 2 (Total Cigna DPPO - Periodontists) dentists in 15 miles, 2 (Total Cigna DPPO - Oral Surgeons) dentists in 15 miles, 2 (Total Cigna DPPO - Orthodontists) dentists in 15 miles State © 2015 QuestAnalytics, LLC. City Employee Zip Code # Employees With. Access Provider Name Total Cigna DPPOGeneral;Dentists Total Cigna DPPO - Endodontists Total Cigna DPPO='Periodontists, Total. Cigna DPPO - Oral Surgeons Total Cigna DPPO ; Orthodontists - Total Cigna DPPO - General Dentists Total Cigna DPPO:=.Endodontists . Total Cigna DPPO - Periodontists Total Cigna DPPO -;Oral Surgeons Total Cigna DPPO,- Orthodontists Total Cigna DPPO.General Dentists Total Cigna DPPO -Endodontists Total Cigna DPPO ``,Periodontiists _ Total Cigna DPPO - Oral Surgeons Total.Cigna DPPO,-,Orthodontists , r,' Total Cigna DPPO - General Dentists Total Cigna DPPO, Endodontiists. Total Cigna DPPO -.Periodontists total'Cigna DPPO - Oral Surgeons,' Total Cigna DPPO -,Orthodontists Total Cigna DPPO General Dentists Total Cigna DPPO - Endodontists Total: Cigna DPPO : Periodontists; , Total Cigna DPPO - Oral Surgeons Total DPPO -Orthodontists;;• Total Cigna DPPO - General Dentists Total Cigna DPPO=Endodontists,: Total Cigna DPPO - Periodontists Total Cigna DPPO Oral,Surgeons - Total Cigna •DPPO - Orthodontists Total Cigna DPPO General Dentists Total Cigna DPPO - Endodontists Total Cigna DPPO- Periodontists Total Cigna DPPO- Oral Surgeons Total Cigna DPPO - Orthodontists Total Cigna DPPO - General Dentists Total Cigna DPPO,-' Endodontists Total Cigna DPPO - Periodontists Total Cigna DPPO - Oral Surgeons Total Cigna DPPO - Orthodontists With Access' Average Distance # # % 1 2 3 18 '18 18 18 18 18 18 18 18 17 17 17 17 17 17 17 17 17 17 17 17 17 17 17 16 16 16 16 16 15. 15 15 15 15 15 15 15 15 15 'Lou 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100A, 100.0 100.0 100.0 100.0: 100.0 100.0 100.0 locho. 100.0 100,6 100.0 100.0. 100.0 100.0 100:0 1 oo.0. 100.0 100.0 100.0 Imo 100.0 10(0 100.0 100.0 100.0 1000 100.0 100.0 100.0 100.0 100.0 • 0.6 0.5 0.7 0.6 0.3 .21- 0.7 1.6 1.3 = 0.3 0.7 0.7 0.5 0.2 1.5 0.7 0.9 0.3 0.7 2.9 2.9 3.1 0.7. 0.5 1.9 1.7 1.9, 1.5 0,7 1.4 1.8 1.6 0.3 0.6 1.1 2.0 0.6 0:4 0.7 OT, 0.7 1.0 0.4 24 0.7 2.4 1.3 ,0.3 0.8 0.6 0.8 0.6: 0.3 1.5. 0.7 1.6 0.9 1,1: 4.0 2.9 3.2 1.5 0.7 2.0 1.9 2.1, 1.7 0.8 1.9 1.8 1.8 1.9 0.3 0.8 2.0 2.0 0.7 Continued on next page... e Cigna N&,.:-vrk Analysis Access Detail for All Employees With Access 23 June 2015 Created for... City of Miami All Accessibility - Total Cigna DPPO - All Employees - Dental Providers The Access Standard is defined as (All Employees) employees accessing: 2 (Total Cigna DPPO - General Dentists) dentists in 15 miles, 2 (Total Cigna DPPO - Endodontists) dentists in 15 miles, 2 (Total Cigna DPPO - Periodontists) dentists in 15 miles, 2 (Total Cigna DPPO - Oral Surgeons) dentists in 15 miles, 2 (Total Cigna DPPO - Orthodontists) dentists in 15 miles State Florida' 02015 QuestAnarytics, LLC. City Miami Hollywood Miami Beach Fort Lauderdale Homestead Miami Employees With Access Employee Provider Zip Code # Name 33167 33181 33020 33024 33140 33331 33032 14 14 12 12 12 Total Cigna DPPO -General Dentists Total Cigna DPPO - Endodontists Total Cigna DPPO Periodontists Total Cigna DPPO - Oral Surgeons Total Cigna DPPO"-Orthodontists Total Cigna DPPO -General Dentists Total Cigna,DPPO - Endodontists Total Cigna DPPO - Periodontists Total- Cigna DPPO - Oral Surgeons Total Cigna DPPO - Orthodontists Total Cigna DPPO -General Dentists Total Cigna DPPO - Endodontists Total Cigna DPPO -Periodontists Total Cigna DPPO - Oral Surgeons Total Cigna DPPO Orthodontists Total Cigna DPPO - General Dentists Total Cigna DPPO - Endodontists Total Cigna DPPO - Periodontists Total Cigna DPPO.-Oral Surgeons Total Cigna DPPO - Orthodontists Total Cigna DPPO - General Dentists! Total Cigna DPPO - Endodontists Total Cigna DPPO - Periodontists - Total Cigna DPPO - Oral Surgeons Total Cigna DPPO - Orthodontists Total Cigna DPPO -General Dentists Total Cigna DPPO'- Endodontists Total Cigna DPPO - Periodontists Total Cigna DPPO - Oral Surgeons Total Cigna DPPO - Orthodontists Total Cigna DPPO-,,- General Dentists Total Cigna DPPO - Endodontists Total Cigna DPPO -;Periodontists Total Cigna DPPO - Oral Surgeons Total' Cigna DPPO - Orthodontists Total Cigna DPPO -General Dentists TotalCigna DPPO - Endodontists: , r; Total Cigna DPPO - Periodontists Total Cigna DPPO Oral Surgeons Total Cigna DPPO - Orthodontists 169 With Access'' Average Distance # o0 14 100.0 14 100.0 14 100.0 14 100.0 1.0: 1414 10000.0 14 100.0 14 100.0 14 100.0 14 100.0 12 100.0 12 100.0 12 100.0 12 100.0 12 100.0 12 100.0 12 100.0 12 100.0 12. 100.0 12 100.0 12 100.0 12 100.0 12 100.0 12 100.0 12 100.0 11 100.0 11` 100.0 11 100.0 11 100,0' 11 100.0 11 100.0 11 100.0 11 100.0' 11 100.0 100.0' 100.0 100.0; 11 100.0 11: 100.0 11 100.0 1 2 0.8 2.9 3.0 1.0 2.5 0.4 1.1 0.7 1.2 0.7 0.4 1.3 1.2 1.3 1.8 0.4 0.6 0.6 0.5 0.6 0.6 0.6 0.9 1.9 1.6 ,1.6 1.5 0.5 3.4 0.8 3.1 3.5 1.0 2.7 0.5 1.2 0.7 1.3 1.1. 0.5 1.9 1.4 1.3 2.0 0.4 0.9 1.2 0.8 0.5 0:6 0.6 0.7 0.7 0.6 1.0 2.4 1.9 1.6 0.9 4.6 39' 4.8 5 0.5 1.0 1.1 06 1.2 0.8 1.2 Continued on nextpage... Cigna Network Analysis Access Detail for All Employees With Access 24 June 2015 Created for... City of Miami All Accessibility - Total Cigna DPPO - All Employees - Dental Providers 1 The Access Standard is defined as (All Employees) employees accessing: 2 (Total Cigna DPPO - General Dentists) dentists in 15 miles, 2 (Total Cigna DPPO - Endodontists) dentists in 15 miles, 2 (Total Cigna DPPO - Periodontists) dentists in 15 miles, 2 (Total Cigna DPPO - Oral Surgeons) dentists in 15 miles, 2 (Total Cigna DPPO - Orthodontists) dentists in 15 miles State City Employee Zip Code # Employees With Access Provider Name With Access' Average Distance # % 1 2 ©2015 Quest Analytics, LLC. Total Cigna DPPQ - General Dentists Total Cigna DPPO - Endodontists TotaLCigna DPPQ, Periodontists Total Cigna DPPQ-Oral Surgeons Total Cig na DPPQ - Orthodontists . - , : Total Cigna DPPO - General Dentists Total Cigna DPPQ Endodontists Total Cigna DPPO - Periodontists Total Cigna DPPQ-:,Oral Surgeons Total Cigna DPPO - Orthodontists Total Cigna DPPQ •General Dentists . `; Total Cigna DPPO - Endodontists Total Cigna DPPQ - Periodontists Total Cigna. DPPO - Oral Surgeons :Total Cigna DPPQ Orthodontists Total Cigna DPPO - General Dentists Total Cigna DPPQ-€ndodontists , Total Cigna DPPO - Periodontists Total, Cigna DPPQ - Oral Surgeons , Total Cigna DPPO - Orthodontists Total Cigna DPPQ-General Dentists Total Cigna DPPO - Endodontists Total. Cigna DPPO.-Periodontists . , Total Cigna DPPO - Oral Surgeons Total Cigna DPPO,- Orthodontists ,. Total Cigna DPPO - General Dentists Total Cigna DPPQ- ;Endodontists Total Cigna DPPO - Periodontists Total Cig a DPPO -'Oral Surgeons.:,_.,;:, Total Cigna DPPO - Orthodontists Total Cigna DPPO-iGenera!Dentists Total Cigna DPPO - Endodontists Total Cigna DPPQ --Periodontists Total Cigna DPPO - Oral Surgeons Total Cigna DPPO-rOrthodontists Total Cigna DPPO - General Dentists Total -Cigna DPPO'- Endodontists Total Cigna DPPO - Periodontists Total Cigna DPPO - Oral Surgeons Total Cigna DPPO - Orthodontists 2 1 0 11 11 11 11 11 0 10 10 10 10 10 10 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 100.0 100.0 100.0. 100.0 1000 100.0 100.0 100.0 100.0 100.0 1polo 100.0 100 0 100.0 1006 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100;0 100.0 100,o 100.0 100.0 100.0 100,0 100.0 100A 1.00.0 100.9 100.0 100.0` 100.0 100.0 100.0 0 9_ 0.9 2.3 2.3 0.9. 2.2 3.0 2:1 2.1;. 0.6 0.6 0.6 0.8 0.6 1.9 2.7 2.7 0.6 0.6 06 2.7 31 0.8 1.0 2.7 0.4 0.5 1,2 0.7 1.2 0.7 0.9 0.2 " 0.4, 0.9 2.7 2.7 2.7, 1.5 2.6 0.8 `' ,1.3 0.4 0.4 1.6 2.5. 2.1 2.1 1.8 2.1. 0.9 1.3 2.9 3.0 4.0 5.3 3.6 6.0 3.6 4.0 3.6 5.3 0.1 0.1 2.1 2.1 0.3 0.4 '0.5 2.1 0.5 1.6 1.0 08 0.5 12 Continued on next page.. Cigna Network Analysis Access Detail for All Employees With Access 25 June 2015 Created for... City of Miami All Accessibility- Total Cigna DPPO-Ali Employees - Dental Providers 1 The Access Standard is defined as (All Employees) employees accessing: 2 (Total Cigna DPPO - General Dentists) dentists in 15 miles, 2 (Total Cigna DPPO - Endodontists) dentists . in 15 miles, 2 (total Cigna DPPO - Periodontists) dentists in 15 miles, 2 (Total Cigna DPPO - Oral Surgeons) dentists in 15 miles, 2 (Total Cigna DPPO - Orthodontists) dentists in 15 miles State ©2015 QuestMalyncs, LLC. Fort Lauderdale Hallandale Employee Zip Code # 33132 33178 33146 33312 33009 Employees With Access Provider Name 9 Total Cigna DPPO-- General Dentists:: Total Cigna DPPO - Endodontists Total Cigna DPPO Periodontists Total Cigna DPPO -Oral Surgeons Total. Cigna DPPO -;Orthodontists 9 Total Cigna DPPO - General Dentists Total CignaDPPO -Endodontists Total Cigna DPPO - Periodontists Total Cigna DPPO ;'Oral Surgeons Total Cigna DPPO - Orthodontists 9 Total Cigna DPPO=General'Dentists Total Cigna DPPO - Endodontists Total Cigna DPPO - Perodontists, Total Cigna DPPO - Oral Surgeons Total 'Cigna DPPO:..Orthodontists: 8 Total Cigna DPPO - General Dentists Total Cigna DPPO L Endodontists Total Cigna DPPO - Periodontists Total Cigna DPPOZ- Oraf Surgeons Total Cigna DPPO - Orthodontists 8 Total Cigna DPPO:--General:Dentsts Total Cigna DPPO - Endodontists Total Cigna DPPO ,Periodontists Total Cigna DPPO - Oral Surgeons Total Cigna DPPO -:Orthodontists 6 Total Cigna DPPO - General Dentists Total;Cigna DPPO-Endodontists Total Cigna DPPO - Periodontists Total Cigna DPPO "Oral Surgeons Total Cigna DPPO - Orthodontists Total,Cigna DPPO - General Dentists Total Cigna DPPO -Endodontists Total Cigna DPPO Periodontists Total Cigna DPPO Oral Surgeons Total Cigna DPPO Orthodontists 6 Total Cigna DPPO General Dentists Total Cigna DPPO . Endodontists, ,, , Total Cigna DPPO - Periodontists Total Cigna DPPO'-' Oral Surgeons Total Cigna DPPO - Orthodontists 2 0 1 With Access' Average Distance 1 2 -9 9 9 9 9 9 9 9 9 9 9 9 9 8 8 8 8 8 8. 8 8 8 8 6 6 6 6' 6 =:6 6 -6 6 6 6 6 6 6 109,0 100.0 100E0 100.0 100.0` 100.0 100.0 100.0 1000 100.0 100.0' 100.0 1000 100.0 100.0- 100.0 100.0 100.0 1000 100.0 1000 100.0 100.0 100.0 100.0 100.0 1000 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100 0` 100 0 1000 100.0 100.0 100.0 0.2 0.2 2.8 2.9 1.2 1.3 0.8 1.7 1.3 1.9 0.8 0.9 1.7 2.9 2.5 2.8 1.0 1.6 1.0 1.0 2A 2.4 2.4 5.8 5.6 6A 5.4 5.4 2 4' 3.4 0.5 0.7 1.2 1.3 1.0 1.5 1.1 1.1 1.0 1.1 0.9 0.9 1.4 4.9 1.4 1.5: 1.4 5.0 1.5 1.5 0.6 0.6 2.3 2.4 2.1 2.1 0.4 0.8 0.6 0.7. 0.7 0.7 051 0.5 0.5 1'3 0.9 1.0 1.3 1.3 1.2 1.7 Continued on nextpage.. 171 Cigna Network Analysis Access Detail for All Employees With Access 26 June 2015 Created for... City of Miami All Accessibility - Total Cigna DPPO -All Employees - Dental Providers 1 The Access Standard is defined as (All Employees) employees accessing: 2 (Total Cigna DPPO - General Dentists) dentists in 15 miles, 2 (Total Cigna DPPO - Endodontists) dentists in 15 miles, 2 (Total Cigna DPPO - Periodontists) dentists in 15 miles, 2 Total Cigna DPPO - Oral Surgeons) dentists in 15 miles, 2 Total Cigna DPPO - Orthodontists) dentists in 15 miles State City Employee. Zip Code # Employees With Access Provider Name With Access' Average Distance # % 1 2 0 2015 Quest Analyfics, LLC. Key Largo Dania 33326 Total Cigna DPPO� General Dentists Total Cigna DPPO - Endodontists Total Cigna DPPO - Penodontists r Total Cigna DPPO - Oral Surgeons Total Cigna DPPO;= Orthodontists, :', Total Cigna DPPO - General Dentists Total Cigna DPPO ".`Endodontists Total Cigna DPPO - Periodontists ;Total Cigna DPPO' `Oral Surgeons ; Total Cigna DPPO -Orthodontists ^TotalCigna DPPO ::General Dentists,, Total Cigna DPPO - Endodontists Total Cigna DPPO - Periodontists " Total Cigna DPPO - Oral Surgeons Total'Cigna DPPOi-Orthodontists Total Cigna DPPO - General Dentists Total Cigna DPPO ;,Endodontists Total Cigna DPPO„- Periodontists Total Cigna DPPO ,Oral Surgeons Total Cigna DPPO - Orthodontists Total Cigria DPPO ;General Dentists Total Cigna DPPO - Endodontists Total Cigna DPPO Periodontists. ., Total Cigna DPPO - Oral Surgeons 'Total"Cigna DPPO ;Orthodontists, Total Cigna DPPO - General Dentists Total Cigna DPPO -;Endodontists," , , Total Cigna DPPO,- Periodontists Total,Cigna DPPO;=,Oral Surgeons Total Cigna DPPO - Orthodontists Total Cigna DPPO General Dentists Total Cigna DPPO - General Dentists Total Cigna DPPO.- Endodontists Total Cigna DPPO - Periodontists Total Cigna DPPO =:;Oral Surgeons Total Cigna DPPO - Orthodontists Total Cigna DPPO - General Dentists , j:: Total Cigna DPPO - Endodontists Total Cigna DPPO ;Periodontists Total Cigna DPPO - Oral Surgeons 0 50 2 6 8 6 6 6 6 6 6 6 6 5 5 5 5 5 5 5 "5 5 5 5 5 5 5 4 4 4 4 4 4 4 4 1000. 100.0 '100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0, 100.0 100,0 100.0 100.0 100.0 100.0; 100.0 1000 100.0 100.0, 100.0 1100.0 100.0 100:0, 100.0 100.0. 100.0 100.0, 100.0 100.0 100.0 100.0, 100.0 100,0 100.0 100.0 100.0 100.0 100.0 1:1 1.2 1.2 1.2 1.2 1.0 1.3' 0.5 0.5 10 1.0 0.8 1.0 0.7 0 9 0.5 0.7 0.8 2.4 2.6 2$; " 3.1 2.1 2.7 1Tj 2.1 0.8 1.8 2.2; 22: 2.3 2.3 2.2 2.2 1.2 1.3 0.5: 0.7. 1.1 1.1 2.0 2.0 0.7 0.7 0.8 1.7 1.7 2.8 3.2 2.7 2.8 2.8 - 3.0 2.7 2.8 3.5 3.8 0.6 0.7 0.7 1.5 1.5 1.5 1'.5 1.5 1.7 1.7 0.7 0.7 0.9 0.9 0.8 0.8 1.0 1.2 Continued on next page_. Cigna Ne,,00rkAnalysis Access Detail for All Employees With Access 27 June 2015 Created for... City of Miami At Accessibility - Total Cigna DPPO - All Employees - Dental Providers The Access Standard is defined as (All Employees) employees accessing: 2 (Total Cigna DPPO - General Dentists) dentists in 15 miles, 2 (Total Cigna DPPO - Endodontists) dentists in 15 miles, 2 (Total Cigna DPPO - Periodontists) dentists in 15 miles, 2 (Total Cigna DPPO - Oral Surgeons) dentists in 15 miles, 2 (Total Cigna DPPO - Orthodontists) dentists in 15 miles State Florida ©2015 Quest Analytics, LLC. City Fort Lauderdale Homestead Jupiter Loxahatchee Miami Miami Beach Palm City Port Saint Lucie; is Employee Zip Code # 33317 4 33035 4 33458 33470 33170 33233 33154 34990 4 4 4 4 4 4 Employees With Access Provider' Name Total Cigna DPPO -.Orthodontists Total Cigna DPPO - General Dentists Total Cigna DPPO - Endodontists Total Cigna DPPO - Periodontists Total Cigna DPPO - Oral Surgeons Total Cigna DPPO - Orthodontists Total Cigna DPPO - General Dentists Total Cigna DPPO - Endodontists Total Cigna DPPO - Periodontists Total Cigna DPPO - Oral Surgeons Total Cigna DPPO -Orthodontists Total Cigna DPPO - General Dentists Total Cigna DPPO - Endodontists Total Cigna DPPO - Periodontists Total Cigna DPPO - Oral Surgeons Total Cigna DPPO - Orthodontists Total Cigna DPPO - General Dentists Total Cigna DPPO - Endodontists Total Cigna. DPPO - Periodontists Total Cigna DPPO - Oral Surgeons Total Cigna DPPO - Orthodontists Total Cigna. DPPO - General Dentists Total Cigna DPPO Endodontists Total Cigna DPPO - Periodontists Total Cigna DPPO -Oral Surgeons Total Cigna DPPO - Orthodontists Total Cigna DPPO - General Dentists Total Cigna DPPO - Endodontists Total Cigna DPPO'- Periodontists, Total Cigna DPPO - Oral Surgeons Total Cigna DPPO - Orthodontists Total Cigna DPPO - General Dentists Total Cigna DPPO -Endodontists Total Cigna DPPO - Periodontists Total, Cigna "DPPO - OratSurgeons Total Cigna DPPO - Orthodontists Total Cigna DPPO - General Dentists Total Cigna DPPO - Endodontists Total Cigna DPPO = Periodontists Total Cigna DPPO - Oral Surgeons With Access" Average Distance # % 1 11 4 100.0 08 0 4 100.0 1.3 4 100.0 1.3 4 100.0 1.3 4 100.0 1.3 4 100.0 1.3 4 100.0 0.9 4 100.0 1.0 4 100.0 1.0 4 100.0 1.1 4 100.0 1.0 4 100.0 1.8 4 100.0 7.1 4 100.0 7.1 4 100.0 6.9 4 100.0 1.8 4 100.0 2.4 4 100.0 4.0 4 100.0 3.4. 4 100.0 4.2 4 10,0.0' 3.3 4 100.0 0.8 4 100.0 S -1.9 4 100.0 1.1 4 100.0 0.8, 4 100.0 1.7 4 100.0 :. 0.2 4 100.0 0.4 4 100.0 0.4 4 100.0 2.5 4 100.0 ; 0.4 4 100.0 1.6 4 100.0 4.4 4 100.0 1.9 4 100.0 1.8" 4 100.0 2.1 100.0' 4 100.0 4 1000 4 100.0 2.3 2.3 2.5 1.6 1.6 2 0.8 1.3 1.3 1.3 1.3. 1.3 0.9 1.1 1.2 1.1 1.0 2.5 7.1 7.1 7.3 6.0 2.5`, 5.5 4.7 5.7 34 0.8 1.9 1.1 1.1 1.7 0.2 2.0 0.4 2.5 2.0 1.8 4.4 1.9 26 2.9 11, 3.2 Continued on next page- 173 Cigna Network Analysis Access Detail for All Employees With Access 28 June 2015 Created for... City of Miami All Accessibility - Total Cigna DPPO - All Employees - Dental Providers The Access Standard is defined as (Ail Employees) employees accessing: 2 (Total Cigna DPPO - General Dentists) dentists in 15 miles, 2 (Total Cigna DPPO - Endodontists) dentists in 15 miles, 2 (Total Cigna DPPO - Periodontists) dentists in 15 miles, 2 (Total Cigna DPPO - Oral Surgeons) dentists in 15 miles, 2 (Total Cigna DPPO - Orthodontists) dentists in 15 miles State City Employee Zip Code # Employees With Access Provider Name With Access' Average Distance # % 1 2 Florida District of Columbia Florida © 2015 Quest Analytics, LLC. PortSaintLucie. Fort Lauderdale Lake Worth Palm.Beach Gardens Washington Fort Lauderdale, , 4 Total, Cigna DPPQ (Orthodontists 3 Total Cigna DPPO - General Dentists Totat Cigna DPPO 'Endodontists Total Cigna DPPO - Periodontists Total Cigna DPPQ OralySurgeons Total Cigna DPPQ - Orthodontists Total Cigna DPPQ rGeneral Dentists; Total Cigna DPPO-Endodontists Total Cigna DPPQ -;Periodontists Total Cigna DPPO - Oral Surgeons Total DPPQ_ `Orthodontists 3 Total Cigna DPPO - General Dentists Total Cigna DPPQ '. Endodontists , Total Cigna DPPO - Periodontists Total Cigna DPPOOral Surgeons Total Cigna DPPO - Orthodontists Tatar Cigna DPPO:,,-.;General", Dentists. Total Cigna DPPO - Endodontists Total Cigna DPPQ - Periodontists.", Total Cigna DPPO - Oral Surgeons Total Cigna DPPQ -.Orthodontists Total Cigna DPPO - General Dentists Total Cigna DPPQ-Endodontists. Total Cigna DPPO - Periodontists Total Cigna DPPQ ','Oral Surgeons Total Cigna DPPO - Orthodontists 3 Total Cigna DPPQ' .General.Dentists , -; Total Cigna DPP O - Endodontists Total Cigna DPPO -!Periodontists Total Cigna DPPO - Oral Surgeons Total Cigna DPPO "Orthodontists 2 Total Cigna DPPO - General Dentists Total Cigna DPPO - Endodontists - - Total Cigna DPPO - Periodontists Total Cigna DPPQ =,:Oral Surgeons Total. Cigna DPPO; Orthodontists 2 Total Cigna DPPO General Dentists Total Cigna DPPO - Endodontists Total Cigna DPPO Periodontists Total Cigna DPPO - Oral Surgeons 3 3 3 3 3 3 3 3 3 3 3 3 3 2 2 2 100.0' 100.0 1000' 100.0 100.0 100.0 100:0 100.0 100.0 100.0 100.0: 100.0 100,.0; 100.0 100.0 100.0 100.0 100.0 100.0, 100.0 100:0 100.0 100.0 100.0 100:0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100:0 100.0 10010 100.0 100.0 100.0 100.0 100.0 . 25. 0.0 0.3 0.2 0.6 . 0.4 0.7 0:7 0.9 0.4 1.0 0.9 1.8; 1.0 .3 0.6 0.6 0.8 1.1' 0.5 1.1: 1.1 0.9 1.4 1.6 2.2 1.8 2.8 2.3 0.4 2.1 2.7 1.1 2.0 0.3 0.8 0.4 0.8 25: 0.0 0.3 0.3 0.7 0.4 0.7 1.0 0.9 0.7 0.5 1.0. 1.0 2,1' 1.8 0.3. 1.1 0.6 1.5 1.7. 0.6 1.1. 1.1 1.4 1.6 1.7. 3.0 3.0 2.8 3.4 0.5 3.2 2.7 1.1'. 2.1 0.3 1.0 0.4 0.8 Continued on next page... Cigna Ne.orkAnalysis Access Detail for All Employees With Access 29 June 2015 Created for... City of Miami All Accessibility - Total Cigna DPPO - All Employees- Dental Providers The Access Standard is defined as (All Employees) employees accessing: 2 (Total Cigna DPPO - General Dentists) dentists in 15 miles, 2 (Total Cigna DPPO - Endodontists) dentists in 15 miles, 2 (Total Cigna DPPO - Periodontists) dentists in 15 miles, 2 (Total Cigna DPPO - Oral Surgeons) dentists in 15 miles, 2 (total Cigna DPPO - Orthodontists) dentists in 15 miles State Florida ©2015 Quest Analytics, LLC. City Fort Lauderdale Fort Myers Homestead Inverness _ake-INo Employee Zip Code # 33316 ''2 33321 2 33322 33327 33334 33908 33034 34453 2 2 2 2 2 Employees With Access Provider Name Total Cigna DPPO - Orthodontists Total Cigna DPPO - General Dentists Total Cigna DPPO - Endodontists, Total Cigna DPPO - Periodontists Total Cigna DPPO Oral Surgeons Total Cigna DPPO - Orthodontists Total Cigna DPPO - General Dentists Total Cigna DPPO - Endodontists Total Cigna DPPO -Periodontists Total Cigna DPPO - Oral Surgeons Total Cigna DPPO - Orthodontists. Total Cigna DPPO - General Dentists Total Cigna DPPO - Endodontists Total Cigna DPPO - Periodontists Total Cigna DPPO - Oral Surgeons Total Cigna DPPO - Orthodontists Total Cigna DPPO - General Dentists Total Cigna DPPO - Endodontists Total Cigna DPPO.-Periodontists Total Cigna DPPO - Oral Surgeons Total Cigna DPPO:- Orthodontists Total Cigna DPPO -General Dentists Total Cigna DPPO - Endodontists Total Cigna DPPO - Periodontists Total Cigna DPPO - Oraf Surgeons Total Cigna DPPO Orthodontists Total Cigna DPPO - General -Dentists Total Cigna DPPO - Endodontists Total Cigna DPPO - Periodontists Total Cigna DPPO - Oral Surgeons Total Cigna DPPO - Orthodontists Total Cigna DPPO - General Dentists Tota(Cigna DPPO - Endodontists Total Cigna DPPO,- Periodontists Total CignaDPPO Oral Surgeons: Total Cigna DPPO - Orthodontists Total Cigna DPPO - General' Dentists . s Total Cigna DPPO - Endodontists Total Cigna DPPO - Periodontists Total Cigna DPPO - Oral Surgeons 63 4 9 8 2 50 8 8 10 3 With Access1 2 2 2 2 i2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 -2 2 2 2 2 2 ;100.0 100.0 1000 100.0 100.0 100.0 100:0 100.0 100.0 100.0 100:0 100.0 100.0 100.0 100.0 100.0 100;0 100.0 100.0 100.0 100A 100.0 100:0 100.0 100:0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100 0, 100.0 100.0- 100.0 Average Distance 1 2 2.3 0.5 0.5 0.5 1.1. 1.2 0.2 0.4 0.4 0.4 0.5 1.3 2.0 2.0 2.7 2.7 0.5 1.2 0.7 0.7 1.0 0.9 3.4 3.4 3.4 1.7 0.8 2.5 2.9 2.5 2.9 1.5 7.4 4.7 1.7 3.8 0.5 1.1 0.5 1.1 1.4 0.4 0.4 0.5 0.4 0.6 1.3 2.8 2.9 2.8 2.8 0'7 1.4 1.7 0.7 1.3 1.2 36 3.4 3.6 1.7 0.8 4.2 4.2 2.9 4.2 1.7 7.4 13.0 10.3 1.7 2.3 2.8 1.4 1.4 2.4 2.4 Continued on next page- 175 Cigna Network Analysis Access Detail for All Employees With Access 30 June 2015 Created for... City of Mianii All Accessibility - Total Cigna DPPO - All Employees - Dental Providers The Access Standard is defined as (All Employees) employees accessing: 2 (Total Cigna DPPO - General Dentists) dentists in 15 miles, 2 (Total Cigna DPPO - Endodontists) dentists in 15 miles, 2 (Total Cigna DPPO - Periodontists) dentists in 15 miles, 2 (Total Cigna DPPO - Oral Surgeons) dentists in 15 miles, 2 (total Cigna DPPO - Orthodontists) dentists in 15 miles State City Employees With Access Employee Provider Zip Code # Name With Access' Average Distance # % 1 2 Florida ©2015 Quest Analytics, LLC. Lake, Worth;;` Lehigh Acres Marathon. Miami 33050 <_ Total, Cigna DPPO y0rthodont`ists , g Dentists Total Ci na DPP General Tofal-Cigna DPPO - Endodontists Total Cigna DPPO - Periodontists Total Cigna,DPPO ;Oral Surgeons . Total Cigna DPPO-Orthodontists Total Cigna DPPO :General Dentists. Total Cigna OPPD.T.Generat Dentists Total DPPO ;- Endodontists Total Cigna DPPO-, Periodontists Total Cigna D- PO `,'Oral,Surgeons Total Cigna DPPO - Orthodontists Total Cigna DPPO -.General Dentists; Total Cigna DPPO - Endodontists Total_Cigna DPPO,= Periodontists Total Cigna DPPO-Oral Surgeons Total Cigna DPPO = Orthodontists Total Cigna DPPO - General Dentists Total Cigna DPPO Endodontists Total Cigna DPPO - Periodontists Total Cigna DPPO -;Aral Surgeons...:; Total Cigna DPPO - Orthodontists Total Cigna DPPO='GeneralDentists Total Cigna DPPO - Endodontists TotalCigna DPPO-Periodontists, Total Cigna DPPO - Oral Surgeons Total Cigna DPPO"-,Orthodontists Total Cigna DPPO,,- General Dentists Total Cigna DPPO; Endodontists Total Cigna DPPO - Periodontists Total Cigna DPPO `;-.Oral Surgeons Total Cigna DPPO - Orthodontists Total Cigna DPPO - General Dentists Total Cigna DPPO - Endodontists- Total Cigna DPPO`-;Periodontists Total Cigna DPPO oral Surgeons Total Cigna DPPO - orthodontists Total Cigna DPPO - General Dentists Total Cigna DPPO - Endodontists Total Cigna DPPO - Periodontists i0 13 0 1 2 2 2 2 2 2 2 2 2 2 2 2 2 -2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 r2 2 2 2 .100:0 100.0 100.0 100.0 11)0':0 100.0 100,0 100,0 100.0 100.0 100.01 100.0 100 0, 100.0 100.0. 100.0 100:0 100.0 100.0 100.0 100.0 100.0 too:° 100.0 100.0; 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100 0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 2.4; 1.9 3.5 3.5: 3.5 0.1 0.2 1.9 0.9 06 1.1 1.1 1.1 1:1; 1.1 0.3 4.1 2.3. 3.8 1.4 0.7 1.5 1.3 1.5 1.5 0.2 0.6 15 0.6 1.5 1.3 3.7 2.0 3.5 3.0 0.1 1:7 0.1 2.0, 1.3 OA 1.9 11 1.0 0.9 1.1 1.3 1.3 1.1 1.0 4.9 2,3 4.2 1.4 0.7 1.5 1.5 1.5 1.5 0.2 0.9 1.5 1.5 1.5 2.0 3.7 7.2 Continued on next page... Cigna NerworkAnalysis Access Detail for All Employees With Access 31 June 2015 Created for... City of Miami All Accessibility -Total Cigna DPPO - Al Employees - Dental Providers 1 The Access Standard is defined as (All. Employees) employees accessing: 2 (Total Cigna DPPO - General Dentists) dentists in 15 miles, 2 (Total Cigna DPPO - Endodontists) dentists in 15 miles, 2 (total Cigna DPPO - Periodontists) dentists in 15 miles, 2 (Total Cigna DPPO - Oral Surgeons) dentists in 15 miles, 2 (Total Cigna DPPO - Orthodontists) dentists in 15 miles State City Employee Zip Code # Employees With Access Provider Name With Access' Average Distance # % 1 2 © 2015 QuestAnalytics, LLC. Naples Pompano Beach Port Orange Port Saint Lucie Sebring Stuart Tarpon Springs The Villages 34113 33063 33073 32128, 33875 34997 34689' 2 2 2 2 2 2 2 2 2 Total Cigna DPPO -Oral Surgeons Total Cigna DPPO - Orthodontists Total Cigna DPPO - General. Dentists Total Cigna DPPO - Endodontists Total Cigna DPPO - Periodontists Total Cigna DPPO - Oral Surgeons Total Cigna DPPO - Orthodontists Total Cigna DPPO - General Dentists Total Cigna DPPO - Endodontists Total Cigna DPPO - Periodontists Total Cigna DPPO - Oral Surgeons. Total Cigna DPPO - Orthodontists Total Cigna DPPO -General Dentists Total Cigna DPPO - Endodontists Total Cigna DPPO - Periodontists Total Cigna DPPO - Oral Surgeons Total Cigna DPPO - Orthodontists Total Cigna DPPO - General Dentists Total Cigna DPPO -,Endodontists Total Cigna DPPO - Periodontists Total Cigna DPPO - Oral Surgeons Total Cigna DPPO - Orthodontists Total Cigna DPPO,- General Dentists Total Cigna DPPO - Oral Surgeons Total Cigna DPPO -Orthodontists Total Cigna DPPO - General Dentists Total Cigna DPPO - Endodontists. Total Cigna DPPO -Periodontists Total Cigna DPPO-- Oral Surgeons. Total Cigna DPPO - Orthodontists Total Cigna DPPO - General Dentists Total Cigna DPPO - Endodontists Total. Cigna DPPO - Periodontists Total Cigna DPPO - Oral Surgeons Total Cigna DPPO 'Orthodontists • Total Cigna DPPO - General Dentists Total Cigna DPPO - Endodontists. Total Cigna DPPO - Periodontists Total Cigna DPPO Oral Surgeons Total Cigna DPPO - Orthodontists 2 2 2 2 2 2 2 2 2. 2 2 2 2 2 2 2 2 2 2' 2 2 2 2, 100.0' 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0' 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0" 100.0 100.0 100.0 100.0 100.0 1600 100.0 100.0 100.0 3.2 3.7 6.5 7.5 0.7 0.7 1.1 1.5 0.7 1.1 1.1 1.1 1.1 ` 1,1' 0.4 0.4 0.4 0.4 0.4 0.4 0.4 0.4. 0.4 0.4 2.0 2.0 4.2 4.2 4.2 4.2 4.2 4.2 4.2 0.5 0.6 0.6 0.7 0.6 0.6 0.6 0.7. 0.6 0.6 2.4" 2.4 3.6 4.3 2.5 3.0 0.8 0.8 0.9 2.3 2.3 0.9 0.9 0.9 0.9 0.5. 0.6 2.5 3.3 3.2 3.4 3.3 3.7 0.7 1.3 1:4 "r2.2 1.4 8.6 1;4 1.4 1.4 2.1 177 Cigna NettworkAnafysis Access Detail for All Employees With Access 32 June 2015 Created for... City of Miami All Accessibility - Total Cigna DPPO - All Employees - Dental Providers 1 The Access Standard is defined as (All Employees) employees accessing: 2 (Total Cigna DPPO - General Dentists) dentists in 15 miles, 2 (Total Cigna DPPO - Endodontists) dentists in 15 miles, 2 (Total Cigna DPPO - Periodontists) dentists in 15 miles, 2 (Total Cigna DPPO - Oral Surgeons) dentists in 15 miles, 2 (total Cigna DPPO - Orthodontists) dentists in 15 miles State City Employee Zip Code # Employees With Access Provider Name With Access' Average Distance. # # % 1 2 North Carolina Alabama ©2015 Quest Analylics, LLC. Rankin -1. Phenix City Flagstaff Sun City -West, Littleton Montrose Alachua Boca Raton Bokeelia Boynton Beach 28734.,; 36867 8600e ,' :.85375- 80129 • • 32615 .;! 33498 .33922 33436 '.1 1 Total Cigna DPPO ,Generl°Dentists °+' Total Cigna DPPO - General Dentists Total,Cigna DPPO 'Oral Surgeons Total Cigna DPPO - Orthodontists Tatar Cigna DPPO General Dentists Total Cigna DPPO - Orthodontists Total Cigna DPPO ,-General.D'entists Total Cigna DPPO -Endodontists TotafCigna DPPO =Periodontists ; Total Cigna DPPO-Oral Surgeons Total Cigna DPPO ,Orthodontists Total Cigna DPPO - General Dentists TotalCigna DPPO- Endodontists F . Total Cigna DPPO - Periodontists ;Total Cigna DPPO ;Oral Surgeons Total Cigna DPPO -,Orthodontists -Total Cigna DPPO.,- General Dentists,? Total Cigna DPPO - Oral Surgeons Total Cigna DPPO _ General Dentists_ Total Cigna DPPO - Endodontists Total,Cigna DPPO .Periodontists , Total Cigna DPPO - Oral Surgeons Total Cigna DPPO Orthodontists Total Cigna DPPO - General Dentists Total Cigna-DPPO:Endodontists Total Cigna DPPO - Periodontists Total Cigna DPPO:-Oral Surgeons Total Cigna DPPO :Orthodontists Total Cigna:,DPPO - General Dentists. Total Cigna DPPO - Endodontists Total Cigna DPPO - Periodontists Total Cigna DPPO - Oral Surgeons Total Cigna DPPO-.Orthodontists.. Total Cigna DPPO-General Dentists TotafCigna DPPO ,Endodontists Total Cigna DPPO Periodontists- Total Cigna DPPO "Oral Surgeons Total Cigna DPPO - Orthodontists Total Cigna DPPO - General Dentists Total Cigna DPPO - Endodontists ,1000 100.0 {1.000 100.0 �100.0 100.0 100.0' 100.0 100:0 100.0 100.0. 100.0 100.0 100.0 100 0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 1.00.0. 100.0 100.0, 100.0 100.0 100.0 100.0. 100.0 000 100.0 100.0 100.0 1000; 100.0 100.0. 100.0 100.0 100.0 0.9 4.1 4.8 0.9 0.9 0.6 0.7 0.7' 0.7 0.2 0.7 9.4 8.8 10.0 9.6 0.9 1.3 1.3 1.3 0.9 3.6 10.3 10.3 10.3 10.3 0.3 07: 0.7 0.3 0.2 1.1 4.5 16 4.8 `09. 1.1 2,4 0.9 09; 0.6 07 0.7 0.7 0.7 0.2 0.7 0.3. 9.4 100`, 10.0 9.6 0.9 1.3 1.3 1.3 1.3 3.6 10.3 10.3 11.8 10.4 0.3 0.7 0.7 0.7 0.2 1.1 Continued on next page... Cigna N. Jrk Analysis Access Detail for All Employees With Access 33 June 2015 Created for... City of Miami All Accessibility - Total Cigna DPPO -All Employees - Dental Providers The Access Standard is defined as (All Employees) employees accessing: 2 (Total Cigna DPPO - General Dentists) dentists in 15 miles, 2 (Total Cigna DPPO - Endodontists) dentists in 15 miles, 2 (Total Cigna DPPO - Periodontists) dentists in 15 miles, 2 (Total Cigna DPPO - Oral Surgeons) dentists in 15 miles, 2 (Total Cigna DPPO - Orthodontists) dentists in 15 miles State City Employee Zip Code # Employees With Access Provider Name With. AccessAverage Distance % 1 2 ©2015 Quest Analyfics, LLC. Delray Beach Total Cigna DPPO -Periodontists Total Cigna DPPO - Oral Surgeons Total Cigna DPP() Orthodontists' Total Cigna DPPO - General Dentists Total Cigna DPPQ - Endodontists. Total Cigna DPPO - Periodontists Total Cigna DPPQ-!Orel.Surgeons Total Cigna DPPO -Orthodontists Total" Cigna, DPPO - General; Dentists Total Cigna DPPO - Endodontists Total Cigna DPPO -,Periodontists Total Cigna DPPO - Oral Surgeons Total Cigna DPPO-;Orthodontists Total Cigna DPPO - General Dentists Total Cigna DPPO - Endodontists Total Cigna DPPO - Periodontists Total Cigna DPPO.- Oral Surgeons Total Cigna DPPO - Orthodontists Total Cigna DPPO -GeneralDentists; Total Cigna DPPO - Endodontists Totar DPPO -Periodontists Total Cigna DPPO - Oral Surgeons Total Cigna DPPQ -:Orthodontists ", . Total Cigna DPPO - General Dentists Total Cigna DPPO - Endodontists" Total Cigna DPPO - Orthodontists Total Cigna DPPQ :;General Dentists, Total Cigna DPPO - Endodontists Total Cigna DPPQ Periodontists,_' Total Cigna DPPO - Oral Surgeons Total Cigna DPPO 'Orthodontists Total Cigna DPPO - General Dentists Total Cigna DPPO -Endodontists Total Cigna DPPO Periodontists ,Total Cigna DPPQ 'Oral'Surgeons Total Cigna DPPO- Orthodontists. Total`Cigna DPPQ :General Dentists;!! Total Cigna DPPO - Endodontists Total Cigna DPPO Periodontists Total Cigna DPPO - Oral Surgeons 179 1 100.0 1.0 1.1 1 100.0 0.4 0.4 1 100.0 0.6 0.6 1 100.0 1.4 1.4 1 100.0 2;0 2.0 1 100.0 2.0 2.8 1 100.0 ,1.8 3.1 1 100.0 2.3 2.8 1 100.0 0:0 0.0 1 100.0 0.3 0.3 1 100:0` ; 0 3 0.3 1 100.0 0.2 0.3 100.0 0.4 1.1 1 100.0 0.2 0.2 1 100.0 0.4 0.4 1 100.0 0.4 0.4 1 100.0 04 0.4 1 100.0 0.4 0.4 1 100.0. 0.3 0.3. 1 100.0 0.6 0.9 1. 100.0 0.3' 0.6 1 100.0 1.0 1.0 1 100.0 0.7 1.3 1 100.0 4.6 4.6 1 100.0 3.2: 3.2 1 100.0 5.2 6.2 1 100.0, 1.0 ,1.4 1 100.0 6.4 6.4 1 100.0 1;4 9.6 1 100.0 6.4 6.4 1 100.0 - 2.0 6.6 1 100.0 0.5 0.6 1 100 0 0.6 2.6. 1 100.0 0.6 0.6 29' 1 100.0 4.6 4.6 100 1 100.0 0.1 0.1 1 100'i0 .. _1.0 1.4 1 100.0 0.4 1.4 Continued on nextpage_ Cigna Network Analysis Access Detail for All Employees With Access 34 June 2015 Created for... City of Miami Ai Accessibility - Total Cigna DPPO - All Employees - Dental Providers 1 The Access Standard is defined as (All Employees) employees accessing: 2 (Total Cigna DPPO - General Dentists) dentists in 15 miles, 2 (Total Cigna DPPO - Endodontists) dentists in 15 miles, 2 (Total Cigna DPPO - Periodontists) dentists in 15 miles, 2 (Total Cigna DPPO - Oral Surgeons) dentists in 15 miles, 2 (Total Cigna DPPO - Orthodontists) dentists in 15 miles State City Employee Zip Code # Employees With Access Provider Name With Access' Average Distance # # % 1 2 Florida ©2015 Quest Malytics, LLC. Fort Lauderdale Fort Myers 33304 33309 33313 33319 .; 33329 • 33912 33913 1 1 ;Total Cigna DPPQ .Orthodontistsr - Total Cigna DPPO - General Dentists Total Cigna DPPQ Endo'donti"sts ,,,, Total Cigna DPPO - Periodontists Total Cigna DPPQ : Oral Surgeons Total Cigna DPPO - Orthodontists Total Cigna DPPQ=General Dentsts `. Total Cigna DPPO - Endodontists Tatar Cigna DPPO -Periodontists, • Total Cigna DPPO - Oral Surgeons Total CignaDPPOOrthodontists - Total Cigna DPPO -General Dentists Total, Cigna DPPQ ,,.,Endodontists Total Cigna DPPO - Periodontists Total Cigna DPPQ ='Oral Surgeons Total Cigna DPPO - Orthodontists Total, Cigna DPPQ-General,Dentists Total Cigna DPPO - Endodontists Total.Cigna DPPQ =`Periodontists Total Cigna DPPO - Oral Surgeons Total, Cigna DPPQ --;Orthodontists ' . Total Cigna DPPQ - General Dentists Total Cigna DPPQ -`Endodontists Total Cigna DPPO - Periodontists Total Cigna DPPQ Oral, Surgeons Total Cigna DPPO -,Orthodontists Total Cigna DPPQ General Dentists ' Total Cigna DPPO - Endodontists Total, Cigna DPPO -Periodontists. Total Cigna DPPO - Oral Surgeons Total Cigna DPPO - Orthodontists' Total Cigna DPPO - General Dentists Total Cigna DPPO -,Endodontists Total Cigna DPPQ - Periodontists Total Cigna DPPQ-;.OraiSurgeons Total Cigna DPPO - Orthodontists Total Cigna DPPQ-Geheral'Dentists, Total Cigna DPPO - Endodontists Total Cigna DPPO - Periodontists Total Cigna DPPO - Oral Surgeons 0 1 1` 1 1 .,1 1 1 100.0 00, 0 100.0 100.6 100.0 1000 100.0 100:0. 100.0 7,00.0 100.0 100`0 100.0 1.00.0 100.0 1000 100.0 100.0 100.0 1000 100.0 00.o 100.0 ion 100.0 100.0 100.0 100.0 100.0 100E 100.0 100.0 100.0 100:0 100.0 100:0 100.0 100.0 100.0 14' 0.1 0,1; 0.5 1.5 1.5 1.0 2.0 1.9 2.1 0.7 2.4 22 1.2 1'0 1.0 1.7 2.4 1.6 1.0 1.0 1.0 1.1 1.1 0.3 1.3 1.3 1.3 1.2 0.6 1.1. 1.2 1.1 1.2 1.3 3.9 3.9 3.9 27 0.1 1.1 2.3 1.6 1.5 1.0 3.3 2.0 2.1 3.1. 0.7 1.7 2.4 2.3 1.5 1.0 1.7 1.7 2.6 2.1 1.0 1.0 1.3. 1.3 0.3 1.3 1.3 1.3 1.3 0.8 1.1 1.3 1:2 1.5 1.3 4.8 3.9 3.9 Continued on next page. Cigna Nt.._ Jrk Analysis Access Detail for All Employees With Access 35 June2015 Created for... City of Miami All Accessibility - Total Cigna DPPO - All Employees - Dental Providers 1 The Access Standard is defined as (All Employees) employees accessing: 2 (Total Cigna DPPO - General Dentists) dentists in 15 miles, 2 (Total Cigna DPPO - Endodontists) dentists in 15 miles, 2 (Total Cigna DPPO - Periodontists) dentists in 15 miles, 2 (Total Cigna DPPO - Oral Surgeons) dentists in 15 miles, 2 (Total Cigna DPPO - Orthodontists) dentists in 15 miles State City Employee Zip Code # Employees With Access Provider Name With Access'Average Distance % 1 2 © 2615 QuestAnalytics, LLC. Fort Myers Gainesville Greenwood: High Springs Hollywood Homestead ++ Indian Lake Estates Jacksonville 33913 32606 32443 32643 33019 ' 33083 33084 33092. 33855 32217 1 Total Cigna DPPO - Orthodontists Total Cigna DPPO - General Dentists Total Cigna DPPO --Endodontists Total Cigna DPPO -Periodontists Total Cigna DPPO - Oral Surgeons Total Cigna DPPO - Orthodontists Total Cigna DPPO - General. Dentists Total Cigna DPPO - Oral Surgeons Total Cigna DPPO -General Dentists Total Cigna DPPO - General Dentists Total Cigna DPPO - Endodontists Total Cigna DPPO -Periodontists Total Cigna DPPO -Oral Surgeons Total Cigna DPPO - Orthodontists Total Cigna DPPO -General Dentists Total Cigna DPPO - Endodontists Total Cigna DPPO - Periodontists Total Cigna DPPO - Oral Surgeons Total Cigna DPPO-Orthodontists Total Cigna DPPO - General Dentists Total Cigna DPPO Endodontists Total Cigna DPPO - Periodontists Total Cigna DPPO - Oral Surgeons Total Cigna DPPO - Orthodontists Total CignaDPPO-_GenerahDentists Total Cigna DPPO - Endodontists Totat,Cigna DPPO -Periodontists Total Cigna DPPO - Oral Surgeons Total Cigna DPPO -Orthodontists Total Cigna DPPO - General Dentists Total Cigna DPPO -General Dentists Total Cigna DPPO - Endodontists Total Cigna DPPO - Periodontists rr, Total Cigna DPPO - Oral Surgeons Total Cigna DPPO. Orthodontists Total Cigna DPPO General Dentists Total Cigna DPPO ,.'Endodontists Total Cigna DPPO - Periodontists Total Cigna DPPO -Oral Surgeons Total Cigna DPPO - Orthodontists 181 1 1 1 1 1 �1. u1 1 1 100.0 100.0 100.0 100.0 100.0' 100.0 •too.o 100.0 1000• 100.0 100.0 100.0 100.0 100.0 100.0` 100.0 100.0 100.0 100:0 100.0 100.0` 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100-0' 100.0 100.0 100.0 0.0 0.9 4.2 4.9 3.9 4.9 4.9 4.9 3.9 3.9 11.2 11.2 1.2 1€3 1.3 2.1 1.4 _2,1 1.4 2.3 2.2 0.4 0.4 4 2.4 2.4 2.4 2.4 2.4 2.4 3.9' 3.9. 0.9 0.9 1.5 1.5. 2.8 3.5 1.3 1.5 1.3 1.3 8.3 8.3 9.1 9.1 1.3 7.0 1.7 1.7 1.7 2.3 1.7 1.7 1.7 1.7 2.5 3.4 0.6, 0.7 1.4 1.4 1.4 1.4 2.0 2.0 0.7! 2.0 0.0 0.0 0.0 1.2 0.6 1.2 0.0 , 0.0 0.0 Continued on nextpage.. Cigna NeiworkAnalysis Access Detail for All Employees With Access 36 June 2015 Created for... City of Miami All Accessiblity -Total Cigna DPPO - All Employees - Dental Providers 1 The Access Standard is defined as (All Employees) employees accessing: 2 (Total Cigna DPPO - General Dentists) dentists in 15 miles, 2 (Total Cigna DPPO - Endodontists) dentists in 15 miles, 2 (Total Cigna DPPO - Periodontists) dentists in 15 miles, 2 (Total Cigna DPPO - Oral Surgeons) dentists in 15 miles, 2 (Total Cigna DPPO - Orthodontists) dentists in 15 miles State ©2015 Quest Analytics, LLC. City Employee Zip Code # Employees With Access Provider Name 1; :Total Cigna DPPO ;General Dentists Total Cigna DPPO - Endodontists Total Cigna DPPO.Periodontists , .y Total Cigna DPPO :Oral Surgeons Total Cigna DPPO ;`Orthodontists, ; 1 Total Cigna DPPO - General Dentists Total Cigna DPPO, ,Endodontists, Total Cigna DPPO - Periodontists Total DPPO ;Oral Surgeons . Total Cigna DPPO - Orthodontists Total Cigna DPPO 'Endodontists Total Cigna DPPO - Periodontists Total Cigna DPPO sOral'Surgeons Total Cigna DPPO - Orthodontists Total Cigna DPPO - General Dentists. Total Cigna DPPO :Orthodontists Total Cigna DPPO :General Dentists ' Total Cigna DPPO - Endodontists Total Cigna DPPO ';Periodontists , Total Cigna DPPO - Oral Surgeons Total,Cigna DPPO:-Orthodontists 1 Total Cigna DPPO - General Dentists Total Cigna DPPO -;Endodontists ; , Total Cigna DPPO -.Periodontists Total Cigna DPPO,-;Oral Surgeons,, Total Cigna DPPO - Orthodontists 1 Total Cigna DPPO -,.General Dentists, Total Cigna DPPO,: Endodontists _ Total Cigna DPPO -;.Periodontists Total Cigna DPPO - Oral Surgeons Total Cigna DPPO - Orthodontists, Total Cigna DPPO - General Dentists Total.Cigna DPPO Endodontists Total Cigna DPPO -_Periodontists Total. Cigna DPPO-'Oral`Surgeons Total Cigna DPPO 7 Orthodontists 1 Total Cigna DPPO =General Dentists Total Cigna DPPO - Endodontists Total Cigna DPPO - Periodontists Total Cigna DPPO - Oral Surgeons With Access' Average Distance # % 1 2 100`.0' 100.0 100,0 100.0 1000.- 100.0 1000, 100.0 100.0 100.0 20.0 20.0 20:0 20.0 100`.0 100.0 100,0. 100.0 100.0 100.0 100,0: 100.0 1dd.t) 100.0 100i0 100.0 100.0 100.0 f oo.0 100.0 100:0 100.0 100.0 100.0 100..0 100.0 100.0 100.0 100.0 100.0 0.9 2.3 07 09, 2.3 2.3 • 1.2 1.2 '4.8 4.8. 4.8 4.8 48 4.8 4.8 4.8 • 13.7! 13.7 13.7 13.7 . 13.7, 13.7 13.7 6.1 12.6. 1.6 12.6 0.8 0.8 1.8 1.8 1F.8 18 1.8 1.8 0.8 3.5 3.5 35 3.5 3.5 3.5 3.5 3.5 3.5 3.5 2.1. 2.1 2.7 2.7 2.5 2.5 2.7 2.7 2.5 3.8 0.7 1.1 1.5 1.8 1.8 1.8 18 1.8 1.8 ._. 1.8 2.3 2.3 3.2 3.2 3.2 6.3 3.2 3.2 Continued on next page._ Cigna N&4..orkAnalysis Access Detail for All Employees With Access 37 June 2015 Created for... City of Miami All Accessibility - Total Cigna DPPO All Employees - Dental Providers 1 The Access Standard is defined as (All Employees) employees accessing: 2 (Total Cigna DPPO General Dentists) dentists in 15 miles, 2 (Total Cigna DPPO - Endodontists) dentists in 15 miles, 2 (Total Cigna DPPO - Periodontists) dentists in 15 miles, 2 (Total Cigna DPPO - Oral Surgeons) dentists in 15 miles, 2 (Total Cigna DPPO - Orthodontists) dentists in 15 miles State Florida © 2015 QuestAnalytics, LLC. City Leesburg Malabar Marco Island Mc Alpin Melbourne Beach Miami Zip Code 34788 32950 34145 32062 32951 33116 33152 33153 33180 Employee 1; 1. Employees With Access Provider Name Total Cigna DPPO -Orthodontists Total Cigna DPPO - General Dentists Total Cigna DPPO Endodontists., Total Cigna DPPO - Periodontists Total Cigna-DPPO - Oral Surgeons Total Cigna DPPO - Orthodontists Total Cigna DPPO - General Dentists Total Cigna DPPO Endodontists Total Cigna DPPO - Periodontists Total Cigna DPPO - Oral Surgeons Total CignaDPPO-Orthodontists. „ Total Cigna DPPO -General Dentists Total Cigna DPPO - General Dentists Total Cigna DPPO - Endodontists Total Cigna DPPD. - Periodontists Total Cigna DPPO - Oral Surgeons Total Cigna DPPO - Orthodontists Total Cigna DPPO - General Dentists Total Cigna DPPO -'Endodontists Total Cigna DPPO - Periodontists Total Cigna DPPO ° Oral Surgeons Total Cigna DPPO - Orthodontists Total Cigna DPPO -General Dentists Total Cigna DPPO - Endodontists Total Cigna DPPO - Periodontists Total Cigna DPPO - Oral Surgeons Total Cigna,DPPO-.Orthodontists ,. Total Cigna DPPO - General Dentists Total Cigna DPPO Endodontists. Total Cigna DPPO - Periodontists Total Cigna DPPD -;Oral Surgeons Total Cigna DPPO - Orthodontists Total Cigna DPPD"- General' Dentists" Total Cigna DPPO - Endodontists Total Cigna DPPO -Periodontists Total Cigna DPPO - Oral Surgeons 1'otal'CignaDPPO, Orthodontists Total Cigna DPPO - General Dentists Total Cigna DPPO - Endodontists Total Cigna DPPO - Periodontists With Access' Average Distance 1 1 1 1 1 1 1 1 1 1 1 1 1 1" 1 100.0 5.6 100.0 2.1 100.0 3.4 100.0 3.3 100.0 , 3.3 100.0 3.3 100.0 0.9 100.0 1.0 100.0 1 0 100.0 0.4 100.0 1.0 100.0 9.8 100.0 '; 4.4 100.0 4.4 100.0 5.2 100.0 5.2 100.0 = 3,5 100.0 0.1 100.0 .1,1; 100.0 1.1 100.0 0.8, 100.0 0.6 100.0 0.7 100.0 1.3 100.0 100.0 1.3 100.0 1.3 100.0 100.0 100.0 1,00.0 100.0 100.0 100.0 1.00.0 =? 100.0 100.0 100.0 100.0 100.0 1.3 0.1 2.0 0.6 0.6, 0.6 0:1;! 0.1 2 5.6 2.1 3.6 3.3 3.4 3.3 1.0 13.7 8.8, 0.9 1.0 10.1 4.4 5.2 5.2 5.2 4.7 0.4 1.1 1.1 10 1.0 0.7 1.3 1.3 1.3 2• 2 0.1 2.1 2:0, 0.6 01 0.1 Continued on next page... 183 Cigna Network Analysis Access Detail for All Employees With Access 38 June 2015 Created for... City of Miami All Accessibility - Total Cigna DPPO - All Employees - Dental Providers 1 The Access Standard is defined as (All Employees) employees accessing: 2 (Total Cigna DPPO - General Dentists) dentists in 15 miles, 2 (Total Cigna DPPO - Endodontists) dentists in 15 miles, 2 (Total Cigna DPPO - Periodontists) dentists in 15 miles, 2 (Total Cigna DPPO - Oral Surgeons) dentists in 15 miles, 2 (Total Cigna DPPO - Orthodontists) dentists in 15 miles State Florida ?, © 2015 QuestAnatytics, LLC. City Employees With Access Employee Provider Zip Code # Name Total Clgna DPPO :Oral Surgeons _ , Total Cigna DPPO - Orthodontists Total Cigna DPPO 'General Dentists. Total Cigna DPPO - Endodontists Total Cigna DPPO=:Periodontistts. Total Cigna DPPO _Oral Surgeons TotalCigna DPPO -.;Orthodontists , ;'' Total Cigna DPPO - General Dentists Total Cigna DPPO-Endodontists - Total Cigna DPPO - Periodontists Total Cigna DPPO ='Oral Surgeons , Total Cigna DPPO - Orthodontists Total Cigna DPP,O'General Dentists: Total Cigna DPPO - Endodontists Total Cigna DPPO-;,Periodontists Total Cigna DPPO - Oral Surgeons Total Cigna DPPO-aOrthodontsts Total Cigna DPPO - General Dentists Total Cigna DPPO -Endodontists Total Cigna DPPO - Periodontists Total Cigna DPPO -'Oral Surgeons_ , Total Cigna DPPO - Orthodontists Total Cigna DPPO GeneralDentists, Total Cigna DPPO - Endodontists Total Cigna DPPO -Periodontists Total Cigna DPPO - Oral Surgeons Total Cigna DPPO`:-Orthodontists, Total Cigna DPPO - General Dentists Total Cigna DPPO - Endodontists Total Cigna DPPO - Periodontists Total Cigna DPPO :Oral Surgeons Total Cigna DPPO - Orthodontists Total Cigna DPPO - General Dentists -. Total Cigna. DPPO - Endodontists Total Cigna DPPO -Periodontists Total Cigna DPPO - Oral Surgeons Total Cigna DPPO-,Orthodontists Total Cigna DPPO - General Dentists Total Cigna DPPO Endodontists- Total Cigna DPPO - Periodontists 0 0 0 0 0 0 0 102 3 9 7 3 19 0 0 With AccessAverage Distance #. %. 1 2 1- 1 1 1 1 1 1 1 1 1 1 1 1 1000 100.0 100.0. 1.00.0 1000. 100.0 1000_ 100.0 100;0, 100.0 1000. 100.0 100:0. 100.0 1000 100.0 106 100.0 100.0 100.0 100.0: 100.0 100.0 100.0 100.0 100.0 100.0. 100.0 106.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 1.4 :1; 0.2 0.3 0.3. 0.1 0.4 0.8 00 0.8 •10.8 0.9 0.1 0.7 0.6 08 1.0 0.1 0.5 0.5 0.3 0.5 0.9 2.0 1.6 1.3 0.9 1.5 5.9 6.0 6.0 • 0.6 0.9 2.8 3.0 2.8 2.8 Continued on next page... 0.3 03 0.1 D4 0.6 14 0.8 0.8 ;22 0.9 0.9 0.1 1.1 0.8 1.1 1.1 0.3 0.5 0.5 0.5 0.5 1.3 2.0 2.2 1.5 1.3 1.5 6.0 6:0 6.0 6.0 Cigna Ne: ork Analysis Access Detail for All Employees With Access 39 June 2015 Created for... City of Miami All Accessibility - Total Cigna DPPO - AU Employees - Dental Providers The Access Standard is defined as (All Employees) employees accessing: 2 (Total Cigna DPPO - General Dentists) dentists in 15 miles, 2 (Total Cigna DPPO - Endodontists) dentists in 15 miles, 2 (Total Cigna DPPO - Periodontists) dentists in 15 miles, 2 (Total Cigna DPPO - Oral Surgeons) dentists in 15 miles, 2 (Total Cigna DPPO - Orthodontists) dentists in 15 miles ©2015 QuestMafytics, LLC. Employees With Access Employee Zip Code # Name Provider Total Cigna DPPO? Oral Surgeons' - Total Cigna DPPO - Orthodontists 1 Total Cigna DPPO - General Dentists Total Cigna DPPO - Endodontists Total Cigna DPPO - Periodontists Total Cigna DPPO - Oral Surgeons Total Cigna DPPO Orthodontists,. Total Cigna DPPO - General Dentists .Total Cigna DPPO,- Endodontists Total Cigna DPPO - Periodontists Total Cigna.DPPO Oral Surgeons Total Cigna DPPO - Orthodontists 1 Total Cigna DPPO -,General Denfists Total Cigna DPPO - Endodontists Total Cigna DPPO-_Periodontists Total Cigna DPPO - Oral Surgeons Total Cigna DPPO -Orthodontists 1 Total Cigna DPPO - General Dentists Total Cigna,DPPO -Endodontists , Total Cigna DPPO -Periodontists Total Cigna DPPO- Oral Surgeons ;• Total Cigna DPPO - Orthodontists 1 TotalCigna DPPO -,,General Dentists . Total Cigna DPPO - Endodontists Total Cigna DPPO periodontists' Total Cigna DPPO -Oral Surgeons Total Cigna DPPO - Orthodontists Total Cigna DPPO - General Dentists Total Cigna DPPO-Endodontists - Total Cigna DPPO -Periodontists Total Cigna DPPO - Oral Surgeons. Total Cigna DPPO - Orthodontists Total Cigna DPPO :General Dentists Total Cigna DPPO - Endodontists Total Cigna DPPO, Periodontists Total Cigna DPPO - Oral Surgeons TotafCignaDPPO Orthodontistsi,', 1 Total Cigna DPPO - General Dentists Total Cigna DPPO-Endodontists Total Cigna DPPO - Periodontists With: AccessAverage Distance 1 1 1 1 1 % 1 2 100.0 1:2 1.5 100.0 1.4 1.4 100.0 2.2 3.0 100.0 6.2 6.2 100.0 6.2 6.2 100.0 4.3 6.2 100.0 : 3.2 3.7 100.0 1.6 1.6 100.05.2 5.2. 100.0 1.6 1.8 100.0 2.0 2.0. 100.0 2.0 5.5 100.0 8.9 8.9 100.0 10.4 10.9 100.0 14.1 14.9 100.0 10.4 10.4 100.0 112 100.0 0.1 0.1 100.0 1.4`. 1.4 100.0 1.4 1.4 100.0 ; 1.4 1.4 100.0 1.3 1.3 100.0 100.0 2.8 2.8 100.0 28- 2.8 100.0 2.5 2.5 100.0' 2.3 2.3 100.0 1.4 1.4 100.0 1.7 1.7 100.0 2.4 3.0 100.0' 2.9 2.9 100.0 2.9 '[00.0 18 100.0 3.7 100 0 ``' 4.4 100.0 3.9 1000: 100.0 100:0 100.0 2.9 1.8 3.7 3.9 1.2 1.4 1.2 :2.3" 1.7 1.9 Continued on next page.. 185 Cigna Network Analysis Access Detail for All Employees With Access 40 June 2015 Created for... City of Miami All Accessibility - Total Cigna DPPO - All Employees - Dental Providers 1 The Access Standard is defined as (All Employees) employees accessing: 2 (Total Cigna DPPO - General Dentists) dentists in 15 miles, 2 (Total Cigna DPPO - Endodontists) dentists in 15 miles, 2 (Total Cigna DPPO - Periodontists) dentists in 15 miles, 2 (Total Cigna DPPO - Oral Surgeons) dentists in 15 miles, 2 (Total Cigna DPPO - Orthodontists) dentists in 15 miles State FIonda © 2015 Quest Analylics, LLC. City Palm Beach. Gardens Pompano Beach Employee Zip Code # Employees With Access Provider Name Total Cigna DPPO,_ Ora1Sur9eons . , . Total Cigna DPPO. - Orthodontists TotalCigna DPPQ, General Dentists`; Total Cigna DPPO - Endodontists Total Cigna,DPPO Periodontists Total Cigna DPPO - Oral Surgeons Total Cigna. DPPQ - 0rthod'ontists Total Cigna DPPO - General Dentists Total Cigna DPPQ -;Endodontists Total Cigna DPPO - Periodontists Total,Cigna DPPQ - Oral Surgeons Total Cigna DPPO -. Orthodontists Total Cigna DPPQ ;General Dentists Total Cigna DPPO - Endodontists Total ;Periodontists;,? Total Cigna DPPO -.Oral Surgeons Total.Cigna DPPQ„ Orthodontists' Total Cigna DPPO- General Dentists Total"Cigna DPPQ - Endodontists, Total Cigna DPPO - Periodontists Total Cigna DPPQ, Orthodontists " Total Cigna DPPQ - General Dentists Total Cigna DPPQ `Endodontists Total Cigna DPPO - Periodontists Total;Cigna DPPQ;-Oral Surgeons . Total Cigna DPPO - Orthodontists Total Cigna DPPQ -General Dentists" Total Cigna DPPQ- Endodontists Total Cigna DPPPeriodontists Total Cigna DPPO - Oral Surgeons Total Cigna DPPO - Orthodontist& , Total Cigna DPPO - General Dentists Total Cigna DPPO Endodontists Total Cigna DPPO - Periodontists Total Cigna DPPQ - Oral Surgeons 'i.,_ Total Cigna DPPO :Orthodontists Total Cigna DPPQ General Dentists ;;';.' Total Cigna DPPO - Endodontists Total Cigna DPPO.-- Periodontists Total Cigna DPPO - Oral Surgeons With. Access' Average Distance # # % 1 2 100 0 100.0 100 0 100.0 1oa:o 100.0 100.0 100.0 00 0 100.0 100A.; 100.0 100.0 1000 100.0 100.0 1 00 .0 100 0 100.0 100.0. 1 00 .0 100.0 100.0 100:0 1 00 .0 i000 1 00 .0 1000 100.0 1000 100.0 100i0 100.0 1000 100.0 100;0 100.0 100.0 100.0 1.4 0,0 0.3 0;.3. 0.3 0.3: 1.5 2.0. 2.0 1.8 1.0 0.6 2.0 2.0 0.2,, 0.3 03 0.3 1.6 2.0 2.0 20 2.0 0.6; 1.0 07. 0.6 2.0 2.3 34. 3.4 3.4 3.9 0.7 0.7 0.7 0.7 0,7 0.7 0.7 0.7 1.9 . 2.4 3.3 3.3 3.2 3.6 2.8 2.8 2.9 2.9. 0.4 0.4 1.0 1.0 1.0 1.0 1.0 1.8 1.6 1.7 0.1 .. 0.1 0.4 0.6 0.4 0.9 0.1 0.1 Continued on next page... 3.4 34 0.2 0.7 Cigna Ne,.orkAnalysts Access Detail for All Employees With Access 41 June 2015 Created for... City of Miami All Accessibility - Total Cigna DPPO-All Employees - Dental Providers The Access Standard is defined as (All Employees) employees accessing: 2 (Total Cigna DPPO - General Dentists) dentists in 15 miles, 2 (Total Cigna DPPO Endodontists) dentists in 15 miles, 2 (Total Cigna DPPO - Periodontists) dentists in 15 miles, 2 (Total Cigna DPPO - Oral Surgeons) dentists in 15 miles, 2 (Total Cigna DPPO- Orthodontists) dentists in 15 miles State City Zip Code Employee Employees With Access Provider Nam With Access' Average Distance 1 2 © 2015 Quest Analytics, LLG. Pompano Beach Total Cigna DPPO - Orthodontists Total Cigna DPPO - General Dentists Total Cigna DPPO-:Endodontists Total Cigna DPPO - Periodontists Total Cigna DPPO - Oral Surgeons Total Cigna DPPO -Orthodontists Total Cigna DPPO - General Dentists Total Cigna DPPO - Endodontists Total Cigna DPPO - Periodontists. Total Cigna DPPO - Oral Surgeons Total Cigna DPPO - Orthodontists, Total Cigna DPPO - General Dentists Total Cigna DPPO - Endodontists Total Cigna DPPO - Periodontists Total Cigna DPPO - Oral Surgeons Total Cigna DPPO - Orthodontists Total Cigna DPPO - General Dentists Total Cigna DPPO - Endodontists Total Cigna DPPO - Periodontists Total Cigna DPPO - Oral Surgeons Total Cigna DPPO - Orthodontists:, Total Cigna DPPO - General Dentists Total Cigna DPPO - Endodontists Total Cigna DPPO - Periodontists Total Cigna DPPO - OralSurgeons Total Cigna DPPO - Orthodontists Total Cigna DPPO -General Dentists Total Cigna DPPO - Endodontists Total Cigna DPPO, Periodontists Total Cigna DPPO - Oral Surgeons Total Cigna DPPO - Orthodontists Total Cigna DPPO - General Dentists Total, Cigna DPPO - Endodontists Total Cigna DPPO - Periodontists Total'Cigria[PESO Oral Surgeons Total Cigna DPPO - Orthodontists Total Cigna DPPO General Dentists:++' Total Cigna DPPO - Endodontists Total Cigna DPPO - Periodontists Total Cigna DPPO - Oral Surgeons 3 1. 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1. 1 100:0 100.0 100,0 100.0 100:0 100.0 100• 0 100.0 100.0 100.0 100.0' 100.0 1000' 100.0 100,0'' 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0' 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0: 100.0 100.0 100.0 0.3 0.8 1.4 0.8 1.5. 1.7 0.3 1.1 1.1 1.1 1.8 0.4 0.5 0.5 0.5 0.5 1.0, 2.5 2.4 2.2 1,5 0.9 1.9 1.9 1.9 0.6 1.3 1.3 1.3 3.2 3.4 0.8 1,4 0.8 44: 1.7 2.7 Continued on nextpage... 0.3 0.8 15 1.5 15 1.7 0.3 1.8 11 1.1 18 0.5 0.5. 0.5 0.5 0.5 10' 2.5 2.5 2.5 2.5 0.9 1.9 1.9 1.9 1.6 1.3 3.4 3:4 3.2 3.4 0.9 1• 4 5.4 0.8 3.2 3.8 48 187 Cigna Network Analysis Access Detail for All Employees With Access 42 June 2015 Created for... City of Miami All Accessibility - Total Cigna DPPO - All Employees - Dental Providers The Access Standard is defined as (All Employees) employees accessing: 2 (total Cigna DPPO - General Dentists) dentists in 15 miles, 2 (Total Cigna DPPO - Endodontists) dentists in 15 miles, 2 (Total Cigna DPPO - Periodontists) dentists in 15 mites, 2 (Total Cigna DPPO - Oral Surgeons) dentists in 15 miles, 2 (Total Cigna DPPO - Orthodontists) dentists in 15 miles State City Employees With Access Employee Zip Code # Provider Name With Access # % Average Distance 1 2 Florida Georgia © 2015 Quest Malytics, LLC. Saint Petersburg .., ... Sanibel Seffner Columbus Cumming Hahira Jonesboro 33957 33584 33411 31904 31632 30238 1 1 1 1 1 1 1 Total CignaIotar Cigna DPPO ?Orthodontists, Total Cigna DPPO - General Dentists Total Cigna DPPO 'Endodontists - - Total Cigna DPPO - Periodontists Total Cigna DPPO ;Oral Surgeons, Total Cigna DPPO -. Orthodontists Total Cigna DPPO.-General Dentists: Total Cigna DPPO - Oral Surgeons Total Cigna DPPO-Orthodontists; Total Cigna DPPO - General Dentists Total Cigna DPPO ,`,Endodontists Total Cigna DPPO -,Periodontists Total Cigna DPPO ;Oral Surg""eons;; Total Cigna DPPO - Orthodontists Total Cigna DPPO General Dentists Total Cigna DPPO -Endodontists Total; Cigna DPPO -Periodontists Total Cigna DPPO -Oral Surgeons Total; Cigna DPPO Orthodontists Total Cigna DPPO -General Dentists Total:Cigna DPPO 'Endodontists Total Cigna DPPO - Periodontists Total:Cigna DPPO - Oral Surgeons: Total Cigna DPPO: Orthodontists Total Cigna DPPO -General Dentists Total Cigna DPPO - Endodontists Total Cigna DPPO -Periodontists - Total Ci•gna DPPO - Oral Surgeons Tetat Cigna DPPO -;Orthodontists Total Cigna DPPO - General Dentists Total Cigna DPPO -':Oral Surgeons Total Cigna DPPO - Orthodontists Total: Cigna DPPO - General Dentists' Total Cigna DPPO - Endodontists Total. Cigna DPPO'- Periodontists Total Cigna DPPO - Oral Surgeons Total, Cigna DPPO- Orthodontists - Total Cigna DPPO - General Dentists Total Cigna DPPO - General Dentists Total Cigna DPPO - Endodontists 1 1 1 1 100.0 100.0 100:0, 100.0 100:0 100.0 100:0. 100.0 �oa:o 100.0 110,6 100.0 100 0; 100.0 1000; 100.0 100:0 100.0 100:0 100.0 1000,. 100.0 106.0. 100.0 100:0, 100.0 100 Q 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0' 100.0 100.0 100.0 8.0 s6 9.6 9.6 0.6 2.5 0.8 3.9; 4.0 3.9 1i`6, 1.9 1.9 1.6; 0.5 016 1.7 0.6' 0.6 0.8 3.8 7.7; 1.0 3.8. 0.5 1.2 1.8 1.1` 1.0 1.7; 1.0 1.1 1.5 1.5 4.6 8.0 9s 9.6 13.7. 9.6 2.1 2.8 0.8 3.9 4.1 4.1. 4.1 2.1 2.1. 3.2 1.6 0.5 1.4: 1.7 0.6. 2.7 0.8 6.1 7.7 1.0 3.8. 1.0 1.4 2.1 1.1 1.8 1.7 1.3 1.4 8.3 2.1 5.0 Continued on next page... Cigna Alt,..,ork Analysis Access Detail for All Employees With Access 43 June 2015 Created for... Cfty of Miami All Accessibility - Total Cigna DPPO - Alt Employees - Dental Providers 1 The Access Standard is defined as (Alt Employees) employees accessing: 2 (Total Cigna DPPO - General Dentists) dentists in 15 miles, 2 (Total Cigna DPPO - Endodontists) dentists in 15 miles, 2 (fotal Cigna DPPO - Periodontists) dentists in 15 miles, 2 (Total Cigna DPPO - Oral Surgeons) dentists in 15 miles, 2 (Total Cigna DPPO - Orthodontists) dentists in 15 miles State Georgia Louisiana Mississippi Nevada orth aro ina • • Ohio 2015 Quest Malytics, LLC. City Jonesboro Roswell Stockbridge Lafayette Picayune Las Vegas Durham . • ' Garner HendersonvilleCtayton • • Son-i-iertoit WeStminster Employees With Access Employee Zip Code # 30238 30075 30281 70503 39466 89129 27705 27529 28739, 29693 Provider Name Total Cigna DPPO - Periodontists Total Cigna DPPO - Oral Surgeons Total' Cigna DPPO - Orthodontists Total Cigna DPPO - General Dentists Total Cigna DPPO - Endodontists Total Cigna DPPO - Periodontists Total Cigna DPPO - Oral Surgeons Total Cigna DPPO - Orthodontists Total Cigna DPPO - General Dentists Total Cigna DPPO - Endodontists Total Cigna DPPO.- Periodontists Total Cigna DPPO - Oral Surgeons Total Cigna DPPO - Orthodontists Total Cigna DPPO - General Dentists Total Cigna DPPO - Orthodontists Total Cigna DPPO - General Dentists Total Cigna DPPO - Orthodontists Total Cigna DPPO - General Dentists Total Cigna DPPO - Endodontists• Total Cigna DPPO - Periodontists Total Cigna DPPO -Oral Surgeons Total Cigna DPPO - Orthodontists Total Cigna DPPO - General Dentists Total Cigna DPPO - Endodontists Total Cigna DPPO - Periodontists Total Cigna DPPO - Oral Surgeons Total Cigna DPPO - Orthodontists Total Cigna DPPO - General Dentists Total Cigna DPPO - Endodontists , Total Cigna DPPO - Periodontists Total Cigna DPPO -Oral Surgeons Total Cigna DPPO - Orthodontists Total'Cigna DPPO - General Dentists Total Cigna DPPO - Endodontists Total Cigna DPPO'''- Generalperitisti Total Cigna DPPO - Periodontists Total Cigna ,130P0.1,Pfal".SOnjeollaT Total Cigna DPPO - Orthodontists TotaiCigna DPPO - General Dentists Total Cigna DPPO - General Dentists 0 1 81 1 2 20 17 116 3 8 31 26 9 1 5 1 136 9 2 5 6 86 0 5 5 105 1 6 7 4 5 0 0 0 0 0 With Access' Average Distance 1 2 ..1 ..1 1 ..1 100.0 3.131 .31.21 100.0 4.6 4.6 100.0 100.0 1.0 1.0 100.0 2.7 3.1 100.0 1.5 1.5 100.0 1.2 1.2 100.0 0.8 0.9 100..0 1.0 1.1 100.0 3.2 3.5 100.0 3.2 3.2 3.2 3.2 100.0 100.0 13 2.8100.0 0.8 0.8 100.0 1.4 1.8 100.0 0.8 0.8 100.0 1.3 1.3 100.0 0.8 0.8 100.0 0.9 , 0.9 100.0 1.9 1.9 100.0 . 0.9 0.9 100.0 0.9 1.3 100.0 0.7 0.7 100.0 2.9 9.1 100.0 2.1 2.1 100.0 2.1 2.1 100.0 100.0 1.0 2.7 100.0 4.7 9.2 100.0 4.9 4.9 100.0 -2.7 2.7 100.0 2.6 4.9 100.0 1.9 1.9 100.0 2.0 2.0 100.0 - 0.7 ."' 0:7 100.0 3.5 3.5 00.0 , ' 3.5 '' -5.2 100.0 6.7 10.7 100.0 10.3 10.3 100.0 9.1 9.1 Continued on next page... 189 Cigna Network Analysis Access Detail for All Employees With Access 44 June 2015 Created for._. City of Miami All Accessibility - Total Cigna DPPO - All Employees - Dental Providers The Access Standard is defined as (All Employees) employees accessing: 2 (Total Cigna DPPO - General Dentists) dentists in 15 miles, 2 (Total Cigna DPPO - Endodontists) dentists in 15 miles, 2 (Total Cigna DPPO - Periodontists) dentists in 15 miles, 2 (Total Cigna DPPO - Oral Surgeons) dentists in 15 miles, 2 (Total Cigna DPPO - Orthodontists) dentists in 15 miles State Tennessei Texas Virginia Grand Totals ©2015 Quest Analytics, LLC. 2 City levelantl i. Columbia Knoxville Rockwood Summertown ., Nacogdoches Fredericksburg, Newport News Employee Zip Code # 37:32 38401 37918 37854 75964 22406 23608 Employees With Access Provider Name Tota( Cigna DPPO General Dentists . Total Cigna DPPO Oral Surgeons Total,Cigna DPPO..;Orthodontists 1 Total Cigna DPPO - General Dentists Total Cigna DPPO, ;Endodontists , Total Cigna DPPO - Oral Surgeons Total Cigna DPPO_, Orthodontists , 1 Total Cigna DPPO - General Dentists Total Cigna DPPO -Endodontists Total Cigna DPPO Oral Surgeons TotalCigna DPPO Orthodontists , 1 Total Cigna DPPO - General Dentists 1 Total CignaDPPO .,General Dentists _. Total Cigna DPPO - General Dentists 1 Total Cigna DPPO - General Dentists Total Cigna DPPO - Endodontists Total;Cigna DPPO Periodontists Total Cigna DPPO - Oral Surgeons T_ dtatCigna DPPO-';Orthodontists,: Total Cigna DPPO - General Dentists Total Cigna DPPO.,Endodontists Total Cigna DPPO - Oral Surgeons Total Cigna DPPO - Orthodontists , 2,394. Total;Cigna DPPO _ General', Dentists;_ 2,368 Total Cigna DPPO - Endodontists 2,364 Total Cigna DPPO-=,Periodontists . 2,374 Total Cigna DPPO - Oral Surgeons 2,378 Total Cigna DPPO :Orthodontists With Access'Average Distance 54 4 33 6 28 0 2 8 0 7 8,788 550 613 714 763 , # % 1 2,394 2,364 2,360 2,370 2,374 100,0'; 100.0 lo0.o 100.0 100.0, 100.0 100.0' 100.0 100:0 100.0 100.0 100.0 100.0 100:0 100.0 100:0;. 100.0 100.0 100.0 100.0 100.0 100.0 100,Q 99.8 99�8 998 99.8 3.8 38 0.2 .6 1.6 0.8 6.8 1.2 4.6 12.7 1.0 6.3 .2:5 2.6 26 1.2 1.8 1.7 0,6 1.6 1.4 1.4 1.1 3.8 3.8. 0.3 1:9 2.0 1144 0.8 9.6 1.2 19 10.8 13.0. 1.0 6.6 2.6 2.6 5.6 1.4 5.8 1.8 1.7 0.7 2.1 1.8 1.8 1.5 Cigna No.vorkAnalysis Access Detail for All Employees Without Access 45 June 2015 Created for... City of Miami All Accessibility - Total Cigna DPPO - All Employees - Dental Providers 1 The Access Standard is defined as (All Employees) employees accessing: 2 (Total Cigna DPPO - General Dentists) dentists in 15 miles, 2 (Total Cigna DPPO - Endodontists) dentists in 15 miles, 2 (Total Cigna DPPO - Periodontists) dentists in 15 miles, 2 (Total Cigna DPPO -_Oral Surgeons) dentists in 15 miles, 2 (Total Cigna DPPO - Orthodontists) dentists in 15 miles State City Zip Code Employee # Employees Without Access Provider Name. Without Access' Average Distance % 1 2 Florida North Carolina Alabama Arizona Colorado Florida © 2015 QuesiAnalyucs, LLC. Key Largo Marathon Sebring Franklin Phenk City Flagstaff Montrose Cedar Key East Palatka Fort White High Springs 33037 86004 32131 32038 32643 5 2 2 2 Total Cigna DPPO - Endodontists. Total Cigna DPPO - Periodontists Total Cigna DPPO - Oral Surgeons Total Cigna DPPO - Orthodontists Total Cigna DPPO - Endodontists Total Cigna DPPO - Periodontists Total Cigna-DPPO'- Oral Surgeons.. Total Cigna DPPO - Orthodontists Total Cigna;DPPO - Endodontists Total Cigna DPPO - Periodontists Total Cigna DPPO - Endodontists Total Cigna DPPO - Periodontists Total CignaDPPO- Oral Surgeons Total Cigna DPPO - Orthodontists Total Cigna ;DPPO - Endodontists Total Cigna DPPO - Periodontists Total CignabPPO -Endodontists Total Cigna DPPO - Periodontists Total :Cigna'DPPO - Oral Surgeons Total Cigna DPPO - Endodontists Total CignaDPPO -Periodontists; Total Cigna DPPO - Orthodontists Total Cigna DPPO - Endodontists Total Cigna;DPPO - Periodontists; Total Cigna DPPO - Oral Surgeons Total CignaDPPO - Orthodontists Total Cigna DPPO- Periodontists Total CignaDPPO -OralSurgeons Total Cigna DPPO - General Dentists Total Cigna DPPO - Endodontists Total Cigna DPPO - Periodontists Total CignaDPPO.-Oral Surgeons Total Cigna DPPO - Orthodontists Total Cigna DPPO Endodontists- Total Cigna DPPO - Periodontists Total Cigna DPPO' -Orthodontists Total Cigna DPPO - Endodontists Total Cigna DPPO :Periodontists- Total Cigna DPPO - Oral Surgeons Total Cigna DPPO:-. General; Dentists 4 4 4 4 2 2 2 2 2 2 2 2 2 2 1 80.0 80.0 80.0. 80.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0' 100.0 100.0`. 100.0 100.0' 100.0 100.0; 100.0 100,0 100.0 100.0'. 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 iVV.V 100.0 100.0 100.0 100.0 22.1 22.1 22.1. 22.1 45.5 63.4 64.3 63.1 63.4 47.2 63.4 36.9 36.9 3.2 41.3 37.3 37.3 53.0 54.3 35.5 48.8 2.6 48.9 4.4 37.3 62.3 71.0 ,43.169.5 69.5 69.6 43.1 61_7 148.5 157.1 73.2 85.3 54.9 54.9 21.5 277 33.9 34.5 34.5 40.7 34.5 34.9 33.9 33.9 19.6 19.6 19.5 19.6 9.9 15.4 15.6 15.6 16.6 24.5 16.6 25.2 16.6 31i` 83.8 29<4 15.8 15.8 156 16.8 15.7 16.1 22.1 22.1 22.1 3.5 16.6 63.0 Continued on next page... 191 Cigna Network Analysis Access Detail for All Employees Without'Access 46 June 2015 Created for... City of Miami All Accessibility -Total Cigna DPPO - All Employees - Dental Providers 1 The Access Standard is defined as (At Employees) employees accessing: 2 (Total Cigna DPPO - General Dentists) dentists in 15 miles, 2 (Total Cigna DPPO - Endodontists) dentists in 15 miles, 2 (Total Cigna DPPO - Periodontists) dentists in 15 miles, 2 (Total Cigna DPPO - Oral Surgeons) dentists in 15 miles, 2 (Total Cigna DPPO - Orthodontists) dentists in 15 miles State Florida. Georgia Mississippi ©2015 Quest Analytic*, LLC. City High.Springs Indian Lake Estates Keystone Heights McAlpin Monticello Palm Coast Sebring " Columbus Hahira Hiawassee' Vidalia Lafayette Picayune Employees Without Access Employee Provider Name Total CignaDPPO Orthodontists , I , _ 1 Total Cigna DPPO - Endodontists Total Cigna DPPO Pndodontists , Total Cigna DPPO - Oral Surgeons ;Total CignaDPPO orthodontists 1 Total Cigna DPPO - Endodontists Total. Cigna.DPPO Periodontists., Total Cigna DPPO- Oral Surgeons 1 Total,Cigna DPPO . Endodontists ; = Total Cigna DPPO Periodontists Total CignaDPPO Oral Surgeons Total Cigna DPPO :Orthodontists. Total Cigna,DPPO. General•Dentists, Total Cigna DPPO - Endodontists Total Cigna'DPPO Penodontisfs_ Total Cigna DPPO ;Oral Surgeons Total CignaDPPO ,Orthodontists,„ 1 Total Cigna DPPO- Oral Surgeons TotalCignaDPPO Endodontists Total Cigna DPPO - Periodontists 1 Total Cigna; DPPO-Endodontists„ Total Cigna DPPO - Periodontists 1 Totat Cigna DPPO `Endodontists., Total Cigna DPPO,- Periodontists Total Cigna DPPO - Oral Surgeons, Total Cigna DPPO ;Orthodontists Total, CignaDPPO General Dentists Total Cigna DPPO - Endodontists Total ignaDPPO - Periodontists Total Cigna DPPO - Oral Surgeons Total Cigna DPPO - Orthodontists 1 Total Cigna DPPO - General Dentists Total Cigna DPPO -:Endodontists' Total Cigna DPPO - Periodontists Total Cigna DPPO-,'Oral Surgeons Total Cigna DPPO- Orthodontists Total Cigna"DPPO-Endodontists . Total Cigna DPPO - Periodontists Total Cigna DPPO - Oral Surgeons Total Cigna DPPO - Endodontists 1 100.0 10o.0 100.0 100.0 100.0 100, 0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 00.0; 100.0 100:0 100.0 100.0 100.0 100.0 100.0 100.0, 100.0 100.0. 100.0 100.0 100.0 Without Access' Average Distance: % 1 2 1000 . 1a4' 15`,7 100.0 19.6 19.6 100.0 22.6 24.6. 100.0 19.6 19.6 100.0 157. 16.4 100.0 21.8 22.8 100,0 ' 228 239. 100.0 22.8 22.8 100.0 19.7; : 19.7 100.0 17.5 46.2 100.0 19 9 •• 46.8 100.0 19.9 19.9 18.9 19.7 . 76'9' 19.1 19.7 21:3, 19.1 20,0 2.7 33.7 2.3 1.0 59.1 10.9 66.3 10.3 10.4 12,6. 53.9 42.8 31.3 26.4 1.6 40.5 65.0 382 26.2 58.4 59.4 58.2 16.8 17.7 33:7, 39.3 35.3 69.7 63.2 69.0 46.0 33.6 15.8: 54.3 42.8 31.3 331 20.3 40.5. 67.3 406 26.3 60.7 62.3 58.4 18.0 Continued an next page.. Cigna NEzwork Analysis Access Detail for All Employees Without Access 47 June 2015 Created for... City of Miami All Accessibility - Total Cigna DPPO - All Employees - Dental Providers The Access Standard is defined as (All Employees) employees accessing: 2 (Total Cigna DPPO General Dentists) dentists in 15 miles, 2 (Total Cigna DPPO - Endodontists) dentists in 15 miles, 2 (Total Cigna DPPO - Periodontists) dentists in 15 miles, 2 (Total Cigna DPPO - Oral Surgeons) dentists in 15 miles, 2 (Total Cigna DPPO - Orthodontists) dentists in 15 miles State Mississippi North Carolina Ohio South Carolina Tennessee Texas Virginia Grand Totals City Picayune Hendersonville Clayton Summerton Westminster Cleveland Columbia Knoxville Rockwood Surnmertown Nacogdoches Newport News Employee Zip Code # 39466 28739 45315 29148 29693 37323 38401 37918 37854 38483 75964 23608 Employees Without Access Provider Name 1 Total Cigna DPPO -Periodontists Total Cigna DPPO - Oral Surgeons 1 Total Cigna DPPO - Periodontists Total Cigna DPPO - Oral Surgeons Total Cigna DPPO - Orthodontists 1 Total Cigna DPPO - Endodontists 1 Total Cigna DPPO - Endodontists Total Cigna DPPO - Periodontists Total Cigna DPPO-Oral Surgeons Total Cigna DPPO - Orthodontists 1 Total Cigna DPPO - Endodontists Total Cigna DPPO - Periodontists Total Cigna DPPO - Oral Surgeons Total Cigna DPPO - Orthodontists 1 Total Cigna DPPO - Endodontists Total Cigna DPPO - Periodontists 1 Total, Cigna DPPO - Periodontists 1 Total Cigna DPPO - Periodontists 1 Total Cigna DPPO -Endodontists Total Cigna DPPO - Periodontists Total Cigna DPPO - Oral Surgeons Total Cigna DPPO - Orthodontists 1 Total Cigna DPPO - Endodontists Total Cigna DPPO - Periodontists Total Cigna DPPO - Oral Surgeons. Total Cigna DPPO - Orthodontists 1 Total Cigna DPPO - Endodontists Total Cigna DPPO - Periodontists Total Cigna DPPO -Oral Surgeons Total Cigna DPPO - Orthodontists 1 Total Cigna DPPO - Periodontists 36 Total Cigna DPPO - Endodontists 40 Total Cigna DPPO - Periodontists 30 Total Cigna DPPO - Oral Surgeons 26 Total Cigna DPPO - Orthodontists 5 Total Cigna DPPO -' General Dentists Without Access`; Average Distance # % 1 2 0 1 100.0 19.0 20.5 0 1 100.0 17.7 17.9 0 1 100.0 13.0 18.2 0 1 100.0 2.5 17.9 0 1 100.0 1.9 18.2 0 1 100.0 16.4 17.2 0 1 100.0 39.4 39.4 0 1 100.0 25.1 25.4 0 1 100.0 - 25.5 25.5 0 1 100.0 24.5 25.5 0 1 100.0 16.8 59.3 0 1 100.0 45.3 45.3 0 1 100.0 26.1 26.3 0 1 100.0 39.7 40.7 0 1 100.0 5.3 18.2 0 1 100.0 19.5 19.5 1 1 100.0 1.6 22.7 0 1 100.0 13.4 15.1 0 1 100.0 23.9 30.3 0 1 100.0 30.7 34.0 0 1 100.0 15.6 15.6 0 1 100.0 28.0 30.3 0 1 100.0 17.6 18.2 0 1 100.0 18.2 41.8 0 1 100.0 17.6 17.6 0 1 100.0 18.3 30.9 0 1 100.0 81.4 81.4 0 1 100.0 64.5 64.6 0 1 100.0 . 21.8 56.4 0 1 100.0 3.0 18.8 0 1 100.0 9.3 27.8 1 35 97.2 31.8 38.3 2 39 97.5 33.9 43.0 1 29 96.7 26.3 32.8 2 25 96.2 19.8 31.1 1 5 100.0 12..7 19.6 @ 2015 Quest Malylics, LLC. 193 City of Miami CIGNA Dental Network Disruption Report Prepared: July 7, 2015 Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. D Copyright 2015 Cigna. 194 Hatches # of Provider Access Points Claim Count Charges Paid Submitted Info rr ourde, Cigna DPPO Network Results Cigna DHMO Results Cigna DPPO Advantage Matcbed,lnfo(, y, 1:,Matchwh W Natch°ed,Infol,yl: ,%Matchedry 191 38% 271 54%1 r 3371 36% 154181 21% 19% cei R,a ate d Creteri 522E 56%1 256921 35% 784991 29% esufts Cigna. DPPO Network Results naDPP Name, Facility, Addr, City, State, Zip 2 IName, Addr, City, State, Zip 3 1Lic Nbr, Addr, City, State, Zip 4 1NPl prov, Addr, City, State, Zip 5 (TIN, Addr, City, State, Zip I - € - 4 6 Name, Facility, City, State, Zip 1 - - i 7 }Facility, Addr, City, State, Zip i 1 8 ,NPl_ofc, Addr, City, State, Zip i i - P 1Strong}Mattch, Criteria 41 5 ,wk 10 2 9 Name, Facility, City, State 5 10 ; Name, City, State, Zip - 3 11 ;Facility, City, State, Zip - 12 I Name, Facility, Zip(— 13 me, City, State 14 !Facility, City, State 15 `NPI_prov, Zip 16 L Nbr, Zip 17 1NPI_ofc, Zip 18 tLic Nbr, State , 19 ITIN i—Total S�tong�Matces at 20 'Name, Zip 21 I Facility, Zip 22 lAddress only {T14.411 afc1i064 30.1V".§ eak:Match_Cnteria 8i 44, Methodology: Name (is based on First Name & Last Name; Limited First Name to 1 character) Facility (is Limited to the first 9 characters, and no Punctuation) Cigna DPPO : U Tof2 tched40011N.Matched fVlatched l fo °{o Aatcti 12 24%. 24026% 12064641 16% 506491 19% 24%. 28%; 0%1 0%1 00 2%g 0%1 0%1 0%l 0%1 0% 6%1 0%1 CITY OF MIAMI Group Plan #` 482277 TIN ID Full Name Address City State Zip Claim Count Charges 16,877.76 Paid 5,629.00 �r ?nr N Cigna DPPO+ Advantage N Cigna DPPO N Total Cigna DPPO 5124 1 Carlos R Fiallo 2828 Coral Way Ste 430 Miami FL 33145 21 N 5735 2 Luis Quinones Luis Quinones Dmd Pa 900 71 St St Miami Beach FL 33141 26 10,464.84 4,454.60 Y N Y Y 4239 3 Alexandra Gherbali All Dental Group 7415 Miami Lakes Dr Miami Lakes FL 33014 22 13,155.00 4,115.10 N Y N Y 0207 4 Eugenio A Mora Mora Family Dentistry 7171 Coral Way Ste 217 Miami FL 33155 16 7,618.90 3,483.40 Y Y N Y 5240 5 Suzanne Abergel-Nahon A New Smile 14050 Sw 84Th St Ste 103 Miami FL 33183 27 7,650.00 3,315.40 N Y N Y 7481 6 JeffA Weiss Main St Orthodontics 15600 Nw 67Th Ave Ste 110 Hialeah FL 33014 15 7,139.97 3,221.94 Y Y N Y 2060 7 Unda Yusman-Wirth The Falls Dental Care Grp Pa 8729 Sw 136Th St Miami FL 33176 33 8,115.00 3,080.40 N Y N Y 2963 8 Connie Arguello A Perfect Smile 11358 Miramar Pkwy Hollywood FL 33025 27 14,046.00 3,056.60 N Y N Y 8315 9 Maria Alvarez Dental Group Of South Florida Ste 401 747 Ponce De Leon Blvd Coral Gables FL 33134 28 14,511.00 3,055.00 Y Y N Y 0136 10 Raul C Gonzalez Smile Studio Associates 1760 Sw Coral Way Miami FL 33145 32 12,980.00 2,809.50 N N Y Y 7997 11 Jorge E Landa Pediatric Dentistry Of Kenda1111790 Sw 89Th St Miami FL 33186 19 7,468.60 2,484.70 Y Y N Y 2503 12 Michael Cogan Micahel L Cogan Dds 1717 N Bayshore Dr Ste 209 Miami FL 33132 19 6,951.00 2,442.60 Y Y N Y 0867 13 Michael Brody 975 Arthur Godfrey Rd Ste 201 Miami Beach FL 33140 19 3,842.16 2,359.60 Y N Y Y 6914 14 Jorge 0 Hernandez 6080 Sw 40Th St Ste 8 Miami FL 33155 19 6,837_00 2,355.66 N N N N 5748 15 Michelle Tydir Dental Associates Of Kendall 11400 N Kendall Dr Ste 207 Miami FL 33176 24 8,637.24 2,332.40 Y Y N Y 3195 16 Jorge M Gutierrez Jorge Gutierrez Dental Office 3822 W 16Th Ave Hialeah FL 33012 11 10,325.00 2,306.00 Y N Y Y 4007 17 Thai K Hur T&C Dental Of Palm Harbor 33633 Us Hwy 19 N Palm Harbor FL 34684 16 11,449.92 2,194.00 N Y N Y 6511 18 Angel Agreda 2611 Sw 147Th Ave Miami FL 33185 17 6,530.00 2,109.50 Y Y N Y 5240 19 Jennifer Y Bossel A New Smile Dental Center 14050 Sw 84Th St Ste 103 Miami FL 33183 10 4,858.00 2,104.60 N Y N Y 6410 20 Aicmee Martinez Main St Childrens Dentistry 7150 W 20Th Ave Ste 103 Hialeah FL 33016 16 5,381.20 2,060.80 Y Y N Y 0039 21 Isabel C Noy Gables Dental Clinic 5450 Sw 8Th St Ste 201 Coral Gables FL 33134 25 6,979.32 2,057.30 N Y N Y 5883 22 Andres S De Cardenas Andres A De Cardenas Dmd 9000 Sw 152Nd St Ste 108 Palmetto Bay FL 33157 25 8,168.76 2,051.50 Y Y N Y 5338 23 Rasheed B Siddiqui Gentle Teeth Of Kendall 6670 Sw 117Th Ave Miami FL 33183 17 6,216.72 2,041.30 Y Y N Y 0396 24 Juan A Anillo-Sar Anillo Dental Center 10201 Hammocks Blvd Ste 146 Miami FL 33196 19 8,49428 2,032.40 N Y N Y 8433 25 Steven Lanster Lanster Dental Associates 7399 Coral Way Miami FL 33155 12 5,437.60 2,011.10 Y Y N Y 9526 26 Leyanne Salvador 6507 Coral Way Miami FL 33155 72 44,686.63 20,305.91 N. N Y Y 9534 27 David D Pena 12781 Miramar Pkwy Ste 106 Miramar FL 33027 36 15,089.36 9,048.40 N Y N Y 5124 28 Carlos R Fiallo 2828 Coral Way Ste 430 Miami FL 33145 19 14,300.00 5,910.00 N N N N 6121 29 Fausto E Felipe 1673 Sw 27 Ave Miami FL 33145 11 16,085.68 5,235.00 N N N N 5918 30 Comfortable Care Dental 8525 Sw92 StA3B Miami FL 33156 18 28,155.92 4,248.00 N Y N Y 4464 31 Calixto Novoa 9280 Sw 72Nd St Ste 101 Miami FL 33173 18 8,211.84 4,197.00 N N N N 1832 32 Mario Martinez South Miami Pediatric Dental 6601 Sw 80Th St Ste 212 Miami FL 33143 21 10,089.04 3,676.40 Y Y N Y 0463 33 Maria V Souto 6512 Coral Way Miami FL 33155 14 6,782.88 3,433.80 Y N N N 4536 34 Ryan Coro M & C Dental Services 4301 Palm Ave Ste C Hialeah FL 33012 18 9,044.88 3,318.00 N N N N 9380 35 Angel L Velazquez Avm Dentistry Pa 3735 Sw 8Th St Ste 203 Coral Gables FL 33134 12 11,402.56 3,100.00 Y Y N Y 2606 36 Aurora Calvo-Menendez 6176 Sw8 St Miami FL 33144 11 4,437.68 3,060.00 N N Y Y 4247 37 Elizabeth Marchan Mayo 184 Westward Dr Miami Springs FL 33166 7 4,667.52 3,058.00 N N Y Y 8799 38 Anthony G Corbo 1160 Kane Concourse Suite 303 Bay Harbor FL 33154 14 4,756.96 2,846.80 N N Y Y 2210 39 Mirtha Amador 357 Almeria Ave Unit 105 Coral Gables FL 33134 20 6,077.76 2,822.00 N N N N 1456 40 Jorge Fornaris 5727 Sw 24 St Miami FL 33155 18 11,126.96 2,787.63 N N Y Y 1445 41 Armando Delgado 9195 Sunset Dr Ste 220 Miami FL 33173 10 5,187.52 2,629.00 N N N N 7303 42 Irving Carvajal 10114 S W 107 Ave Miami FL 33176 9 4,646.72 2,465.00 N N Y Y 5299 43 Ody Gonzalez -Fabian 14252 Sw 8Th St Miami FL 33184 11 5,336.19 2,457.33 N Y N Y 5299 44 Alan G Gonzalez 14252 Sw 8Th St Miami FL 33184 16 12,143.04 2,379.00 Y Y N < G Z < < Z G 8982 45 Jesus Barreto 14353 Miramar Park Miramar FL 33027 8 6,487.52 2,262.40 N N N 9069 46 Jan Ziegler 13840 Sw56 St Miami FL 33175 12 6,277.44 2,205.00 N Y N 0734 47 Delroy Webb 1830 Nw 183 St Miami FL 33056 9 9,618.96 2,135.00 N Y N 7788 48 Andrew R Hirschl 4300 Alton Rd Ste 1190 Miami Beach FL 33140 9 5,718.12 2,12520 N N N 6096 49 Ciro A Sotomayor 8221 W Flagler St Miami FL 33144 11 3,641.04 2,116.00 N N Y 5429 50 Marco Contreras 10621 North Kendall Dr Ste 114 Miami FL 33176 10 5,070.00 2,080.00 Y N Y 196 Consultative Anal ticssm Dental Utilization 4-1_ Table of Contents Cigna. ' •1, l'y , . I , Current $178.49 $309.45 $487.95 Cign Dental Summary Dental Utilization Plan cost & trend $520 $390 $260 $130 $0 • Cost Share PMPY Paid Amount PMPY Plan Spend PMPY Base $186.45 $324.16 $510.61 ectl.ve ;o.= i� iPre Se zatrortnCrease, Norm $212.86 $305.79 $518.65 Increase :'Averagem Averag,N'umbetof,l1� A'verag e;! M emb e r;'AgE Services,'per CCa mar °(d of Mem ers Using'= %or`df:Unique Members Cleaning;"' Clai'msSummary/;I''s s' em'ographi'c"Summa,ry'' Vumber of Employee erribers :'C larges'in~Nett ANSP;Charg'es N'etiiYork: lltilizat DNSP tUti,llzatiol To mp oyer'Paid'Amoun 'aid`Amou'nt PEP aid Am'ounYPMPY Current Period reflects claims incurred between Jan. 2013 and Dec. 2013, paid through Jan. 2014 Base Period reflects claims incurred between Jan. 2012 and Dec. 2012, paid through Jan. 2014 200 PAGE 3 OF 17 Dental - Utilization by Type of Service Dental Utilization Services:;per',1 000.-Mem bers'i ` Diagnostic%Preventive ,•Basic, Restorative Majorr•R'estorative Endodontics Periodontics Oral: Surge y Orthodontics Otter=Services Current Perr ''?ecis claims incurred between Jan. 2013 and Dec. 2013, paid through Jan. 2014 Base Period r.,.ects claims incurred between Jan. 2012 and Dec. 2012, paid through Jan. 2014 PAL, 4OF17 Dental- Utilization by Type of Service and Network Dental Utilization mansse /vd a $R s rti Major ek kv • dnc§, eribdaiitfos Oral Omooif # c+Ar,0O kg rPee/ ®.... • iRsr \ oRs,i :ooeti\'\ °°{.\ 0 s pen e a a$g or Current Period reflects claims incurred between Jan. 2013 and Dec. 2013, paid through Jan. 2014 PAGE 50 17 Dental - Cleanings Utilization Dental Utilization % of unique members receiving a cleaning 80.0% 60.0% 40.0% 20.0% 0.0% rend L?antal Base 61.0% Current 62.2% Norm 60.4% mmencan DeritaGAssociation Cleanings utilization 32.0% 24.0% 16.0% 8.0% 0.0% Base ■ Current G1 Norm 1 Cleaning 2 Cleanings 3 or more Cleanings 28.8% 30.3% 1.9% 29.7% 30.8% 1.7% 31.1 % 26.8% 2.6% Current Pei sects claims incurred between Jan. 2013 and Dec. 2013, paid through Jan. 2014 Base Period w..ects claims incurred between Jan. 2012 and Dec. 2012, paid through Jan. 2014 PAt,- o OF 17 Dental - Top 10 Procedure Types rigna. Dental Utilization 000-dra.oforEvaluation,:4Prophylaxis enaptegf. a fa „sae:VA-tie 4; meatetatoct, • MI Current .k? Norm 0141:427t,':ezY,44-itz14.3•,,00,ni'Ve-a511- L.,56,44A. 4,`:,:gagitefeMilg 4,1`gsuf,W, Current Period reflects claims incurred between Jan. 2013 and Dec. 2013, Paid through Jan. 2014 PAGE 7 OF 17 Dental - Network Utilization and Cost Share i • Dental Utilization , Cost share % of total spend 100% 75% 50% 25% 0% ■ Cost share Employer paid Base Current Norm Network utilization — submitted charges 100% 75% 50% 25% 0% Base 36.5% 36.6% 41.0% Out of network 44.2% 63.5% 63.4% 59.0% ■ Dental Network Savings Program 13.6% In -network 42.3% Current Pe € ,lects claims incurred between Jan. 2013 and Dec. 2013, paid through Jan. 2014 Current 38.2% 16.6% 45.2% Norm 37.0% 9.2% 53.7% Base Period ,...sects claims incurred between Jan. 2012 and Dec. 2012, paid through Jan. 2014 Dental - Claim Cost and Savings Summary Dental Utilization Deducti6Ce°:4h*'s Cooed inationnof Benefts' Annu'aULifetien Maximum;'. Maximuriirl2eimburs"afile; G` lization'Man'agement and 350 004 50',6 Current Period reflects claims incurred between Jan. 2013 and Dec. 2013, paid through Jan. 2014 Base Period reflects claims incurred between Jan. 2012 and Dec. 2012, paid through Jan. 2014 PAGE 9 OF 17 Dental - Claim Cost and Savings - Network Dental Utilization b ,�i', �. ".,J� .e:. ,P: !?`• ;-,F'-;rca:• ',Y4^ :::e„ tV, - - ;.r, ;:adt.Jn'.� c,G'Jf�`"9�' Current Period.NetworlcUtilization Numbe''r'of Un que:;Clai`manfs= , ,KOrnb'er; of Claims Submitted. Submitted. 9 Char � `es, Einp,l`oyer,Paid°°; ,p Discount'Dollarsi,' N.et Effective Discount Phan D`esign`Savings; Deductible' _rCoinsurance --Coordination of Benefits Annumu'nial%Lifetime; Maximum, MaxiReimbursable Charge Scheduled` Plan' Savingsr•, Other'Savings,;} r. Total J3 ` Savings -as:%` of submitted'= DentaliVetviork;•' avings"Program`•' 068;856': '" $`1 46.4A 741417° t 80$ 11.8 : „+s $2 193 593s ; r ; ;': $ 74% $2466fi2`"';'.'-'.$`O.;y`-i�G''";,;,',$ Utilization` ManagementandrUail zation'ReviewSavings?I , `"i, '' IVlissing,iTo'ofh; L"'i'initafionvy`- �' ,"W . -$6;' Age/FSeg iency'Limitation,"' $51 75"1};,, Addit onal'_`Plan;Design:, $67;;1.51; P 1,9ternative Berl* Provision~ $73,875' Utilization,Revievr;, Total` ,.r "$266;236"ri;� Savings,',as• %l of submitteii Total Savings - - $2,327,639',: Total'Savings, as`%of submitted `` ,241;43 277.6T Current Pc 'ilects claims incurred between Jan. 2013 and Dec. 2013, paid through Jan. 2014 PAC ,0 OF 17 Dental - Claim Distribution (all services, including orthodontic) �Pa a171e _ �oun`� b 'Doll�Ra �e' Buse° "N'u'mber�of Unl ue l Q I I i 0= ,-i � �r • 3 637,. $ r_I 0 250� 3108 275/0 yn� � 0 755529 "20 4 / $ .$5 $ 500 75a` 3 4l0 300 222 8�1 to-. I,N {. r �'Ij:i n•"! i $1 000 1 250 "�345" a , r1 ^ s 237460� 6 4 /o- �r k I 'k' < Dental Utilization 1, - kd� — �`N'o7r'r►°� o.ofE`%ial`wr .(,'; �:J .�i,i ,.,.�t�- .4,� '. pis .pit, �i. ,,�.,;F41•',a; '�t. ,• .,.,n .�,qi:;ry .,, r. ��; .;,,,. d� o rY•- � r0 '.Pa lil'e` , , r�-�•', v � , Pa 'tilekArio�unt��., �ofTotal Pa"'able ��-�` , ,. .. � a 1o�•of Merritieishi ` � a � . , � /o. g p' ' Y a{� l • ��.1`4'6 o-'',�- / {, I t� i i I .,Y _$701;OA0��, '"iS �• �'•r.�"�i'r $ •-r. r,• =G 0 2000 •;500;'-� ', 'I� $ , rz . _ .I`v.N?".:,ms..�'v'�.w ✓Al �i.. r ! .'r",.,.y ." f. _ yaole,amot nts•represent,al o , r. .?.'i• aid excktding'CO'B and other claim' Ievel adju-striients; ko': ra 1 {,r o is + s, 3,' �0 !rt - 0 �1` 14.010, 5 8 689:�'� 0 I, a o: �10..4'/oi�>' , 12n8, o r, o` 5713 82 15.4 �. _ v s•'t;.rVRyes'. rt.. r; ... w'. �. G , Current Period reflects claims incurred between Jan. 2013 and Dec. 2013, paid through Jan. 2014 Base Period reflects claims incurred between Jan. 2012 and Dec. 2012, paid through Jan. 2014 PAGE 11 OF 17 Dental - Claim Distribution (excluding orthodontic services) wgntL Dental Utilization otferclaim level' adjus Current Pe.. %I:flects claims incurred between Jan. 2013 and Dec. 2013, paid through Jan. 2014 Base Perioo .,,,sects claims incurred between Jan. 2012 and Dec. 2012, paid through Jan. 2014 PAC.- 2 OF 17 Cign Dental - Membership Summary Dental Utilization �S `t ','I Percent of membership by age band and product summary of rnembersl PP0 28% 21% 14% 7% 0% <1 1-17 18-29 30-39 40-49 50-59 60-64 65+ Percent of spend by age band and product 32% 24% 16% 8% 0% EL PPO <1 1-17 18-29 30-39 40-49 50-59 60-64 65+ ouses{ & Average ,h Percent Percen end enfs:;;MemberssE Family;Size l emale.;;,': 210 Current Period reflects claims incurred between Jan. 2013 and Dec. 2013, paid through Jan. 2014 Base Period reflects claims incurred between Jan. 2012 and Dec. 2012, paid through Jan. 2014 PAGE 13 OF 17 'tetVie'eviren , pte, ciriahas co or Restorati' enteffeeeiiiieigOr procedures,targetin1 crowns,servces such as prosthodontic ern tncludes ble*ra issing TO'oth Limitati A. H .,, • • contractual provision which rmiter•orOcaltrdO*0-aymritfortOre'::terilacemOrlt of teeth thaiidiTehirSir)4,0Toritojfiepetierite,effec tv.edate o ..plen: coverage. 212 gin. Glossary Pre=Determinatio'of' A'process'that `all,ows tl by`':thei;denfal plan;'i"n'*ac dentisti an d' pa rti c i p a ntyi availablex,at theitimewth'i informations With,`thepa i"ncu rred°;Says ngs-.from ;more costly dental trea roilider'Discounts;°, hedifferenc'e'-, between large "for a`'procedure: ervice� he;.n'um ient ana:aentistie'arn;wnat oenetats.are;:proviaea Of.treatment. The PDB3`process' rovides=tthe=:'1:;I; detailed ex "I"gnat on`of'whats' ``ecif c';:benefits'ari Im.;'" , �9�;ia'. i,"'g,:�'�;-f2ii eviewerhso;thatthe dentist:.ma.''.'discuss'the efore;treatrneni' is rendered and expenses are ro°"ess'are so'realzed'throu h>the''..�avoidance;;c swt ere a'lesscostly alternative is;.recommendei veralII1 a urrent .; - :. ,r,_ ;v;,,: ;yBasi 2013 6' 1:2/2013 :_: ? ti' ; ' > 0172012't0`2/20t 2013 to 01J2014 s' ,.,;z; Y ` s'y ,,04..2012''to.0>1%201'� 214 PAGE 17 OF 17 Cigna Implementation Calendar City of Miami - Adding Dental PPO Account Number: 3202272 Effective Date: January 1, 2016 - : L2e§pons4:111 y ti n M1 A4 ,n.. ° , ... .. v. ., VI.w.�"I fir• aa° � . _ ., y,.t. V i:p ��� ®, `lGlaam �:� y�5 � Dal* v .. � s �si,; _.4 —.'Y �Tar e,�; /+. �y:,. V 00 0 efio` K ,wh . a <r 1+ '�cfua(N w, V I ion " y Pw �, ;,,�'., �, ...•: � �„o4n C �er1 Uri -�' .µ. C't Notification of Sale X 9/1/2015 9/1/2015 Hold Customer Interface Session (CIS) (Discuss benefits, HIPAA elections, reporting, structure, billing, eligibility, enrollment materials, ID cards, schedule on- going weekly implementation status calls ) X X 9/9/2015 9/9/2015 First Weekly Implementation Call Establish time and day of week for weekly calls : X X TBD TBD Provide updated documents with changes from the Implementation Meeting X 9/10/2015 9/11/2015 Cigna receives approval of employer benefit summaries, administrative summary and structure X 9/14/2015 9/15/2015 Meet with Eligibility Analyst to review automated eligibility (ACE, HIPAA 834 or SES) and any electronic contributions tape requirements for addition of Dental PPO X X 9/21/2015 9/21/2015 Set up the Pre -Enrollment Line. Cigna Sales will test Tine to ensure appropriate handling of questions. (cannot initiate set up request until employer benefits are approved.) X 9/21/2015 9/25/2015 Go Live Date for pre -enrollment line X TBD TBD Account structure in production, Cigna can now accept live eligibility X 9/16/2015 10/14/2015 Conduct Enrollment meetings Open Enrollment Period - X X 10/19/2015 10/30/2015 First eligibility test file sent 11/16/2015 11/16/2015 Eligibility test file results returned X 11/17/2015 11/19/2015 Request Generic Dental PPO ID Cards X 11/23/2015 11/23/2015 Submit open enrollment eligibility to Cigna 12/1/2015 12/1/2015 Load open enrollment eligibility into Cigna's eligibility system X 12/2/2015 12/4/2015 Review and approve benefit description certificate draft(s) X X 12/7/2015 12/21/2015 215 Call/Claim ready X 12/30/2015 Celebrate Implementation Success and discuss ongoing reporting and X X 1/29/2016 administrative procedures The dates included in this Implementation Calendar are subject to change. If a change is necessary, Cigna will work with you to reach a new agreement that reflects the changes in circumstances. 12/30/2015 1/29/2016 The term "Cigna" refers to the various entities which will provide the coverage and/or services described, including, but not limited to, Connecticut General Life Insurance Company, Cigna HealthCare, Cigna Dental, Intracorp, and Cigna Behavioral Care. Cigna Health and Life Insurance Company Marling Address: Hartford, Connecticut 06152 Home Office: Bloomfield, Connecticut CIGNA HEALTH AND LIFE INSURANCE COMPANY POLICYHOLDER: City of Miami ADDRESS: Miami, Florida ACCOUNT/GROUP NUMBER: 3202272 Group Insurance Policy and Policy Number CIGNA DENTAL CARE INSURANCE 3202272-DHMO Effective Anniversary Date Date 01/01/2013 01/01 This policy is issued in New York and shall be governed by its laws. This Policy contains the terms under which the Insurance Company agrees to insure certain Employees and pay benefits. The Insurance Company and the Policyholder have agreed to all of the terms of this policy, Shertnona Mapp, Corporate Secretary Wilbur E. Parsell, Registrar Matthew G. Manders, President HP-POL130 04-10 217 Cigna Health and Life Insurance Company POLICY CONTENTS Page THE INSURANCE SCHEDULE 3 PREMIUMS 4 CANCELLATION OF POLICY 6 MISCELLANEOUS PROVISIONS 7 PROVISIONS 8 CERTIFICA I h, CONTENTS ELIGIBILITY Certificate EFFECTIVE DA I Certificate BENEFITS Dental Insurance Certificate GENERAL LIMITATIONS Certificate COORDINATION OF BENEFITS Certificate PAYMENT OF BENEFITS Certificate TERMINATION OF INSURANCE Certificate DEFINITIONS Certificate 2 POL135 04-10 218 Cigna Health and Life Insurance Company THE INSURANCE SCHEDULE The terms set forth herein and in the Certificate(s) listed below describe the insurance underwritten by the Insurance Company. These Certificates are included in and made a part of the policy(ies). Each Certificate is identified by a Certificate Number (CN). Any reference in the certificate to "you" or "yours" refers to the Employee. An Employee in any of the classes shown below may be insured but only for the policy(ies) listed for his Employee Class. The Effective Date shown below is the date on which a policy becomes effective for an Employee Class. An Employee will become eligible and insured in accordance with the terms of the "Eligibility" and "Effective Date" sections of the Certificate. GROUP POLICY(IES) Certificate Number CN011 Policy(ies) CIGNA DENTAL CARE INSURANCE 3202272-DHMO EMPLOYEE CLASS Eligible Employees Effective Date Each Employee as reported to the 01/01/2013 insurance company by your Employer, excluding Illinois residents 3 POL136 04-10 219 Cigna Health and Life Insurance Company PREMIUMS PREMIUM PAYMENT. The first premium will be due on the Effective Date. After that, premium will be due monthly unless the Policyholder and the Insurance Company agree on some other method of premium payment. The Policyholder and the Insurance Company may agree to change the method of premium payment from time to time. Premiums are payable at the Home Office of the Insurance Company or to an authorized agent of the Insurance Company. PREMIUM DUE DA IL. After the Effective Date, the Premium Due Date will be the first of the month. The Anniversary Date will be the first of the month when the policy becomes effective. If the Policyholder and the Insurance Company agree that premiums will be paid on a quarterly, semiannual or annual basis, the Premium Due Date will be at the appropriate regular interval, quarterly, semiannually or annually. Premiums must be received at the Home Office or by an authorized agent of the Insurance Company on the Premium Due Date or the policy will be cancelled except as set forth in the Grace Period. MONTHLY STA '1'EMENT DATE. If premiums are to be paid monthly, the Monthly Statement Date will be the same as the Premium Due Date. If premiums are to be paid on a quarterly, semiannual or annual basis, the Monthly Statement Date will be the day in each month with the same number as the Premium Due Date. MONTHLY PREMIUM STA I'EMENT. If premiums are due monthly, a Monthly Premium Statement willbe prepared as of the Premium Due Date. This Monthly Premium Statement will show the premium due. If premiums are due quarterly, semiannually or annually, a Monthly Premium Statement will be prepared as of the Monthly Statement Date for the time from the Monthly Statement Date to the next Premium Due Date. This Monthly Statement will reflect any pro rata premium charges and credits due to changes in the number of insured persons and changes in insurance amounts that took place in the preceding month. SIMPLIFIED ACCOUNTING. To simplify the accounting process, premium adjustments will be made on the Monthly Statement Date that is the same as or next follows the date that: • A person becomes insured. • The amount of insurance on a person changes, but not due to a revision of The Schedule. • .A person ceases to be insured. MONTHLY PREMIUM RA 1E FOR DENTAL INSURANCE. The monthly premium rate for Dental Insurance is determined by written agreement between the Policyholder and Cigna Health and Life Insurance Company. DENTAL INSURANCE PREMIUM. The monthly premium for Dental Insurance will be calculated as follows: • Multiply the number of Employees insured on the Premium Due Date in each rate class by the premium rate in effect on that date for that class, • Add the results. CHANGE IN METHOD OF PREMIUM PAYMENT. If premiums are to be paid other than monthly, the method of calculation is the same. However, the rate for each class is first changed to quarterly, semiannual or annual rates by multiplying them by 2.9852, 5.9557 or 11.8227, respectively. All results are taken to the nearer cent. If the Policyholder and the Insurance Company agree to a change in the method of premium payment or to a change in the Anniversary Date, a pro rata adjustment will be made in the premium due. 4 POL138 04-10 220 Cigna Health and Life Insurance Company CHANGES IN PREMIUM RA I ES. Any premium rate may be changed by the Insurance Company from time to time with at least 31 days advance written notice. No such change will be made until 12 months after the Effective Date. An increase will not be made more often than once in a 12-month period. If an increase in premium rates takes place on a date that is not a Premium Due Date, a pro rata premium will be due on the date of the increase. The pro rata premium will apply for the increase from the date of the increase to the next Premium Due Date. If a decrease in premium rates takes place on a date that is not a Premium Due Date, a pro rata credit will be granted. The pro rata credit will apply for the decrease from the date of the decrease to the next Premium Due Date. The Insurance Company may change rates immediately if, following the latter of the effective date or renewal date, the enrolled population either increases or decreases by 10% or more. As of any Anniversary Date after the policy has been in force for 12 months, the Insurance Company may grant a credit in such amount as it may determine, based on experience. The experience under this policy may be combined with the experience under other contracts issued by the Insurance Company or its affiliates and covering the policyholder or its employees. The Insurance Company may change rates immediately if, in its opinion, its liability is altered by any change in state or federal law or by a revision in the insurance under the policy. Any such change in rates will take effect on the effective date of the change in law or change in the .insurance. 5 POL138 04-10 221 Cigna Health and Life Insurance Company CANCELLATION OF POLICY The Policyholder may cancel the policy as of any Premium Due Date by giving written notice to the Insurance Company before the date. The Insurance Company may cancel the policy due to the following reasons only: • with at least 90 days prior written notice, if the Insurance Company ceases to offer coverage of this type, in accordance with applicable state or federal law; • as of any Premium Due Date, if the premium is not received at the Home Office or by an authorized agent of the Insurance Company when due; • immediately, if the Employer has performed an act or practice that constitutes fraud or has intentionally misrepresented a material fact; as of any Premium Due Date, if the number of insured Employees or if the number of insured Dependents fails to meet the minimum required per group participation rules; or for failure to comply with any other material plan provision relating to Employer contributions or group participation rules; • if the Insurance Company withdraws from the health insurance market with prior written notice and in accordance with applicable state or federal law; • in accordance with any applicable state law, if it is determined that the size of the Employer group has changed, making such group eligible for a guaranteed issued small group product; • in accordance with any applicable state or federal law, if prior notice is given to the Employer; • as to an Employer member of an association to which this policy is issued, when the Employer's membership in the association ceases, in accordance with applicable state or federal law. Coverage will cease at midnight on the date on which termination occurs, unless otherwise stated above. Uniform Modification of Coverage. At renewal, the provisions of this policy may be modified to reflect product revisions which have been uniformly made to this product. GRACE PERIOD. If, before a Premium Due Date, the Policyholder has not given written notice to the Insurance Company that the policy is to be canceled, a Grace Period of 31 days will be granted for the payment of each premium after the initial premium. The policy will stay in effect during that time. If any premium is not received at the home office or by an authorized agent of the Insurance Company by the end of the Grace Period, the policy will automatically be canceled at the end of the Grace Period; except that, if the Policyholder has given written notice in advance of an earlier date of cancellation, the policy will be canceled as of the earlier date. The Policyholder will be liable to the Insurance Company for any unpaid premium for the time the policy was in force. 6 POL139 04-10 222 Cigna Health and Life Insurance Company MISCELLANEOUS PROVISIONS EXECUTION OF POLICY. The policy is executed at the Home Office of the Insurance Company. The Post Office address of the Insurance Company is Hartford, Connecticut. CONSIDERATION. The policy is issued to the Policyholder in consideration of the application and payment of premiums. INSURANCE DATA. The Policyholder will give the Insurance Company all of the data that it needs to calculate the premium and all other data that it may reasonably require. Failure of the Policyholder to give this data will not void or continue an Employee's insurance. The Insurance Company has the right to examine the Policyholder's records relative to these benefits at any reasonable time while the policy is in effect. It also has this right until all rights and obligations under the policy are finally determined. MALE PRONOUN. The male pronoun as used herein will be deemed to include the female. 7 POL 140 04-10 223 Cigna Health and Life Insurance Company PROVISIONS ENTIRE CONTRACT. The entire contract will be made up of the policy, the application of the Policyholder, a copy of which is attached to the policy and all subsequent versions of the policy, and the applications, if any, of the Employees. POLICY CHANGES. Changes may be made in the policy only by amendment signed by the Policyholder and by the Insurance Company acting through its President, Vice President, Secretary, or Assistant Secretary. No agent may change or waive any terms of the policy. STATEMENTS NOT WARRANTIES. All statements made by the Policyholder or by an insured Employee will be deemed representations and not warranties. No statement made by the Policyholder or by the Employee to obtain insurance will be used to avoid or reduce the insurance unless it is made in writing and is signed by the Policyholder or the Employee and a copy is sent to the Policyholder, the Employee or his Beneficiary. CLAIM. Notice of Claim, Claim Forms and Proof of Loss provisions do not apply to services received from, or upon referral by, a Participating Dental Facility or a Participating Dentist. NOTICE OF CLAIM. Written notice of claim must be given to the Insurance Company within 120 days after the occurrence or start of the loss on which claim is based. If notice is not given in that time, the claim will not be invalidated or reduced if it is shown that written notice was given as soon as was reasonably possible. CLAIM FORMS. When the Insurance Company receives the notice of claim, it will give to the claimant, or to the Policyholder for the claimant, the claim forms it uses for filing proof of loss. If the claimant does not get these claim forms within 15 days after the Insurance Company receives notice of claim, he will be considered to have met the proof of loss requirements if he submits written proof of loss within 120 days after the date of loss. This proof must describe the occurrence, character and extent of the loss for which claim is made. PROOF OF LOSS. Written proof of loss must be given to the Insurance Company within 120 days after the date of the loss for which claim is made. If written proof of loss is not given in that time, the claim will not be invalidated nor reduced if it is shown that written proof of loss was given as soon as was reasonably possible. PHYSICAL EXAMINATION. The Insurance Company, at its own expense, will have the right to examine any person for whom claim is pending as often as it may reasonably require. LEGAL ACTIONS. No action at law or in equity will be brought to recover on the policy until at least 60 days after proof of loss has been filed with the Insurance Company. No action will be brought at all unless brought within 3 years after the time within which proof of loss is required by the policy. TIME LIMITATIONS. If any time limit set forth in the policy for giving notice of claim or proof of loss, or for bringing any action at law or in equity is less than that permitted by the law of the state in which the Employee lives when the policy is issued, then the time limit provided in the policy is extended to agree with the minimum permitted by the law of that state. CERTIFICATES. The Insurance Company will issue to the Policyholder for delivery to each insured Employee an individual certificate. The Policyholder will be responsible for distributing the certificates to its Employees. The certificate 8 POL141V24 04-10 224 Cigna Health and Life Insurance Company will show the benefits provided under the policy. It will set forth any changes in benefits due to age and to whom benefits will be paid. Nothing in the certificate will change or void the terms of the policy. NOTICE OF TERMINATION OF ELIGIBILITY. Written notice of the termination of eligibility of any Employee or Dependent must be given to the Insurance Company within (60) days of the loss of eligibility. If such notice is not received by the Insurance Company within (60) days of the date of loss of eligibility for an Employee or Dependent, then the Employer shall be responsible for all claims for that Employee or Dependent incurred through the (60th) day prior to the Insurance Company's receipt of notice of termination of eligibility for the Employee or Dependent. 9 POL141V24 04-10 225 Cigna Health andLife Insurance Company AMENDMENT POLICYHOLDER:. City of Miami POLICY ,NUMBEAi• V01272,PHMO EFFECTIVE DATE OF THIS AMENDMENT: January 1,20114 ISSUE DATE: 04/61/2014 .As of the Effective Date of this Amendment, the Policy specified above is amended by the: provisions shown below. As of the effective date of this Amendment, CNOII i$ NULL and VOID and is replaced with CNO13 Th folloWing page attached to this Ameridnient is a(iicied to the polity: POL136(1) wino. Regintar ACCEPTED BY: PolicylloIder Repre8enuktive FIP-A CIGNA HEALTH AND LIFE INSURANCE COMPANY Anna Krishhil, Cor orate Setreiwy Title Date 04-10 VI Cigna Health and Life Insurance Company '1"FIE, INSURANCE SCI-IEDUT .F (Continued) GROUP POL,ICY(IES) EMPLOYFX CLASS Certific-att: Eligible Effective Number Policy40 'Tnployeel Date CNO13 3202272-DHMO Each Eligible EMployee as 01-01-14 repotted to the insurance company by your EMployer 2 POL1.36 0,1-10 2 7 Cigna Health and Life 1n.srancG Oenapany AMENDMENT POLICYHOLDER: City of Mmi POLICY NUMBER: 3202272-DFIMO EFFECTIVE DATE OF THIS MENDMENT: jitimnry 1, 2015 ISSUE DATE: Februaq 20, 2015 As of the Effective Date of tbia Amendrnent, the Pelicy specified above is amended by tbe proviaiona shown below. The following page attadyed to this Aihendrnent is added to the policy; POL136 (2) Wilbur E. Proven, Registrar ACCEPTED BY: CIGNA HEALTH AND LIM INSURANCE COMPANY Anna Kfishtut, Corporate Secretary Policyholder Representative Title HP,AAID1 I Date 410 Health and Life Insurance Oonwany THE INSURANCE SCHEDULE (Continued) The Certificate may include Certificate Riders which are identified by Rider Numbers, These Certificate Riders arc listed below. ACI\TYD15 (Annual Compliance Rider) CR7I31013-4 (Rider for Active Service ati4 Employee Definition update) 2 CN01.3, CNOI3 POL136 (2) 04-lo Mailing Address: Hartford, Connecticut 06152 Home Office: Bloomfield, Connecticut CIGNA HEALTH AND LIFE INSURANCE COMPANY GROUP: City of Miami ADDRESS: Miami, Florida POLICY NUMBER: 3202272 EFFECTIVE DATE: January 1, 2013 ANNIVERSARY DA 1'h.: 01/01 GROUP CONTRACT OF PRE -PAID DENTAL PLAN SERVICES This policy is issued in Illinois and shall be governed by its laws The Insurance Company and the Policyholder have agreed to all of the terms of this policy. Shertnona Mer,pp, Corporate Secretary Wilbur R. Parsell, Registrar HP-POL203 1 230 Matthew G. Manders, President 04-12 Cigna Health and Life Insurance Company TABLE OF CON 1LNTS The Dental Plan 3 Effective Date; Eligibility 3 Premiums 4 Administration 4 Covered Services 5 Cash Indemnity 5 Method of'Treatment: Confidentiality 5 Responsibility for. Service, 5 Grace Period 6 Reinstatement 6 Termination of Contract 6 Renewal 6 Amendments to Contract 7 Entire Contract 7 Governing Law 7 HP-POL203 2 04-12 231 Cigna Health and Life Insurance Company The Dental Plan Cigna Health and Life Insurance Company ("Cigna") shall provide dental benefits to Subscribers and Dependents in accordance with the terms of this Contract and as set out in attached Pre -Contract Application, Certificate, applicable Riders, and Patient Charge Schedule. The terms and conditions of the Certificate, applicable Patient Charge Schedule, Riders and any amendments or revisions thereto, are incorporated into this Contract by reference and made a part hereof as if fully set forth herein. Each Subscriber shall receive a Certificate of Coverage outlining the terms, exclusions and limitations of the coverage provided hereunder. Any conflicts between the Group Contract and Certificate of Coverage shall be resolved according to the terms most favorable to the Subscriber. The relationship between Cigna Dental Health and a Network Dentist is an independent contractor relationship. All contracts between Cigna Dental Health and Network Dentists state that under no circumstances shall any Covered Persons be liable to any Network Dentist for any sums owed to the Network Dentist by Cigna Dental Health, notwithstanding any delay by Cigna Dental Health in paying the Network Dentist any such sums. Cigna Dental Health shall provide reasonable notice to the Group of any termination, breach of contract or inability to perform of any Network Dentist if Cigna Dental Health determines that Covered Persons may be materially and adversely affected thereby. Effective Date; Eligibility The effective date of coverage of the Group under the Dental Plan shall be the day set forth on the Pre -Contract Application following receipt of the appropriate Premiums by Cigna Dental Health, on behalf of Cigna (the Effective Date). The original term of this Contract shall extend until the expiration of the initial Premium guarantee (the Expiration Date) set forth in the Pre -Contract Application executed by Cigna Dental Health and the Group, a copy of which is attached hereto and the terms of which are incorporated herein by reference. This Contract shall be automatically renewed on an annual basis effective on the day following the Expiration Date (the Renewal Date), unless terminated in accordance with the provisions of the Termination of Contract Section hereof. The Group shall determine which of its Employees are eligible to enroll in the Dental Plan. Present Employees of the Group actively at work will be eligible upon completion of the Group's stipulated period of service, Future Employees of the Group will be eligible, if they are actively at work, upon completion of the Group's stipulated period of service. Employees who satisfy the eligibility requirements and who enroll prior to the Effective Date of the Contract will be covered on the Effective Date of the Contract. Employees who become eligible after the Effective Date of the Contract, and who enroll within 30 days of initial eligibility shall be covered on the first day of the month following processing of such form by Cigna Dental Health (unless otherwise specified in the Pre -Contract Application). Dependents are eligible upon enrollment of Subscriber, or within 31 days of their attainment of eligibility due to a change in status, such as birth or marriage. If Employees and/or their Dependents are not enrolled within 31 days of attainment of eligibility, they cannot be enrolled until the next open enrollment period unless a change in status, such as divorce, has occurred. Cigna Dental Health may require evidence of good dental health at Employee's expense before enrollment of: Dependents who were disenrolled due to nonpayment by Employee while still eligible, or Employees and/or Dependents who enroll after the initial period of eligibility has expired. A Subscriber's newborn child is automatically covered during the first 31 days, the child must be enrolled in the Dental Plan and Premiums must be paid during that period. HP-P0I.203 3 04-12 232 Cigna Health and Life Insurance Company Effective Date; Eligibility (Cont.) Under the Family Medical Leave Act of 1993, Subscribers may be eligible to continue coverage during certain leaves of absence from work. During such leaves, the Subscriber shall be responsible for paying the Group the portion of the Premium, if any, for which Subscriber would have been responsible if the Subscriber had not taken the leave. In the event a Covered Person is eligible for benefits pursuant to the requirements of the Family and Medical Leave Act of 1993 or the Consolidate Omnibus Budget Reconciliation Act of 1985 (COBRA), the Group shall be responsible for collecting the Subscriber's portion of the Premium/Payment Fees, if any, for which the Subscriber would have been responsible if the Subscriber hadnot taken the leave or become qualified for COBRA coverage. Premiums In consideration of the services to be rendered or made available to the Covered Persons by Cigna Dental Health, on behalf of Cigna, the Premium for the initial month of coverage is to be remitted by the Group to Cigna Dental Health on the 15th day of the month preceding the month of coverage, accompanied by a list of persons covered under the Dental Plan. On the loth day of each calendar month thereafter for the term of this Contract, Cigna Dental Health, on behalf of Cigna, will send the Group an alphabetized list of Subscribers and a bill for the next month's coverage. On or before the 25th day of each month thereafter, the Group shall remit the Premium to Cigna Dental Health, on behalf of Cigna, with an updated list indicating Covered Persons to be added to, or deleted from, the Dental Plan, and any changes in type of coverage for that month. Premiums are guaranteed for an initial period of 12 months (unless otherwise extended in the Pre -Contract Application). However, Premiums may be adjusted upon 30 days notice by Cigna Dental Health, on behalf of Cigna, upon notification to the Group if, in Cigna Dental Health's sole opinion, its liability is altered by any state or federal law. With the exception of the preceding two sentences, which shall remain in effect, alternative payment mechanisms developed for the Group by Cigna Dental Health shall supersede the terms of this Section. Administration The Group will cooperate with Cigna Dental Health, on behalf of Cigna, with respect to soliciting and enrolling persons eligible to enroll hereunder and in obtaining authorized payroll withholding from Subscribers to the extent that the applicable Premium exceeds the Group's contribution on the Subscriber's behalf for the covered services, if. any. Cigna Dental Health, on behalf of Cigna, shall receive copies from the Group of all signed enrollment forms and/or change forms; shall be permitted to inspect the Group's records for information pertaining to eligibility, enrollment and payment of Premiums hereunder, and shall be permitted to make copies thereof at any reasonable time upon reasonable prior notice to the Group. Cigna Dental Health, on behalf of Cigna, shall arrange for the organization and maintenance of administrative records of all covered persons, but shall not be liable for any obligation Dependent upon information from the Group prior to the receipt of such information in a :form satisfactory to Cigna Dental Health. Incorrect information furnished by the Group may be corrected if Cigna Dental Health shall not have acted in reliance upon such information to its prejudice. Cigna Dental Health, on behalf of Cigna, shall be entitled to receive from each dentist who renders service to a Covered Person hereunder all information reasonably necessary to fulfill the terms of this contract. Covered Persons, by their enrollment in the Dental Plan, authorize each dentist who renders service hereunder to disclose to Cigna Dental Health all facts pertaining to such service and to render to Cigna Dental Health, reports and copies of records pertaining to such service for Cigna Dental Health administrative or quality management purposes. HP-POL203 4 04-12 233 Cigna Health and Life Insurance Company Covered Services Services under the Dental Plan will be provided according to the Patient Charge Schedule delivered to Subscribers. Certain services are subject to a Patient Charge as listed in the Schedule. Patient Charges listed on the Patient Charge Schedule of the Dental Plan will be reviewed and may be adjusted on an annual basis, generally on the anniversary of the Renewal Date. Patient Charges shall then be in effect for a minimum of one year, Cigna Dental Health, on behalf of Cigna, may change the Plan's covered services, effective as of any Renewal Date to this Contract, upon written notice sent to the Group, at least 45 days before that Renewal Date. All contracts between Cigna Dental Health and the Network General Dentist state that under no circumstances shall any Covered Person be liable to any Network General Dentist for any sums owed to the Network General Dentist by Cigna Dental Health, notwithstanding any delay by Cigna Dental Health in paying the Network General Dentist any such sums. Covered Persons may be liable to noncontracting dentists for the cost of services in the event Cigna Dental Health fails, for any reason, to pay the noncontracting dentist. Cash Indemnity No cash payments or other indemnity shall be paid to any Covered Person or to any Network General Dentist with the exception of any payment due a Network General Dentist pursuant to his or her contract with Cigna Dental Health. Method of Treatment: Confidentiality The services to be provided under this Contract shall be provided in accordance with recognized standards of sound dental practice. Cigna Dental Health, on behalf of Cigna, shall impose no restrictions as to methods of diagnosis or treatment. The private dentist -patient relationship shall be maintained between Subscribers and Network General Dentists, and Cigna Dental Health will not disclose the contents of any records, charts, files or other data pertaining to the condition of Covered Persons without their prior authorization. Responsibility for Service Dental services hereunder will be provided in accordance with recognized standards of sound dental practice through contracts with Network General Dentists and Network Specialists. Cigna Dental Health shall not be obligated to cover any dental service listed in the applicable Patient Charge Schedule other than through Network General Dentists or Network ! Specialists, unless prior authorization has been granted by Cigna Dental Health. Grace Period The Grace Period for the payment of Premiums by the Group and by any Subscriber shall be 31 days. If at the expiration. of this Grace Period the Group has not paid amounts due, then the entire Dental Plan shall terminate as of the last day of the month for which payment is due. If at the expiration of the Grace Period any Subscriber has not paid amounts due, then the Subscriber's coverage and coverage for his or her Dependents under the Dental Plan shall cease as of the list day of the month for which payment is due. Upon such expiration, terminated Covered Persons shall be liable for the cost of services received during the Grace Period, unless the Group failed to remit dollars previously deducted on behalf of the Subscriber. Reinstatement If Cigna Dental Health elects to reinstate this Contract, the coverage provided herein will, resume as of the date of termination with no gap in coverage. If Cigna Dental Health elects not to reinstate the Contract, it will notify the Group of HP-POL203 5 04-12 234 Cigna Health and Life Insurance Company such decision in writing. In such event, any unearned Premium/Prepayment Fees submitted with the request for reinstatement will be returned to the Group. Cigna Dental Health's reinstatement of the Contract or waiver of the right to terminate this Contract pursuant to this Section shall not constitute a waiver of any future right to terminate for nonpayment of Premium/Prepayment Fees, Termination of Contract In addition to termination for nonpayment of Premium/Prepayment Fees either the Group or Cigna Dental Health may terminate this Contract for any reason, including low participation, effective as of any Renewal Date by providing a minimum of 60 days prior written notice to the other party. In the event of termination of this Contract by either Cigna Dental Health or the Group, the Group shall provide a notice of terminate to each Covered Person. Upon the request of Cigna Dental Health, Group agrees to provide Cigna Dental Health proof of such notice and the date of such notice. In the event of termination of this Contract, Cigna Dental Health shall within 30 days return to the Group the pro rata portion of Premium/Prepayment Fees, if any, which correspond to any unexpired period for which payment has been received, if any, less amounts due to Cigna Dental Health. Cigna Dental Health will pay covered claims incurred by Covered Persons prior to termination. This subsection shall not apply to termination by Cigna Dental Health made as a result of fraud or deception in the use of services or facilities, or knowingly permitting such fraud or deception by another. Renewal Upon expiration of the original Premium guarantee, this Contract shall be automatically renewed on an annual basis effective on the Renewal Date, unless otherwise terminated in accordance with the Termination of Contract Section hereof. Except as otherwise herein provided, each amendment to this Contract, including a change in Premiums or Covered Services, proposed by either party, in writing at least 45 days prior to the Renewal Date shall become effective on that Renewal Date. Amendments to Contract Except as otherwise provided herein, Cigna Dental Health may amend this Contract by giving the Group 60 days prior written notice of the proposed amendment. Failure of the Group to object in writing of any such proposed amendment within such notice period shall constitute the Group's acceptance of the amendment as of its effective date. Except as otherwise provided herein, changes in the Premium/Prepayment Fees or Patient Charge Schedule shall be effective as of the Renewal Date following proper notice. In the event that federal, state, or municipal laws or regulations should change, alter or modify the present services, levels of premiums to Cigna Dental Health, standards of eligibility of Covered Persons, or any operations of Cigna Dental Health such that the terms, benefits and conditions of this Contract must be modified accordingly, Cigna Dental Health shall have the right to amend this Contract upon 30 days' written notice to the Group. Except as otherwise provided herein, this Contract may be amended only in writing as approved by both Group and Cigna Dental Health. Only a duly authorized officer of Cigna Dental Health has the authority to amend this Contract. Entire Contract This Contract, including the attached Patient Charge Schedule, Pre -Contract Application, Certificate Booklet and any amendments thereto, represents the entire agreement between the parties with respect to the subject matter. The invalidity HP-POL203 6 04-12 235 Cigna Health and Life Insurance Company or unenforceability of any Section or sub -Section of this Contract shall not affect the validity or enforceability of the remaining Sections or sub -Sections hereof. Governing Law This Contract shall be construed for all purposes as a legal document and shall be interpreted and enforced in accordance with pertinent laws and regulations of the State of Illinois. HP-POL203 7 04-12 236 PROFESSIONAL SERVICES AGREEMENT By and Between The City of Miami, Florida and Cigna Health and Life Insurance Company / Cigna Dental Health of Florida, Inc. This Professional Services Agreement ("Agreement") is entered into this. — day of , 2014 by and between the City of Miami, a municipal corporation of the State of Florida, whose address is 444 S.W, 2nd Avenue, 10th Floor, Miami, Florida 33130 ("City"), and Cigna Health and Life Insurance Company, a Connecticut domiciled life and health insurance company licensed to do business in Florida whose principal address is 900 Cottage Grove Road, Bloomfield, CT and its affiliate, and by Cigna Dental Health of Florida,, Inc., a Florida Corporation qualified to do business in Florida whose principal address is: 1571 Sawgrass Corporate Parkway, Suite 140, Sunrise, Florida 33323 (collectively and jointly and severally "PROVIDER"). RECITALS: WHEREAS, the City of Miami issued a Request for Proposal No, 336312 on August 16, 2012 (the "RFP" attached hereto, incorporated hereby, and made a part of as Exhibit A) for the provision of an insured prepaid dental plan, Employee Group Benefit Dental Plan, ("Services" as more fully set forth in the scope of work "SOW" attached hereto as Exhibit. A Part 3) for the Risk Management Department and Provider's proposal ("Proposal", attached hereto, incorporated hereby, and made part of hereof as Exhibit B),' in response thereto, has been selected as the most qualified proposal for the provision of the Services. WHEREAS, the Evaluation Committee appointed by the City Manager determined that the Proposal submitted by the Provider was responsive to the RFP requirements and recommended that the City Manager negotiate with the Provider; and Employee Benefit Dental Plan 237 1 WHEREAS, the City wishes to engage the Services of Provider, and Provider wishes to perform the Services for the City; and WHEREAS, the City and the Provider desire to enter into this Agreement under the terms and condition set forth herein. NOW, THEREFORE, in consideration of the mutual covenants and promises herein contained, Provider and the City agree as follows: TERMS OF AGREEMENT; �. RECITALS AND INCORPORATIONS; DEFINITIONS: A. The recitals are true and correct and are hereby incorporated into and made a part of this Agreement, -The City's RFP is hereby incorporated into and made a part of this Agreement and attached hereto as Exhibit "A". The Services are hereby incorporated into and made a part of this Agreement as attached Exhibit "A, Part 3". The Provider's Response dated, September 28, 2012, is hereby incorporated into and made a part of this Agreement as attached Exhibit "B". The Provider's Insurance Plan Document is hereby incorporated into and made a part of this Agreement as Exhibit "C". The order of precedence whenever there is conflicting or inconsistent language between --documents is_.asfollows;—(1)—P-rovider's_P-r-ofessiorial-Services Agreement ("PSA") with the Scope of Work; (2) Addenda/Addendum to the Request for Proposals; (3) Request for Proposals; and (4) Provider's response to the Request for Proposals. it is mutually agreed to that Provider will issue an insured prepaid dental plan to City which will be governed by this Professional Services Agreement, and in addition is also governed by applicable laws and the provisions of such insurance policy and shall notwithstanding the foregoing be subject to the terms of this Professional Services Agreement. Employee Benefit Dental Plan 238 2 2. EFFECTIVE TERM: The initial term of this Agreement shall commence on the January 1, 2013 and shall continue in effect for a terra of three (3) years ending on December 31, 2015. 3. OPTION TO EXTEND: The City, acting administratively through its City Manager, shall have two (2) option(s) to extend the term hereof for a. period of one (1) year each, subject to availability, allocation and appropriation of funds and satisfactory performance by the Provider in the opinion of the City Manager. The City shall exercise its right to extend the term hereof by giving Provider at least thirty (30) days written notice prior to the expiration of the previous term. City Commission approval shall not be required as long as the total extended tenn does not exceed two (2) years. 4. SCOPE OF SERVICES: A. Provider agrees to provide the Services as specifically described, and under the special terms anzd conditions set forth in Exhibit "A, Part 3" hereto, which by this reference is incorporated into and made a part of this Agreement. B. Provider represents to the City that: (i) it possesses all qualifications, licenses as required by applicable 1.aws,__cod.es, rules and_regulati.ons_and —expertise. required for the performance .of the Services, including but not limited to full qualification to do business in Florida; (ii) it is not delinquent in the payment of any sums due the City, including payment of permits, fees, occupational licenses, etc., nor in the performance of any obligations to the City, (iii) all personnel assigned to perform the Services are and shall be, at all times during the term hereof, fully qualified and trained to perform the tasks assigned to each; (iv) the Services will be performed in the manner described in Exhibit "A,. Part 3"; and (v) each person executing this Agreement on behalf of Provider has been duly authorized to so execute the same and fully bind Employee Benefit Dental Plan 239 3 Provider as a party to this Agreement. C. Provider shall at all times provide fully qualified, competent and physically capable employees to perform the Services under this Agreement. City may require Provider to remove any employee the City deems careless, incompetent, insubordinate, or otherwise objectionable and whose continued services under this Agreement is not in the best interest of the City. 5. COMPENSATION: A. The amount of compensation payable by the City to the Provider shall be based on the rates and schedules described in Exhibit "D" hereto, which by this reference is incorporated into and made a part of this Agreement. B. Payment shall be made in arrears based upon work performed to the satisfaction of the City within forty-five (45) days after receipt of Provider's invoice for Services performed, which shall be accompanied by sufficient supporting documentation and contain sufficient detail, to allow a proper audit of expenditures, should the City require one to be perfonmed. Invoices shall be sufficiently detailed so as to comply with the "Florida Prompt Payment Act", §218.70. - 218 79—Merida-Statates,and-other-applicable laws. Io-advance paryments_shall be_inade_at-any time. C. Provider agrees and understands that (i) any and all subcontractors providing Services related to this Agreement shall be paid through Provider and not paid directly by the City, and (ii) any and all liabilities regarding payment to or use of subcontractors for any of the Services related to this Agreement shall be borne solely by Provider. Employee Benefit Dental Plan 240 4 6. OWNERSHIP OF DOCUMENTS: Provider understands and agrees that any information, document, report or any other material whatsoever which is given by the City to Provider, its employees, or any subcontractor, or which is otherwise obtained or prepared by Provider pursuant to. or under the terms of this Agreement, is and shall at all times remain the property of the City. Provider agrees not to use any such information, document, report or material for any other purpose whatsoever without the written consent of the City Manager, which may be withheld or conditioned by the City Manager in his sole discretion. Provider is permitted to make and to maintain duplicate copies of the files, records, documents, etc. if Provider determines copies of such records .are necessary subsequent to the termination of this Agreement; however, in no way shall the confidentiality as permitted by applicable law be breached. The City shall maintain and retain ownership of any and all documents which result upon the completion of the work and Services under this Agreement. Provider acknowledges that nothing herein shall impair any ownership interest the City of Miami has with respect to eligibility, claim and other related information ("Plan Information") provided, however, that: (i) The City -of Miami shall make -available to-Provider_and Provider may possess and use all such Plan Information as Provider may reasonably require for purposes of administering the Services and that Provider may maintain such information in accordance with its record retention policy; (ii) City's ownership shall not extend to any of Provider's business records, including, without limitation to the extent such business records incorporate Plan Information recorded for or otherwise integrated into Provider's data processing systems in the ordinary course of business; 241 5 Employee Benefit Dental Plan (iii) Subject to compliance with Chapter 119, Florida Statutes, the Public Records Act, as amended, the City of Miami acknowledges that Plan Information reflecting the reimbursement rates or other terms under Provider's agreements with its participating subcontracted vendors/arrangers of health care services/supplies is the proprietary information of Provider and shall be used solely for thepurpose of administering the Services or as otherwise required by law and that such proprietary information shall not be released to any third party without Provider's written consent and subject to a non -disclosure agreement from the third party that is satisfactory to Provider, and (iv) Such ownership shall not be interpreted to require Provider to divulge to the City of Miami any insured prepaid dental plan information or other information that, Provider reasonably believes it cannot divulge to the City of Miami due to applicable state and/or federal privacy laws and/or regulations. (v) The requirements of this section shall be understood to exclude ownership in the Provider's Insurance Plan Document and its other related insured prepaid dental plan information. (vi) Provider shall comply, unless Provider wishes to avail itself of a public records exemption under the laws of the 'United States or of the State of Florida, with the Public Records Act as set forth in Section 9 of this Agreement. 7. AUDIT AND INSPECTION RIGHTS AND RECORDS RETENTION: A. Provider agrees to grant access to the City or to any of its duly authorized. representatives, to any books, documents, papers, and records of Provider which are directly pertinent to this Agreement, for the purpose of audit, examination, excerpts, and transcripts, The Employee Benefit Dental Plan 242 6 City may, at reasonable tunes, and for a period of up to three (3) years following the date of final payment by the City to Provider under this Agreement, audit and inspect, or cause to be audited and inspected, those books, documents, papers, and records of Provider which are related to Provider's performance under this Agreement. Provider agrees to maintain any and all such books, documents,. papers, and records. at its principal place ofbusiness for a period of three (3) years after final payment is made under this Agreement and all other pending matters are closed. Provider's failure to adhere to, or refuse to comply with, this condition shall result in the immediate cancellation of this Agreement.by the City. E. The City may, at reasonable times during the ternn hereof, inspect the Provider's facilities and perform such tests, as the City deems reasonably necessary, to determine whether the goods or services required to be provided by Provider under this Agreement conform to the terms hereof and/or the terms of the .Administrative Services Agreement, if applicable. Provider shall make available to the City all reasonable facilities and assistance to facilitate the performance of tests orinspections by City representatives. All tests, inspections, and audits shall be subject to, and made in accordance with, the provisions of Sections 18-100, 18-101 and 1.8- 1-0: -of--the Code_a_the City_of_iVlianai, El.orida_as_same ma_y_be_amended_or-supplemented, from time to time, 8. AWARD OF AGREEMENT: Provider represents and warrants to the City that it has not employed or retained any person or company employed by the City to solicit or secure this Agreement and that it has not offered to pay, paid, or agreed to pay any person any fee, commission, percentage, brokerage fee, or gift of any kind contingent upon or in connection with, the award of this Agreement. Employee Benefit Dental Plan 243 7 9. PUBLIC RECORDS: A. Provider understands that the public shall have access, at all reasonable times, to all documents and information pertaining to City Agreements, subject to the provisions of Chapter 119, Florida Statutes, as amended, the Public Records .Act, and agrees to allow access by the City and the public to all documents subject to disclosure under applicable laws. Provider's failure or refusal to comply with the provisions of this section shall result in the immediate cancellation of this Agreement by the City. Pursuant to the provisions of § 119.0701 Fla. Stat., to the extent applicable, Provider must comply with the Florida public records laws, specifically the Provider must: (a) Keep and maintain public records that ordinarily and necessarily would be required by the public agency in order to perform the service. (b) Provide the public with access to public records on the same terms and conditions that the public agency would provide the records and at a cost that does not exceed the cost provided in this chapter or as otherwise provided by law. (c) Ensure that public records that are exempt or confidential and exempt from public records disclosure-requir-ements-are_not_disci.o.sed_except_as_author_ized byLlaw (d) Meet all requirements for retaining public records and transfer, at no cost, to the public agency all public records in possession of the contractor. upon termination of the contract and destroy any duplicate public records that are exempt or confidential' and exempt from public records disclosure requirements. All records stored electronically must be provided to the public agency in a format that is compatible with the information technology systems of the public agency. Employee Benefit Dental Plan 244 8 ( (e) Should Provider detenriine to dispute any public access provision required by Florida Statutes, then Provider shall do so at its own expense and at no cost to the City. 10. COMPLIANCE WITH FEDERAL, STATE AND LOCAL LAWS: Provider understands that agreements with local governments are subject to certain laws and regulations, including laws pertaining to public records, conflict of interest, record keeping, etc,. City and Provider agree to comply with and observe all such applicable federal, state and local laves, rules, regulations, codes and ordinances, as.they may be amended from time to time. Provider further agrees to include in all of Provider's agreements with subcontractors for any Services related to this Agreement this provision requiring subcontractors to comply with and observe all applicable federal, state, and local laws rules, regulations, codes and ordinances, as they may be amended from time to time. 11. INDEMNIFICATION: Provider shall indemnify, defend and hold harmless the City and its officials, employees, and its designated third -party administrator for claims (collectively referred to as "Zndernitees") and each of them from and against all loss, costs, penalties, fines, damages, claims, expenses (in cluding_attor-n.ey's fees) -or 1i,abilities_(co.1.lectivel_y_;eferred-to_as"Liabilities_')-b_y_z:eason ofrany injury to or death of any person or damage to or destruction or loss of any property arising out of, resulting from, or in connection with (i) the negligent performance or non-performance of the Services contemplated by this Agreement (whether active or passive) of Provider or its employees or subcontractors (collectively referred to as "Provider") which is directly caused, in whole or in part, by any act, omission, default or negligence (whether active or passive or in strict liability) of the Tndelnnities, or ,any of them, or (ii) the failure of the Provider to comply materially with any of the requirements herein, or the failure of the Provider to conform to Employee Benefit Dental Plan 245 9 statutes, ordinances, or other regulations or requirements of any governmental authority, local, federal or state, in connection with the performance of this Agreement. Provider expressly agrees to indemnify, defend and hold harmless the Indemnitees, or any of them, from and against all liabilities which may be asserted by an employee or former employee of Provider, or any of its subcontractors, as provided above, for which the Provider's liability to such employee or former employee would otherwise be limited to payments under state Workers' Compensation or similar laws. Provider further agrees to indemnify, defend and hold harmless the hndemnitees form and against (i) any and all Liabilities imposed on account of the violation of any law, ordinance, order, rule, regulation, condition, or requirement, related directly to Provider's negligent performance under this Agreement, compliance with which is left by this Agreement to Provider, and (ii) any and all claims, and/or suits for labor and materials furnished by Provider or utilized in the performance of this Agreement or otherwise. Provider's obligations to indemnify, defend and hold harmless the Indemnitees shall survive the termination of this Agreement. Provider understands and agrees that any and all liabilities regarding the use of any subcontractor for Services-related--ta-this A-gr-eement-shall-be-bo-.rnae-solely-b--y-P-rovider_throughout the duration of this Agreement and that this provision shall survive the termination or expiration of this Agreement, as applicable. 12. DEFAULT: If Provider fails to comply materially with any term or condition of this Agreerent, or fails to perform in any :material way any of its obligations hereunder, and fails to cure such failure after reasonable notice from the City, then Provider shall be in default. Provider understands and agrees that termination of this Agreement under this section shall not release Employee Benefit Dental Plan 246 10 Provider from any obligation accruing prior to the effective date of termination. Should provider be unable or unwilling to commence to perform the Services ,within the time provided or contemplated herein, then, in addition to the foregoing, Provider shall be liable to the City for all expenses incurred by the City in preparation and negotiation of this Agreement, as well as all costs and expenses incurred by the City in the re -procurement of the Services, including consequential and incidental damages. 13. RESOLUTION OF AGREEMENT DISPUTES: Provider understands and agrees that all disputes between Provider and the City based upon an alleged violation of the terms of this Agreement by the City shall be submitted to the City Manager for his/her resolution, prior to Provider being entitled to seek judicial relief in connection therewith. In the event that the amount of compensation hereunder exceeds Twenty- Five Thousand Dollars and No/Cents ($25,000), the City Manager's decision shall be approved or disapproved by the City Commission. Provider shall not be entitled to seek judicial relief unless: (i) it has first received City Manager's written decision, approved by the City Commission_ if the amount of compensation hereunder exceeds Twenty -Five Thousand:Dollars and No/Cents ($255000)—ox (ii)-a periodeof'sixty—(6.0)-days has-expired,-aEter_submitting to the City Manager .a reasonably detailed statement of the dispute, accompanied by all reasonable supporting documentation ninety (90) days if City Manager's decision is subject to City Commission approval.); or (iii) City has waived compliance with the procedure set forth in this section by written instruments, signed by the City Manager. 14, TERMINATION; OBLIGATIONS UPON TERMINATION: A. The City, acting by and through its City Manager, shall have the right to terminate this Agreement, in its sole discretion, at any time, by giving written notice to Provider at least 11 Employeo Benefit Dental Plan 247 sixty (60) calendar days prior to the effective date of such termination. In such event, the City shall pay to Provider compensation for Services rendered and approved expenses incurred prior to the effective date of termination. In no event shall the City be liable to Provider for any additional compensation and expenses incurred, other than that provided herein, and in no event shall the City be liable for any consequential or incidental damages. The Provider shall have no recourse or remedy against the City for a termination under this ,subsection except for payment of fees due prior to the effective date of termination. B. The City Manager shall have the right to terminate this Agreement, without notice or liability to provider, upon the occurrence of an event of a material default hereunder. In such event, the City shall not be obligated to pay any amounts to Provider for Services rendered by Provider after the date of termination, but the parties shall remain responsible for any payments that have become due and owing as of the effective date of termination. In no event shall the City be liable to Provider for any additional compensation and expenses incurred, other than that provided herein, and in no event shall the City be liable for any consequential or incidental damages. C. This Agreement may=b.e.-terminated.,Jn—whoie--or_in part,_at_an_y_time_b_y_mutual written consent of the parties hereto. In such event, the City shall not be obligated to pay any amounts to Provider for Services rendered by Provider after the date of termination, but the parties shall remain responsible for any payments that have become due and owing as of the effective date of termination.. In no event shall the City be liable to Provider for any additional compensation and expenses incurred, other than that provided herein, and in no event shall the City be liable for any consequential or incidental damages. Employee Benefit Dental Plan 248 12 ( D. This Agreement may be terminated, in whole or in part, by either party if there has been a material default or breach on the part of the other party in any of its representations, warranties, covenants, or obligations contained in this Agreement and such default or breach is not cured within ninety (90) days following written notice from the non -breaching party. In such event, the City shall not be obligated to pay any amounts to Provider for Services rendered by Provider after the date of termination, but the parties shall remain responsible for any payments that have become due and owing as of the effective date of termination. In no event shall the City be liable to Provider for any additional compensation and expenses incurred, other than that provided herein, and in no event shall the City be liable for any consequential or incidental damages. 15. INSURANCE: A. Provider shall, at all times during the term hereof, maintain such insurance coverage(s) as may be required by the City. The insurance coverage(s) required as of the Effective Date of this Agreement are attached hereto as Exhibit "E" and incorporated herein by this reference. The City RFP number and title of the REP must appear on each certificate of insuranee—The-Provider shall--add-the-City-of-Miarni-as-an-additional-named--insured to its commercial general liability and auto policies and as a named certificate holder on all policies. Provider shall correct any insurance certificates as requested by the City's Risk Management Administrator. All such insurance, including renewals, shall be subject to the approval of the City for adequacy of protection and evidence of such coverage(s) and shall be furnished to the City Risk Management Administrator on Certificates of Insurance indicating such insurance to be in force and effect and providing that it will not be canceled, modified, or changed during the performance of the Services under this Agreement without thirty (30) calendar days prior written Employee Benefit Dental Plan 249 13 notice to the City Rislc Management Administrator. Completed Certificates of Insurance shall be filed with the City prior to the perfomaance of Services hereunder, provided, however, that Provider shall at any time upon request file duplicate copies of the policies of such insurance with the City. B. If, in the reasonable judgment of the City, prevailing conditions in the insurance marketplace warrant the provision by Provider 'of additional One Million Dollars ($1,000,000) of professional liability insurance coverage, the City reserves the right to require the provision by Provider of up to such additional amount of professional liability coverage, and shall afford written notice of such change in requirements thirty (30) days prior to the date on which the requirements shall take effect. Should the Provider fail or refuse to satisfy the requirement of additional coverage within thirty (30) days following the City's written notice, this Agreement shall be considered terminated on the date the required change in policy coverage would otherwise take effect. C. Provider understands and agrees that any and all liabilities regarding the use of any of Provider's employees or any of Provider's subcontractors for Services related to this Agreement-shall-bbo e-solely-by-Provider throughout the -term -of thisAgreement-and-that-this provision shall survive the termination of this Agreement. Provider further understands and agrees that insurance for each employee of Provider and each subcontractor providing Services related to this Agreement shall be maintained in good standing and approved by the City Risk Management Administrator throughout the duration of this Agreement. D. Provider shall be responsible for assuring that the insurance certificates required under this Agreement remain in full force and effect for the duration of this Agreement, including any extensions hereof. If insurance certificates are scheduled to expire during the terns Employee Benefit Dental Plan 250 14 of this Agreement and any extension hereof, Provider shall be. responsible for submitting new or renewed insurance certificates to the City's Risk Management Administrator at a minimum of ten (1Q) calendar days in advance of such expiration. In the event that expired certificates are not replaced, with new or renewed certificates which cover the term of this Agreement and any extension thereof: (i) the City shall suspend this Agreement until such time as the new or renewed. certificate(s) are received in acceptable form by the City's Risk Management Administrator; or (ii) the City may,. at its sole discretion, terminate the Agreement for cause and seek re -procurement damages from Provider in conjunction with the violation of the terms and conditions of this Agreement. E. Compliance with the foregoing requirements shall not relieve Provider of its liabilities and obligations under this Agreement. 16. NONDISCIUMINATION: Provider represents to the City that Provider does not and will not engage in discriminatory practices and that there -shall be no-discriminatiatl in_connection with P o ider's_ performance under this Agreement on account of race, color, •sex, religion, age, handicap, marital status or national origin, Provider further covenants that no otherwise qualified individual shall, solely by reason of his/her race, color, sex, religion, age, handicap, marital status or national origin, be excluded from participation in, be denied services, or be subject to discrimination under any provision of this Agreement. Employee Benefit Dental Plan 251 15 17. ASSIGNMENT: Except as provided in the paragraph immediately below, this Agreement shall not be assigned. by Provider, in whole or in part, and Provider shall not assign any part of its operations, without the prior written consent of the City, which may be withheld or conditioned, in the City's sole discretion through the City Manager. Provider may not change or replace sub -contractors performing work under the Services Agreement identified in Exhibit "B" without the prior written consent from the City Manager. Provider agrees not to assign this Agreement in whole or in any substantial part, however while Provider serves as the sole provider of Services requested in this Agreement, a number of Services under Provider's contracts are performed by its affiliates or by subcontracted vendors without prior written approval for such subcontractors. Every such service will be supervised by Provider, which will be wholly responsible and liable for the services set forth in the Agreement. 18, NOTICES: All notices or other communications required under this Agreement shall be in writing and shall be given by hand -delivery or by registered or certified U.S. Mail, return receipt requested,, addressed -to the-other-party-atthe-address indicated-her-ein-or-to-such-oth.er_address as a party may designate by notice given as herein provided. Notice shall be deemed given on the day on which personally delivered; or, if by snail, on the fifth day after being posted or the date of actual receipt, whichever is earlier. TO PROVIDER: TO THE CITY: Cigna Dental Health of Florida, Inc. 1571 Sawgrass Corporate Parkway Sunrise, Florida 33323 Attn.: Daniel J. Alfonso, City Manager 444 SW 2nd Avenue, 10th Floor Miami, FL 33130-1910 Employee Benefit Dental Plan 252 16 19. MISCELLANEOUS PROVISIONS: A. This Agreement shall be construed and enforced according to the laws of the State of Florida. Venue in any proceedings between the parties shall be in Miami -Dade County, Florida. Each party shall bear its own attomey's fees. Each party waives any defense, whether asserted by motion or pleading, that the aforementioned courts are an improper or inconvenient venue. Moreover, the parties consent to the personal jurisdiction of the aforementioned courts and irrevocably waive any objections to said jurisdiction. The parties irrevocably waive any rights to a jury trial. B. Title and paragraph headings are for convenient reference and are not a part of this Agreement. C. No waiver or breach of any provision of this Agreement shall constitute a waiver of any subsequent breach of the same or any other provision hereof, and no waiver shall be effective unless made in writing. D. Should any provision, paragraph, sentence, word or phrase contained in this Agreement be determined by a court of competent jurisdiction to be invalid, illegal or otherwise unenforceable-undor-the-laves-of-the-State -of l lor-ida^or-the-City-of-Miami.,_such_provis.ion, paragraph, sentence, word or phrase shall be deemed modified to the extent necessary in order to conform with such laws, or if not modifiable, then the same shall be deemed severable, and in either event, the remaining terns and provisions of this Agreement shall remain unmodified and in full force and effect or limitation of its use. E. Provider shall comply with all applicable laws, rules and regulations in the performance of this Agreement, including but not limited to licensure, and certifications required by law for professional service providers. Employee Benefit Dental Plan 253 17 F. This Agreement constitutes the sole and entire agreement between the parties hereto. No modification or amendment hereto shall be valid unless in writing and executed by properly authorized representatives of the parties hereto. Except as otherwise set forth in Section 2 above, the City Manager shall have the sole authority to extend, to amend or to modify this Agreement on behalf of the City, 20. SUCCESSORS AND ASSIGNS: This Agreement shall be binding upon the parties hereto, their heirs, executors, legal representatives, successors, or assigns. 21. INDEPENDENT CONTRACTORS: Provider has been procured and is being engaged to provide Services to the City as an independent contractor, and not as an agent or employee of the City. Accordingly, neither Provider, nor its employees, nor any subcontractor hired by Provider to provide any Services under this Agreement shall attain, nor be entitled to, any rights or benefits under the Civil Service or Pension Ordinances of the City, nor any rights generally afforded classified or unclassified employees. Provider further understands that Florida Workers' Compensation benefits available to-employees-ot' the -City -are -not available -to Provider.,_its_exnployeesror_any subcontractor hired by Provider to provide any Services hereunder, and Provider agrees to provide or to require subcontractor(s) to provide, as applicable, workers' compensation insurance for any employee or agent of Provider rendering Services to the City under this Agreement. Provider further understands and agrees that Provider's or subcontractors' use or entry upon City properties shall not in any way change its or their status as an independent contractor. Employee Bonet Dental Plan 254 18 22, CONTINGENCY CLAUSE: Funding for this Agreement is contingent on the availability of funds and continued authorization for program activities and the Agreement is subject to amendment or termination due to lack of funds, reduction of funds, failure to allocate or appropriate funds, and/or change in applicable laws or regulations, upon thirty (30) days written notice. 23. FORCE MAJEURE: A "Force. Majeure Event" shall mean an act of God, act of governmental body or military authority, fire, explosion, power failure, flood, storm, hurricane, sink hole, other natural disasters, epidemic; riot or civil disturbance, war or terrorism, sabotage, insurrection, blockade, or embargo. In the event that either party is delayed in the performance of any act or obligation pursuant to or required by the Agreement by reason of a Force Majeure Event, the time for required completion of such act or obligation shall be extended by the number of days equal to the total number of days, if any, that such party is actually delayed by such Force Majeure Event, The party seeking delay in performance shall give notice to the other party specifying the anticipated duration of the delay, and if such delay shall extend beyond the -duration -specified in -such- notice, —additional notice -shall be -repeated no_less_than monthly so long as such delay due to a Force Majeure Event continues, Any party seeking delay in performance due to a Force Majeure Event shall use its best efforts to rectify any condition causing such delay and shall cooperate with the other party to overcome any delay that has resulted. 24. CITY NOT LIABLE FOR DELAYS: Provider hereby understands and agrees that in no event shall the City be liable for, or responsible to Provider or any subcontractor, or to any other person, firm, or entity for, or on Employee Benefit Dental Plan 255 19 • account of, any stoppages or delay(s) in work herein provided for, or any damages whatsoever related thereto, because of any injunction or other legal or equitable proceedings, or on account of .any delay(s) for any cause over which the City has no control. 25, USE OF NAME:: Provider understands and agrees that the City is not engaged in research for advertising, sales promotion, or other publicity purposes. Provider is allowed, within the limited scope of normal and customary marketing and promotion of its work, to use the general results of this project and the name of the City. The Provider agrees to protect any confidential information provided by the City and will not release information of a specific nature without prior written consent of the City Manager or the City Conunission. 26. NO CONFLICT OF INTEREST; Pursuant to City of Miami Code. Section 2-611, as amended ("City Code"), regarding conflicts of interest, Provider hereby certifies to City that individual member of Provider, no employee, no subcontractor under this Agreement nor any immediate family member of any of the same, is also a member of any board, commission, or agency of the City. Provider hereby represents and warrants to the City that throughout-the-teem-o-f-this-A.gteement, Provider,.its employees and its subcontractors will abide by this prohibition of the City Code. 27. NO THIRD -PARTY BENEFICIARY: No persons other than the Provider and the City (and their successors and assils) shall have any rights whatsoever under this Agreement. 28. SURVIVAL: All obligations (inclu.ding but not limited to indemnity and obligations to defend and hold harmless) and rights of any party arising during or attributable to the period prior to expiration or Employee Benefit Dental Plan 256 20 earlier termination of this Agreement shall survive such expiration or earlier termination. 29. TRUTH: -IN -NEGOTIATION CERTIFICATION, REPRESENTATION AND WARRANTY: Provider hereby certifies, represents and warrants to City that on the date of Provider's execution of this Agreement and so long as this Agreement shall remain in full force and effect, the wage rates and other factual unit costs supporting the compensation to Provider under this Agreement are and will continue to be accurate, complete, and current. Provider understands, agrees and acknowledges that the City shall adjust the amount of the compensation and any additions thereto to exclude any significant sums by which the City determines the contract price of compensation hereunder was increased due to inaccurate, incomplete, or non -current wage rates and other factual unit costs. All such contract adjustments shall be made within one (1) year of the end of this Agreement, whether naturally expiring or earlier terminated pursuant to the provisions hereof. 30. COUNTERPARTS: This Agreement may be executed in three or more counterparts, each of which shall eonstitute an original but -all -Of -which, when taken-togeilier—shall-constitute-ane-and-the same agreement. 31. ENTIRE AGREEMENT: This instrument and its attachments constitute the sole and only agreement of the parties relating to the subject natter hereof and correctly set forth the rights, duties, and obligations of each to the other as of its date. Any prior agreements, promises, negotiations, or representations not expressly set forth in this Agreement are of no force or effect. Employee Benefit Dental Plan 257 21 IN WITNESS WHEREOF, the parties hereto have caused this instrument to be executed by their respective officials thereunto duly authorized, this the day and year above written. "City" CITY OF MIAMI, a municipal ATTEST: corporation By: Todd Hannon, City Clerk Daniel J. Alfonso, City Manager ATTEST: Frhit Name: Title: (Corporate Seal) "Provider" Cigna Health and Life Insurance Company By: (Authorized Corporate Officer) ATTEST: Print Name: Title: (Corporate Seal) Cigna Dental Health of Florida, Inc, By: (Authorized Corporate Officer) Employee BencEt Dental Plan 258 22 APPROVED AS TO LEGAL FORM APPROVED AS TO INSURANCE AND CORRECTNESS: REQUIREMENTS: Victoria Mendez City Attorney Ann Marie Sharpe Acting Risk Management Director Employee Benefit Dental Plan 259 23 ,CORPORATE RESOLUTION ION WHEREAS, Cigna Health and Life Insurance Company/Cigna Dental Health of Florida, Inc., a Florida. corporation, desires to enter into an agreement with the City of Miami for the purpose of performing the work described in the contract to which this resolution is attached; and WHEREAS, the Board of Directors at a duly held corporate meeting has considered the matter in accordance with the bylaws of the corporation; This Resolution needs to authorize the signatory to sign Employee Benefit Dental Plan 260 24 EXHIBIT A REQUEST FOR PROPOSAL (RFP) AND SCOPE OF WORK See Attached Employee benefit Dental Plan 261 25 EXHIBIT B PROVIDER'S PROPOSAL AND RESPONSE TO RIP See Attached Employee Benefit Dental Plan 262 26 EXIIIBIT C INSURANCE PLAN DOCUMENT See Attached Employee Benefit Dental Plan 263 27 EXHIBIT D COMPENSATION See Attached Einployee Benefit Dental Plan 264 28 EXHIBIT E INSURANCE REQUIREMENTS I. Commercial General Liability A. Limits of Liability Bodily Injury and Property Damage Liability Each Occurrence $1,000,000 General. Aggregate Limit $2,000 000 - — Personal and Adv. Injury $1,000,000 Products/Completed Operations $1,000,.000 B. Endorsements Required City of Miami included as an Additional Insured II< Business Automobile Liability A. Limits of Liability Bodily Injury and Property Damage Liability Combined Single Limit Owned/Scheduled Autos Including Hired, Borrowed or Non -Owned Autos Any One Accident $1,000,000 B. Endorsements Required City of Miami included as an Additional Insured IIL Worker's Colx;!pensation Limits of Liability Statutory -State of Florida Waiver of Subrogation. IV. Employer's Liability A. Limits of Lability $100,000 for bodily injury caused by an accident, each accident $100.,000 for bodily injury causedby disease, each employee $500,000 for bodily injury caused by disease, policy limit Employee Benefit Dental Plan 265 29 V. Professional Liability/Errors and Omissions Coverage Combined Single Limit Each Claim $1,000,000 General Aggregate Limit $1,000,000 Deductible- not to exceed 10% The above policies shall provide the City of Miami with written notice of cancellation or material change from the insurer not less than (30) days prior to any such cancellation or material change. Companies authorized to do business in the State of Florida, with the following qualifications, shall issue all insurance policies required above: The company must be rated no less than "A" as to management, and no less than "Class V" as to Financial Strength, by the latest edition of Best's Insurance Guide, published by A.M. Best Company, Oldwick, New Jersey, or its equivalent. All policies and /or certificates of insurance are subject to review and verification by Risk Management prior to insurance approval. Employee Benefit Dental Plan 266 30 EXHIBIT F CORPORATE RESOLUTIONS AND EVIDENCE OF QUALIFICATION TO DO BUSINESS IN FLORIDA (To be provided upon document execution) Employee Benefit Dental Plan 267 31 THIS IS A SAMPLE CONTRACT PROVIDED FOR REVIEW PURPOSES ONLY Administrative Services Only Agree By and Between. Account Legal "Emplq Cigna Health a ife In nce Company Eff Effective Date THIS AGREE „D ITS TERMS ARE PROPRIETARY AND CANNOT BE DISCLOSED WITHOUT THE PERMISSION OF EACH OF THE PARTIES 268 Table of Contents Definitions 3 Section 1. Term and Termination of Agreement 4 Section 2. Claim Administration and Additional Services 4 Section 3. Funding and Payment of Claims 5 Section 4. Charges 6 Section 5. Enrollment and Determination of Eligibility 6 Section 6. Claim Audits and Confidentiality. 7 Section 7. Plan Benefit Liability 8 Section 8. Modification of Plan and Charges ,...... 8 Section 9. Modification of Agreement 8 R., Section 10. Laws Governing Agreement 9 Section 11. Information in CHLIC Processing Syste s ,.... .4 9 Section 12. Resolution of Disputes9 ,,.,,,,,,� • 04040 10 ,,,,,,,,, .414,10 10 Section 15, Headings 10 P Section 16, Severability 10 Section 17, Force Majeure , ,,,,,,,,,,,,, 10 Section 18, Asslgninent and Subcontracts r r 10 Section 19. Notices 11 Section 20. Identifying Info ® � . trite iet Us: 11 SIGNATURES12 Schedule of Financial Charges 13 Exhibit A - Plan ' o klet 35 Exhibit B — Service . 36 Exhibit C — Claim A di A `s ement (Samle) 53 Exhibi D Privacydde u, :.', 56 Exh l Condition aim/Sub , gation Recovery Services 62 E ibit FCalifornia transfer Addendum to ASO Agreement 64 Section 13, Third Party Beneficiaries Section 14, Waivers 269 Client Name: SAMPLE ASO AGREEMENT Administrative Services Only Agreement THIS AGREEMENT, effective Effective Date (the "Effective Date") is by and between Account Legal Name ("Employer") and Cigna Health and Life Insurance Company ("CHLIC"). RECITALS: WHEREAS, Employer, as Plan sponsor, has adopted the benefit described in Exhibit A, as may be amended, ("Plan") for certain of its employees/members and their eligible dependents (collectively "Members"); and WHEREAS, Employer has requested CHLIC to furnish certain administration services in connection with the Plan Account Number NOW, THEREFORE, in consideration of the mutual promises and covenants co follows: Definitions Agreement — this entire document including the Schedule of Finan Charges and all Exhi Applicable Law —means the state, federal and international 1 but is not limited to the Employee Retirement Income Secu thereunder ("ERISA"), the Health Insurance Portabilii regulations thereunder ("HIPAA"), the Foreign Cor corruption laws in the countries where the Parties Bank Account — a benefit plan account with a ba its or a nominee's name. ERISA — the Employee Retirement d regns th a e ility Ac t ("FCPA" ned herd n, it is hereby agreed as hat appl Applicable Law includes nded • the rules and regulations as amended and the rules and d any other anti -bribery or anti- ALct,,iestablished and maintained by Employer in s amended and related regulations. Extra -Contractual Benefits — Paymentswaich E r has instructed CHLIC to make for health care services and/or products that CHLIhas determined a enot covered under the Plan. Member — a person eligibletfara T' o led in th1an as an employee or dependent. Participant/Par ieipating Me er — Mem • ) who is (are) participating in a specific program and/or product available to Members • eit Plan. Partici at CHLIC to p der ®- • vider nf health care services and/or products, who/which contract directly or indirectly with or products to Members. Plan Benefits — Amounts pay }le for covered health care services and products under the terms of the Plan. Party/Parties — refers mployer and CHLIC, each a "Party" and collectively, the "Parties". Plan Year — the twelve (12) month period, beginning on the Effective Date and, thereafter, each subsequent twelve (12) month period. Run -Out Claims — claims for Plan Benefits relating to health care services and products that are incurred prior to termination of this Agreement; termination of a Plan benefit option or termination of eligible Members, as applicable. 11/04/2014 3 270 Client Name: SAMPLE ASO AGREEMENT Administrative Services Only Agreement Section 1. Term and Termination of Agreement This Agreement is effective on the Effective Date and shall remain in effect until the earliest of the following dates: i. The date which is at least sixty (60) days from the date that either Party provides written notice to the other Party of termination of this Agreement; ii. The effective date of any Applicable Law or governmental action which prohibits performance of the activities required by this Agreement; iii. The date upon which Employer fails to fund the Bank Account as required by Ftlisgreement or fails to pay CHLIC any charges identified in this Agreement when due provided CHLIC n 'ies Employer of its election to terminate; iv. Any other date mutually agreed upon by the Parties. The following provision v. will be included only if a 36-month PBM is purchased: v. Notwithstanding the foregoing, all provisions in this Agreement re. n c nably related to C Plan's Pharmacy Benefit (as such term is defined in the Sche.R. financial Char Provisions"), shall continue in effect for no less than thirty-six (3. j the commen except that, if any of the following dates occurs, the Pha nefit isions wil such date: a. The effective date of any Applicable La activities in connection with the Pharm b. The date upon which Employer fails to under the Pharmacy Benefit or fails to p identified in this Agreement when due, pi Pharmacy Benefit Provisiot c. The date that is sixty (60) day ft the other Party (the "defaulting p , Benefit (other tlra failure to fund Section l.v.b ab reasonable time fo o ,that-.init stration of the harmacy Benefit fig on the Effective Date, ase being in effect as of 1 action ' _ prohibits performance of the ed by this Agr ement; he Ba ount as required by this Agreement for claims C any c ,; n connection with the Pharmacy Benefit HLIC no ies Employer of its election to terminate the ne Pa i ' ("non -defaulting party") of the material breach by ial obligation of the defaulting party related to the Pharmacy ,Bank Account or failure to pay any charges when due pursuant to t is not curedt ,the, reasonable satisfaction of the non -defaulting party within a • al note o if breach. During such trty-six (36) on 3 eriod c porter period, as applicable under (a), (b) or (c) above), CHLIC will continue t 'be$th exclusive pr ;v ider of Pharmacy Benefit administration services for the Plan's Pharmacy Benefit. The follof applies: In the evef paragraphh will be 'hided only if a 36-month PBM is purchased and an early termination, fee mplo a puiports to terminate such arrangement or enters into an agreement with another pharmacy benefit manager PBM") or other third party to provide any or all pharmacy benefit management services for Employer's l efit ;'i prior to the end of such thirty-six (36) month period, then, within thirty (30) days of CHLIC's written req, st, Employer shall pay CHLIC the amount of $XX.XX per the average monthly number of Members who were enrolled in the Plan's Pharmacy Benefit from the beginning the thirty-six (36) month period to the effective date of such purported termination or other agreement multiplied by the number of months remaining until the end of the thirty-six (36) month. period. Section 2. Claim Administration and Additional Services a. While this Agreement is in effect, CHLIC shall, consistent with, the claim administration policies and procedures then applicable to its own health care insurance business (i) receive and review claims for Plan Benefits; (ii) 11/04/2014 4 271 Client Name: SAMPLE ASO AGREEMENT Administrative Services Only Agreement determine the Plan Benefits, if any, payable for such claims; (iii) disburse payments of Plan Benefits to claimants; and (iv) provide in the manner and within the time limits required by Applicable Law, notification to claimants of (a) the coverage determination or (b) any anticipated delay in making a coverage determination beyond the time required by Applicable Law. b. Following (i) termination of this Agreement, except pursuant to Section 1 (iii); (ii) termination of a Plan benefit option or (iii) termination of eligible Members, if the required fees have been paid in full, if any, CHLIC shall process Run -Out Claims for the applicable Run -Out Period (Refer to Schedule of Financial Charges for applicable fees and Run -Out Period). At the termination of any applicable Run -Out Period, C IC shall cease processing Run -Out Claims and, subject to the requirements of Section 6.b, make all relevant r, i! ° spin its possession relating to such claims reasonably available to Employer or Employer's designee. C ry IC is ot required to provide proprietary information to Employer or any other party. c. Employer hereby delegates to CHLIC the authority, responsibility and discretion incoverage. under the Plan based on the eligibility and enrollment information provided to CHLIC by Em • . -r. Employ also hereby delegates to CHLIC the authority, responsibility and discretion to (i) make factual dete . tion d to interpret the provisions of the Plan to make coverage determinations on for Plan Benefits, (i e :: ct a full and fair review of each claim which has been denied as required by ERI; i) decide level, one andatory appeals of : ,� Urgent Care Claims" "Concurrent", Pre -service and - ervic laims (as the terms are defined under ERISA) and notify the Member or the Member's aut ; ze entatti of its de ion. Employer will ensure that all summary plan description materials provid emb effect thistle . tion. d. In addition to the basic claim administrative d administrative duties agreed upon by the P Agreement shall be provided by CHLIC on air# Section 3. Funding and Payment of Claims ve, CHLIC hall also perform the Plan -related d in Exhibit B. All services identified in this ss otherwise agreed to in writing by CHLIC. a. Employer shall establish a Banikc end ma% stain in= lank Account an amount sufficient at all times to fund checks written on it for the folio "Bp k Account Payments"): (i) Plan Benefits; (ii) those charges and fees identified in the Schedule of Fin Charges as payable through the Bank Account and (iii) any sales or use taxes, or a milar benefit- o ` :an -related charge or assessment however denominated, which may be imposed by any gover� :.uthority. Ba ccount Payments may include without limitation: (i) fixed per person payments and pa ance inincentive payments to Participating Providers; (ii) amounts owed to CHLIC; an . iii) amountsiliates and/or subcontractors for, among other things, network access or in- an f network :,e h care svices/products provided to Members. CHLIC may credit the Bank Accou . with pa ~ ments due Ty, ployer under a stop loss policy issued by CHLIC or an affiliate. b. CHLI t a en orthe mp .r, shall make Bank Account Payments from the Bank Account, in the amount CHLICo be proper under the Plan and/or under this Agreement. c. In the event that sufficien ' ands are not available in the Bank Account to pay all Bank Account Payments when due, CHLIC o process claims for Plan Benefits including Run -Out Claims. d. CHLIC will promp1l adjust any underpayment of Plan Benefits by drawing additional funds due the claimant from the Bank Account. In the event CHLIC overpays a claim for Plan Benefits or pays Plan Benefits to the wrong party, it shall take all reasonable steps to recover the overpayment; however, CHLIC shall not be required to initiate court, mediation, arbitration or other administrative proceedings to recover any overpayment. CHLIC shall not be responsible for reimbursing any unrecovered payments of Plan Benefits unless made as a result of its gross negligence or intentional wrongdoing. 11/04/2014 5 272 Client Name: SAMPLE ASO AGREEMENT Administrative Services Only Agreement e. Employer shall promptly reimburse CHLIC for any Bank Account Payments paid by CHLIC with its own funds on Employer's behalf and no such payment by CHLIC shall be construed as an assumption of any of Employer's liability. f. Following termination of this Agreement, Employer shall remain liable for payment of all due Bank Account Payments and for all reimbursements due Members under the Plan. This Section 3 shall survive termination of this Agreement. Section 4, Charges a. Charges. CHLIC shall provide to Employer a monthly statement of all charges l mployer this Agreement that are not paid as Bank Account Payments. Payment of alti(1e_= charge day of the month, as indicated on the monthly statement. Payments received a the which they are due, shall be subject to late payment charges, from the due date at a one (1) year Treasury constant maturities rate for the first week enr�ding in January p purposes of calculating late payment charges, payments receivec1 ill be applied first t amount due. CHLIC may reasonably revise the methodology for c $.ating late paytf ent c days' advance written notice to Employer. b. Member Changes —Additions and Terminations. If day of the month, full charges applicable to that does not start or ceases on or before the fifteenth(15th) that Member for that month. c. Retroactive Member Changes and Tereuinatio Account Payments incurred or charged through change or termination of Membe i • . Howev" charges, CHLIC shall credit to. " : redo period preceding the date CHLIC prod to the date CHLIC processes the notice. This Section 4 shall surviv nation of this A = ement. Section 5. Enrollment and deter igibility a, b. fectiv e for tha onth for a st day o culated eve peck obligated to pay under 1 be due on the first he month in follows: the e nt (5%). For est outstanding ges upon thirty (30) r before the fifteenth (15th) er for that month. If coverage mber, no charges shall be due for e ain responsible for all charges and Bank i cessed Employer's notice of a retroactive or termination would result in a reduction in rfges charged for the shorter of (a) the sixty (60) day he period from the date of the change or termination �beminations ,: d Information. Employer is responsible for administering Plan enrollment. In ing any person's rigtto benefits under the Plan, CHLIC shall rely upon enrollment and eligibility he E p`oyer. Such information shall identify the effective date of eligibility and the lit and shall be provided promptly to CHLIC in a format and with such other may be required by CHLIC for the proper administration of the Plan. withstanding any inconsistent provision of this Agreement to the contrary, if Employer, fails to provide CH C with accurate enrollment and eligibility information, benefit design requirements, or other agreed -upon information in CHLIC's standard timeframe and format, CHLIC shall have no liability under this Agreement for any act or omission by CHLIC, or its employees, affiliates, subcontractors, agents or representatives, directly or indirectly caused by such failure. c. Reconciliation of Eligibility and Information and Default Terminations. CHLIC will periodically share potential discrepancies in eligibility information with Employer. Employer will review and reconcile any discrepancies within thirty (30) days of receipt. If Employer fails to timely do so, CHLIC may terminate coverage for any Member not listed as eligible in Employer's submitted eligibility information. Eligibi deter inform io • u� terminate te, • e r. information as reasonabl Release of Liabilf v . 11/04/2014 6 273 Client Name: SAMPLE ASO AGREEMENT Administrative Services Only Agreement Section 6. Claim Audits and Confidentiality a. Claim Audit. Employer may, in accordance with the following requirements and at no additional charge while this Agreement is in effect, audit CHLIC's payment of Plan Benefits subject to the following conditions: i. Employer shall provide to CHLIC a scope of audit letter and the fully executed Claim Audit Agreement, a sample of which is attached hereto as Exhibit C, together with a forty-five (45) day advance written request for audit. Employer will designate with CHLIC's consent, such consent not to be unreasonably withheld, an independent, third party auditor to conduct the audit (the "Auditor"). In additio :employer and CHLIC will agree upon the date for the audit during regular business hours at CHLIC' -offie(s). Employer shall be responsible for its Auditor's costs. The audit shall be conducted in acco ance with he twins of CHLIC's Claim Audit Agreement, which is hereby agreed to by Employer and wh10 a l be sig ,cl by the Auditor prior to the start of the audit. ii. If Employer has five thousand (5,000) or more employees who a e Members, Empl ay c . duct one such audit every Plan Year (but not within six (6) months of a p'= udit); otherwise, Emp ."e ay conduct one such audit every two (2) Plan Years (but not within eighteen months of a pr or au� iii. Auditor will review payment documents (subject t relating to a random, statistically valid sample prior Plan years and not previously audited. If the a will be made in accordance with this A • AIment a statistical projections or extrapolations. b. Confidentiality i. Subject to the requirements of Exhibit D, a signed Business Confidentiality Agreement between claims and Plan Benefit payment info may release copies L etary informat Information") to the e /or its de Confidential Informati ,,nformations er i°solely resp ation provided by C Partici - ng Provider agreements) twenty20) claims paid during the two es any clan e justments, any such adjustments upon the aotial claims reviewed and not upon he to of this Agreement and the Privacy Addendum in ent b® een Employer and its designee, and a signed 1ica6le designee; CHLIC shall release copies of confidential tion in C ILIC's claims system ("Confidential Information") and nelating to the Plan in CHLIC's claims system ("Proprietary ees. Employer agrees that. Employer and its designees will keep *formation confidential and will use Confidential Information and y for thpurpose of administering the Plan or as otherwise required by law. sible for the consequences of any use, misuse, or disclosure of Confidential IC pursuant to this paragraph b. ii. CHLIi1ti i'`antam%S confidentiality of all Protected Health Information in its possession in accordance with the Privacy Addendunn Exhibit D and any applicable state privacy laws, including, without limitation, 201 CMR 17.00!Iassausetts Standards for the Protection of Personal Information of Residents of the Commonwealt c. Upon termination of this Agreement and subject to the provisions of Section 6.b above, CHLIC shall make information available, to the extent administratively feasible, if the Parties agree upon the charge to be paid by Employer. The obligations set forth in this Section 6 (b), shall survive termination of this Agreement. 11/04/2014 7 274 Client Name: SAMPLE ASO AGREEMENT Administrative Services Only Agreement Section 7. Plan Benefit Liability a. Employer Liability for Plan Benefits. Employer is responsible for all Plan Benefits including any Plan Benefits paid as a result of any legal action. Employer is responsible for reimbursing CHLIC, its directors, officers and employees for any reasonable expense incurred (including reasonable attorneys' fees) by them in the defense of any action or proceeding involving a claim for Plan Benefits. CHLIC shall reasonably cooperate with Employer, in its defense of such actions. If Employer directs CHLIC in writing to pay a claim for Extra -Contractual Benefits ployer is responsible for funding the payment and such payments shall not be considered in determining rei taurse ents or payments under stop loss insurance or in determining any risk -sharing or performance guarante-" eimbursbnients. Employer shall reimburse CHLIC for any liability or expenses (including reasonable a fees) LIC may incur in connection with making such payments. b. Employer Liability for Plan -Related Expenses. Employer shall reir nurse CHLIC for a ` ount CI1L1C may be required to pay (i) as state premium tax or any similar Plan -relate Vic charge, surcharge or ent, or (ii) under any unclaimed or abandoned property, or escheat law, with res ect t an Benefits and ny p ° alties and/or interest thereon. The following provision c. will only be included if the c. Alternative Litigation Management Option. Prior t payment by Employer of the associated addition "Clam: Charges, Employer may elect to have CHLIC; action and bear the legal expenses associated in dispute. This option does not extend to action Contractual Benefits. Each Party will provide defense of the action unless a p onflict o contravene the explicit terms f 7 an E determined due under the Plan and an° The reimbursement oblig Section 8. Modification o ume respoia ending a, �e t Emplo atictti jthe othe agent tiro purchased: of each P i i e, r, and contingent upon timely on Charge" s (forth in the Schedule of Financial lity for the management of any claim -related legal Ma ction so long as CHLIC processed the claim(s) x dror CI ILIC related to the payment ofExtra- f any action and will fully cooperate in the s. Nothing in this paragraph (c) shall be read to Toyer 11 remain responsible for payment of any benefits nalties assessed in connection with the action. s set forth in this'ection 7 s all survive termination of this Agreement. harges a. CHLIC s1La ave the righ vise the identified in this Agreement (i) on the first anniversary of this AgreemOt an any time t eafter by giving Employer at least sixty (60) days' prior written notice, but not more frequently than once in a twel (12) month period, (ii) upon any modification or amendment of the benefits under the Pla _ariati f fifteen percent (15%) or more in the number of Members used by CHLIC to calculate i s ha es uncler this Agreement, and/or (iv) upon any change in law or regulation that materially impacts CHLIC's liabilities and/or responsibilities under this Agreement. b. Employer shall provide CHLIC written notice of any modification or amendment to the Plan sufficiently in advance of any such change as to allow CHLIC to implement the modification or amendment. Employer and CHLIC shall agree upon the manner and timing of the implementation subject to CIILIC's system and operational capabilities. Section 9. Modification of Agreement This Agreement constitutes the entire contract between the Parties regarding the subject matter herein. Except, as otherwise provided herein, the provisions of this Agreement shall control in the event of a conflict with the terms of any other agreements. No modification or amendment hereto shall be valid unless in writing and signed by an authorized person of each of the Parties, except that modification of charges pursuant to Section 8 above may be made by written 11/04/2014 8 275 Client Name: SAMPLE ASO AGREEMENT Administrative Services Only Agreement. notice to Employer by CHLIC. If Employer pays such revised charges or fails to object to such revision in writing within fifteen. (15) days of receipt, this Agreement shall be deemed modified to reflect the charges as communicated by CHLIC. Section 10. Laws Governing Agreement a. This Agreement shall be construed in accordance with the laws of the State of Connecticut without regard to conflict of law rules, and both Parties consent to the venue and jurisdiction of its courts. b. The Parties shall perform their obligations under this Agreement in conformane y 11 Applicable Laws and regulatory requirements. Section 11. Information in CHLIC Processing Systems CHLIC may retain and use all Plan -related claim and Plan Benefit payment informati-corded fcr otherwise integrated into CHLIC's business records including claim processin stems during the o course of business (provided, however, that claim or payment information will be aval• ~ o Employer puruan ction 6). CHLIC will retain claim and payment information as required by Applicable m Section 12. Resolution of Disputes It is understood and agreed that any dispute betwee h . ".rties sing fromE elating to the performance or interpretation of this Agreement ("Controversy" . `f all be rs ® xclusively pz' suant to the following mandatory dispute resolution procedures: a. Any Controversy shall first be referred to an ex u cvel empl cif each Party who shall meet andconfer with his/her counterpart to attempt to resolve the disp to (` xeeutive Review") as follows: The disputing Party shall initiate Executive Review by givi other Party = oboe of the Controversy and shall specifically request Executive Review of said Contro e; c no , e. Wi in twenty (20) calendar days of any Party's written request for Executive Review, the receivin ` 11 su = it a written response. Both the notice and response shall include a statement of each Party'osition art a summary of the evidence and arguments supporting its position. Within thirt (330) calendar day f any Party's request for Executive Review, an executive level employee of each Party al i dcsignated by = Party to meet and confer with his/her counterpart to attempt to resolve the dispute. Eac ave full authority to resolve the dispute. b. In the eve . at a Contra has not een resolved within thirty-five (35) calendar days of the request of Execut. Revi z, under Se ion 12.a, above, the disputing Party shall initiate mediation by providing written notice the other Party, whi shall be conducted in Hartford, Connecticut, in accordance with the American Health u�yr a ationAlternative Dispute Resolution Service Rules of Procedure for Mediation ("Media rn w ac Paysh ° assume its own costs and attorneys' fees, and the compensation and expenses of the mediator and any administrative fees or costs associated with the mediation proceeding shallbe borne equally by the Parties. c. In the event that a controversy has not been resolved by Executive Review or Mediation, the Controversy shall be settledexclusively by binding arbitration. The arbitration shall be conducted in the same location as noted in Section 12.b. above, in accordance with the American Health Lawyers Association Alternative Dispute Resolution Service Rules ofProcedure for Arbitration, and which to the extent of the subject matter of the arbitration, shall be binding not only on all Parties to this Agreement but on any other entity controlled by, in control of or under common control with the Party to the extent that such affiliate joins in the arbitration, and judgment on the award rendered by the arbitrator may be entered in any court having jurisdiction thereof. Each Party shall assume its own costs and attorneys' fees, and the compensation and expenses of the arbitrator and any administrative fees or costs associated with the arbitration 11/04/2014 9 276 Client Name: SAMPLE ASO AGREEMENT Administrative Services Only Agreement proceeding shall be borne equally by the Parties. The decision of the arbitrator shall be final, conclusive and binding, andno action at law or in equity may be instituted by either Party other than to enforce the award of the arbitrator. d. The Parties intend this dispute resolution procedure described above to be a private undertaking and agree that an arbitration conducted under this provision will not be consolidated with an arbitration involving other plans administered in whole or in part by CHLIC or other Cigna Corporation affiliate, or third parties not parties to this Agreement. The arbitrator will be without power to conduct arbitration on a class or representative basis. The Parties waive their right to participate in a class action or representative proceeding. The arbitrator may award declaratory or injunctive relief only in favor of the individual party seeking relief and only to the extent necessary to provide relief warranted by that party's individual claim. All issues are for the arbitrator to decide, exc% e courts will decide those issues relating to the scope and enforceability of the arbitration provision. This Section 12 shall survive termination of this Agreement. Section 13. Third Party Beneficiaries This Agreement .is solely for the benefit of Employer and CHLICt shall not be cons relationship between CHLIC and any other party. Section 14. Waivers eate any legal No course of dealing or failure of either Party to strictly , right o ct on of this Agreement shall be construed as a waiver of such term, right or conditQn.by er Party o ny default shall not be deemed a waiver of any other default. Section 15. Headings Article, section, or paragraph headings, ontained in t A ent armor reference purposes only and shall not affect the meaning or interpretation of this xA T t. Section 16. Severability If any provision or any pad unenforceability shall not it Section 17 Force Maieure CHLIC ship not be liable for an tfailure to meet any of the obligations required under this Agreement where such failure to p o u any co ` �'gency beyond the reasonable control of CHLIC, their employees, officers, or directors. S clue e, but are not limited to, acts or omissions of any person or entity not employed or reasonably controlled by CHIC, their employees, officers, or directors, acts of God, fires, wars, accidents, labor disputes or shortages and governmental laws, ordinances, rules or regulations. rovision of its A vreement is held invalid or unenforceable, such invalidity or ender uneq ceable any other portion of this Agreement. Section 18. Assignmen`. and Subcontracting No Party may assign any right, interest, or obligation hereunder without the express written consent of the other Party; provided, however that CHLIC may assign any right, interest, or responsibility under this Agreement to its affiliates and/or subcontract specific obligations under this Agreement provided that CHLIC shall not be relieved of its obligations under this Agreement when doing so. 11/04/2014 10 277 Client Name: SAMPLE ASO AGREEMENT Administrative Services Only Agreement Section 19. Notices Except as otherwise provided, all notices or other communications hereunder shall be in writing and shall be deemed to have been duly made when (a) delivered in person, (b) delivered to an agent, such as an overnight or similar delivery service, (c) delivered electronically, or (d) deposited in the United States mail, postage prepaid, and addressed as follows: To CHLIC: Cigna Health and Life Insurance Company TBD To Employer: TBD The address to which notices or communications may be given by either Party may be c given by one Party to the other pursuant to this Section. Section 20. Identifying Information and Internet Usage Except, as necessary in the performance of their duties u. this Agrment, service marks, trademarks or other identifying infornkati x to est i)ish a link without its prior written approval. 11/04/2014 1.1 d by w ' n notice use the other's name, logo, other's World Wide Web site 278 Client Name: SAMPLE ASO AGREEMENT Administrative Services Only Agreement SIGNATURES THIS IS A SAMPLE AGREEMENT. THE SIGNATURE PAGE HAS BEEN INTENTIONALLY LEFT BLANK. 11/04/2014 12 279 Client Name: SAMPLE ASO AGREEMENT Administrative Services Only Agreement 00 Schedule of Financial Charges Certain fees and charges identified in this Schedule of Financial Charges will be billed to Employer mo e t ° y in accordance with CHLIC's then standard billing practices. However, CHLIC is authorized to pay all fees and charges from the Bank Acco nless oth ise specified in this Agreement. (Note: This document provides a sample of the various products/benefit options available. Only those p customer will be reflected in the final customer -specific Agreement. In addition, the charges and fees for servic at the time that this sample was issued. However, CHLIC reserves the right to revise the fee or these particular Effective Date of Cigna's administr of the plan.) I service `fined be es at are actually purchased by the re representative of those in place ect those which are current on the Medical Medical Vision • [Insert Medical Product] with PHS o$'HS • Benefit Advisor Fees [If Applicab i • Vision Care e , . al Managen $X.XX/employee/month I $X.XX/em ployee/month $X.XX/employee/month Vision Dental Dental • Benefit Advisor Fees [If Applicable [Insert Dental Product] • Benefit Advisor Fee Pharmacy Pharmacy Medical Dental • Standalone Pharmacy • Benefit Advisor Fees [If A • [Itaert Medical rod • Dental P ble ee et l AcceswFee $X.XX/employee/month SX.XX/employee/month $X.XX/employee/month $X.XX/employee/month $X.XX/employee/month $X.XX/employee/month $X.XX/employee/month Behavioral Health [If Applicable] Behavioral Health [If Applicable] 11/04/2014 contracts sitused ineolorado, an Administrative Charge for Mental Health/Substance Abuse ice ; noyl hfest' anagement programs, a cognitive behavioral modification program, a m e Ps c iatric ase Management program, and a Narcotics Therapy Management program, will be pr , essed through the Bank Account for all members with a Network Product. An Adm. istrativ 4 Charge for Mental Health/Substance Abuse Services, including lifestyle manageme ams, a cognitive behavioral modification program, a Complex Psychiatric Case Management ogram, and a Narcotics Therapy Management program, will be processed through the Bank Account for members residing in North Carolina with a Network Product. 13 $2.49/Member/month $2.56/Member/month Client Name: SAMPLE ASO AGREEMENT Administrative Services Only Agreement , teat7,1‹y' '4,-01%‘ " 4 .e-, i4, t',.,.. • NAtv.1,40., .,.. , , A ,, ,004,N00$00f, '' ' 7 , J.?.; Product0 i ,, 70,• ' '0,..2' 7700A „ 7, ;57:M-It'',t061t1 [If Applicable] • Cigna Choice Fund [Insert CCF Product] Administration 04,7, 7 A SX.XX/employeehnonth Health Advisor — A [If Applicable] The Health Advisor program focuses on engaging targeted Members ra f'O a variet3t9f o, b r:'A- wellness and prevention topics, and is designed to facilitate healthy behavior40.and pro achievement of health -related goals. The program includes4ae following compo. .‘, ,,%. ..., • • Health and wellness coaching on high blood pr- su71sskgh cholestero %, heajny eating, physical activity and pre -diabetes using multiple,coachirti&sions, behar ffiodffication techniques and other motivational intervie , - achir4, ft les to e 0 4Mage behavior change that helps Participants reach estayl : ed goal! -r,„,,, '' .. • Education and referral coaching on progffijyith r rral to appri3,.. te internal and external resources available 4 • Access to educational materials and ed Mem, ols and resources For [Insert CCF Produet(s)]: Included in Medical Access Fee • Identification of gaps in care and outre embers to :4 oaching for those identified with gaps for high cholesterol, high blood pre r 4 • Support of Participar;N entified th ,,,4 gh . ctiye modeling with certain preference sensitive care conditlo ying17. partT3Uidence based medical information, to empower Participants' to ;'4,:r ai Atenti , enefits/ disadvantages of a specific course of action and make more info .4 ed care' ions. • Answering ft. and medical re 4ed questions • Counseling II ' s on preven" 'fr and the benefits of compliance with prescribed medications at itrea ,,,„,,, [if Applicable] • [hisFsAJDFs.,* 'r c - 0 stration SX.XX/employee/month Healthy Future Account [If Applicable] _, Apikag , tion of Err( : oyer's HA thy Future Account which provides Participants with pre- 07 - ipk tterrnmed funds for nrticipation in the Healthy Future Medical Option. The funds will be *4.7, itj,_'f0,Fp.,ye,w4:,ar artici ,,N,, reaches the age of eligibility, years of service, retirement, or other by the Employer. SX.X.X/employee/month Healthy Awards Account [If Applicable] Administration of ployer's Healthy Awards Account which provides Participants with pre- determin reward:, or participation in one or more incentive programs. $X.XX/employee/month \77 11 /04/2014 14 Client Name: SAMPLE ASO AGREEMENT Administrative Services Only Agreement N co N Amounts paid by CHLIC with its own funds on behalf of Employer or the Plan with respect to charges under this Agreement including Plan Benefits, Bank Account Payments (including fix per per Participating Providers), governmental taxes or assessments Definitions • "Average Wholesale Price" or "AWP" is the Average Wholesale Price for a give, aceutical product i ct on the dispense date for the actual package size dispensed as published by Medi-Span or other alternative publication o chmark reaso =. bl esignated by CHLIC. • "Brand Drug Claim" is a claim for a pharmaceutical product that is adjudic bran . as indic. s on the claim record generated by the claim processing system used by CHLIC. For application of discounts and dis eising - "Bran g C = i " includes a claim for a generic drug within its exclusivity period or other period of limited competition, as CHLIC yel ably de es un standard policies. • "Generic Drug Claim" is a claim for a pharmaceutical product t is adj tech `s a generic •- g as indicated on the claim record generated by the claim processing system used by CHLIC. For application of dis is and di mg fees, a "Generic Drug Claim" excludes a claim for a generic drug within its exclusivity period or other period of limited competiti' CHLIC ably deteiiuines under its standard policies. • "Mail Service Phai niacy" or "Cigna Tel -Drug" or "Cigna Home IS ' harmac pharmacy that is owned or operated by CHLIC or an affiliated com an ies currentl Tel -Drug, Inc. and Tel-Dru• ofPenns lva L which enses drugs covered under the Plan's PharmacyBenefit bymail p Y( ) ( Y� g� Y un. �p g and is not a Retail Pharmacy. • "Pharmacy Benefit" means the terms of the Plan tha o :` e rake and p e/utilization management of drugs and related supplies dispensed to Members and charged to the Plan by the Mail Service P a ac • '1 Pharmacies through CHLIC's pharmacy claim processing system. • "Rebates" or "Manufacturer Formulary ayments" means unts tha HLIC collects under contracts with drug manufacturers that are based on utilization of certain of the manufacturer drugs under Pl 's Pharmacy Benefit and the drug's status on the Cigna drug formulary. • "Retail Pharmacy" is a pharmacy that is ent e • • 6 • ent under' Plan for drugs it dispenses that are covered under the Plan's Pharmacy Benefit, and is not a Mail Service Pharmacy. • "Specialty Drug Claim" is a c at for a ph a tical pro ct that is reasonably determined by CHLIC to be a specialty drug in accordance with industry practice. Speci igs enerally (i) inject d or infused and derived from living cells, or are oral non -protein compounds (e.g., oral chemotherapy drugs); (ii get the underlying c •<« dition, which is usually one of a relatively rare, chronic and costly nature; and/or (iii) require restricted access and/or close mon which Employer or the Plan is obligated to pay paymeri and pay -for -performance payments to 11/04/2014 15 Client Name: SAMPLE ASO AGREEMENT Administrative Services Only Agreement la • Cigna Pharmacy or Cigna Pharmacy Plus Product Administration Fee: $X.XX/employee/month q per script Drugs Dispen dispenaed'b,thc 11/04/2014 t ge Brand Drug Claims: AWP minus an average discount of_% plus an average dispensing fee o For Generic Drag Claims, choose o Generic Drug Claims: AWP minus an average discount of_% pl Generic Drug Claims: The drug's charge on a CHLIC generic discount across Generic Drug Claims dispensed at Cigna Horn plus an average dispensing fee across such Generic Drug For Specialty Brand Drag Specialty Brand Drug Claims: The drug's charge under a nana AWP for Specialty Drug Claims dispensed at C. 1Tome Dehvory P Drug Claims dispensed by Mail Service Phar a allowing opa ensing fee 44`, um Al gable Chdule that generates an annual average aggregate har,cy to CHLI . : oup-client book of business of AWP minus _% than $ d un 0 Specialty Brand Drug Claims: The drug's charge un a nail count schedule that generates a 13.7% annual average aggregate discount off AWP for Specialty DrugClaims dis ed at Cigna Homm elive Pharmacyacross CHLIC 's group -client book of business (includingSpecialty p tY �µ.� � �' �' p P �' Drug Claims dispensed by Mail Servi acy, whether ed under group -clients' Cigna Pharmacy Benefit or Cigna medical benefit). OR Specialty Brand Drug Claoff $ms: The dru s chaff ational discount schedule that generates a 15.6% annual average aggregate discount AWP for Specialty Drum s dispense igna Ho e Delivery Pharmacy across CHLIC 's group -client book of business (including Specialty Drug Claims dispens, by Matt Service P 1 nacy, whether covered under group -clients' Cigna Pharmacy Benefit or Cigna medical benefit). 16 free following options: le that generates a 11.8% annual average aggregate discount off loss CHLIC 's group -client book of business (including Specialty oup-clients' Cigna Pharmacy Benefit or Cigna medical benefit). Client Name: SAMPLE ASO AGREEMENT Administrative Services Only Agreement N 00 11/04/2014 eased %y a,1 ail Pha ae tot P do ,M be s sul c o Ehe ` Drlag� harge ; d do For Retail Brand Drag Claims, choose one of the two fol r viJg opti cs: Retail Brand Drug Claims: The lesser of (i) AWP minus the contracted discount plus the b . eted dis ing fee charged by the Retail Pharmacy for the Brand Drug Claim; or (ii) the Retail Pharmacy's usual and customary charge. OR Retail Brand DrugClaims: The lesser of(i)AWP minus an average discount o %oplus an ave° ' dis e ,Sri fee of $ - or u the Retail g p��� g .� ( ) Pharmacy's usual and customary charge. Retail Generic Drug Claims (other than those to which the above brand discount a Maximum Allowable Charge schedule that generates an annual av Pharmacies to CHLIC group -client book of business of AWP min dispensing fee across such Generic Drug Claims of no more th egate -specie e Retail less Hof. (i) the drug's charge on a CHLIC generic acre Generic Drug Claims dispensed at Retail ay vary based on drug mix), plus an average acy's usual and customary charge. For 1Retaail Specialty Brand Clem as, ", e one of the three following options: Retail Specialty Brand Drug Claims: The lesser of (i) A a s an ann erae aggregate discount of XX.X%, plus an average dispensing fee of no more than $X.XX; or (ii) the Retail Pharmacy's usu d a �, ; stomary ,°' a e. Retail Specialty Brand Drug Claims: The lei AWP Pharmacy for the Specialty Drug Claim; or (n) th Retail Specialty Brand Drug Clai s s: The lesser of (i fee of no more than $1.40; or (ii) the.. Pharmacy's us emus th ° . ted discount plus the contracted dispensing fee charged by the Retail 's usu, and customary charge. min °': annual average aggregate discount ofXX.X%, plus an average dispensing customary charge. 17 Client Name: SAMPLE ASO AGREEMENT Administrative Services Only Agreement ITN Cigna Home Delivery Pharmacy's discounts are applied to the manufacturer average wholesale price manufacturer -packaged quantity closest to the dispensed size, if there is no AWP for the dispen • The amount paid to the Retail Pharmacy for Brand, Generic, or Specialty Drug Claims may or may CHLIC will absorb or retain any difference. for the dispensed size (or to the AWP for the e mount charged to Employer, and i n anyother • An excess achieved in any Plan -specific discount floor or dispensing fee cap offered ender this Agreemen ° be wed to offset a shortfall n Plan -specific discount floor or dispensing fee cap offered under this Agreement. x Industry Changes to or Replacement of Average Wholesale Price (AWP). N tw Exhibit, in the event of any major change in market conditions affecting example, any change in the markup, methodologies, processes or algc charges, rates, discounts, guarantees and/or fees in connection with CHLI are based on AWP, as it reasonably deems necessary to preserve change. Additionally, and notwithstanding any other provis pharmaceutical pricing benchmark with an alternative benchmar /" may rep alternative benchmark with a different pricing source, provided that C adjust based charges as it reasonably deems necessary topreserve the ec omi ue replacement or immediately prior to the event(s) gI <., . such rplace e Network, Network OA, Network POS, Network POSOA, Vision Care Run -Out Period of twelve (12) PPO, EPO, OAP, OAPIN, LCP, LCPIN, Comprehensive, Base Plan, BP/MM, Wrap, Super/MM, DPPO, DEPO, Dental Indemnity 11/04/2014 Run -Out Period o G hall not be ed to p fees. nths ss Run -Out Claims until it has received full payment of ithst g any other P vision in this Agreement, including in this aceuti r pharma enefit management market, including, for lying the rs AWP(s), CHLIC may adjust any or all of the ation of th 's Pharmacy Benefit hereunder, including any that l` or benefit o Agreement as it existed immediately prior to such ent, including in this Exhibit, CHLIC may replace AWP as its e -Span, or other such publication as its source for the AWP or s r all such AWP-Based Charges or such alternative benchmark- o r.t enefit of this Agreement as it existed immediately prior to such s the case may be, re No Additional Cost 18 The sum of the last four (4) months of billed fees applicable to the terminated (i) Agreement, (ii) Plan benefit option or (iii) Members. Client Name: SAMPLE ASO AGREEMENT Administrative Services Only Agreement CO Pharmacy 11/04/2014 Run -Out Period of three (3) months for all pharmacy claims CHLIC shall not be required to process Run -Out Claims until it has receive the required fees. MaiRgf,' kaiAtf ' • • JP ,„ "4111"tr - ' „olittlitt Subrogation/Conditional Claim Payment. Identification, estigation and recoVt,t a payments involving other party liability or where another itity is responsi e f (including by way of example but not by limitation#' c .w 'bile insurance, horneon . commercial property insurance, worker's com Osatiii)A.'((This e is respect to Medical coverage). azfit't) ,-4424.1 19 claim payment er insurance, provided with The sum of the last three (3) months of billed fees applicable to the terminated (i) Agreement, (ii) Plan benefit option or (iii) Members. 5% of recovery plus litigation costs if counsel is retained and an appearance is filed on behalf of CHLIC or Employer in any litigation, or a lawsuit is filed on their behalf; 29% of recovery if no counsel is retained and in all other instances, including cases where state law requires that employee benefit plans be named as party defendants or involuntary plaintiffs. Client Name: SAMPLE ASO AGREEMENT Administrative Services Only Agreement f !} 4 r. ..,.,"���. .., .,.,. _�����...,mi�i�•S„a.4rfu, Atrt.0..a..m.W"x +,..z!' ,r CHLIC, a Cigna company, Plan. In administering these administers the following programs to contain costs with respect to charges fo n eal care service/supplies programs, CHLIC contracts with vendors to perform program related sere es. Specific vendor fees these programs is the percentage (indicated below) of either (1 , , t say'i.e. the difference made absent the program savings and the charge made as a result of the pft j , • 4 min s les . e p� g g P g� of the program savings) or (2) the "gross savings" (i.e. the difference b - the char ; that savings and the charge made as a result of the program savings. HLIC pays the ap. .le v- ®4a"or fee) applicable. services received from a non -Participating Provider (including e :- ncy/urgent c e s vices that are apply discounts available under agreements with s or t h negotia of the billed charges. Savings Program, Supplemental Network edit " Revie e pay ent). CHLIC charges Applying these discounts may result in art than if t ; imum reimbursable reimbursable charge may result in the pa'gilt beinb an Milled for thentire unreimbursed amount, substantially reduces the patient's out o ket cost or negotiated, reimbursement will be base to CHLIC's benefit enhancement policy — e p ':'; maxim ' reimbursable charge (in which case if the provider's charge - the plan max ;imbursable charge); or to CHLIC's benefit enhance depending on the Employer's election: of provider's billed charge no cee ea er of a CHLIC determined percentage of the 80th percentile of the reasonable and cu omary cpi e if there is no Medicare allowable charge) or the law (in the case - ergency room vice) for charges subject to CHLIC's benefit enhancement billed by the pro"o :. rovider's c ge exceeds such amount), or that are covered by the are available upon request between the charge applicable vendor fee which pP the provider would have or (3) the "recovery" (Le. covered at the in -network These programs are the percentage shown for charge is applied. Whereas applying these discounts the patient may be balance Medicare allowable amount amount required by state or policy (patient may be practices with respect to CHLIC's charge for administering that theprovider would have generally ranges from 7-11% made absent the program the amount recovered) as For charges for covered benefit level), CHLIC may identified below as the Network administering these programs. application of the maximum avoids balance billing and If no discount is available (i) If charges are not subject billed by the provider (ii) If charges are subject a. the amount (the federal, balance b. the provider's This billed charges for "' Providers is with the administration of charges svered servi non a is pating consistent claim administration CHLIC's own health care inst== . 'giness whe pplicable MEID1t AT AI=TARMAGI , ®SSG G4 '-AINNIE T ; 1. Ne gram 29% of net savings 2. Supp e 29% of net savings 3. Medical Bill Review I' re -payment Cost Containment for Non -contracted claims): Inpatient Itpita II Review 11/04/2014 20 Client Name: SAMPLE ASO AGREEMENT Administrative Services Only Agreement N co 00 • Line Item Analysis Lesser of 5% of hospital bill or the savings achieved • Professional Fee Negotiation W 29% of net savings fi Outpatient Hospital Bill Review • Professional Fee Negotiation 29% of net savings • Line Item Analysis Re -pricing 29% of net savings. Physician/Professional Bill Review • Professional Fee Negotiation 29% of net savings • Line Item Analysis Re -pricing 29% of net savings 4. Medical Bill Review — (Pre or Post -payment Cod ontain , for N tr ' ed and Contracted claims): . • Bill Audit 29% of the savings/recovery achieved plus hospital fees or expenses passed through Diagnosis Related Group' ai idatio°' udi" ecovery. An overpayment audit and recovery program in which CBI =- on '" o revie paid claim data to identify overpayments based on inaccurate G co w 29% of recovery plus any fees or expenses passed through g by the hospital or regulatory agency Inpatient Admission ,etr Review 29% of recovery Medical implant DeviAu 29% of recovery 5. COB V'l r Recoveri elusive pharmacy programs where claims are adjudicated at time pre - iption is' received ] , 29% of recovery 6. See ndary Vent c ecov ' P ogram 29% of recovery 7. Prop .. p' g e R very Program 29% of recovery 8. 29% of recovery Hith Cos pecialty - aceutical Audits jlf Applicable] 9. Pharmacy Vendor Reveries 30% of recovery 10. Class Action ies 35% of recovery 11/04/2014 21 Client Name: SAMPLE ASO AGREEMENT Administrative Services Only Agreement f pplicable] f Applicable] Dental Network Savings Program 135% of gross savings Dental Cost Containment 35 % of gross savings CHLIC arranges for third parties to provide care management services to: (i) contain the cost of specified health care services/ite insured and/or administered by CHLIC, and/or (ii) improve adherence to evidence based guidelines`desi efficient s atient care. overall with res to all ®i s to promote p tienafety and 00 Specific vendor fees and care management program services are available upon request. [If Applicable] 11/04/2014 Eligibility Overpayment Recovery Vendor S situations where the overpayment is due to e late rig service is only provided with respect to cal cove When a Member elects an External Rev determination by an independent third party, the nature and complexity o lue on ap related to new technology or e process a panel of reviewers may with the number of reviewers (usuall required to comple review. 010 ly one i cation ember te that te. a specs overy of funds in ion information. (This defined in ERISA) of a benefit third party review is dependent on y complex, non -routine cases or cases treatment, as part of the internal appeal arty review charges will be commensurate d), as well as their level of expertise and time Fixed per person per priod o o ervie charges for vision care services will be paid as claims and will ear in Employe star " `' ank Account activity data reports. Such payments will be at CI-ll 'cable fixed er person er period or fee -for -service charges then in effect, which may be mended from time to time. Some Vision services are provided by CHLIC and/or designated ve dapplicable r'� o Employer for this product and identity of the provider of vision servi available upon request. 22 29% of recovery $500-$4,000 Review All Vision Products Client Name: SAMPLE ASO AGREEMENT Administrative Services Only Agreement N co �,�" �" r l ��s w �r a � w � T�i{,� A�7: , 6.. *w " . ,» ,., a ,,a•,�s' ��„ J,. ,»„ „ n, „>;, , .. +r.. CHLIC contracts directly or indirectly with other managed care entities and t arty network vendors for access to their provider networks and discounts. These third ies c arge either a network access fee, which is included in CHLIC's monthly charges, or a p ,tentage o he savings realized on a claim by claim basis as a result of the application of their df • . Ch asedon percentage of savings are paid from the Bank Account. Additional details regard gWecific charges will be provided upon re uest All Medical Products Fixed per person per period and fee -for -service ch or various vendors other providers/arrangers of health care services and/or supplies will b'" "d as claims for. larenefits. In addition, performance -based payments to Participa vide ill be char _ to the Bank Account. Such payments will be at the payment s the ffect,'"''`' ma, e amended from time to time. Additional details regarding chard d the ide of the r provider of health care services will be made available upon r ,„ est. All Products �t y [If Applicable] Unless indicated otherwise in the Schedule ancial , CHLIC retains all payments it may receive from manufacturers of pharmaceuti v cts cove t: Eder the Plan. Information on the amount of such payments with respect to thelan -, , be pro ed upon request. All Pharmacy Products From time to time, CHLIC, rely • r throug 'ts e •arranges with third party parties (e.g., 4ryf service vendors, provider netw age provi arious services (e.g., cost -containment initiatives) in connection with the d it affiliates may receive payments from such third parties to help defray CHLIC's e . • enses as iated with the implementation and/or ongoing administration of 6 n:° arrangements. IC may also receive compensation from third -party vendors that Em • to 'n based u • a referral from CHLIC. All Products )$ „', ,,, „:, �a, o, s. 3�a�H*,,k'� .. �� ,°�', If Applicable] The foil ; 'ng PPACA e sessnie ' attributable to the Cigna Health Care of California group Network Products: • Network • Network Open Access • Network POS • Network POS/Open Access serve agr - ent that p ,. „ides in -network coverage for Participants in California: • ComparativeT-ffectiveness Research Fee ® Insure ins e Assessment 11/04/2014 23 Client Name: SAMPLE ASO AGREEMENT Administrative Services Only Agreement 1. Preparation of SBC, translation notice. CHLIC will not be responsible for any ch makes to the SBC. 2. 3. Third Party Stop Loss Interface Fee Lifestyle Management Program 11/04/2014 Provide SBC, translation notices prepared by CHLIC to updates or material modifications. Include in SBC a summary of benefits administered vendor provides CHLIC with necessary carve -out to the date the SBCs are to be delivered to Em1 The following se CHLIC will provide its st Employer have executed C standard reporting package is b claims, projected claims, pre-certifi prognosis is notf o�-d). ilab hat Empl er electronicall as No charge as any No charge r if Empl• ;r or carve -out (12) weeks prior e purchase: ge only after the stop loss carrier and ld hass/confidentiality agreement. CHLIC's data only (infoiivation on incurred -but -not -paid rage, case management, course of treatment or • Health Ste s o Loss : T e eight management Lifestyle Management Program offers assistanc to • ified through the results of a health risk assessment u ionnaire an r: e -enro = a'nt. This program offers Members a non -diet approach to eigoss that fo "ses on lon: -term lifestyle changes. The telephone coaching model offers one-to-one contact 'th a dedicated wellness coach who provides personalized, motivational durat of the program. For Participants who prefer to work individually, ms are available. The web -based program consists of online tools and articles email campaign. Both telephone and online options focus on changing oviding Participants with practical strategies to help them. pr with a support' behaviors an 24 $500 for each benefit option under the Plan for which carve -out vendor benefits are included in SBC ar $X.XX/employee/month $X.XX/employee/month Client Name: SAMPLE ASO AGREEMENT Administrative Services Only Agreement co Lifestyle Management Program e Cigna Quit TodaysM: The tobacco cessation Lifestyle Management Program offers assistance $X.XX/employee/month to Members identified through the results of a health risk assessment quest' ire and/or self - enrollment. This program provides interventions for all tobacco types all "ready to change levels" (even for Members not sure about quitting). The telephone c ing mo • offers one- to-one contact with a dedicated wellness coach who provides lized, , • ..ivati a nal support for the duration of the program. For Participants who prefer • • • ' individuly, web -based programs are available. The web -based program consists of onlin �", is and i es with a supporting email campaign. Both telephone an online options foc ch ' g behaviors and providing Participants with practical s egies to help them. Both s o alities include over the counter nicotine replacement therapy ch or gum) anoost to the Participant. Lifestyle Management 51i1 "' styleProgram Strength &Resilience :The stress m � emenf�� em : Pro am offers $X.XX/employee/month Program assistance to Members identified throughresults o -g ® ealth risk "`; ment questionnaire and/or self -enrollment. This program tovide ctic 4 ' solutions fo proving resilience to stress. The telephone coaching m " , offers o one contact with a dedicated wellness coach who provides personalized, onal supportor the duration of the program. For Participants who prefer to work indi d " . web-ba - ams are available. The web - " Both based program consists of online tools a d es with supporting email campaign. telephone and online .:t • - ocus on c: an fors and providing Participants with practical strategies to e • ,;; Behavioral Health Behavioral Care Advocacy s be ealtli services in which claims are funded on a $XXX/employee/month proms' fee -for -service basis. It includes used u ation review and case management for both inpatient and ou • •t, in -network b vioral health services. 11/04/2014 25 Client Name: SAMPLE ASO AGREEMENT Administrative Services Only Agreement Health Advisor — A 11/04/2014 The Health Advisor program focuses on engaging targeted Members related to a variety of wellness and prevention topics, and is designed to facilitate healthy beha ' and promote achievement of health -related goals. The program includes the following c ponents: • Health and wellness coaching on high blood pressure, high choleste activity and pre -diabetes using multiple coaching sessions, behavior and other motivational interviewing and coaching styles to encourage helps Participants reach established goals • Education and referral coaching on program topics with re al to appropriate intern resources available • Access to educational materials and web based Me • Identification of gaps in care and outreach to Me gaps for high cholesterol, high blood pressur • Support of Participants identified th sensitive care conditions by supplR. empower Participants' to understan of action and make more informed c • Answering health and medical relate • Counseling Participant .reventio medications and trea e 26 imp xotential. k isions ources ing for ealthy ea , physical n ttehni' ues for change .t xtemal identified with modeling certain preference ence based edical information, to ts/ disadvantages of a specific course its of compliance with prescribed $X.XX/employee/month Client Name: SAMPLE ASO AGREEMENT Administrative Services Only Agreement co Comprehensive Maternity Program Cigna Healthy Pregnancies, Healthy Babies program is a comprehensive mate . ' management program. The goal of the program is to reduce the number of pre -term and erweight babies by $X.XX/employee/month promoting a healthy pregnancy. The program delivers education and telep is suppo , to pregnant women through the post-partum period. Nurses answer medical r . e n questio d ake suggestions for behavior changes and medical interventions aimed at impro health o e mother and baby. Program support also covers preconception and infertility. ial incentives are awarded to women at the completion of this self -referral prram based on the tr r e ed. Members must enroll in the program by calling the phone . ber on the back o ember identification card. Incentives Elected: Grose one of the three aptio Option 1: $400 —1st Trimester/$200 — 2nd Tr' r Option 2: $250 — 1st Trimester/$125 — 2nd Tr e Option 3: $150 — 1st Trimester/$ 75 — 2nd rimeste Comprehensive Oncology Program The Cigna Cancer Support Program A e amdesi_ to deliver comprehensive oncology $X.XX/employee/month support targeting Members through all stag - • , cer; fro se ewly diagnosed, in post cancer 11/04/2014 27 Client Name: SAMPLE ASO AGREEMENT Administrative Services Only Agreement Clinical Program [Applicable to Cigna Pharmacy Products and Cigna Medical Products with PHS Plus Medical Management] Cigna TheraCare® Program — a targeted condition drug therapy management - am that targets Included at No Additional Cost individuals using specialty medications for certain chronic conditions a . elps them better understand their condition, medication side effects and importance of a nce. Your Health First A proactive health education and improvement program forte : bers with a chronic co it`on. The $X.XX/employee/month [Applicable to the 300 program involves services that span across the Member's aIt needs. Beh ivior coaching Program] principles and evidence based medicine guidelines aid ed to rt• e ize self-mm igement skills and foster sustained health improvements. The program targets a chronic population at highs mode , e risk for : s erm and future high cost medical expenses. Members are ident ed as h hronic condition through a variety of ` sources which may include: claims data, . ls, and entification. A variety of resources is provided to those with a chronic condition s ding access o online tools, personalized support, and targeted materials. The program includes the foliowi compon s fo e a chronic condition: • Chronic condition- f c e lam • Pre- and post-discharg is • Lifestyle management co ping: stres , weight management and tobacco cessation • Treatment • ' ion support aid : coaching In order to contmuou"' . asse iveness of the program and/or test new ideas to further engage Members aroun t hea small sample of Members may be placed in a comparison heir grou ' F"iicfor a define eriod of ' e receives alternative services or is suppressed from receiving pr ctive outreach, such . engagement letters and/or calls. This could affect a few Members tar ;r Turin liPs limited time period. 11/04/2014 28 Client Name: SAMPLE ASO AGREEMENT Administrative Services Only Agreement Well Being Coordinator Well Being Coordinator CHLIC shall provide to Employer Well Being Coordinator Services (" z' t ervices") described herein. Services will be restricted to health and wellness promoti ics and l exclude disease management. The following Services may be nldified in the profes jud -' ent of the Health Promotion Manager, as necessary to meet the specific needs of the E7 er and Eligible Participants Number of Well Being Coordinators: Number of hours per week: 40 Hours Days per week: Monday- Friday Location of Services (Employer work sit Well -Being Coordinatorer, Onsite Wellness Promotion 1. Lead Wellness Committe 2. Wellnes ducation Courses 3. Wellness ti.on Seminar 4. Wellness CCU 5. Wellness E ellness Resau 11/04/2014 6 s ations): 29 The cost of Well Being Coordinator is included in the Administration Fee. Fees shall include all travel costs for the Well Being Coordinator, including travel between Employer worksite locations in which the Well Being Coordinator will provide Services under the Agreement. Client Name: SAMPLE ASO AGREEMENT Administrative Services Only Agreement 1. Qualifications The Well -Being Coordinator will work closely with CHLIC's Account Management Team and Customer's Health and Wellness team in executing the organizations he manageent goals. The primary focus of the Well -Being Coordinator is health promotion. In collaboration, with the CHLIC account team, the Weil -Being Coordinator e , lutes the app riate delivery and coordination of wellness programs includi event scheduling ,. ap ,; ; ntment coordination, community and vendor programs, and mo effectiveness of the ; ams. The focus of the Well -Being Coordinator is the working we 1 po ion of employ es ggregate. A core objective of this position is to facilitate wellnes ,'� . s t ` ucate and i uence employees at the worksite to lead healthy lifestyles. 2. General Responsibilities 1. Lead Wellness Committee a. Lead the Formation of a gq-ss comet #`'e if one has not already been established and include different leve o a . foyer le 0 ~ and employees from the worksite b. Ongoing le. :.. of empl r wel<y s mmittee -alth c. Review the promo strategy with the wellness committee, partnering with i I fa ealt , and wellness as appropriate. The strategy will be developed by the IC a t team lead for health and wellness. 2. Collaborate ' o; ment and defy of promotion campaign a. New utter ,os emai `, raffles, weekly quiz, reminders, etc. b. Overa pr ; otic) N,e opment and deployment I 1 /04/2014 30 Client Name: SAMPLE ASO AGREEMENT Administrative Services Only Agreement CO General Responsibilities continued 3. Health Education Courses a. End to end coordination of educational courses b. Deliver single or multi -session workshops on a gro . lunch ea c. Develop or pull from defined list of wellness topics; may ed to population, season, etc. d. Education for various health related topics trition/healthy ea by ' activity, etc.) t; w 4. Wellness Campaigns a. Facilitate health related group a itie a ng po $ ion o a defined time period (walking groups, wei• ) s supp : groups,` b. Focus of campaign is life le h han improveme 5. Wellness Event/Fair a. Assist employer Human ces/Man - with coordination of event/fair o,y. 11/04/2014 31 Client Name: SAMPLE ASO AGREEMENT Administrative Services Only Agreement 4. Paid Time Off and Leave The Well -Being Coordinator shall be entitled topaid time off (PTO) and of Via. "heave ("Leave") in accordance with CIH,IC's standard policies and procedures ("Policies" , PTO shall include: (a) vacation days; (b) personal days; (c) holidays; (d) floating holidays; (e) ': leave; an ) other PTO in accordance with applicable law and current CHLIC Policies. Leave a' ude: taryleave; (b) Family Medical Leave (FMLA); 2 (c) disability leave; and (d) other le accordance with applicable law and current CHLIC Policies. CHLIC shall not be required to make any adjustments to Fe- or PTO and Leave gr • u - e Well - Being Coordinator. 5. Equipment Employer shall provide the following equipment, fps nec forth„ ell -Being Coordinator a. Office space of approximately 1200180 sq ee ith electrica cutlet b. Standard office furnishings (desl ' air, etc) c. Locking file cabinet. �F d. Telephone land line within Emplo er rk. e. Equipment and services necessary f,e e and e Tent wireless telephone connectivity. f. Dedicated Employe • •ee OR Op DS' 1 k:i g. Employer desktop compu te. , -o Emp ; er network , if Employer required h. Employer printer connecte Ito e ork, if Employer required CHLIC will prov el l ()Rowing equip and supplies necessary for Well -Being Coordinator yF a. CHLIC lapto an or co . ectivity to CHLIC network b. CIIILIC printe d - ppl CIC cell -phone 11/04/2014 32 Client Name: SAMPLE ASO AGREEMENT Administrative Services Only Agreement Telehealth Services Access to on line and on demand Telehealth services provided through M LIVE. MDLIVE physicians can diagnose, treat and, if appropriate, write prescriptions (nocontrollee Substances only) for routine medical conditions 24/7/365. $X.XX/employee/month Claim Litigation Claim Litigation Services $X.XX Flat Annual Amount Internet -Based Enrollment and Eligibility Management System CHLIC, either directly or through its affiliates, will grant to Employer ancip IS a nontransferable limited license to access an Internet -Based ment and Eligibility �;. . ement System to enable online enrollment for and selection of benefit . ducts and sere ces e outlined in the Choicelinx® Statement of Services. More spec i orma bout the pr ucts, services, charges, grant of license and applicable restrictio . e ar . le up uest. $X.XX/employee/month Medical Management RelayHealth Online Services $X.XX/employee/month MotivateMe® Incentives Program The MotivateMe incentive program allows unds to r individuals fctaking steps to achieve $X.XX/employee/month health goals or make progress towards im i g their h . Eligible individuals can earn rewards for active participation in achieving a he oal or ira 'ng their health in Cigna's health °: improvement programs and activities that fo s eventin ":' . style and behavior modification and disease management. Em - oyees track t it i 've ac ity online and earn rewards as has been designated per the F election" Reward types include: de Wheal hcare premium reductions (if incentive participation file isent to Employer dminis ion of reward). one of tie flowing program options: Base Pal age — includ -. a u mistr , - of Employer selected CHLIC standard Incentives Program whi ro s Particip , is with E ployer's pre -determined rewards for participation in the a combination of online Life style Management or Vielife coaching programs, a health risk assessment, biome ,o -_ d ace° . to self reported activities; or Value Package — includes administration of Employer selected CHLIC standard incentives Program which provi s Part ants with Employer's pre-deteunined rewards. This is in combination with Lifestyle Mana . nt and/or Vielife online coaching programs, a health risk assessment, biometric screening, access to self reported activities and telephonic coaching for progressing or achieving health goals in association with Your Health First and/or Integrated Personal Health Team clinical 11/04/2014 33 Client Name: SAMPLE ASO AGREEMENT Administrative Services Only Agreement programs; or Engage Package - includes administration of Employer selected CHLIC andard Incentives Program which provides Participants with Employer's pre -determine ewards. \This is in combination with Lifestyle Management and/or Vielife online coaching ams, al . aalth risk assessment, biometric screening, access to self reported activities, clinical a e, telephonic coaching, progressing or achieving health goals of biometric targets in associatiok h Your He First and/or Integrated Personal Health Team clinical progran , , or Custom Package - includes administration of Employer select provides Participants with Employer's pre-determ Lifestyle Management and/or Vielife online coachi screening, access to self reported activities, cl following; telephonic coaching, biometric gets, eligibility file feed requirements failing o + e of C i "" tandard incentive design in conjunction with any of its clinical combinations of YoTM' r th First, a th Advisor, Personal Health Team or Integrated Personal Health Team Programs Healthy Pregnancy, Health hies® Pa Employee's participating in 11/04/2014 age egnacy, 34 pro adhere wards. axis, a in I3LIC Incentives Pro am which is is in combination with hea with c sk ass ' ent, biometric ion of any of the g, rewar b. , aps, frequencies and s additional reward incentives for Babies® clinical program. o a ; a w co �+ O h O 0. r fa. O ,OY x 0 O" _ o ccep bw 'n'UV'ct ° P C• 'c3 lyt3 O N' . O O �s co "O C - W d0c,o 0::-.. ,o-- : - i L-'n° co:9 0 9 0 CD x C) C1 p O h�.� n= w `-. O '.3' c, Ix/ cl.co .a0 CD CD - }a P 0 w 4 ploog uI[d - y viatgx D 0 3CD - p1 CD cD U1 N cam ca co D O0 D6) t� �7 rn ccDD lil Client Name: SAMPLE ASO AGREEMENT Administrative Services Only Agreement Ai 0 w 2. 3. Exhibit B — Services oducts excluding dealt Furnishing CHL1C's standard Bank Account activity data reports to Employer as an• h eed o C t- IC's administration of the Plan does not include performing obligations, if any, under state at or uncla ` ed property laws. It is Employer's responsibility to determine the extent to which these laws m:. .ly to Ian and to comply with such laws. Report to Employer the claim payment information required in cone Revenue Code. If Employer has elected, pursuant to section 63 of the New Yor of the Public Health Law) ("the Act"), to pay the assessme consented to the conditions set forth in section 63, CHU assessment on covered lives on behalf of Employer throb Such obligation shall end immediately upon Employe fulfill this obligation, the failure to comply with any re the failure of Employer to properly fund the Bank Acco'i it. In addition, where permitted and agree Employer and/or the Plan any assessment, s Employer and/or the Plan based on covered 1 required by other applicable s e and/or federal 1 any such payments made by C All Products All Products All Products h the B PA 'lure to pr . U9 ent impo with Section eR lives s forms unt to the e: Internal Act of 19'a (section 2807-t trisection 63 and has such surcharge and ent set forth in section 63. e any information required by CHLIC to on Employer pursuant to the Act or C, C IC applicable forms and pay on behalf of her sar charge which is required to be made by 1 claims or otherwise in accordance with and as and reg"'ations and the Bank Account will be charged for 1. 2. 3. 4. 5. 6. 7. 11/04/2014 and/or elegy payments will ap`"oear in mployer's Calculate benefit c paym is disbursed from Employer's Bank Account. Bank Account andard Bank Account activity data reports. Prepare and m available, caLIC's s an hard claim forms. Investigate clai Discuss claims, when appropriate C's Special Investigations Unit. ith providers of health services. Perform, based on CHL1C's boolf business internal audits of plan benefit payments on a random sample basis. Claim control procedureslted annually in Statement on Standards for Attestation Engagements (SSAE) No. 16 Report (SAS70 successor report). Respond to Insurance Department complaints. 36 All Products All Products All Products All Products All Products All Products (excluding Vision) All Products Client Name: SAMPLE ASO AGREEMENT Administrative Services Only Agreement 8. 9. 10. 1. 2. 3. 1. 2. 3. 4. 1. 2. 3. 4. 11/04/2014 Dedicated toll -free telephone line for Member and Provider calls to CHLIC Service Centers. Member Explanation of Benefit ("EOB") statements including, when applicable, notice of • d claims, denial reason(s) and appeal rights. Verify enrollment and eligibility using Member information submitted by Employer aril /or its au rized agent. CHLIC's standard enrollment forms are prepared and delivered to Employer for distributit�'3indiveduals eligible to enroll in the Plan. y CHLIC's standard ID card with toll -free telephone number are prepared plan mailed directly to Administration of subrogation/conditional Claim Payment (terms deso CHLIC's standard enrollment forms are prepared and delivered eligible to enroll in the Plan. CHLIC's generic ID cards are prepared and bulk shipped employees. Standard Dental predetermination of benefits for den When elected, the Cigna Oral Health Integration Pro services necessary to provide eligible Members with c program covers the following conditions: (stroke), chronic kidney disease, organ, overall health by encouraging Members to o appropriate, OHIP may be expanded to include CHLIC's standard ID cards wi Pharmacy claims are adjudicate coverage, and therefore coordinate Benefits will be mitt 4ardless of c ernity, Diab and h w pro Y,. telephone n cedures Exhibit E). address voluntary basis. dividuals ibute to their (DRIP) Jude the provision of administrative lth con s enhanced dental benefits. The "ovasca ar Programs, cerebrovascular disease 1/nec er radiation, and is aimed at improving tal tre a`" ent by providing enhanced benefits. As conditions and programs in the future. P are prepared and mailed directly to Members. ine at.me of service without access to information on other B) for pharmacy claims does not occur. Claims for Plan age undanother plan. CHLIC's stand43d drug utilization re ew services. CHLIC may r aym der contracts with drug manufacturers with respect to utilization covered under the=; ,,..; cal b,.e efit for the manufacturer's specialty drugs, which are drugs that typically are injected or infused and derive om living cells; target an underlying rare, chronic or costly condition; and/or require restricted access and/or c e monitoring. If CHLIC enters into any such contracts, it does so on its own behalf, and not as agent o ployer or the Plan. 37 All Products All Products (excluding Pharmacy) All Products All Medical Products All Medical Products All Medical Products All Dental Products All Dental Products All Dental Products All Dental Products All Pharmacy Products All Pharmacy Products All Pharmacy Products All Pharmacy Products Client Name: SAMPLE ASO AGREEMENT Administrative Services Only Agreement Health Care Flex' 'Unlit en a: 0 1. 2. 3. 4. 5. 7. Providing generic enrollment forms and reimbursement request forms to Employer for .-`' e in connection with Health Care Flexible Spending Account ("FSA") and/or Dependent Care Flexible Sp mg Acco not ("DFSA") under which eligible employees (collectively "FSA Members") may elect to reduce e o .e-taxbasis up to the IRS maximum contribution allowed for deposit into a FSA and/or DFSA. At the end of each reimbursement period of the Plan Year, CHLIC shall issue payments to tent that ds remain in each FSA Member's account, for the amount that is determined it to be proper unde 1 At the end of the final reimbursement period of the Plan Year, CHLIC shall isments for any amou s . n due for those expenses that are determined by it to be proper under the Plan. Allowable expenses for reimbursement under a DFSA include dependents pursuant to I.R.C. Sections 125 and 129. Allowable expenses for reimbursement under a FSA incl I.R.C. Sections 125 and 213 except where reimbursement unde FSA Member accounts will remain open after conclu ,,of the P (the "Run Out Period"), so that FSA Members can sub ,. rem the Plan Year. Separate account balances will be mainta esae: Reimbursement requests of terminating FSA Members wig con. termination of Membership for any expe e ed prig to the S and DFSA, reimbursement will be up to the bal the originally selected goal amount, minus pr funded. health -re 5 44 prohibited. for the care of xpenses, pursuant to ar until [_Annual Claim Filing Deadline], enses incurred but not paid out during is election for the new Plan Year. to be ceased for [Runout Period] following r ;l1ership termination date. In the case of a m�he case of a FSA, reimbursement will be to nts, regardless of whether this amount has been FSA and DFSA Products FSA and DFSA Products DFSA Product FSA Product FSA and DFSA Products FSA and DFSA Products 8. 9. 10. 11/04/2014 For FSA payments that are not rha e 'th a Debit Calatbut e a result of automatic claim forwarding ("AutoPay") 4 A° of medical or dental claims fiom4 oirA.� a e dental pl " - administered by CHLIC or Direct Submit Request For Reimbursement, an explanation f ayme 1 ed to the FSA Member at their home address or, if elected, provided electronic " An explan f paym' is not issued for FSA payments that are issued to a pharmacy at the point of s ice a result of ,'omatic claim forwarding from the employee's pharmacy Plan. For DFSA pay ents made as a result & a Direct Submit Request For Reimbursement, an explanation of payment will be mailed i tie„ e . er at"" ` it home address or, if elected, provided electronically. An 800 number da tl 1ff>,, ed o status inquiries. This 800 numbe having access to accoun`fo.., e's Member Services will be available for FSA Members' questions and ill be listed in the instructions on the reimbursement request form as well as on via Internet. 38 FSA Product DFSA Product FSA and DFSA Products Client Name: SAMPLE ASO AGREEMENT Administrative Services Only Agreement 11. The Employer will identify through eligibility submission, FSA Members who elect to have medical and pharmacy claims processed but unpaid by CHLIC automatically submitted ("rolled over") to their FSA. h rollover claims will be processed without additional submissions by the Participant and CHLIC shall b - ntitle to rely on the Employer's submission of the Participant's rollover election that the submitted expenses re proper incurred, not reimbursable from any other source and are eligible for payment under the regulation ^s ov' ing fl- _ ; spe ding accounts. FSA Product 12. When CHLIC takes over a FSA administration mid -Plan Year, CHLIC will provide adminis n service .m FSA and DFSA Product the date CHLIC receives the FSA Plan information for claims incurred anytime during the Pl r 'a`^' '4uxe fj ^ tf �..,f L,+ e "'."i",F +,'e I, • e. mC. `',1 t gA *(�Y eal y,r ..• nl ,o� '!0"6, 4 a" 3'�'%� r � � w.,v..y. �� +� ' ` , W ? £r fxn.N:k' , .. „n, vef: nay y "a x,ui " ;d' rr•g" .5 ,t9 n ?.• 4 '• r,">wr 9,". 1. The Employer will make available specific funds to Participants c the Heatt Future M al Option. The HF Product funds will be suspended until the Participant reaches the age c eligi ., 2. The Employer will make available specific funds to Partic m hoosi e Heal ds Medical Option. The funds will be available when the Participant satisfies an in ° tie ering. HA Product 3. Providing reimbursement request forms to Employer; -'" HRA, HA, HF Products 4. Employer will make available specific funds to eligt ployees 6 lied in the HRA, HA and/or HF as applicable ("Participating Members"). At the end of ea h � ; iod of the Plan Year, CHLIC shall HRA, HA, HF Products iburseme issue payments to Participating Members (or their medic ro ' if app epriate) to the extent of the maximum amount of payment allowed by Employe y prior ' bu e ,; s for the same period of coverage, for the amount that is determined by it to be prope :� ?fin. 5. Allowable expenses for reimbursement under a'' s"' or , as applicable, include all allowable health- related expenses, pursuant to 1, R C. Section 213 e ept whey ayment for any such products is prohibited. The Employer can further limit t ,able expenses eed to by the Employer during implementation. HRA, HA, HF Products 6. Account balances for Participating e ve untiffhe end of the Plan Year will remain open after conclusion of the Plan Year fd a period o An l ,' fling Deadline, (the "Run Out Period"), so that such Participating Mem ..can submit a '"' emaininiv xpenses incurred during the Plan Year. HRA, HA, HF Products 7. Requests of M~ = bers terminating as articipants will continue to be processed for [Runout Period] following termination for expe ed ^ ° o their Membership termination date up to the originally selected goal amount, minus pn ` ts. HRA, HA, HF Products 8. For reimbursement payments tha e made as a result of automatic claim forwarding ("AutoPay") of medical claims from a medical p . as ' . '' ered by CHLIC or Direct Submit Request For Reimbursement, an explanation of payment will be maile ® _� articipating Member at their home address. An explanation of payment is not issued for payments that are ssued to a pharmacy at the point of service as a result of AutoPay from the employee's pharmacy Plan or for any Debit Card transactions. HRA, HA, HF Products 11/04/2014 39 Client Name: SAMPLE ASO AGREEMENT Administrative Services Only Agreement 9. Providing information on account balances and submitted claims to Participating Members calling the number on the ID card. In addition, Participating Members will have access to account information via:rnet. BRA, HA, HF Products 10. When automatic claim forwarding ("AutoPay") is turned on, medical claims processed b npaic by CHLIC will be automatically submitted for reimbursement from the BRA and/or HA Member's "' ° and/o account. Such "rollover" claims will be processed without additional submissions by the P. •m : g Mew• Y HRA, HA Products 11. When CHLIC takes over HRA, HA and/or HF administration mid -Plan Year, CHLIC wil . e administr Live services from the date the Plan information is received. HRA, HA, HF Products 12. Pharmacy claims: Eligible pharmacy expenses, under the HRA and/or that are processef : gut u : aid by HRA, HA, HF Products CHLIC may be automatically submitted ("rolled over") to the Reins sement Accounts CIO"' ffice for reimbursement from the Participating Member's HRA, HA and/or HF acco the AutoPay'option is enabled. Such rollover claims will be processed without additional sub ' s by t c : ®. 'cipatin ember. When pharmacy is covered and Cigna Pharmacy is the pharmacy ve , the • ti and/o ° , will « omatically pay the pharmacy through the HRA and/or HA at the point of sal, p 11 Participating Meg` a `.bligations under the pharmacy Plan including deductibles, copays, and/or co'.: suran c li ions. A Part `'' pating Member will not receive an Explanation of Benefits for these . a enter "pk^ yY 3Yk1; �� tG �., d�6R% � a �. A ''' `, ; e bird h•'� ! e'r' a,^ ``1,,y„ V ;drinalstxta„or 1. Provision of Health Savings Account: C Cs 'a 1 provide o E , enrollment materials for Health Savings HSA Product Accounts ("HSA") at a bank or other auth ee "' •t withwhic : HLIC contracts (the "Bank Vendor") for Employer's employees enrolled in an eligible h D ed - Health Plan ("HDHP"). CHLIC and/or the Bank Vendor shall provide to Emplo er's eligible emp es who op n an HSA ("HSA Account Holder") telephonic and Internet customer service, rds, HSA chec (o tion made available to HSA account holders from the bank) to access HSA funds, req u' rms such '`tie 1099 and 5498 and access to Individual Summary Statements that reflect account ac' ity. rovide to Employer its standard reports of aggregate non - identifiable information concerninggth mis on of the HSA. 2. Claim Forwardhig: Each USA Account Holder may elect to have claims not payable under the HDHP paid from HSA Product funds in the A unt Holder's HSA, t e extent that funds are available in such account ("Claim Forwarding"), whether or not . lifie S medical expense. Claim Forwarding is only available for payments due medical provi 1 a . ding is not available for pharmacy expenses. 3. Use of HSA: HSA Account Holde & are solely responsible to use HSA funds as permitted by law, including Section HSA Product 223(a) of the Internal Reunite ;- .. e, to qualify for applicable tax benefits. 11/04/2014 40 Client Name: SAMPLE ASO AGREEMENT Administrative Services Only Agreement 4. Enrollment in High Deductible Health Plan - Employer acknowledges that its prompt furnishing of complete and HSA Product accurate HDHP eligibility and benefit information, including prompt depositing of contribu i , is essential to the timely and efficient administration of its employees' health savings accounts and impacts abi ity to respond to employee account withdrawals or payments. It is understood that employee HD coverag terminations, including default terminations whether or not caused by employer failure to reconcil ee e . lity when so requested by CHLIC, could result in health savings account tax consequences for i. s oyee and r in interrupting the employee's eligibility to make health savings account contributions. 5 Access Codes. Employer shall ensure that each authorized user establishes . Access Code fora ' to tl€nline HSA Product Portal. Employer shall further ensure that authorized users safeguard al e s Codes and shall be °"risible for all use of Access Codes. 6 o °' Online Portal. Access to the Online Employer Portal delivered • h;-;; : ank unt Adrnix F ator shall be in HSA Product accordance with such manuals, training materials, terms of _ , a. • a �trative e trol p educes, terms and conditions, and other information as shall be provided to E -r from e to t1m; p. �` rn pto yer shall ensure access to Online Employer Portal complies with any sucla;;iufo . aterials. E loyer's authorized users may be assigned different levels of access. Some of "` ctions ' R ' mployer may access on the Portal are: 1) view reserve funding account balance and activity; 2. • up to ,$ articipants using a CSV template; 3) perform manual funding of employee bank accounts; 4) • '.ad various" s; 5) learn of upcoming changes in HSA rules; 6) use the links and tools for HSA education and :. tonal ' ation. 7. , Employer agrees that any access, transact • •usiness c : duct ing the Online Employer Portal is presumed by CHLIC to have been in compliance Ori dm istratio .:'"' der Section 223(a) of the Internal Revenue Code. Any unauthorized use of the Online Emo er g ,:• y Access Code shall be solely the responsibility of the Employer. HSA Product . mplo'SreesPoils' bihtle < < ..,•, , HSA Product 1. HSA Contributions -Employer xlt to pre-tax p:. 11 contributions by HSA Account Holders. Employer t may elect to make its own contrib " o s� ` ` m o er shall send HSA Account Holder contributions plus any Employer contribute directly to e B 2. Eligibility and . t - Emplo is responsible for distributing to eligible employees the HSA enrollment HSA Product application an® documents provide. o Employer by CHLIC and the Bank Vendor. Employer will submit completed HS °`°'I of OPe ; ation. HLIC and/or Bank Vendor, as indicated, in the established timeframe. It is understood . a . a-. ligi e employee's HSA cannot be opened until the Bank Vendor has received all necessary documents and info ation and has determined the HSA can be established. 3. Information Verificatio - Emplo,, r shall verify information provided to CHLIC and Bank Vendor that is necessary HSA Product for the establishment of SA. It is understood that the Bank Vendor shall rely on such information and verification in establishing and maintaining the HSA and in reporting required by law. 11/04/2014 41 Client Name: SAMPLE ASO AGREEMENT Administrative Services Only Agreement etatio 1. 2. 3. 4. Employee Agreement with Bank — Eligible employees wishing to enroll in an HSA may b certain bank documents including a custodial agreement. Approved eligible employee Holders and contract directly with the Bank Vendor for the establishment and mainten the issuance of debit cards and checks. Investment of Account Funds — While Bank Vendor offers various investment options in c in the HSA, the HSA Account Holder is solely responsible for selecting and a proving the in which their HSA funds will be invested. HSA Account Holders exercise sje investment discreti investments. uired to execute ill become Account e of the A, including Bank Fees — CHLIC pays Bank Vendor to administer the HSA Accounts 10),, Bank Fees to Accountholder — It is understood that there are se coin* Holder by the Bank Vendor pursuant to terms communicate H count documents. HSA Product n with thends HSA Product ent vehicle. to er tla HSA charged h HSA Account ers tugh separate bank HSA Product HSA Product 0 CO 1. 2. *rx111114> Termination of HSA Account Holder's HDHP or of S termination of an HSA Account Holder's HDHP cov "Free Agent". Similarly, should CHLIC's HSA service a specific employee, or for the Employer as a whole, the Free Agents. For Free Agents: (1) CHLI ' o altlonger p no longer be applicable; (3) HSA shall con contractor to CHLIC; (4) Bank Vendor shall is and (5) Bank Vendor shall infirm Free Agents o Even if HSA Account Holders c purposes of HSA services hereun es Unde%' ough is E Exhibit Free Agents: In the event of the , the HSA Account Holder becomes a rminated for any reason, either for t Holders shall from that point on be rvices; (2) Any terms of this Exhibit shall e Bank Vendor directly not in its role as a t numbers, debit cards, checks etc. to Free Agents; cable schedule of bank fees. ugh COBRA, they are still considered Free Agents for Retroactive Terminations- It is unds too �ihat although this ASO Agreement contemplates instances in which an employ 1, . ° HP coverag; ay be red P. actively terminated, there will be no retroactive terminations with respect to A serves providedereunder. Termination of an employee's HDHP coverage or termination of It in the termination eices rendered under this Exhibit and the applicable fees, effective as of notice of such termination an HSA shall r the end of the HSA Product HSA Product et.o' l"au, o ,reea i rt 1e All applicable provisions of the A of a conflict between and services, the terms of this E. 11/04/2014 Agreement apply to the HSA Services described in this Exhibit. In the event n of the ASO Agreement and the terms of the Exhibit with respect to the HSA ibit shall govern. 42 HSA Product Client Name: SAMPLE ASO AGREEMENT Administrative Services Only Agreement 4,,Z44ft001144 „4•44044r.,44,44, :4,44,W444,444444 4R44- Prepare Member benefit booklet drafts to Employer. 1, 5500 Schedule C reporting. 2, 5500 Schedule A or Annual Reconciliation Disclosure reporting (when a licable) rst, 02Vere"' k CHLIC's standard Underwriting services: a) benefit design analysis-b) kdajected cost analysi F.memootonf 1. 2. Handling of requests from Members for access to, amendmen and requests for restrictions and alternative communica regulations, as set out in this Agreement and its Exhibits W15 Maximum reimbursable charge determinations of n CI-MIC's standard cost containment controls: Applica and coordination with Medicare. 3. 4. [If Applicable] 5. 6. 7. [If Applicable] 8. 1. [If Applicable] 2. 11/04/2014 Delivery of information, as necess benefits. Review of medical bills in accordance with ;1J Dental Cost Containment, a I1vork of additiona CELIAC retains a portion of th47,1ugs generated. Network Savings Program, a nki: care through a Network Savingsogr_ Annual reportin Pharmacy V HL1C's st or Recoveries, -4,444,44§44E107,„14,10,,), a4, rticipa Or, All Products 0.**, All Products All Products All Products :ro untin rotected lth information, 1 All Products fedef HIPAA law and '10 ovider charges for covered services. n-duphc • and coordination of benefits rules 4V4grei,,,44-f 4,44444'41044-4 444a4,40,44".. 4,4:0 g•i,gar ,414446.4•1:. 4131444;. „ All Medical Products (with out -of -network benefits) All Medical Products stand app n of non -duplication or coordination of me4Pi netw rren't Medical Bill Review program. icipag4g PPO providers that provide discounts for which orJ!iat provides discounted rates when a Member accesses eft provider. .'cost co amment results upon Employer's request. 45545: 4 4MV Summary reportnrrre-dical, dp1and pharmacy cost and utilization experience are available through Cigna's web site, CignaAccess.Q7. CHLIC's standard pharma utilization reports. 43 All Medical and Dental [If Applicable] Products All Medical Products All Dental Products All Medical and Dental [If Applicable] Products All Medical and Dental [If Applicable] Products All Pharmacy Products 4:.,'VOrEFI" All Medical, Dental [If Applicable] and Pharmacy [If Applicable] Products Pharmacy Product Only Client Name: SAMPLE ASO AGREEMENT Administrative Services Only Agreement 3. [If Applicable] 4. [If Applicable] 5. Claim Reporting: CHLIC will provide standard banking and financial report information based upon paid claim data. CHLIC will not provide information on incurred -but -not reported claims, projected cla" re -certifications of coverage, case management information or information on a Member's prognosis o H urse of treatment. Stop Loss Reporting is an optional service provided at an additional fee to Employe . o have s o oss through another entity other than CHLIC. CHLIC will provide its standard reporting only afte sto . as `° arrit and Employer have executed CHLIC's standard Hold Harmless/Confidentiality Agreement. CHLIC's standard management and statistical reports for Employer. CHLIC's standard Individual Summary Statements for applicable Part ants. [If Applicable] 6. [If Applicable] 1. pplicable] 2. [if Applicable] 3. [If Applicable] 4. 11/04/2014 CHLIC's standard Health Reimbursement Account, Healthy Aw Employer. Each FSA Member who experiences a qualifying ev with COBRA will be maintained until the earlier of tit or other termination of the FSA. FSA Members electing continuation of exceed 102% of the applicable premi • n continuant to elect a lump -sum salary reduc l coverage period. FSA Members who continue Reimbursement Requests for. date of the qualifying event bu earlier of the end of the Plan Ye coverage ur loyertaay re t re elects e� fthe Pla althy Futuret ctiity report for tion of account coverage in accordance e exhaustion of the FSA balance wiIccontinue contributions at a rate not to fter-tax contributions, or may allow the ed in contributions for the remainder of the All Medical Products FSA and DFSA Products FSA, DFSA, HRA, HA, and HF Products er COBRA and " ;hose contbutions have been made as required may submit es and any ehg. dependents, for expenses incurred before or after the nd of tl coverage period. Requests may be submitted until the of the FSA, including any applicable Run -Out Period. The HRA, HA . of each il' ° HA a or HF Member who experiences a qualifying event and elects continuation er. ccount overage in ,m. cordance with COBRA will be maintained similar to the maintenance of an active emplo -. HF me e - rs that . v not met their vesting requirements determined by the plan are not required to be = :fir th- 44 HRA, HA and HF Products FSA Product FSA Product FSA Product HRA, HA and HF Products Client Name: SAMPLE ASO AGREEMENT Administrative Services Only Agreement (21 N 1. 2. 3. 4. 5. 6. 7. 8. CHLIC contracts with three (3) independent review organizations that meet the Patient Prot n and Affordable Care Act (PPACA) external review requirements. Members may appeal eligiblvc aims to an external independent review organization which is selected by CHLIC on a random basis. If Toyer h-0 chosen not to participate in this program, the Employer may be responsible for making other arr Protection and Affordable Care Act (PPACA) external review requirements. Pre -Admission Certification and Continued Stay Review (PAC/CSR) ser ; sub -acute inpatient admissions/stays or provides guidance to ate alt s a accordance with CHLIC's then applicable medical manage procedures. Case Management and Retrospective Review of Inpatient Cad Member who is at risk of developing medical compl for rehabilitation or additional health care support. Assisting providers with resources and tools to en management of chronic or catastrophic cases. The Cigna HealthCare Healthy Babies with prenatal care education and resources program include Cigna Healthcare's 24-Ho myCigna.com HealthCare Cost and Quality A panel of physicians and othe. technologies. The panel meets Cigna HealthCa -' A -Hour Heii nurses, whop +vide aitswers to h Participants i ocating ph sicians. It topics. wow � _........ $ Cigna LifeSOUlf ° " ransplan than one -hundred fifty (150) i marrow/stem cell trans to de he Patient All Medical Products to certify co of acute and All Medical Products ve setting dministered in ation ivies, practices and ce designed provide assistance to a a health inci ent has precipitated a need ong term treatment plans in the i&nal mailing which provides Participants er m age their pregnancy. Other benefits of this rmation LinesM and pregnancy information on assess t e safety and effectiveness of new and emerging medical d update coverage policies. formatic LinesM is a service that provides 24 hour toll free access to thcare questions, recommends appropriate settings for care and assists o includes access to an extensive audio library on awide range of medical etwark® contracts with over seven hundred (700) transplant programs at more pendent transplant facilities and provides access to solid organ and bone while improving cost containment and reducing financial risk. All Medical Products All Medical Products All Medical Products All Medical Products All Medical Products All Medical Products All Medical Products 11/04/2014 45 Client Name: SAMPLE ASO AGREEMENT Administrative Services Only Agreement 9. All Medical Products Except Comprehensive and Indemnity A health education program that delivers mailings to Members with certain conditions. 10. If behavioral health services are provided/arranged by Cigna Behavioral Health (CB CBH pro . es utilization review and case management for both inpatient and outpatient, in -network behavid 1th se s . e PPO or OAP, LCP, LCPIN or Network Products Only 11. Implementing clinical quality measurements, managing data, tracking and validating perf ce and init ting continuous quality improvement. , All Medical Products Except Comprehensive and Indemnity 12. Transition of care services to allow Members with defined conditions tr . ue treatment with no ticipating Providers after enrollment for continued uninterrupted care for a limited IL All Medical Products Except Comprehensive and Indemnity [If Applicable] 13. Focused utilization management of outpatient procedur an t " `=ificatio ,s.o app , °riate alternatives. Administered in accordance with CHLIC's then applic edical nageme 4 laims administration All Medical Products with PHS Plus policiweys, practices and procedures. , "; '*' f� ''T�''"+'rb'q�.�4�� ?e',,.zevw'�. ?' <s fi.: {¢ F: '1p 5 fii, � '„fl $,a .... ' yi 'gqi�Yi `rL �r '' 15 i 4 fan � � i ri C1C. an iat ^� , y 8 x �. ,y; > ? , `�, s l,i�l�,��CL1���r 1�.,�', a,�1,H�sd'S�a�� 5 . �. a x � � •� 1. a Provide or arrange access to the applicable netwo 'articipa :�"roviders to furnish health care services/products to Members at negotiated rates and • or � reimb ement (e.g. fee -for service, fixed per person per period, per diem charges, .- vel bonuse ase ithholds etc.). The amount and type of negotiated reimbursement may vary depen ' , 0 6 e _ - of pl = . or example, a hospital may accept less for patients enrolled in certain types of plans th others; - All Medical and Pharmacy Products [If Applicable] 2. Provide or arrange access o the applicable- twork o Participating Providers to furnish health care services/products to Member; - • otiated rates a et ods of reimbursement (e.g. fee -for service, fixed per person per period, per diem ch g - -motive bonus case rates, withholds etc.); All Dental Products 3. Credential and re -credential Parti patine ': accordance with CHLIC's credentialing requirements and ensure that third- network n. • s ere. e"" ' 1/re-credential Participating Providers in accordance with CHLIC's requi en - All Medical, Dental [If Applicable] and Pharmacy [If Applicable] Products 4. Monitor Participating Provider come nee with protocols and procedures for quality, Participant satisfaction, and grievance resol lion; - All Medical, Dental [If Applicable] and Pharmacy [If Applicable] Products 5. Facilitate the identification of P. icipating Providers by Members; and All Medical, Dental [If Applicable] and Pharmacy [If Applicable] Products 11/04/2014 46 Client Name: SAMPLE ASO AGREEMENT Administrative Services Only Agreement 6. Dedicated toll -free telephone line for Member and Provider calls to CHLIC Service Centers. All Medical, Dental [If Applicable] and Pharmacy [If A licab e Products y„�' ski f+s, r .. _ ...��. ,.. : . .� yl �� „;� , a These services are included „�' ). provide •-pro ision a Behavioral Health �CBH to pge f CHLIC has contracted with an affiliate Cigna <.; of managed in -network behavioral health services, CBH is a Participating Provider, and is b1'sed primay on in the following products: a monthly fixed fee basis. This fixed fee for CBH services will be paid as claims and will ap in Empler's PPO, OAP, LCP, LCPIN and monthly reporting and on financial documents. Such payments will be at th relevant monthly r then effect. All Network The monthly rates paid to CBH vary depending on geographic location bers and on benefit des and may be subject to change. The rates will be made available upon request. ixed fee also: inc . es lifestyle management programs, a cognitive behavioral modification pro f Comp , sychiatric se Management program, and a Narcotics Therapy Management program. Beh coral from •ent sp - is network are not included in the behavioral monthly fixed fee and will be par the B Accoun e states, payment for behavioral health services must be paid on a fee -for -se ice bad : In , ese states, fe or -service payments for behavioral health services and the CBH administra• fee (inc g the lifestyle management programs, a cognitive behavioral modification program a Comple : chiatric `a anagement program and a Narcotics i Management be from the " s and will appear in Employer's Therapy program) will paid a ccount monthly reporting. 11/04/2014 47 Client Name: SAMPLE ASO AGREEMENT Administrative Services Only Agreement The Cigna HealthCare of Arizona, Inc. staff model ("Cigna Medical Group") is a Particip metropolitan Phoenix, Arizona. Plan Participants may at some time receive treatment _ ("CMG") facility or provider even if they do not reside in Arizona (as when traveling network will access certain specialty and/or ancillary services (including laboratory an through the CMG system. Lab services are not provided by CMG for Participants in PPO g Provider located in a Cigna edical Group e IPA es) Except as provided below, for services provided to Participants, CMG 'd at the rates in effe 4 ;fie time of service (as may be revised from time to time). Representative rates for routm performed serves a attached. A complete copy of the rates is available on request under a mutual eed no losure agre ent (NDA). If the Plan requires Participants to select a primary care ph select a PCP during open enrollment are assigned to a C in effect at the time of service. Primary care services rendered to Participants in Ope assignment are paid at the rates then in effect, as descri 11/04/2014 48 hoenix 'paid for PC cipants who do not equired Plans at the rates do not provide for PCP All Medical Products Client Name: SAMPLE ASO AGREEMENT Administrative Services Only Agreement CIGNA HEALTHCARE OF ARIZONA - CIGNA MEDICAL GROUP (CMG) REPRESENTATIVE RATES FOR ROUTINELY PERFORMED MEDICAL SERVICES All Departments Adult Medicine Pediatrics Gastroenterology EFFECTIVE AUGUST 1, 2014 (Applicable to all PPO and EPO Products) 99213 OFFICE VISIT,EST EXP PROB FOC WELL EXAM, EST, 40-64 YEARS WELL EXAM, EST, 1-4 YEARS $65.80 99396 99392 45378 COLONOSCOPY - Professional Fee on' facility Neurology Ophthalmology Podiatry Radiology Radiology Urology General Surgery Optometry ASC (Ambulatory sur center) / Endoscopy Su Grouper 2 ASC (Ambulatory surgica center) / Endo scopy Suite * Medicare daps not assign (or may no et have assigned) relative value units (RVUs) for certain service codes. Codes not valued by Medicare ar ; eferred to as " ap codes. ore ample, Medicare does not assign values for wellness service codes (99381-99397). Cigna Medical Gro erst 'al R9 R Annual) guide to obtain relative values for such gap codes for billing purposes. Typically, Cigna pays CMG gt es n ued°by Medicare either at the discounted fee schedule referenced above or, for new codes not yet valued by Medicare, at the same ra it pays its IPA providers. 64615 66984 11721 71020 G0202 + 77052 9 CHEMODENERV REMOVE CATARACT, I Fee only, it OF MUSCLE MIGRAIN T LEN- Profe DEBRI[}l` LENT NA11.='lIX OR CHSTX- NING M ^it'!IOGRAPHY DIGITAL CY0SCPY LAP A OS $102.94 $157.18 $700.01 $39.95 $30.38 $141.02 $253.87 •CHOLCYSTECTOMY- Professional ee o l)r, at a iity $837.79 & T' EATMENT $109.35 $469.00 $1,104.00 The Urgent Care case et excluding radiology and laboratory services is $115. The CMG CareToday (CMG low acuity clinics) visit rate is $59. Lab tests performed at the CMG CareToday facilities are $10 per service. A complete list of rates for CMG CareToday services is available on request. CMG pharmacy rates (30-day supply): Brand Name:AWP — 10.56% + $2.75 dispensing fee Generic: AWP — 35% + $2.75 dispensing fee 11/04/2014 49 316 Client Name: SAMPLE ASO AGREEMENT Administrative Services Only Agreement CIGNA HEALTHCARE OF ARIZONA - CIGNA MEDICAL GROUP (CMG) REPRESENTATIVE RATES FOR ROUTINELY PERFORMED MEDICAL SERVICES All Departments Adult Medicine Pediatrics Gastroenterology Neurology Ophthalmology Podiatry EFFECTIVE AUGUST 1, 2014 (Applicable to all Open Access Plus Products) 99213 OFFICE VISIT,EST EXP PROB FOC 99396 99392 45378 64615 66984 11721 WELL EXAM, EST, 40-64 YEA WELL EXAM, EST, 1-4 YEARS COLONOSCOPY - Professional Fee facility CHEMODENEROF MUSCLE MIGRA'' REMOVE CATARAC , RT LEN- Pro signal Fee only ' 'ty DEB ENT SIX OR $65.80 $102.94 $85.77 $257.75 $157.18 $700.01 $39.95 Radiology Radiology Urology General Surgery Optometry ASC (Ambulatory surgic center) / En oscopy Suite ASC (A surgical center) Endoscopy Suite 71020 G0202 + 77052 52000 80 80061 Chi EST EENING' LAT q MOGRAPHY DIGITAL LAECYSTECTOMY- Pro ssiona AOonly, at a facility M 84TREATMENT CO "`W HENSIVE METABOLIC PANEL ip p PANEL $30.38 $141.02 $253.87 $837.79 $109.35 $14.87 $18.85 $469.00 $1,104.00 * Medicare Medicare are Medical Group refers to The Essent Cigna pays CMG for gap codes not valued by Medicare, at t not y . ave assigned) relative value units (RVUs) for certain service codes. Codes not valued by es." or example, Medicare does not assign values for wellness service codes (99381-99397). Cigna RBRVS (Annual) guide to obtain relative values for such gap codes for billing purposes. Typically, lued by Medicare either at the discounted fee schedule referenced above or, for new codes not yet to it pays its IPA providers. The Urgent Care case rate excluding radiology and laboratory services is $115. The CMG CareToday (CMG low acuity clinics) visit rate is $59. Lab tests performed at the CMG CareToday facilities are $10 per service. A complete list of rates for CMG CareToday services is available on request. CMG pharmacy rates (30-day supply): Brand Name: AWP — 10.56% + $2.75 dispensing fee Generic: AWP — 35% + $2.75 dispensing fee 11/04/2014 50 317 Client Name: SAMPLE ASO AGREEMENT Administrative Services Only Agreement CIGNA HEALTHCARE OF ARIZONA - CIGNA MEDICAL GROUP (CMG) REPRESENTATIVE RATES FOR ROUTINELY PERFORMED MEDICAL SERVICES All Departments Adult Medicine Pediatrics Gastroenterology Neurology Ophthalmology Podiatry Radiology Radiology Urology General Surgery Optometry La b ASC (Ambulat6ry surgical center) / Ej y Suite ASC (Am center) / latory surgical EFFECTIVE JANUARY 1, 2015 (Applicable to LocalPlus Products) 99213 99396 99392 OFFICE VISIT,EST EXP PROB FO WELL EXAM, EST, 40-64 YEAR WELL EXAM, EST, 1-4 YEARS 45378 COLONOSCOPY - Pissional Fee only, at 64615 CHEMODENERVATION k1lUSCLE MIGIN 66984 REMOVE INSE - Prof- onal Fee only, a , cility, 11721 DE RIDE NA,. IX OR MOR 71020 T X RAY P W LAT G0202 + 77052 52000 PHY DIGITAL Q,PA SCOP OLECYSTECTOMY- Professional Fee 1 . faciti 9201 EYE Eg`>i& TREATMENT 80053 061 uper 8 EHENSIVE METABOLIC PANEL PANEL $52.64 $82.35 $68.62 $206.20 $125.74 $560.01. $31.96 $29.17 $116.68 $203.10 $ 670.23 $87.48 $7.66 $9.44 $469.00 $1,104.00 * Medicare does not assign(or ma, ofyet have assigned) relative value units RVUs or certain service codes. Codes not valued g Y� 9 ) ( )f by Medicare are referred t as "gap es." For example, Medicare does not assign values for wellness service codes (99381-99397). Cigna Medical Group refers to Cigna pays CMG for gap co not valued by Medicare either at the discounted fee schedule referenced above or, for new codes not yet valued by Medicare, at the same rate it pays its IPA providers, The Urgent Care case rate excluding radiology and laboratory services is $115. The CMG CareToday (CMG low acuity clinics) visit rate is $59. Lab tests performed at the CMG CareToday facilities are $10 per service. A complete list of rates for CMG CareToday services is available on request. *dal RBRVS (Annual) guide to obtain relative values for such gap codes for billing purposes. Typically, CMG pharmacy rates (30-day supply): Brand Name: AWP — 10.56% + $2.75 dispensing fee Generic: AWP — 35% + $2.75 dispensing fee 11/04/2014 51 318 Client Name: SAMPLE ASO AGREEMENT Administrative Services Only Agreement CIGNA HEALTHCARE OF ARIZONA - CIGNA MEDICAL GROUP (CMG) REPRESENTATIVE RATES FOR ROUTINELY PERFORMED MEDICAL SERVICES Dertartrwieril All Departments Adult Medicine Pediatrics Gastroenterology Neurology Ophthalmology Podiatry Radiology Radiology Urology General Surgery Optometry Lab ASC (Ambulatory surgic center) / Endoscopy Suite' ASC (Ambulatory surgical center) / Endo1 oopySuite EFFECTIVE AUGUST 1, 2014 (Applicable to all Network and Network POS Products) CPT Code* * Medicare d {snot assiyh(or may not are referred as "gap codes," exam refers to The t'� .I) gui codes not valueeQ`r .re e .t tt same rate it pays its IPA providers. 99213 OFFICE VISIT,ESTEXP PROB FOC 99396 99392 45378 64615 66984 WELL EXAM, EST, 40-64 YEARS WELL EXAM, EST, 1-4 YEA COLONOSCOPY - Professional Fe`at a facili CHEMODENERVAS ION OF MUSCLE MI `fNE REMOVE CAT , INSERT LEN- Pr fess .I Fee only, at a facility 11721 DEBRIILS 'MOR 71020 G0202 + 7705 ., 52000 47562 1)61 Grouper 2 CHFfi -RAY, LAT CREENIGM MOGRAPHIIGITAL TOSCO';; �g ' •SCOPY, l CYSTECTOMY F e • at a fact PANEL $95.41 $149.26 $124.36 $311.45 $207.19 $1,015.00 $57.93 $44.05 $204.48 $306.76 $1,012.30 $158.56 $21.95 $27.82 $469.00 $1,104.00 t have assigned) relative value units (RVUs) for certain service codes. Codes not valued by Medicare Medicare does not assign values for wellness service codes (99381-99397). Cigna Medical Group to obtain relative values for such gap codes for billing purposes. Typically, Cigna pays CMG for gap discounted fee schedule referenced above or, for new codes not yet valued by Medicare, at the The Urgent Care cased . luding radiology and laboratory services is $115. The CMG CareToday (CMG low acuity clinics) visit rate is $59. Lab tests performed at the CMG CareToday facilities are $10 per service. A complete list of rates for CMG CareToday services is available on request. CMG pharmacy rates (30-day supply): Brand Name: AWP — 10.56% + $2.75 dispensing fee Generic: AWP — 35% + $2.75 dispensing fee 11/04/2014 52 319 Client Name: SAMPLE ASO AGREEMENT Administrative Services Only Agreement Exhibit C — Claim Audit Agreement (Sample) A. WHEREAS, Cigna Health and Life Insurance Company ("CHLIC") desires to cooperate with requests by (" Employer") to permit an audit for the purposes set forth below and subject to Section 6 of the Administrative Services Only Agreement between CHLIC and Employer; B. C. WHEREAS, ("Auditor") has been retained by Employer for the purpose of performing an audit ("Audit") of claims administered by CHLIC; WHEREAS, the Auditor and the Employer recognize CHLIC's legitim interests in maintaining the confidentiality of its claim infotination, protecting its business reputation p oiding uiicessary disruption of its claim administration, and protecting itself from legal liability; and NOW THEREFORE, IN CONSIDERATION of the premises and the mutuo omises con ed herein, CHLIC, the Employer and the Auditor hereby agree as follows l . Audit Specifications The Auditor will specify to CHLIC in writing at least commencement of the Audit the followin a. b. c. d. e. f. g• the name, title and profession the Claim Office locations,i the Audit objectives; the scope of the Audit (t the process by which clai the records/information re the length o contempl 2. Review of Specification CHLIC w411 have the right conditions ' 1 Audit Speci interests idragraph 3. ?Access to Inf CHIC will ma�"<- the records/information called for in the Audit Specifications available to the Audit° a mutual cceptable time and place. lificati e a riod, lin e selec he Audi we (45) day prior to the of indiv�� ditors; ed; coverage and number of claims); >tidit; for purposes of the Audit; and o complete the Audit. eview Audit Specifications and to require any changes in, or on which may be necessary to protect CHLIC's legal and business ove. 4. Ei Repo Th Auditoi11 provide CHLIC with a true copy of the Audit's findings, as well as the Audit Report, if an is submitted to the Employer. Such copies will be provided to CHLIC at the same time that the Audit findings and the Audit Report are submitted to the Employer. 5. Comment on Audit Report CHLIC reserves the right to provide the Auditor and the Employer with its comments on the findings and, if applicable, the Audit Report. 11/04/2014 53 320 Client Name: SAMPLE ASO AGREEMENT Administrative Services Only Agreement 6. Confidentiality The Auditor understands that CHLIC is permitting the Auditor to review the claim records/information solely for purposes of the Audit. Accordingly, the Auditor will ensure that all information pertaining to individual claimants will be kept confidential in accordance with all applicable laws and/or regulations. Without limiting the generality of the foregoing, the Auditor specifically agrees to adhere to the following conditions: a. The Auditor shall not make photocopies or remove any of the claim records/information without the express written consent of CHLIC; b. The Auditor agrees that its Audit Report or any others •, nary pre.'.ed in connection with the Audit shall contain no individually identifiable in k° on. 7, Restricted Use of the Audit Information f With respect to persons other than the Employer, the uditor will hold and nfcpation obtained from CHLIC during the Audit with the same d d standard of confi. t ality owed by the Auditor to its clients in accordance with all applicable in - nd profession s ndards. The Auditor shall not, without the express written conse f •. IC e ted by an o er of CHLIC, disclose in any manner whatsoever, the results, con `lions, arts or in o ati of whatever nature which it acquires or prepares in connection vu # Audit `°.' any pa __ than the Employer except as required by applicable law. The " ' ploy d ditor agreeindemnify and to hold harmless CHLIC for any and all claims, c s expenses = amages which may result from any breaches of the Auditor's obligations under para:. 6 and is Agreement or from CHLIC 's provision of information to the Auditor. The E r authoriz # SIC to provide to the designated Auditor the necessary information to perform the edit anner c sistent with all Health Insurance Portability and Accountability Act .-' "HIPAA4Priv. tan ards and in compliance with the signed Business Associate Agreeme 8. Termination CHLIC m through 7 s 11/04/2014 mate this agree ent ith prior written notice. The obligations set forth in Sections 4 erminati this agreement. 54 321 Client Name: SAMPLE ASO AGREEMENT Administrative Services Only Agreement Cigna Health and Life Insurance Company By: TO BE SIGNED AT TIME OF AUDIT Duly Authorized Print Name: Title: Date: Employer: By: TO BE SIGNED AT TIME OF AUDIT Duly Authorized Print Name: Title: Date: Auditor: By: TO BE SIGN Duly Auth''' 11/04/2014 55 322 Client Name: SAMPLE ASO AGREEMENT Administrative Services Only Agreement Exhibit D — Privacy Addendum ("Business Associate Agreement") I. GENERAL PROVISIONS Section 1. Effect. As of the Effective Date, the terms and provisions of this Addendum are incorporated in and shall supersede any conflicting or inconsistent terms and provisions of (as applicable) the Administrative Services Only Agreement and/or Flexible Spending Account or Reimbursement Accounts Administrative Services Agreement to which this Addendum is attached, inchtall exhibits or other attachments to, and all documents incorporated by reference in, any such a cable agreements (individually and collectively any such applicable agreements are referr o as the `> a. reement"). This Addendum sets out terms and provisions relating to the use and discl rote W.ealt Information ("PHI") without written authorization from the Individual. To the extent th " conflict b een the Agreement and this Addendum, this Addendum shall control. Section 2. Amendment to Comply with Law. CHLIC, o that perform services under the Agreement (collectively referri to as "Plan Sponsor"), and the group health plan t the "Plan") agree to amend this Addendum to t comply with applicable laws and regulations and Accountability Act of 1996 and its ink_ Privacy and Security Rules"). Section 3. Relationship of Parties. The p agent of the Plan. II. PERMITTED USES AND f of itself and it afand subsidiaries as "CHLIC' E loyer (also referred subj = % the Agre `i nt (also referred to as ssary ®e +w ei$' r the Plan or CHLIC to t limited ,i a ealth Insurance Portability tons (45 C. .' . Parts 160 to 164) ("HIPAA is an independent contractor and not an Section 1. Uses a d Disclosures Ge pally. Ex pt as otherwise provided in this Addendum, CHLIC may use or disclose P rform functions;activ ties or services for, or on behalf of, the Plan as specified in the Agreement, pro . « ich use or 41/Closure would not violate the HIPAA Privacy & Security Rules if done by the fan i .1°got further use or disclose PHI other than as permitted or required by this dendum, or S ion 2. To Ca Ou ° lan Ob1i_ations. To the extent CHLIC is to carry out one or more of the Plan's ob ati urd ubpart_.°° 45 C.F.R. Part 164, CHLIC agrees to comply with the requirements of Sub hataa p!y thee lan in the performance of such obligations. Section 3. ana ent and Administration. (A) CHLIC mad use PHI for the proper management and administration of CHLIC or to carry out the legal responsibilities of CHLIC. (B) CHLIC may disclose PHI for the proper management and administration of CHLIC, provided that disclosures are: (a) required by law; or (b) CHLIC obtains reasonable assurances from the person to whom the information is disclosed that it will remain confidential and used or further disclosedonly as required by law or for the purpose for which it is disclosed to the person, and the person notifies CHLIC of any instances of which it is aware in which the confidentiality of the information has been breached. 11/04/2014 56 323 Client Name: SAMPLE ASO AGREEMENT Administrative Services Only Agreement (C) CHLIC may use or disclose PHI to provide Data Aggregation services relating to the Health Care Operations of the Plan, or to de -identify PHI. Once information is de -identified, this Addendum shall not apply. Section 4. Required or Permitted By Law. CHLIC may use or disclose PHI as required or permitted by law. III, OTHER OBLIGATIONS AND ACTIVITIES OF CHLIC Section 1. Receiving Remuneration in Exchange for PHI Prohibited. CHL indirectly receive remuneration in exchange for any PHI of an Individual obtained from the Individual, in accordance with 45 C.F.R. § 164.508, exchanged for remuneration by the entity receiving PHI of that individual, under the HIPAA Privacy Rule. Section 2. Limited Data Set or Minimum Necessary Stanend Determination. extent practicable, limit its use, disclosure or request of Indivr PHI to the amount of Individuals' PHI to accomplish the intend , p ose ® f ch use, disc perform its obligations under the underlying Agre , e is A, +''td um. constitutes the minimum necessary to accomp e inten : purpos Section 3. Security Standards. CHLIC C.F.R. Part 164 with respect to Electroni for by the Agreement. not directly or thorization is ,her PHI can be herwise pmitted shall, to the necessary ure or request and to IC shall determine what 'disclosure. to safeguards and comply with Subpart C of 45 or disclosure of PHI other than as provided Section 4. Protection of Bleat nnic PHI. W resp to F ectronic PHI, CHLIC shall: (A) Implement administrative; s1a� hnicsafeguards that reasonably and appropriately protect the confidentiality, in ity an lability of the Electronic PHI that CHLIC creates, receives, m ins or transmits behalf of the Plan as required by the Security Standards; (B) Ensure that a actual, succes becomes away ~' reasoti? Incident ontr to whom CHLIC provides Electronic PHI agrees to implement real iate safeguards to protect such information; and, shall proir tly report to the Plan any Security Incident with respect to Electronic PHI of times a and which has compromised the protections set forth in the HIPAA n t event of a Security Incident, CHLIC shall report to the Plan in writing (i) any 1 Security Incident within ten (10) business days of the date on which CHLIC first f such actual, successful Security Incident and (ii) to the extent commercially e Plan may request CHLIC to report in writing attempted but unsuccessful Security nvolving PHI of which CHLIC becomes aware, provided however that such reports are not required for trivial and routine incidents such as port scans, attempts to log -in with an invalid password or user name, denial of service attacks that do not result in a server being taken off-line, malware and pings or other similar types of events. Section 5. Reporting of Violations. CHLIC shall report to the Planany use or disclosure of PHI not provided for by this Addendum of which it becomes aware. CHLIC agrees to mitigate, to the extent practicable, any harmful effect from a use or disclosure of PHI in violation of this Addendum of which it is aware. 11/04/2014 57 324 Client Name: SAMPLE ASO AGREEMENT Administrative Services Only Agreement Section 6. Security Breach Notification. CHLIC will notify the Plan of a Breach (including privacy related incidents that might, upon further investigation, be deemed to be a Breach) without unreasonable delay and, in any event, within ten (10) business days after CHLIC's discovery of same. This notification will include, to the extent known: i. the names of the individuals whose PHI was involved in the Breach; ii. the circumstances surrounding the Breach; iii. the date of the Breach and the date of its discovery; iv. the information Breached; v. any steps the impacted individuals should take to protect themselves; vi. the steps CHLIC is taking to investigate the Bread, Breaches; and, vii. a contact person who can provide additi For purposes of discovery and reporting (as "agent" is defined under common la applicable state and federal law, includin notification is required pursuant to 45 C.F laws. With the Plan's prior approval, CHL agencies — including the De • ent of Hea required to notify pursuano; § +Gordan C.F.R. §§164.404-408). CHLI remediation and mitigation which, i Breach. CHLIC '> of be required t CHLIC shall provi • + p with info Breaches affecting f er Q Individ sclosures Sect i` sir contractors that create re fictions .•o:.'.•ns an gate losses, and prat • ainst future ion a ofreac HL is not the ag 4 t of the Plan or the Employer CHLIC vestigate Bre ches, assess their impact under CH, and,.., ke a recommendation to the Plan as to whether 4.404 40 i or applicable state breachnotification ue notic to such individuals, state and federal an, 'ervices, and/or the media — as the Plan is e with t equirements of applicable law (including 45 is of4ssuing notices required by law and other cretion, are appropriate and necessary to address the ue notifications that are not mandated by applicable law. necessary for the Plan to fulfill its obligation to report als to the Secretary as required by 45 C.F.R. § 164.408(c). ents with Third Parties. CHLIC agrees to ensure that any receive, maintain, or transmit PHI on behalf of CHLIC agree to the same uirements that apply to CHLIC with respect to such information. Section 8. Access to HI. CHLIC shall provide an Individual. with access to such Individual's PHI contained i a Desigted Record Set in response to such Individual's request in the time and manner required in 4 . § 164.524. Section 9. Avai ability of PHI for Amendment. CHLIC shall respond to a request by an Individual for amendment to such Individual's PHI contained in a Designated Record Set in the time and manner required in 45 C.F.R. § 164.526. Section 10. Right to Confidential Communications and to Request Restriction of Disclosures of PHI. CHLIC shall respond to a request by an Individual for confidential communications or to restrict the uses and disclosures of PHI contained in such Individual's Designated Record Set in the time and manner required by 45 C.F.R. § 164.522. CHLIC shall not be obligated to agree to, or implement, any restriction, 11/04/2014 58 325 Client Name: SAMPLE ASO AGREEMENT Administrative Services Only Agreement if such restriction would hinder Health Care Operations or the provision of the functions, activities or services, unless such restriction would otherwise be required by 45 C.F.R. § 164.522(a). Section 11. Accounting of PHI Disclosures. CHLIC shall provide an accounting of disclosures of PHI to an Individual who requests such accounting in the time and manner required in 45 C.F.R. § 164.528. Section 12. Availability of Books and Records. CHLIC hereby agrees to make its internal practices, books and records relating to the use and disclosure of PHI received from, or created or received by CHLIC on behalf of the Plan, available to the Secretary for purposes of dete the Plan's compliance with the Privacy Rule. Section 13. Standard Transactions. CHLIC certifies that it conducts cti ns that are subject to the HIPAA. standard transaction rules (45 C.F.R. Parts 160-164) ed under ach rules. IV. TERMINATION OF AGREEMENT WITH CHLIC Section 1. Termination Upon Breach of Provisions Applicabl HI. Any oth pr ision of the Agreement notwithstanding, the Agreement may be ted b Plan upon or written notice to CHLIC in the event that CHLIC materially breac an ration 3 Is Ad dum and fails to cure the breach within such reasonable time as the PI r in suc , provided that in the event that termination of the Agreement is not feIle, P1 s sole discr n, the Plan shall have the right to report the breach to the Secretary. If CHLIC knows of a pattern of activity or violation of the Plan's duties and obligation period of time, as agreed up t e parties, Provided, however, that, i time period, CHLIC may termina Section 2. Use an for CHLIC to retu Addendum for PHI and disclosures of suc infea:r V. OBL sclosure of PHI constitutes a material breach or ttum, CHLIC shall provide a reasonable cure the material breach or violation. rial breach or violation within such agreed upon end of such period. on Termination. The parties hereto agree that it is not feasible a.tion of the Agreement; therefore, the protections of this nation of the Agreement, and CHLIC shall limit any further uses se or purposes which make the return or destruction of such PHI TIO. S Q►F 'HE I` A4\1 AND PLAN SPONSOR Section 1. Disclosu Generall . Except as otherwise provided for in this Addendum, the Plan will not request that,CHLIC ,e or disclose PHI in any manner that would not be permissible under HIPAA or HITECH if t r b the Plan. Section 2. Disclosures to the Plan or Third Parties. To the extent the Plan requests that CHLIC disclose PHI either to the Plan or to a third party acting for the Plan, the Plan represents and warrants that: (A) It only will request PHI for the purposes of Treatment, Payment, or Health Care Operations, or another permitted purpose under the HIPAA Privacy Rule; (B) The information requested is the minimum necessary to achieve the purpose of the disclosure; and 11/04/2014 59 326 Client Name: SAMPLE ASO AGREEMENT Administrative Services Only Agreement (C) If the PHI is to be disclosed to a third party, the Plan has a business associate agreement in place with the third party, where required. Section 3. Disclosure to Plan Sponsor. To the extent the Plan requests that CHLIC to disclose PHI to the Plan Sponsor, the Plan and Plan Sponsor each represent and warrant that: (A) The information only will be used for one of the following purposes: i. Plan Administration functions, as defined by the HIPAA Privacy Ru) has executed the required plan amendment and certification all in the HIPAA Privacy Rule; ii. Enrollment functions, provided the information to be disclosed is disenrollment information; or iii. To amend, modify, or teiiuinate the Plan, or to coverage under the Plan, provided the informatio Health Information, as defined in the H Privacy (B) The information requested is the minimu VI. DEFINITIONS FOR USE IN THIS AD Definitions. Certain capitalized terms use HIPAA and HITECH including their respe any term defined herein is c modified automatically to eor" not otherwise defined have the m Addendum to a section in the HIPA then in effect, as "- ded. "Breach" means the Informa 'on which co persa a st om such in ,fmation. A. Breach oyee orriual ac good c the employee or individ authorized o access same facilit authorization b by regular Elie a rivacy d that the Plan Sponsor e disclosure, as set out emium bids to pro e disclosed isimi e; and enrollmnt and ealth insurance to Summary chieve t se of the disclosure. kl have the meanings ascribed to them by egulations and guidance. If the meaning of dry o;' la e amendment, then this Addendum will be nded'°; ition. All capitalized terms used herein that are d in4fIPAA and HITECH. A reference in this e, HIPAA Security Rule or IIITECH means the section cquisitTon, access, use or disclosure of Unsecured Protected Health rity or privacy of such information, except where an unauthorized oration iisclosed would not reasonably have been able to retain such es not include any unintentional acquisition, access or use of PHI by an under the authority of CHLIC if such acquisition, access or use was made in rse and scope of the employment or other professional relationship of such with CHLIC; any inadvertent disclosure from an individual who is otherwise I at a facility operated by CHLIC to another similarly situated individual at the eh information is not further acquired, accessed, used or disclosed without any person. "Business Associate" means CHLIC. "Covered Entity" means the Plan. "Designated Record Set" shall have the same meaning as the term "designated record set" as set forth in the Privacy Rule, limited to the enrollment, payment, claims adjudicationand case or medical management record systems maintained by CHLIC for the Plan, or used, in whole or in part, by CHLIC or the Plan to 11/04/2014 60 327 Client Name: SAMPLE ASO AGREEMENT Administrative Services Only Agreement make decisions about Individuals. "Effective Date" shall mean the effective date of the Agreement. "Electronic Protected Health Information" shall mean PHI that is transmitted by, or maintained in, electronic media as that term is defined in 45 C.F.R. § 160.103. "Limited Data Set" shall have the same meaning as the term "limited data set" as set forth in 45 C.F.R. § 164.514(e)(2). "Protected Ilealth Information" or "PHI" shall have the same meaninJ s set fo ;,at 45 C.F.R. §160.103. "Secretary" shall mean the Secretary of the United States Department of Hea d Human vices. "Security Incident" shall have the same meaning as the § 164.304. "Unsecured Protected Health Information" s or indecipherable to unauthorized individuals the Secretary in the guidance issued under ectio 11/04/2014 61 ecurity incident" as h in 45 C.F.R.. I tha of a tec ) of A end tI unusable, unreadable, methodology specified by 328 Client Name: SAMPLE ASO AGREEMENT Administrative Services Only Agreement Exhibit E — Conditional Claim/Subrogation Recovery Services I. Plans Without CHLIC General Stop Loss Coverage If Employer has not purchased individual or aggregate stop loss coverage from CHLIC or an affiliate with respect to its self -funded employee welfare benefit plan: A. All conditional claim payment and/or subrogation recoveries under the Plan will checked below; Employer An independent recovery vendor whose name and addrt o11ow: CHLIC and its subcontractor(s) B. If Employer has designated CHLIC and its subcontractors to act as its recovery a: in paragr I.A. above, then: be handled by the entity i. Employer hereby confers upon CHLIC and its recovery amounts by as much as fifty percent (50%) of behalf, and to enter into binding settlemen ii. In the event a settlement offer repres CHLIC and its subcontractors sho Name: Title: Address: Telephone: iii. All amounts reign CHLIC's and it subco subcontractors' have retain its subco h tors are both re C. Except where agre obligation to represert of this , '`,z Bement, but a r° akea to sty ac or procee 'E g as CHL un er this Agreement. D. In�p pug es individual or aggregate stop loss coverage from CHLIC or an affiliate with respec gaits self -fun ed employee welfare benefit plan at any time during the life of this Agreement, the kl provisions of patparagra b. II., below, shall control. ractors' discre onarathority to reduce al amount ofne,its paid on Employer's amount percentage identified above, mount shall be refunded at the gross amount. dministration fee on cases where CHLIC and its ounseFa n cases where no counsel has been retained by CHLIC and ed in the Schedule of Financial Charges. ployer, CHLIC and its subcontractors shall have no duty or gation or court proceeding involving any matter which is the subject able to Employer and/or Employer's counsel such information relevant C and its subcontractors may have as a result of its handling of any matter 11/04/2014 62 329 Client Name: SAMPLE ASO AGREEMENT Administrative Services Only Agreement II. Plans with CHLIC Stop Loss Coverage If Employer has purchased individual or aggregate stop loss coverage from CHLIC or an affiliate with respect to its self -funded employee welfare benefit plan: A. CHLIC and its subcontractors shall have the right and responsibility to manage all conditional claim payment and/or subrogation recoveries under the Plan. CHLIC and its subcontractors shall reimburse to the Plan the recovery minus relevant individual and aggregate stop loss payments made by IC. B. All amounts reimbursed to Employer's Bank Account shall be refunded at t"_rosy ae ount. CHLIC's and its subcontractors' subrogation administration fee on cases where CHLIC s subco .ctors' have retained counsel and in cases where no counsel has been retained by CHLIC andits s tr ors, : e b gth reflected in the Schedule of Financial Charges. C. CHLIC and its subcontractors shall have no duty or obligation proceeding involving any matter which is the subject of this; and/or Employer's counsel such information relevant to s subcontractors may have as a result of its handling of foregoing, CHLIC and its subcontractors reserve tea interests in any subrogation and/or conditiona 11/04/2014 represent Emplo Bement but shall mak ation or court ble to Employer ction or proc`-edirras CHLIC and its this Agree nt. Notwithstanding the coun o represent CHLIC's own lan. 63 330 Client Name: SAMPLE ASO AGREEMENT Administrative Services Only Agreement Exhibit F — California Transfer Addendum to ASO Agreement Exhibit F will only be included i f California Maximum Premium (Cal Max) is applicable. The following provisions are applicable to that portion of the Plan that covers California Members under a managed care coverage option utilizing a provider network established by Cigna HealthCare of California, Inc. or its affiliates ("CHC"), and the Agreement is hereby modified accordingly. These provisions are added for the purpose of ensuring compliance with California regulatory requirements which are applicable when the provider network includes providers reimbursed on a fixed per person per period basis. 1. California Banking Arrangements a. In addition to the Bank Account(s) required to be established under Se 3, pa'ate 'tibank, N.A., program account (the "CHC Program Account") will be established by or the purpof funding all in -network benefits. b. Employer shall, through a bank of its choice, periodic d the CHC Programs nt as described in the CHC Group Service Agreement ("GSA"). 2. California Contracting Requirements a. CHC shall issue to Employer a GSA. w.-iie ervi under the 1 for California Members shall be provided by CHC pursuant to this 3. Funding a. In addition to any other charges payab 4 bye oyer to iLIC for the performance of services under this Agreement, Empl1 pay to �HLI�C�a mounts funded by Employer through the CHC Program Account which to ret to Employer pursuant to the Return of Payments provision of the GSA. In rec It on ligation to fund benefits under this Administrative Services Agreement, Employer authorize pd directs HC to pay over any such amounts directly to CHLIC. Such. amounts shal J Id by CHLIC to e paid to CHC in the event CHC seeks to recover from Employer any prior yea rL F der the L ecovery provision of the GSA. In the event that the GSA terminates at a t= e w C i ill holding amounts paid by CHC under the Return of Payments prOision, such a ou s sha � considered additional compensation owed to CHLIC for services pursuant Y this Administrative Services Agreement. b. From the amounts paid t CHLIC pursuant to the preceding subsection, CHLIC shall pay to CHC any mpl r may be required to pay to CHC under the "Loss Recovery" provision of the 4. Stop Loss C verage 1 a. All amoun s funded by Employer through the CHC Program Account shall be considered as benefit payments under the Plan for purposes of any stop loss policy issued to the Employer by a Cigna company with respect to the Plan, including amounts in excess of the Maximum Premium amount reflected in the GSA. 11/04/2014 64 331 CEfkil-FIPAT OF LIA ILITY IN tJRANCE THis CERTIFICATE IS IS)wb A$ A'.MATTER OF INFORMATION ONLY AND coip5RS Nth Pi$HTS UIU bN THE CEFtTIFICATE HOLDER, TH)S OttgIpiG ATV. DOES NOV, AFFIRNIAT1VI LY,OR'NEGATIVELY AMEND, EXTEND OR ALTER, THE 'COVERAGE AFFORDED aY TAUTHORIZES EL BOW., TN1S Q>r t1iFiOATE bF IN$100140.e bOES NOT CONSTITUTE A CONTRACT 'SE1'WEt N `� H5 ISSUING` INSURER(SS), REPIRt*SENTATIVE''Ol': PAW:A./OEft, AND THE, Ci ATIP10ATE HOLID EA. IMPORTANT! If tho:certif1t4ate •holder is an •ADDITiQNAL INSURED, the pater y(Ie1) must Ire'endorsed. If 5( UROC�ATIbN IS VYAiVED, sutJjact to flat ts;rr»s;•and aandltleria of the petit!, oertairi'pcalieies may teytdre.an end:nr pliant. A'otatottio*or thus• t:H"rkIII.O. ;e does not confer rights to the oprt(ficate h°ldcrin lieu titatrah endoraemonf{s)_ PROOOPErt, A ih Al sk° -servi Bras central Xn : Phi 1attelphi a PA office 060 Liberty 1,1 °ce 1650 Markat Street slit t!e 1."000 Phi 1 adelph'i a PA 10103 USA 1tISUEEa'I Cigna cd 11.04tioh Et 41 900 cottaj5 Urova Road ttlbOmfie1U r 05002 USA, NAME: :PHONE BOA ADDRESS;. G85sj 2a3-7L72 {cY.NgIs Gab°; IN WRENS) AFFORDING COVERAGE !NSURERA: ACE American .Zn$U'rante Cbinpany IN tiregii'et DAT5MMIDO YYVY) 07r07t.Vn5 353.0105 226&7 INSUR Ro: 1145GRtfi17. $UF iN5URER QVERA S " C Ri1Hl"K:ATE NUMBER: 70O t}EZ9 70 REVISION NUMBER: THIS Is 1U G EHHIFY THAT THE f 0LIQIE§. OF,INSURANCC LISTED SaL0W HAVE OE EN ISSUED TO THE. NAMg0 ABOVE FOR THE POLICY PWO CONOITICIN iFANY CCINTftACT OR C)TFIEt3 I�CC�IM HT MITI- RESPECT TO WHICH THIS 4) iNDtGAiED 0ErtTIFIQATf EXCLUSIONS N,OTWITHs.FAND1Ntti ApoY.44thr IulCNT I rwM.o1T . NiAY- B 1$SHED C5R"NMAY PERTAIN, THE INSURANCE AFFORD.0 RY THE R4OLIOIES OESCRi6ED HEREIN iS SUBJECT TO ALL THE TERMS, AND CONDITIONS IONS OF SUCH POL G;)ES,1•IMIT:S SHOWN NIAY HAVE,•BEEN Re0UUEL BY PAID Ot.AI1lAd. I fmlt,S shown are as regueatea INSit .-... 7YPOP INSURANCE ADt7L t9U0R Ny�b,�,'ia. PatIOYNUMt*Ft _ PpY:I-'F EDP. MttlraDIYYYYI.: -1---r^.^w^- poLIQV PX hf ,1_,,YY.`rYL, . LihttTS .. - �..,,.. 1�T ... . ,.I,.. Ohl MaNuE oMM i tAG.GENERAtI R OCC 1 CLkim$4,1ACig I 1 SES {Ex.b dune teQ) P-fAnY Fneperson) ... ME .. _ • t'ERSQNAL a,AIV INJURY.. .. bENERALAGGREGATE GEnikAOO EOATa Lih71T AP?UE$ PER: LQG' - PRODUCTS` 06M:�top AGCz . ... .. PbUGY JECT OTHER: ur. AUTD`!dr)Rll•F i,itiSYLI'I'1' GCyDagNT i:D SIi?Gt:EtimiT 4ta - ,.,1911 - eQa°iLY' 1t9J'lljt"r Gr>r jlBrbPi1) . 4�: 0 ,k AUT0 C11E0ULEO- OOdICT ' 1,AY'(Pse ac Id$nt) -. ,N ALL MINk.O arts al.110,9 I'�-tlN-oWNEp PR PERTY r1AMAr c' 4PFr aeciaPolf. u HIREDAIJ`rS AUTOS "LLN' --. .. >=AcC1 1 kr0RFIE.Nas - 11MBR 1A0 . -• Qe'd0'n AGI{EakrE - aESS Liha tAilaS4MAOE otb IRetorno - .. 671,0iER OOM-P.O gATOYJAND , -. -.- I•PEil'9TATUTE'. I6R0.. ...: tapi 5YEh'S'-4Aanarie YtN l:,L„a;a4HA�DtDataT • ... _. FNY:YtiVFti 4FriOFF/ IErURr PAa'i'N riI>tXN_CUYrvO: 1FM13e$ t IOOFU7 NI" -A .- ... E.t . b{SEASa-EA EMl LOYEE • I It ,1106lktar,ln NIA V@,5, des,t $ hFSildt r•I ar:17P.RAT1Gpos ke14+N E.L, ,., E-POI lCV LYMR' .. . --- ,q O5aRIPTI mh,0 aCars Liah . ... MS002701054300 Primary •Managed Cara •Pia SIR applies per polity. tiaras 10/oJ1201A & Condilatns' 16j01l2415 Agg - Claims M44,6 15 000,000 0ESCR,iPTIoN tlE OP r'tA".•1' p 'I I: ocooN57:VPHICLES (ACORD 4$1, Aitd)41en l Remarks Schotiu1o,.may Ire sttached If Mare tpxcpiis ceg4Irad) Evidence ttt Coverage WISIS tegatd to city of Miami, Rt gu at for Proposals for ! mpIoy o netrt P ntFtl 1 tan RFP NU Tiber 49w3:5 $t at, Cig+ip Health and Llfe insgro,noa Carrip'any Cigna Pertal Npaith Plan of Arizona, Inc., Cigna Dental Health of Colorado , In-c,, Cigna Rental I-1salth t�i ilonda, Inc.; Cigna Dental Health of t4hrtti'CO3.:olinO, InO,,.Oigna Dsrffal Health af,Qhie„ Inc., Cigna Dental Health of Texas, Irio., and Cigna Qenfal Health of Virginia, Inc. CItVIIOATE ]`1.3Lb N'. CANCELLATION 'S looLD• Aral OF THE A9nVF OFsckint0 pDLICIE5 9E UANGELLED' BEFORE THE ExpinA00N GATE T34Wi0OR, N0T105"WILL,•t3E DaLIVERED •fN AOCO00ANCE WITH THE ROtity PobvIsION$. "n City of PO aini 444 .sw 2ntt Avr<:rnUE, 6th F1aor h4i alti FL 33J.50 'USA. Ab7HO0IZEt?•REPRESENTATIVE - ACORO 2 4r Ci19I 8 2014I.ACORO CORPO Ttna A00RD Flame and logo are: t`Goostersd:.marks of ACORD TION. All rights resarvad. 332 C RTIFICATE OF LIABILITY INSURANCE IOATe0{hvltvllDCSlt^5 /11) 7/07i201 THIS 22, TIF ClkTE IS.ISSL3Eti AS A MATTER OF -INFORMATION ONLY AND CONFERS NO MOH( T5 PbN THE CERTIFICATE: HOLDER, THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTEk THE COVEMGE AFFORDED BY THE-PO41ClEs BELOW TiiIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT EETvv EN THE ISsUINO INSt1FtER(S), AUTHORIZED REPPeser4TATI.WEPRODUCER, AND THE CERTIFICATE HOLDER, IMPORTANT:' if the certificate holder Is art ADl3ITION4aL INSURED,the policy(ies) must be endorsed, If ."SUBROGATION IS WAIVED, subjet the terms and c<ettttitione of the policy, certain policies may require an ondorsumont. A statenrlonteo this certificate: aloes not serifs( rijtits to the Certificate holder lr lieu of such endoirsement(s). Aoh ltisk services teritrai,. zfc, Philaclelphi a PA. ;Office One Liberty place 1650.market stretet SU`Ite 1000 Phi.Tade1phi a 'PA L9103 USA oNTACT CN NON (44E� O'MAA L APbRIn_SS r (8, ) -712 coo) 35; 0105. iNS&IF8ER{S} AREORbiNG COVERAGE NA0$ INSUREo C'jdna torooralti on fl't-Al 900 cottagge Grove Road` B1000fi21el CT 06002 USA, )VgRAGES Tl E A: ACE Am' VIlEit l: ACE Fi AS U an ce Company Ondervrriters IN,SUREi( I(usuRi9 o: INSURER ti INSURER F;. GA E NUM ER 570058621F309 nce co„ Xndemnity,Insurance Co of 'North America Agri Trent•Fo�) Xlisilraoce Company AlliOe lcetr • Guarantee & Liebi lity ins co RE /ISI( J I UIWBER^' 2167 20102 43575 42757 26247 TH1$ 10'M OCIITIVY.T1-16T THE POLICIES OF iNSI-IRANCE INDICATED: NOTVVITHSTANDINGANYREQUIREMENT, cERTIFt('ATEMAY $E ISSUED OR` MAY PERTAIN EXDt US1ONSAND CONDITION$ OF S.UGI1 POLICIES. LISTED BELQWHAVE BEEN HSSUbD TQ THE INSURED NAIVIED ABOVE FOR THE POLICY PERIOD PERM OR: CONDITION OP ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT `fO WHICH THIS THE INSURANCE AFFORDED $Y THE POLJCiES DESoF18ER,H_ EREI'N 1$ SUSJEGT TO ALL THE TERMS, LIMits SHOWN MAY HAVE SEEN REDUCED 8Y,PAID. CLAIMS, Limits shown are as requested NSR LTR 71rt OF INSURANCE u1. SD SUX3R v vD POLICY NUMBER RA FF.. YYp (MOMADD P LIMITS A - .x G0 AERCUai. GENERAL LIABILiT1`-' ... HtloG27302921-- - U /I,1/�025 0//01/:401u aASH ototniRetIOS L. S1, 000,:000 CL\IMSMADE X - OCCUR OANIi'1GE TO RENTED PREMISES (Ea gr$direnr.$) $1.000, OOtD - PAED FXp'(Any ape parson) 35.t000 P0RSONA1�d,ACiVINJURY $1.000,000 GEN1..AGGREGATE.LIMITAPPLIESPER' X POLICY Ti flRo ( LOC �IJEOT 1. ! OTHER:- CaENERALAOOREOATE $d,000,000 PACOI)4TS-COMPJOPAGO $1,000,.900 A A r4OMOO X LE LIA0I1JTY ANYAUTO ALL OWNED -' —., 'SCHEALED. AurOs. NON-' tiLo ALFTp3 ISA H08P 56710 07/01/2015 07/01/2016 07/01/20t6'EA(HoccURaellda COMtnuaD SINGLE LIMIT';T tea n`ccldon0 ' 000, 090 0bryil.YINJURY(Per)tat8Qn) . . eo ityINJURY(Peracaldent)I PROP6RtYoAMAOS P,dr'acckinnt?< MddiGal PaA8 nts Lie $5, 000 E x LIMUREL.6ALIAR Ex9SsS UA$ x ocrUR CI.AIHIS•MADE AU0967096607 07/01/2015 -$w25,000,000 AGGtiCGAre $26, 000, 000 °Eel {RE"l'EN'TION. WOR1tERSCQ)AP'ENSATII' NAND AN-. P(ROPRIRTORJPARTHaRI <CUIV8 OFFICER/MEMBERE,X6LUDEpt (Man8atery in: Idly - I: yes, dasEliPt2-ur7der 06000IPTION'OroPERATIoNsbe(0w VI N .,, N N!A WLitC48149339 (ADC) WLItC48149327 (CA, MA) - 07/01/2015 07/01/2015 - 07/01/2016 07/01/2016 x ER STATAra 0EMPLOYERS'LIABI.ITY El, EACH ACCIDENT $1,000,009 E'.L, DISEASE,01t:EM1OLOYEE _ $1, 000 .000 EL.0SEAS0PLiLIGYLIMIT _.. ..51,000,000: _... DESCRIPTION Or OPERATIONS! LOCATIONS !VEHICLES (ACORD 161, Additional Ramapo Schedule, may be et -lambed if mere spade le required) - --- y Evidence of Coverage with regard to City of Miami, Request for Proposals for Employee Benefit Dental Plan RFP Number 406345, eta!, Cigna Health and Life I ,; Insurance Company, Cigna Dental Health Plan of Aelzone, Inc., Cigna Dental Health of Colorado, Imo., Cigna DentAI Health of Florida, lno, Cigna Dental Health of North Carolina, Inc., Cigna Dentai Health of 0hid, Inc„, Cigna Dental Healthof Texas, Ind., and Cigna Dental Health of Virginia, Inc. City of Miami is included ' I as Additional Insured in accordance With the policy provisions of the General Liability policy, DER CANCELLATION t i ty opt 311 awl 444 SW grad Avenue, 6th Floor Miaml FL 33130 USA SHOULD ANY or TVS ABOVE DESCRIBED rOU0r6s BE CAN40LUL, H0POR6 THE EXPIRATION DIM THEREOF NOTICE WILL 6E. DELIVERED IN ACCORDANCE WITH THE POLICY; PROVISIONS. - AUTHORIZED REPRESENTATIVE ACORD 26 (2014/01) The ACQRt) name and logo are regi 01P8$-2014AGOFio CORPORATION, All rights reserved. ered marks of ACORD Ce?tifica e Nis 333 Acc,a,t, kOENCY" AON RiSk Servi ces Central , Inc AGENCY CUSTOMER ICI 10042_023 LOC f: ADDITIONAL REMARKS SCHEDULE NAMED INEOREO Cigna Corporation Et Al PnutriwmseR See certificate Nuenber 570056621800 'CARRIER see certificate NUmher: 570056621809 NAIO tone Page 0-f EFEI'lVtbkrt, AbbfflONAL REMARKS it4N.ADDITIONAL REMARKS FOM IS A SCHEDULE TO •ACORD PORM, rogm NUMBETU ACORD25 FORM, TITLE: Cartifitato of Liability Insurance INSURERM AFPORD1NG COVERAGE NATO NSURER INSURER NSJiUR ir a policY below dos not Include I zn t information, retbr t the cOtrespon cy on the ACORD ding poll • ADDITIONAL- POLTICiES cord fleet° form for policy limits, IN$11 ADM SLIBlii POLICY NIOARER CYR TYPE OF INSURANCE NED WYD WORKERS COMPENSATION Mt:EEOWE DATE INUYTYyy. POLICY EEPiRATION DATE (mni/OnlYVATY) IMITS N/A SCPC40L42340 6.41). OT/01/2015 07/01/2016 N/A V0448150652 Workers (*oho (MT) /A W R t4Sis 6 4 workers Comp (NY) WA Ka C48150640 workers Como (Ks) N/A un“pc481449864 workers. comp (TN) 07/01/2015 07/01/2016 07/01/2015 07/01/2016 07/01/2015 07/01/2016 07/01/2015 07/01/20t Acoab 101 2bo8(01) Tho ACORD name and logo are registered marks 1 A,CORO 0/8 AP:DM) CORPORATION, MI rights r 334 GLOBP 'ISK MANAGEMENT AvaIrt."*WIT;`.:a. Couith'eiavalito %tat att 4.et-6 Insgr, 14,10424t, Indura, k • - SCHEDULE I INSURANCE INSURERS, COVERAGES, & LIMITS A.M. BEST INSURANCE CARRIERS RATINGS' -rtirt '1-.4-3K116'41,40 "`' unillany4ouno 112-, rtati*.T4C7.6iliP.thi 5. 7.044 Wgiftifik4 4.0,1710 tR.0 441$41, ;114,4M06 .140„,yr, us-709666 Vf1.1.41WAK 9492 a jit-R4K44,..WgrtM4 .;! 4 X1,20 toW„OkOr47" rss*frI44",I4f-t-tiP. fr'-'15Y4'43,1itapo- -4-',;47-14-vrza ,m2iyk.,20 . T, , on, tA. .10 e'aulify-f441 Ta jici "vx de, tka4a.' oqip,p24 v14'0,;-14, Sidet13-!- ,, u ra veer 9g-A afp. Q ctitt;eng,,, e Qicear,eztelif In.g;,5,41r *These ratings are under continuous review and subject to change and/or affirmation. To confine the current rating, please dick on the rating or visit the A.M. Best websiter www.ambestcom I . tertransactrot*oot.:in$oro.0001n tie ate Florida,, T i- ertificate sisignifiesthat the company has chts of :Florida It) r Ufa And Et i sure .ate return Subject the= laws Fria,. Issuance:: Feb a N. 10 -:1 Coon Er w e, 'ro P V o*o ro Wo�G ono o:o o o o c o 0 0 0 0 C 0 0 o' 0 0 0 0 0 o quo o:� ;;o:{oyo::pro,¢;o;{o;•;o„o;{o;.n;o{o;;o;;oDO, .4.. ororo o�o:o{6io.o dro'o:{e:o{o•o.o•a:olo,�::io:q:o;:o;Co;�o�o:o:o:ego•,.,:...A....a.................,......,....,...:.,..............A ..A .,... .;...; .:• ;-.:•:;3ri'so*or.vo o�ote�orow.e''ro�mri*•'�o�s�'• o;o{o;;o:o;•:b,o;;o�o;oyp{o;o o{a',`e;{e;;o•.•o;�cYv7o:o;�o;v�o;o.o;o:�o•or�o{�o:�o:;o;✓a;o:rCo;�s;6,�,p;e;{�s.�';o{e e{o:;o;;o:;do;�o;�e{e;;o o�0 0 o,y,o o e,o o,o,,,.,o, �. .. .. , pFi ORO XX ae �etftcte of eitavr,4 STATE OF FLORIDA OFFICE OF AL004S5 INSURANCE COMMISSIONER AND TREASURER THIS IS TO CERTIFY THAT: CIGNA.DENTAL HEAL.TH.OF FLCAIDA INC 1525 NW • 167 • ST/SALES ADMIN/4TH FLOOR MIAMI*. FLORIDA 331.69 HAS "DULY QUALIFIED PURSUANT. TO I CHAPTER 63.6.. 1.FLORIDA STATUTES FOR A PREPAID LIMITED. HEALTH SERVICE. ORGANIZATION CERTIFICATE OF AUTHORITY .AND.IS HEREBY AUTHURIZED TO ..WRITE THE FQLLOMING LINEL S) •• OF •BUSINESS. • 04S1 DENTAL .PLANS 06 01 94 10 3+6 4509-50 .500s 00 660 0T ISSUE DATE TYPE CLASS APPLICATION TAXES & FEES COMPANY CODE EXPIRATION DATE u=' • alp TREASURER ' I NSURANCX. COMMISSION ER FIRE MARSHAL .dt';a,{p;.o{s;0;�9d'9,o„e,oho,e„o, o,;o;{e;;o',{o;;oyob;o:•o{u o9'6{O:io {o;o�6 oP,q'o{�•ono;o;OiK{K:O;:doX:0X00X•u?o',PX4t.:07AF6,op000 N4EiK $ :.1 •V.t.. s .:Ay:K{+::6 Y :K.aK 'f'. q{,�':b;�f::e;.O;K{Kie;{K :KiK:K die:{iia4K:e:iKiK:Kia {e:K{Kre CK4stP ;d,{A,;o;, :e:p:o:rE:mr'ie.3►:6.A :K.e:o:{e::e;:o:ro:<Kie;:o;•� • k • AA :R3► 4:1{o.:97P:9;{0;:o {K:o {o;o {o• K.o ;o;.''•'X 37 2014 ANNUAL REPORT 338 Cigna. ��s�a 2 LETTER TO OUR SHAREHOLDERS TO OUR SHAREHOLDERS In the face of a dynamic and challenging global environment, Cigna has demonstrated consistent success by addressing our customers' desire for affordable and personalized solutions which - consistent with Cigna's mission help improve their health, well-being and sense of security. This remained the case in 2014 when, for the fifth consecutive year, Cigna delivered competitively attractive financial results to our shareholders. OUR STRATEGY: GO DEEP WITHIN TARGETED GEOGRAPHIES AND BUYING SEGMENTS GO GLOBAL TO LEVERAGE OUR CAPABILITIES IN A BORDERLESS FASHION GO INDIVIDUAL TO ENGAGE AND SERVE THE NEEDS OF INDIVIDUALS This outstanding track record continues to be driven by the disciplined execution of our "Go Deep, Go Global, Go Individual" strategy, as we continue to invest in new capabilities, personalize our product and service offerings, and expand our geographic footprint. 341 David M. Cordanl Pr Sident and Chief Executive Officer Cigna Corporation "CIGNA WILL DOUBLE THE SIZE OF OUR BUSINESS IN 7 TO 8 YEARSa" We also continue to innovate through meaningful investments ranging from new clinical programs and aligned customer incentives, to the expanded use of enabling technologies and programs for health care professionals. We believe that Cigna has the right strategy and growth framework to continue meeting and exceeding the needs of our customers and clients - giving us the foundation to achieve our goals, including: Growing revenues by eight to ten percent in 2015; Doubling the size of our business over the next seven to eight years and; Delivering on our long-term Earnings Per Share objective of 10 to 13 percent compound growth on an annual basis. 2014 Performance Highlights: Another Year of Strong Results First, let's review Cigna's 2014 financial performance. Cigna's full -year consolidated revenue increased by eight percent, to approximately $35 billion. Adjusted income from operations* was $2 billion, or $7.43 per share - representing a per-share increase of nine percent compared with 2013. Cigna reported shareholders' net income for the full- year of $2.1 billion. In the five years since implementing our "Go Deep, Go Global, Go Individual" strategy, Cigna has delivered compound annual growth of 14 percent for revenues and '14 percent for adjusted income from operations* on a per share basis. Further, over the past five years, we have continued to deliver industry leading medical cost trend results. *Adjusted Income from Operations and Adjusted Income from Operations per share are non-GAAP measures used to describe the Company's financial results, Definitions of Adjusted Income from'Operations on a consolidated and segment basis are contained In Management's Discussion and Analysis of Financial Condition and Results of Operations (MD&A) on page 32 and 45 respectively, of the Form 10-K included in this annual report. The MD&A also includes reconciliations of Adjusted Income from Operations to the mostWectly comparable GAAP measures. 3 4 LETTER TO OUR SHAREHOLDERS Business Segment Performance Highlights Each of Cigna's business segments - Global Health Care, Global Supplemental Benefits, and Group Disability and Life - delivered strong growth in 2014 over the prior year, as we grew our number of customer relationships to more than 85 million worldwide. GLOBAL HEALTH CARE Cigna's Global Health Care business segment provides health care, wellness and preventive solutions to individuals and employers around the world. In another strong year for this segment, we grew premiums and fees by seven percent, to $24.5 billion, reflecting growth in all of our Global Health Care businesses, including continued growth in our fast-growing self -funded and specialty products businesses. We ended 2014 with 14.5 million global medical customers, representing an increase of approximately 380,000 customers during the year (excluding limited benefits customers). We continue to effectively manage medical costs that reflect better health outcomes and strong clinical excellence for our customers and clients, as a result of our deep, collaborative relationships with physicians and our focus on the personalization of care. For example, in 2014 we surpassed our goal of 100 Collaborative Accountable Care Organization arrangements with large physician groups, serving more than 1.4 million customers. Cigna also introduced a new suite of value -based initiatives, which we refer to as Cigna Collaborative Care, to include small physician groups, specialists and hospitals, all with an eye to improving care for our customers. GLOBAL SUPPLEMENTAL BENEFITS Cigna's Global Supplemental Benefits business segment, which provides supplemental health, Life and accident insurance in several markets around the world - including Medicare supplement coverage in the United States - once again delivered attractive growth and profitability for our shareholders. Our highlights included formally launching our Cigna Health Insurance joint venture in India, and continued success in Korea, where we continue to innovate and grow, serving millions of customers. Premiums and fees for this segment grew by 14 percent year -over -year, with adjusted income from operations* of $230 million - reflecting attractive operating margins, and continued strategic investments to drive future growth. 5 GROUP DISABILITY AND LIFE Our Group Disability and Life business segment - which provides life, accident and disability insurance, along with back -to -work prograrns - delivered solid results, with premiums and fees increasing by six percent over 2013, and full -year adjusted income from operations* of $317 million. These results reflected favorable claims experience in Cigna's life insurance business and a lower operating expense ratio. Cigna continues to be a leader in group disability product sales, and we maintain a strong share of the market for group disability, life and accident solutions as well as for leave of absence programs such as Family and Medical Leave Act (FMLA) administration. Creating a more sustainable health care environment We are proud of the results we've generated for our shareholders as well as for those we serve around the world. Market by market, the global environment is a challenging one for those of us in the health service sector. It's far more so for the millions of individuals trying to manage their health, and the health of their families, in a way that's effective, affordable and relevant to their personal needs. The anxiety and confusion of consumers surrounding their health care is easy to understand, For example, in the United States, health care costs have grown faster than the economy over the past three decades, with health care expenditures on pace to represent $1 of every $5 produced by the United States economy by 2021. Further, chronic diseases - many of them preventable with better lifestyle and behavior choices - represent about 75 percent of United States health care spending. Chronic diseases are the leading cause of death and disability in the United States, accounting for seven out of every ten deaths each year. At the same time, there's a significant "disconnect" between individuals and their medical costs, with too many people acting as passive consumers of. health care, in large part because of the difficulty in navigating and engaging with a high -cost, fragmented system. Yet, these same consumers of health care are expected to understand and select from more choices than ever before. Ultimately, these individuals want peace of mind. Fulfilling these needs is a dynamic process, as customer needs evolve and vary over time due to life and health stage changes. 344 LETTER TO OUR SHAREHOLDERS 7 "OUR GUIDING FRAMEWORK DRIVES DIFFERENTIATED VALUE FOR CUSTOMERS AND STAKEHOLDERS." It is clear that, as a society, we are long past due for a reasoned dialogue on health care in the United States, exploring how employer groups, government and health care suppliers can work together to build a sustainable system better equipped to provide quality, affordable care over the long term - a system which transcends its historic focus on sick care and addressing existing illness, to one more adequately focused on the preventive care, and lifestyle and behavior improvements, that help people avoid getting sick in the first place. At Cigna, we believe consumers of health care services deserve more choice, higher quality, transparency and affordability. No single entity has all of the answers to get us there. From Cigna's perspective, we believe we can take major steps toward a sustainable health care system by increasing the effectiveness of what we already know is working today and for which Cigna strongly advocates, including: Access to quality medical care through employer -sponsored plans, a robust individual market and a variety of safety nets available to those in need; Improved affordability, which includes rewarding doctors and hospitals based on quality outcomes; Broadening choice for all purchasers of health care insurance and services; ) Making costs and quality of care as transparent as possible, and Engaging individual customers of health care as important partners. 346 8 LETTER TO OUR SHAREHOLDERS "CIGNA WILL CONTINUE TO GROW THROUGH AFFORDABILITY AND PERSONALIZATION." Society's desire for improvement is evident. From an employer -group perspective, Cigna sees our clients increasingly focused on engaging their workforces to drive improved health outcomes, To continue doing so, they require choices of effective and efficient health and productivity services, including more benefit choices that are valued by their employees, ranging from employer -funded base offerings to employee -paid voluntary benefits; and innovative engagement tools, including incentive and network programs that yield superior value from both a quality and affordability perspective. Similarly, as government funding of health costs continues to grow, governments across the globe are seeking paths to better drive improved quality and health outcomes at affordable costs - including high -value based social programs for the neediest members of the population as well as innovative programs for the higher risk/higher complexity populations, such as Medicare/Medicaid dual eligible individuals in the United States, and the aged, blind and disabled populations. Finally, health care professionals are seeking new partnerships that leverage information, incentives and care resources to help them navigate to a value -based performance and reimbursement environment. We're seeing this approach gain momentum in the United States. Affordability and personalization For Cigna, market needs and expectations are framed in the context of two strategic imperatives that guide our approach as we respond to, engage and interact with our customers: affordability and the personalization of services. There's an inherent and natural tension involved in striking the right balance between affordability and personalization - a balance which Cigna aims to strike by: Understanding our customers' unique needs, in part by leveraging data analytics and insights; Localizing our operations to meet theneeds of a specific market or country; Fulfilling our brand promise of helping individuals in a personally relevant way, and Harnessing our breadth of talent - more than 35,000 team members around the world. Cigna is committed to continuing to participate in, and play a convening role in prompting constructive dialogue on how we can best create a sustainable health care system. At the same time, we will continue to incorporate these elements in our own organization, and ensure we are positioned to rise to these opportunities and challenges. 347 9 Converting challenges into growth opportunities To achieve our growth goals in a disruptive global environment for health care, Cigna has built a guiding framework - comprising three main components: Leveraging our core capabilities in existing businesses; Effectively deploying capital; Pursuing new and emerging opportunities. Taken together, Cigna believes this framework will enable us to continue driving differentiated value for our customers and shareholders over time. LEVERAGING OUR CORE CAPABILITIES As part of this first component, we see significant opportunity to leverage the three pillars of our "Go Deep, Go Global, Go Individual" strategy, to focus on markets and segments where we are well -positioned to continue winning in the market. Our existing portfolio, along with our focused execution, will play a significant role in doubling the size of business over the next seven to eight years, which will result in an average annual revenue growth rate of eight to ten percent. Our 2015 outlook is consistent with this goal. CAPITAL DEPLOYMENT Relative to the second part of our framework - targeted and effective capital deployment - our portfolio of businesses continued to contribute significant free cash flow for shareholders. Over the past five years, we have effectively deployed capital through a balance of investments in our business portfolio, strategic mergers and acquisitions, and share repurchase. A good, recent example of this is our agreement to purchase QualCare Alliance Networks - an acquisition directly aligned with our Go Deep strategy, and our physician -partnership strategy. We also have a strong track record of generating high levels of free cash flow, which provides us with financial flexibility, and the opportunity to deploy capital tb create additional value for our shareholders. And given the health of our balance sheet and underlying capitalization levels of our subsidiaries, we expect to have $1.8 billion dollars of capital available for deployment in 2015. 348 �: k 12 LETTER TO OUR SHAREHOLDERS NEW AND EMERGING OPPORTUNITIES The third component of our framework where we will seek to drive additional value for our shareholders is through new and emerging opportunities. These opportunities include: ) New distribution marketplaces such as public and private exchanges; Geographic expansion, such as new Medicare Advantage markets in the United States and expanding international opportunities; New buying segments and service expansions, such as Medical Service Organization offerings for the benefit of integrated health care professionals. Cigna is well -positioned to pursue each of these potentially attractive future growth opportunities that are aligned with our strategy. As such, we have dedicated resources to fuel future expansion in these areas. Conclusion Cigna remains confident in the strength of our product and service portfolio, our financial flexibility, and our ability to build on our current markets and segments as well as to create new opportunities in target geographies. The proven effectiveness of our "Go Deep, Go Global, Go Individual" strategy, along with our framework for longer -term growth, puts us in a strong position to meet our goals of: Growing revenues by eight to ten percent in2015; Doubling the size of our business over the next seven to eight years and Delivering on our long-term Earnings Per Share growth objective of between 10 to 13 percent compound growth on an annual basis. Our 35,000-plus employees around the world remain committed, day in and day out, to living Cigna's mission of helping the people we serve improve their health, well-being and sense of security. On behalf of our entire organization, I thank you for your support of Cigna. David M. Cordani President and Chief Executive Officer Cigna Corporation 351 13 352 14 USING INSIGHTS Cigna Lases its deep insights to connect customers p rc(r1aiiz€d pro)d'(ts, pro rarf s. with innovative and services. In 2014, Cigna launched a new brand campaign with a promise to customers to work together with them to lead healthier, more secure lives. Our brand promise, Together, all the way. is based on insights rooted in research and experience, which tell us that customers want us to work as their partners. When it comes to staying well - physically, financially, emotionally... we're with our customers all the way. Affordability and personalization Affordability and personalization are central to our brand promise. Affordability means helping customers find the right care, at the right price. Affordability also compels us to help customers get the most value from their benefit plans - and to help them lower their costs as their health improves. One important way we do this is through maximizing the relationship between our customers and health care professionals to help customers get quality, cost-effective care. Personalization means we use the insights we've gleaned from customers to segment individuals into groups with common needs. This allows us to deliver personally relevant products and services to each group of customers. Keeping our promise Evidence of how we provide affordability and personalization can be found ih the United States and around the world. For example, during the 2014 fall benefits enrollment period, millions of United States` Cigna customers were introduced to Cigna Health Matters', a way to make health management more interesting by combining our health coaches, mobile applications, social media and games to heip customers and their families evaluate their health, find tools to improve their health, track their' progress and earn rewards. Additionally, Cigna and Samsung teamed up to create aital health coaching tool that fits in the palm of customershands. "Coach by Cigna" is available at no additional charge to Samsung Galaxy SAS smartphone andNote4'4 users around the globe. This app helps customers collect and evaluate their health and "wellness progress, create a personalized lifestyle improvement program, and ultimately achieve their health and wellness goals. Another example of how we live the brand promise is through the work of Cigna- HealthSpring', which serves our Medicare and Medicaid customers. After a successful pilot in Tennessee, we're expanding our heart 353 failure remote patient monitoring program in collaboration with Intel -GE Care InnovationsTM Patients with a prior admission to the hospital for heart failure receive a tablet to assess their health for at least 90 days. The tablet helps customers interact with a Cigna-HealthSpring nurse practitioner, track their health metrics and learn how to manage their condition at home. Customers know they haveeasy and direct access to someone who cares about them and their health. Further demonstrating our understanding of customers, Cigna led an effort to replace the International Symbol of Access - the iconic "wheelchair'' symbol, created in 1969 - with a new icon. Led by Cigna's People With Different Abilities Colleague Resource Group, a support and networking group within Cigna, the new image shows a more active figure that emphasizes ability rather than disability. The icon serves as affirmation of our commitment to help our customers achieve their full potential both inside and outside of the workplace. Through Cigna's efforts, Phoenix, AZ became the latest city to approve the new symbol .for use in business parking areas. 354 1 Cigna's new brand expression, Together, all the way." focuses on being a partner to our customers. 2 Hazel, a customer with Cigna-HealthSpring®, stays active through ballroom dancing. 3 Cigna helped to create a new handicapped parking icon focused on ability rather than disability. In international markets 1n China, the first -ever Cigna and CMS Home Shopping Channel aired recently on Jia You- Hyundai Home Shopping Channel, and replicated the success we've had in distributing direct -to - consumer products in Korea. In Turkey, as part of our joint venture with Finansbank, a leading Turkish bank, Cigna Finans Pension and Insurance Advisors are available in banks to help educate customers and encourage them to consider their future needs. In India, Cigna TTK is developing prevention and wellness programs for a country with diverse needs and an explosive growth in the rates of chronic disease, where 60 million people struggle with diabetes. And in Korea, where more than 33 percent of the Korean population is over 50 years old, Cigna Korea launched "Heyday," the first health care membership program in Korea. Through Heyday, seniors enjoy various health and wellnessprograms and services with no membership fee. Wherever Cigna customers are, we're showing that we listen and we care, connecting them to the people, products and programs that help them improve their health, well-being and sense of security. 15 16 FINDING INSPIRATION lnspirec by° the wor< ound tic)n is Conte to work together to secure world. In 2014, the Cigna Foundation created a new grant -making platform focused on impact of others, the Cigna in withnonprof it partners create healthier, more investing - moving beyond financial support to creating strong partnerships with nonprofits. The partnerships also mean involving Cigna employees to share their skills and talents with the community. This approach to grants brought the Cigna Foundation together with change agents far and wide. Arogya World, for example, is a nonprofit partner in engaging people in India to improve their health. With the Cigna Foundation's support, Arogya is creating a mobile app that will house heart and kidney disease education, awareness and prevention information. The mobile app will be distributed to India's workforce through employers. In New York, with the help of the Cigna Foundation, the New York Botanical Garden is conducting world -class research to improve health outcomes for Latino and Caribbean populations living in New York City through a new discipline known as urban ethnobotany. This program is teaching health professionals how to understand and communicate with their patients who use plant -based remedies. We expect this research will be of importance to the medical community around the world. In the northeast neighborhood of Hartford, CT, the Cigna Foundation's work with Community Solutions is designed to turn around the health of a neighborhood ravaged by poverty, in an area where life expectancy is 10 years lower than in other surrounding neighborhoods. This work involves looking at the root causes of high emergency room use by residents, as well as how home visits and better housing and employment options can improve health. Additionally in 2014, Cigna employees organized the company's largest -ever volunteer effort, with 1,000 Connecticut employees packing 250,000 meals for Feeding Children Everywhere. The meals were delivered to needy children in Kenya. All of this work expresses the Cigna Foundation's passion for removing the barriers people face in their daily lives so that everyone has a chance to achieve their best health. 355 1 Samahope raises funds to help the needy get life-saving surgeries around the world. 2 The New York Botanical Garden helps doctors understand their patients' use of plant - based remedies. 3 Cigna employees in Hartford, CT run for the March of Dimes°. 4 Community Solutions improves health and wellness in a Hartford neighborhood. 5 Achilles studies the Impact of running to help children with autism, 6 Girls en the Run helps girls learn to be healthy and self-confident, 356 7 Arogya World helps prevent chronic disease in India through mobile phone messages. 8 Children in Memphis, TN receive food for the weekends through Blessings In a Backpack. 9 Stylists With the University of Maryland HAIR program teach clients about the Importance of cancer prevention. 18 MAKING AN IMPACT icjna connections make arl impact worldwide. We strive o be a p csitiv force fcr change in the lives c)f C.iJstonlers clients and communities• The impact we have on those we serve can be life -changing, and is measured in statistics as well as by the individual stories from our customers and clients, A proven difference Within Cigna, for example, 94 percent of employees and families are tobacco -free, and nearly 70percentof elployees and families report they're at a healthy weight. Through our collaboration with physicians and other health care professionals, we're improving health care costs and quality. Among our 23 Cigna Collaborative Care arrangements with two or more years of experience, 91 percent are having success controlling total medical costs, while 78 percent are haying success with improving the quality of health care - and 74 percent are having success with both total medical costs and quality. Research with customers Our studies with customers tell a similar story of lowering costs and improving health. For example, Cigna research shows that a single phone call from a nurse to high -risk heart and respiratory patients, after they've been discharged from the hospital, can reduce future readmissions by 22 percent. This is significant from a cost perspective, as readmissions represent 30 percent of total inpatient costs. Cigna also monitored the health outcomes of customers with hepatitis C who have undergone treatment using Sovaldi°!as part of a combination prescription therapy, and found that 91 percent of our customers were cured after completing treatment. And for the eighth year in a rows a Cigna Choice Fund' study demonstrated that an account - based approach in which customersuse savings and reimbursement accounts in higher deductible plans- is helping millions of customers reduce their health care expenses without compromising their care. When compared with customers in other types of health plans, our Choice Fund customers are more likely to use health improvement programs, comply with evidence -based medicine best practices, and 357 m / ' � � - i quaUtyand ltiDg Eind lower total customers used the ernorgency room at a five tot n Si 1HM0 a) =la,n,, � 'Fuhd products provide tools and y" �d=" ~"," eto "kacost- conscious �bouttheirhea�hand 'health spending, FEEDING CHILDREN EVERYWHERE 1,000 omwAVOLUNTEERS PACKING MEALS MEALS DELIVERED roxEwyA stories and recognition �Aroundthevvo�d'oUr nd�idua|ytor�sare ` compelling. For exampl ' e, we helped a family who moved from the United States to Sweden, whose five -year -old needed her anti -seizure medicine. The family hadn't yet become a part of Sweden's health care system. ACigna nurse case manager' took charge and made sure that the child received , 'the medicine she needed. Another example isthe businessman who - dfromchroniokidney failure, whose job required him totravel around the'vvodd.HsO�nanurse case manager �o| d ^` upand arranged his dialysis for him wherever he was inthe world. We're proud of this level of service to custombrs,, 'oa2O14| - ' which led t_ ,p"'�`~.�.~�»,,"�� Benefits Provider of the Year award, given toCigna Global Health Benofito19for overall excellence bythe Expatriate Management and Mobility Awards. This iythe third time infour 358 20 359 MAKING AN IMPACT 21 Committed to corporate responsibility and the environment Our success depends on earning trust through responsible business practices, corporate citizenship and service that meets our customers' needs, all through a unique approach to corporate responsibility called Cigna Connects. In 2014, Cigna took its commitment to corporate responsibility (CR) to the next level by issuing the 2013 Cigna Connects Corporate Responsibility Report, available online at Cigna. com/CorporateResponsibility. Cigna's first CR report provides a detailed look at the company's environmental, social and governance policies and priorities, and explores how they support the company's core businesses and benefit Cigna stakeholders and society. The report provides relevant facts, figures and stories about CR initiatives at Cigna, including the company's new 2017 environmental targets: a nine percent reduction in greenhouse gas emissions, a nine percent reduction in energy use, and a three percent reduction in water consumption. Additionally, representative of our continuous improvement, Cigna's score on the 2014 CDP Climate Change Information Request improved from a disclosure score of 59/100 in 2013 to 86/100, and our performance band moved from C to B. Through Cigna Connects, the company aims to serve as a, catalyst for change and a convener of stakeholders, in the more than 30 countries in which we operate. With more than 35,000 colleagues, we're united by the goal of building a better world for today and for future generations. 360 22 CIGNA IN PERSPECTIVE Cigna is a global health service leacer that arovides mecical, cental, cisaaility, life and accident insurance, and relatec oroducts and services to customers in the United States anc arounc the glooe. Global Health Care Global Health Care includes a commercial line of business encompassing United States and international operations. Commercial offers a broad line of insured and self -insured medical, dental, behavioral health, vision, prescription drug benefit plans, health coaching programs and other products and services that may be integrated to provide comprehensive global health care benefit programs to employers and their employees, including globally mobile individuals. Global Health Care also includes a government line of business that offers Medicare Advantage, Medicare Part D and Medicaid plans for Medicare or Medicaid -eligible individuals, primarily seniors. A significant portion of our Medicare Advantage customers are served by physicians in innovative plan models designed to improve health outcomes and lower medical costs. Cigna offers Medicare Advantage plans in 16 states and the District of Columbia, Medicare Part D plans in all 50 states and the District of Columbia, and Medicaid plans in select markets in Texas and Illinois. In 2015, we expect to expand Medicaid operations. Global Supplemental Benefits Global Supplemental Benefits offers supplemental health, life and accident insurance products in select international markets and the United States. With licenses and partnerships across Asia -Pacific, Europe and North America, Cigna offers products and services to local citizens and globally mobile individuals. Global Supplemental Benefits also offers Medicare supplement coverage. Group Disability and Life Group Disability and Life provides insurance products and related services for group long - and short-term disability insurance, group life insurance, and accident and specialty insurance. Cigna markets products in all 50 states, the District of Columbia, Puerto Rico, the United States Virgin Islands and Canada. Group disability programs are designed to help improve employee productivity and lower employers' overall absence costs. Products are coupled with comprehensive tools and services for easy benefit management. 361 23 • Government - 31% COMMERCIAL SEGMENT • Medical - 63% Dental - 6% E South Korea - 52% Taiwan -10% • Europe -10% United States - 13% • Other -15% • Disability - 49% itt Life 45% • Other - 6% GLOBAL SUPPLEMENTAL BENEFITS BY COUNTRY GROUP DISABILITY AND LIFE BY PRODUCT PREMIUMS AND FEES \ AND OTHER REVENUES IN MILLIONS $24,714 PREMIUMS AND FEES . AND OTHER REVENUES IN MILL IONS $2,896 PREMIUMS AND FEES AND OTHER REVENUES IN MILLIONS $3,635 362 I UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 FORM 1O-K (Mark �One) I7 I ANNUAL REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934 For the fiscal year ended December 31, 2014 OR LJ TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934 For the transition period from to Commission file number 1-8323 •00i � �o.4i• • na. CIGNA CORPORATION (Exact name of registrant as specified in its charter) Delaware (State or other jurisdiction of incorporation or organization) 900 Cottage Grove Road, Bloomfield, Connecticut (Address of principal executive offices) (860) 226-6000 Registrant's telephone number, including area code (860) 226-6741 Registrant's facsimile number, including area code 06-1059331 (I.R.S. Employer Identification No. 06002 (Zip Code) SECURITIES REGISTERED PURSUANT TO SECTION 12(B) OF THE ACT: Title of each class Name of each exchange on which registered Common Stock, Par Value $0.25 New York Stock Exchange, Inc. SECURITIES REGISTERED PURSUANT' TO SECTION 12(G) OF THE ACT. NONE Indicate by check mark YES: NO • if the registrant is a well-known seasoned issuer, as defined in Rule 405 of the Securities Act. ✓ E. • if the registrant is not required to file reports pursuant to Section 13 or Section 15(d) of the Act. _ ✓ • whether the registrant (1) has filed all reports required to be filed by Section 13 or 15(d) of the Securities Exchange Act of 1934 during the preceding 12 months (or for such shorter period that the registrant was required to file such reports), and (2) has been subject to such filing requirements for the past 90 days. _ _ • whether the registrant has submitted electronically and posted on its corporate Web site, if any, every Interactive Data File required to be submitted and posted pursuant to Rule 405 of Regulation S-T during the preceding 12 months (or for such shorter period that the registrant was required to submit and post such files). ✓ • if disclosure of delinquent filers pursuant to Item 405 of Regulation S-K is not contained herein, and will not be contained, to the best of registrant's knowledge, in definitive proxy or information statements incorporated by reference in Part III of this Form 10-K or any amendment to this Form 10-K. � F. l • whether the registrant is a large accelerated filer, an accelerated filer, a non -accelerated filer, or a smaller reporting company. See definitions of "large accelerated filer", "accelerated filer" and "smaller reporting company" in Rule I.2b-2 of the Exchange Act. Large accelerated filer I v l Accelerated filer mp Non-accelerated filer Smaller Reporting Company ❑ • whether the registrant is a shell company (as defined in Rule 126-2 of the Exchange Act). E. C The aggregate market value of the voting stock held by non -affiliates of the registrant as of June 30, 2014 was approximately $24.3 billion. As of January 31, 2015, 258,442,718 shares of the registrant's Common Stock were outstanding. Part III of this Form 10-K incorporates by reference information froMethe registrant's definitive proxy statement related to the 2015 annual meeting of shareholders. Table of Contents Page CAUTIONARY STATEMENT PART I 1 Item 1. Business • Overview 1 • Global Health Care 2 • Global Supplemental Benefits 8 • Group Disability and Life 9 • Other Operations 11 • Investments and Investment Licome 12 • Regulation 12 • Miscellaneous 17 Item 1A. Risk Factors 18 Item 1B. Unresolved Staff Comments 27 Item 2. Properties 27 Item 3. Legal Proceedings 27 Item 4. Mine Safety Disclosures 27 EXECUTIVE OFFICERS OF THE REGISTRANT 28 PART II 29 Item 5. Market for Registrant's Common Equity, Related Stockholder Matters and Issuer Purchases of Equity Securities 29 Item 6. Selected Financial Data 31 Item 7. Management's Discussion and Analysis of Financial Condition and Results of Operations 32 Item 7A. Quantitative and Qualitative Disclosures about Market Risk 59 Item 8. Financial Statements and Supplementary Data 60 Item 9. Changes in and Disagreements with A.ccountants on Accounting and Financial Disclosure 116 Item 9A. Controls and Procedures 116 Item 9B. Other Information 116 367 PART III Page 117 Item 10. Directors, Executive Officers and Corporate Governance 117 A. Directors of the Registrant 117 B. Executive Officers of the Registrant 117 C. Code of Ethics and Other Corporate Governance Disclosures 117 D. Section 16(a) Beneficial Ownership Reporting Compliance 117 Item 11. Executive Compensation 117 Item 12. Security Ownership of Certain Beneficial Owners and Management and Related Stockholder Matters 118 Item 13. Certain Relationships, Related. Transactions and Director Independence 118 Item 14. Principal Accountant Fees and Services 118 PART IV 119 Item 15. Exhibits and Financial Statement Schedules 119 SIGNATURES 120 INDEX TO FINANCIAL STATEMENT SCHEDULES FS-1 INDEX TO EXHIBITS E-1 368 CAUTIONARY NOTE REGARDING FORWARD - LOOKING STATEMENTS This Annual Report on Form 10-K contains forward -looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. Forward -looking statements are based on. Cigna's current expectations and projections about future trends, events and uncertainties. These statements are not historical facts. Forward -looking statements may include, among others, statements concerning our business strategy, strategic or operational initiatives, including our ability to deliver improved health services outcomes and productivity for our customers and clients while lowering the costs of health care; future growth and expansion; future financial or operating performance; economic, regulatory or competitive environments; and our projected cash position, future pension funding and financing or capital deployment plans. You may identify forward - looking statements by the use of words such as "believe," "expect," "plan," "intend," "anticipate," "estimate," "predict," "potential," "may," "should," "will" or other words or expressions of similar meaning, although not all forward -looking statements contain such terms. Forward -looking statements are subject to risks and uncertainties, both known and unknown, that could cause actual results to differ materially from those expressed or implied in forward -looking statements. Such risks and uncertainties include, but are not limited to: our ability to achieve our financial, strategic and operational plans or initiatives; our ability to predict and manage medical costs and price effectively and develop and maintain good relationships with physicians, hospitals and other health care providers; our ability to identify potential strategic acquisitions or transactions or realize the expected benefits of such strategic transactions; the substantial level of government regulation over our business and the potential effects of new laws or regulations or changes in existing laws or regulations; the outcome of litigation, regulatory audits, investigations and actions and/or guaranty fund assessments; uncertainties surrounding participation in government -sponsored programs such as Medicare; and unfavorable industry, economic or political conditions, as well as more specific risks and uncertainties discussed in Part I, Item 1A — Risk Factors and Part II, Item 7 — Management's Discussion and Analysis of Financial Condition and Results of Operations of this Form 10-K and as described from time to time in our future reports filed with the Securities and Exchange Commission. You should not place undue reliance on forward -looking statements, which speak only as of the date they are made, are not guarantees of future performance or results, and are subject to risks, uncertainties and assumptions that are difficult to predict or quantify. Cigna undertakes no obligation to update or revise any forward - looking statement, whether as a result of new information, future events or otherwise, except as may be required by law. 369 PART I ITEM 1, Business ITEM 1. Business Overview Cigna Corporation, together with its subsidiaries (either individually or collectively referred to as "Cigna," the "Company," "we," "our" or "us") is a global health services organization dedicated to a mission of helping individuals improve their health, well-being and sense of security. To execute on our mission, Cigna's strategy is to "Go Deep", "Go Global" and "Go Individual" with a differentiated set of medical, dental, disability, life and accident insurance and related products and services offered by our subsidiaries. We: • GO DEEP by targeting key segments and geographies; • GO GLOBAL with solutions that leverage our capabilities in a borderless environment; and • GO INDIVIDUAL to better understand and satisfy the holistic needs of each person we serve. In an increasingly retail oriented marketplace, we deliver affordable and personalized products and services to customers through employer -based, government -sponsored and individual coverage arrangements. We increasingly collaborate with health care providers We present the financial results of our businesses in the following three reportable segments: to transition from volume -based fee for service arrangements toward a more value -based system designed to increase quality of care, lower costs and improve health outcomes. We operate a customer -centric organization enabled by keen insights regarding customer needs, localized decision -making and talented professionals committed to bringing our "Together All the Way" brand promise to life. As of December 31, 2014, our consolidated shareholders' equity was $10.8 billion, assets were $55.9 billion and we reported revenues of $34.9 billion for 2014. Our revenues are derived principally from premiums on insured products, fees from self -insured products and services, mail-order pharmacy sales and investment income. As explained in Note 22 to the Consolidated Financial Statements, effective with the first quarter of 2014, we began combining the results of our run-off reinsurance business with other immaterial operating segments in Other Operations for segment reporting purposes. Prior year segment information has been conformed to the current year presentation. $ gil t t x ., aistrof ie'''�ites 1,1 ye a, r t',r, f, ' u; . , f I?es4j tptioilr. ,, fit . a ; tiR , - ; Global Health Care 78% Aggregates the Commercial and Government operating segments: Commercial • Encompasses both our U.S. commercial and certain international health care businesses, • Serves employers and their employees, including globally mobile individuals, and other groups (e,g., governmental and non -governmental organizations, unions and associations), In addition, our U.S. commercial health care business also serves individuals. • Offers our insured and self -insured customers medical, dental, behavioral health, vision, and prescription drug benefit plans, health advocacy programs and other products and services that may be integrated as part of a comprehensive global health care benefit program. Government • Offers Medicare Advantage, Medicare Part D and Medicaid plans. Global Supplemental Benefits 9% Offers supplemental health, life and accident insurance products in selected international markets and the U.S, - Group Disability and Life 11% Provides group long-term and short-term disability, group life, accident and specialty insurance products and related services, 370 CIGNA CORPORATION - 2014 Form 10-K 1 PART I ITEM 1. Business We present the remainder of our segment results in Other Operations, consisting of the corporate -owned life insurance business ("COLI"), run-off reinsurance and settlement annuity businesses and deferred gains associated with the sales of the individual life insurance and annuity and retirement benefits businesses. Key Transactions Over the past three years, we have entered into a number of transactions that are helping us to achieve our strategic goals by; (1) repositioning the portfolio for growth in targeted geographies, product lines, buying segments and distribution channels; (2) improving our strategic and financial flexibility; and (3) pursuing additional opportunities in high growth markets with particular focus on individuals. Specifically: • In June 2013, we entered into a ten-year pharmacy benefit management services agreement with Catamaran Corporation ("Catamaran"). Under this agreement, we utilize Catamaran's technology and service platforms, retail network contracting and claims processing services. • In February 2013, we effectively exited our Run-off guaranteed minimum death benefit ("GMDB" also known as "VADBe") and guaranteed minimum income benefit ("GMIB") reinsurance businesses by entering into an agreement with Berkshire Hathaway Life Insurance Company of Nebraska ("Berkshire") to reinsure 100% of our future exposures for these businesses, net of retrocessional arrangements in place as of February 4, 2013, up to a specified limit. • In 2012, we entered into three strategically significant transactions targeting several key markets: seniors, individual and global supplemental benefits: • We acquired HealthSpring, a Medicare Advantage provider, to assist us in serving individuals across their life stages and deepen our presence in a number of geographic markets. This acquisition brought us industry -leading physician partnership capabilities, deepened our existing client and customer relationships, and facilitated a broader deployment of our range of health and wellness capabilities andproduct offerings. • We acquired Great American Supplemental Benefits to both strengthen our capabilities in the individual market and facilitate our expansion into the Medicare supplement business. • We entered into a joint venture with Finansbank to expand our global footprint in Turkey. Global Health Care Health Care Reform The Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act (collectively referred to throughout this Form 10-K as "Health Care Reform" or "PPACA") continues to have a significant impact on our business operations. The effects of Health Care Reform are discussed throughout this Form 10-K where appropriate, including in the Global Health Care business description, Regulation, Risk Factors, Management's Discussion and Analysis of Financial Condition and Results of Operations, and the Notes to the Consolidated Financial Statements. Other Information The financial information included in this Annual Report on Form 10-K for the fiscal year ended December 31, 2014 ("Form 10-K") is in conformity with accounting principles generally accepted in the United States of America ("GAAP"), unless otherwise indicated. Industry rankings and percentages set forth herein are for the year ended December 31, 2014 unless otherwise indicated. In addition, statements set forth in this document concerning our rank or position in an industry or particular line of business have been developed internally, based on publicly available information, unless otherwise noted. Cigna Corporation was incorporated in Delaware in 1981. Our annual, quarterly and current reports, proxy statements and other filings, and any amendments to these filings, are made available free of charge on our website (http://www.cigna.com, under the "Investors — Quarterly Reports and SEC Filings" captions) as soon as reasonably practicable after we electronically file these materials with, or furnish them to, the Securities and Exchange Commission (the "SEC"). We use our website as a channel of distribution for material company information. Important information, including news releases, analyst presentations and financial information regarding Cigna is routinely posted on and accessible at www.cigna.com. See "Code of Ethics and Other Corporate Governance Disclosures" in Part III, Itern 10 beginning on page 117 of this Form 10-K for additional available information. The Global Health Care segment constitutes approximately 80% of our revenues and aggregates the Commercial and Government operating segments due to their similar economic characteristics, products and services and regulatory environment. We seek to differentiate ourselves through deep customer insights, resulting in personalized solutions and service, and high quality physician partnerships to optimize quality and affordability of care for our customers and clients. We expect to accomplish these goals, in part, by targeting selected geographies and market segments and by accelerating our engagement with employers and individuals. The health care delivery system is moving away from a volume -based reimbursement system to a value orientation. We are actively driving this "volume -to -value" transition through our continued partnership with preferred health care professionals and our internal investment in people, process and technology. 371 2 CIGNA CORPORATION - 2014 Form 10-K PART I ITEM 1. Business Our Commercial operating segment encompasses both our. U.S. commercial and certain international health care businesses serving employers and their employees, including globally mobile individuals, and other groups (e.g., governmental and non -governmental organizations, unions and associations). In addition, our U.S. commercial health care business also serves individuals through our product offerings both on and off the public health insurance exchanges. Through this segment, we offer our insured and self -insured customers medical, dental, behavioral health, vision, and prescription drug benefit plans, health advocacy programs and other products and services that may be integrated as part of a comprehensive global health care benefit program. Our Government operating segment: offers Medicare Advantage, Medicare Part D and Medicaid plans. Principal Products and Services Commercial Medical Health Plans — U.S. and International The Commercial operating segment, either directly or through its partners, offers some or all of its products in all 50 states, the District of Columbia, the U.S. Virgin Islands, Canada, Europe, the Middle East, and Asia. We offer a variety of medical plans including: • Managed Care Plans including Network, Network Open Access and Open Access Plus. We offer a product line of Health Maintenance Approximately 90% of our commercial medical customers are in funding arrangements where lower medical costs directly benefit our corporate clients and employees who share in the cost of their coverage. The funding arrangements available for our commercial medical and dental health plans are as follows: Organization ("HMO") and indemnity managed care benefit plans that use meaningful cost -sharing incentives to encourage the use of "insnetwork" versus "out -of -network" health care providers and provide the option to select a primary care physician. The national provider network for Managed Care Plans is somewhat smaller than the national network used with the preferred provider ("PPO") plan product line. Generally, customers may use non -participating health care professionals, but the customers' cost -sharing obligation is usually greater for out -of -network care. • PPO Plans. Our PPO product line features a network with broader provider access than the Managed Care Plans. The preferred provider product line may be at a higher medical cost than our Managed Care Plans. • Choice Fund° Suite of Consumer -Driven Products. Our medical plans are often integrated with the Cigna Choice Fund suite of products, including Health Reimbursement Accounts ("HRA"), Health Savings Accounts ("HSA") and Flexible Spending Accounts ("FSA") that are designed to encourage customers to play an active role in understanding and managing their health and associated expenses. Customers can use these accounts to finance eligible health care expenses and other approved services. In most cases, these products are combined with a high deductible medical plan. We continue to experience strong growth in these products and they represent a rapidly growing percentage of our overall medical customer base. Fr�fcdarrg Aty pe��ti r i g ,�. anent �P "` Administrative Services Only ("ASO" or "self -insured") Clal i-�}, x is , 3 ��ediq SC'tt�ainks� x� 1n ad :t 82% Zy :...fkv�c' - a� x {' em s .. ti }t'i�.y {`� , � ��� ��� �;���°�,�}�rh.� � � ��.��Aescr�R�1O� � � w��� ,� x�� ��ivC 'E .,r.�4 �7 4 Ys,n.. l' rst�`k.,,. Cvd.,tit '� .AkS�tf F.a • ASO plan sponsors are responsible for self -funding all claims, but may purchase stop loss insurance to limit exposure for claims in excess of a predetermined amount. • We collect fees from plan sponsors for providing access to our participating provider network and for other services and programs including: claims administration; behavioral health; disease management; utilization management; cost containment; dental; and pharmacy benefit management. • In some cases, we provide performance guarantees associated with meeting certain service standards, clinical outcomes or financial metrics. Insured — Experience Rated 6% • Premium charged during the policy period ("initial premium") may be adjusted following the policy period for actual claim, and in some cases, administrative cost experience of the policyholder. • When claims and expenses are less than the initial premium charged (an "experience surplus"), the policyholder may be retrospectively credited for a portion of this premium. • However, if claims and expenses exceed the initial premium (an "experience deficit"), we generally bear the risk. In certain cases, experience deficits may be recovered through future year experience surpluses if the policyholder renews, Insured — Guaranteed Cost 12% • We establish the cost to the policyholder at the beginning of a policy period and generally cannot subsequently adjust premiums to reflect actual claim experience until the next annual renewal. • Employers and other groups with guaranteed cost policies are generally smaller than those with experience -rated group policies; accordingly, our claim and expense assumptions may be based in whole or in part on prior experience of the policyholder or on a pool of policyholders, depending on the policyholder's size and the statistical credibility of their experience. • HMO and individual plans (medical and dental) are offered on a guaranteed cost basis only. 372 CIGNA CORPORATION - 2014 Form 10-K 3 PART I ITEM 1. Business We offer stop loss insurance coverage for ASO plans that provides reimbursement for claims in excess of a predetermined amount for individuals ("specific"), the entire group ("aggregate"), or both. Our experience rated group medical insurance policies include funding options similar to stop loss coverage. In most states, individual and group insurance premium rates must be approved by the applicable state regulatory agency (typically department of insurance) and state laws may restrict or limit the use of rating methods, Premium rates for groups andindividuals are subject to state review for reasonableness. In addition, Health Care Reform subjects individual and small group policy rate increases above an identified threshold to review by the United States Department of Health and Human Services ("HHS") and requires payment of premium refunds on individual and group medical insurance products if minimum medical loss ratio ("MLR") requirements are not met. In our individual business, premiums m.ay also be adjusted as a result of the government risk mitigation programs. The MLR represents the percentage of premiums used to pay medical claims and expenses for activities that improve the quality of care. See the "Regulation" section of this Form 10-K for additional information on the commercial MLR requirements and the risk mitigation programs of Health Care Reform, Government Health Plans Medicare Advantage We offer Medicare Advantage plans in 16 states and the District of Columbia through our Cigna-HealthSpring brand. Under a Medicare Advantage plan, Medicare -eligible beneficiaries inay receive health care benefits, including prescription drugs, through a managed care health plan such as our coordinated care plans. A significant portion of our Medicare Advantage customers receive medical care from our innovative plan models that focus on developing highly engaged physician networks, aligning payment incentives to improved health outcomes, and using timely and transparent data sharing. We are focused on continuing to expand these models in the future. We receive revenue from the Centers for Medicare and Medicaid Services ("CMS") for each plan customer based on customer demographic data and actual customer health risk factors compared to the broader Medicare population. We also may earn additional revenue from CMS related to quality performance measures (known as "Medicare Stars"). Additional premiums may be received from customers, representing the difference between. CMS subsidy payments and the revenue determined as part of our annual Medicare Advantage bid submissions. Beginning in 2014, Health Care Reform requires Medicare Advantage and Medicare Part D plans to meet a minimum MLR of 85%. If the MLR for a CMS contract is less than 85%, we are required to pay a rebate to CMS and could be subject to additional sanctions if the MLR continues to be less than 85% for successive years. Medicare Part D Our Medicare Part D prescription drug program provides a number of plan options, as well as service and information support to Medicare and Medicaid eligible customers. Our plans are available in all 50 states and the District of Columbia and offer the savings of Medicare combined with the flexibility to provide enhanced benefits and a drug list tailored to individuals' specific needs. Retirees benefit from broad network access and value-added services intended to help keep them well and save them money. Medicaid We offer Medicaid coverage to low income individuals in selected markets in Texas and Illinois, Our Medicaid customers benefit from many of the coordinated care aspects of our Medicare Advantage programs. We expect to further expand our Medicaid operations during 2015 under existing contracts. Specialty Products Our specialty products and services described below are designed to improve the quality of and lower the cost of medical services and help customers achieve better health outcomes. The vast majority of these products can be sold on a standalone basis, but we believe they are most effective when integrated with a Cigna -administered health plan. Our specialty products are focused in the areas of medical, behavioral, pharmacy management, dental and vision. Medical Specialty • Cost -Containment Service. We administer cost -containment programs on behalf of our clients and customers for health care services and supplies that are covered under health benefit plans. These programs may involve vendors who perform activities designed to control health costs by reducing out -of -network utilization, including educating customers regarding the availability of lower cost, in -network services, reviewing provider bills, and recovering overpayments from other payers or health care providers. We charge fees for providing or arranging for these services. • Health Advocacy. We offer a wide array of medical management, disease management, and other health advocacy services to employers and other plan sponsors to help individuals improve their health, well-being and sense of security. These services are offered to customers covered under plans that we administer, as well as plans insured or administered by competing insurers or third -party administrators. Our health advocacy programs and services include early intervention in the treatment of chronic conditions. We also offer online tools and software to help customers manage their health and an array of health coaching programs designed to address lifestyle management issues such as stress, weight, and tobacco cessation. Behavioral Health We arrange for behavioral health care services for customers through our network of approximately 89,000 participating behavioral health care professionals and 11,400 facilities and clinics, We offer behavioral health care case management services, employee assistance programs ("EAP"), and work/life programs to employers, government entities and other groups sponsoring health benefit plans. We focus on integrating our programs and services with medical, pharmacy and disability programs to facilitate customized, holistic care. 4 CIGNA CORPORATION - 2014 Form 10-K 373 PART I ITEM 1. Business Pharmacy Management We offer prescription drug plans to our commercial and government (Medicare/Medicaid) customers both in conjunction with our medical products and on a stand-alone basis. With a network of over 74,000 pharmacies, Cigna Pharmacy Management is a comprehensive pharmacy ,benefits manager ("PBM") offering clinical integration programs and specialty pharmacy solutions. We also offer high quality, efficient, and cost-effective mail order, telephone and on-line pharmaceutical fulfillment services through our home delivery operation. Our medical and pharmacy coverage can meet the needs of customers with complex medical conditions requiring specialty pharmaceuticals. These types of medications are covered under both pharmacy and medical benefits and can be expensive, often requiring associated lab work and administration by a health care professional. Therefore, coordination is critical in improving affordability and outcomes. Clients with Cigna -administered medical and pharmacy coverage benefit from continuity of care, integrated reporting, and aggressive unit cost discounts on all specialty drugs. Dental We offer a variety of dental care products including dental health maintenance organization plans ("Dental HMO") in 37 states, dental preferred provider organization ("Dental PPO") plans in 48 states and the District of Columbia, exclusive dental provider organization plans, traditional dental indemnity plans and a dental discount program. Employers and other groups can purchase our products as stand-alone products or integrated with medical products. Additionally, individual customers can purchase Dental PPO plans in conjunction with individual medical policies. As of December 31, 2014, our dental customers totaled approximately 12.9 million, most of whom are in self -insured plans. Our customers access care from one of the largest Dental PPO networks and Dental HMO networks in the U.S., with approximately 134,000 Dental PPO health care professionals and 20,000 Dental HMO health care professionals. Vision Cigna Vision offers flexible, cost-effective PPO coverage that includes a range of both in and out -of -network benefits for routine vision services offered in conjunction with our medical and dental product offerings. Our national vision care network, consisting of approximately 69,700 health care providers in over 24,800 locations, includes private practice ophthalmologist and optometrist offices, as well as retail eye care centers.. Service and Quality Customer Service For U.S.-based customers, we operate 18 service centers that together processed approximately 158 million medical claims in 2014. As of December 31, 2014, we operated 15 call centers, and provide service to customers 24 hours a day, 365 days a year. In our international health care business, we have a service model dedicated to the unique needs of our 1.3 million customers around the world. We service them from 8 service centers that are available 24 hours a day, 365 days a year. Technology Technology continues to play a significant role in the execution of our Go Deep, Go Global, Go Individual strategy. Our information technology (IT) investments and priorities are focused on building a retail -centric IT infrastructure and developing innovative business capabilities that support affordable health solutions and create a personalized customer experience. We continue to leverage technology, information and analytics globally to engage our customers in more meaningful, relevant and customized methods, guided by their needs, preferences, likes and interests. Our investments in digital, mobile, gamification, social media and big data enable us to create solutions that improve health and wellness. With increased engagement across the health care ecosystem, we believe that technology can significantly upgrade the customer experience and improve care delivery through collaboration with delivery systems, enabling the transition from a volume based fee -for -service system to a value based health care marketplace. While focusing on innovation, we will remain focused on the delivery of strong foundational IT capabilities including optimization and resilience of the core infrastructure; building appropriate business continuity and disaster recovery capabilities; and developing layered information protection and strengthened cybersecurity solutions. We will also continue to seek opportunities to expand the role technology plays in delivering value to our customers and partners. Quality Medical Care Our commitment to promoting quality medical care to the people we serve is reflected in a variety of activities. Health Improvement through Delivery System Engagement Cigna is committed to developing innovative solutions that span the delivery system. We are focused on executing our connected care strategy that engages providers and customers to achieve affordability and access at the local market level, We continue to increase our engagement with physicians and hospitals by rapidly developing the types of arrangements discussed below, More than one million medical customers are currently serviced by more than 48,000 health care providers in these types of arrangements. Collaborative Accountable Care Organizations ("CACs'). We increasingly collaborate with physicians and other health care professionals and facilities to improve the quality of care and patient satisfaction while lowering medical costs, resulting in improved overall value. This collaboration is illustrated by our 114 CAC arrangements, spanning 28 states and reaching 1.2 million customers and by our commitment to continue increasing the number of CACs over the next several years. Our goal is to reach 135 of these programs in 2015. 374 CIGNA CORPORATION - 2014 Form 10-K 5 PART I ITEM 1. Business We continue to grow Cigna's National Hospital Quality Incentive Program with compensation to 195 hospitals tied to quality metrics and we expect to add an additional 100 hospitals over the next two years. Additionally, we continue to develop our arrangements with specialists through innovative programs such as National Ob/Gyn and our episode -of -care program focused on deliveries along with hip and knee replacements. Our Patient Care Collaboration program will put the small physician practice first by providing them with key actionable patient information to improve outcomes in a way that fits their practice needs. The program is newly developed and we anticipate piloting with select physicians in a few markets in 2015. • Delivery System Alliances. We are now forming alliances with hospitals and hospital systems that will provide access to quality, value -based care in local communities. • Independent Practice Associations — Cigna-HealthSpring. With the innovative physician engagement models in our Cigna- HealthSpring business, we utilize a variety of business arrangements that shift the physician's reimbursement from the traditional fee -for -service model to one that is focused on rewarding quality medical outcomes and an enhanced patient experience at a lower cost. In these arrangements, the physician groups share financial outcomes with us. The Cigna-HealthSpring clinical model also includes outreach to new and at -risk patients to ensure they are accessing their primary care physician. Participating Provider Network We provide our customers with an extensive network of participating health care professionals, hospitals, and other facilities, pharmacies and providers of health care services and supplies. In most instances, we contract with them directly; however, in some instances, we contract with third parties for access to their provider networks and care management services. In addition, we have entered into strategic alliances with several regional managed care organizations (e.g., Tufts Health Plan, HealthPartners, Inc., Health Alliance Plan, and MVP Health Plan) to gain access to their provider networks and discounts. We credential physicians, hospitals and other health care professionals in our participating provider networks using quality criteria that meet or exceed the standards of external accreditation or state regulatory agencies, or both. Typically, most health care professionals are re-credentialed every three years. The Cigna Care Network, a benefit design option available in 70 service areas across the U.S., is a subset of participating specialist physicians so designated based on specific clinical quality and cost -efficiency criteria. Customers pay reduced co -payments or co-insurance when they receive care from a specialist designated as a Cigna Care Network physician. Participating specialists are evaluated regularly for the Cigna Care Network designation. LocalPlus® is a select network of local, quality doctors and hospitals designed to offer clients greater affordability, by limiting the network to a subset of quality, cost-efficient physicians and hospitals. We currently offer LocalPlus in 12 markets and will expand this approach in additional markets in 2015. Onsite Medical Care • Cigna Medical Group is a multi -specialty medical group practice that delivers primary care and certain specialty care services through 23 medical facilities and approximately 150 employed clinicians in the Phoenix, Arizona metropolitan area. All of the these health care centers have received accreditation as a Patient Centered Medical Home from the National Committee for Quality Assurance ("NCQA") a private, nonprofit organization dedicated to improving health care quality. Cigna Medical Group holds the highest level of this accreditation (level 3). Cigna Medical Group has the greatest number of practices and physicians in the state of Arizona with this accreditation. • Cigna Onsite Health. Our onsite services include more than 150 health centers at various employer sites that offer health coaching, wellness seminars and biometric screenings. • LivingWell Health Centers. Our Medicare Advantage customers may receive care from a team of physicians, nurse practitioners and pharmacists. We operate seven free-standing clinics and "six "embedded" clinics that incorporate the principles and resources of stand-alone clinics while allowing the customer to continue local office visits to his or her primary care physician. External Validation We continue to demonstrate our commitment to quality and have a broad scope of quality programs validated through nationally recognized external accreditation organizations. We retained Health Plan accreditation from the NCQA in 36 of our markets. Additional NCQA recognitions include Full Accreditation for Managed Behavioral Healthcare Organization for Cigna Behavioral Health, accreditation with Performance Reporting for Wellness & Health Promotion, accreditation for our wellness programs and Physician & Hospital Quality Certification for our provider transparency program. We have Full Accreditation for Health Utilization Management, Case Management and Pharmacy Benefit Management from URAC, an independent, nonprofit health care accrediting organization dedicated to promoting health care quality through accreditation, certification and commendation. We participate in the NCQA's Health Plan Employer Data and Information Set ("HEDIS°") Quality Compass Report, whose Effectiveness of Care measures are a standard set of metrics to evaluate the effectiveness of managed care clinical programs. Our national results compare favorably to industry averages. 375 6 CIGNA CORPORATION - 20.14 Form 10-K PART I ITEM 1. Business Markets and Distribution We offer health care and related products and services in the following customer segments or markets: % of Medical Customers National Middle Market Select Individual Government International Multi -state employers with 5,000 or more U.S,-based, full-time employees. We primarily offer ASO funding solutions in this market segment, Employers generally with 250 to 4,999 U.S.-based, full-time employees. This segment also includes single -site employers with more than 5,000 employees, Taft -Hartley plans and other third party payers. We offer ASO, experience -rated and guaranteed cost funding solutions in this market segment. Employers generally with 51-249 eligible employees. We offer ASO and guaranteed cost funding solutions in this market segment. Individuals in ten states: Arizona, California, Colorado, Connecticut, Florida, Georgia, North Carolina, South Carolina, Tennessee and Texas, In 2014 we offered coverage on the state -run public health insurance exchange in Colorado, as well as the federally facilitated exchanges in Arizona, Florida, Tennessee and Texas. In 2015 we will expand our public exchange participation to include the state -run exchange in Maryland and the federally facilitated exchanges in Georgia and Missouri. Consistent with the regulations for Individual PPACA compliant plans, we offer plans only on a guaranteed cost basis in this market segment. Offers Medicate Advantage (both to individuals who are post-65 retirees, as well as employer group sponsored pre and post-65 retirees), Prescription Drug programs, and Medicaid products. Focused on the needs of local and multinational companies and organizations and their local and globally mobile employees and dependents. We offer guaranteed cost, experience -rated and ASO funding solutions in this market segment. Cigna Guided SolutionssM, is our proprietary retail health insurance exchange targeting clients that value fully integrated solutions, and focusing on engaging employees in their health and their health spending. It leverages. Cigna's ability to provide a fully integrated solution with our broad spectrum of plans and services, and broad suite of funding options, focused on improving total cost, health, and improved productivity. Together with integrated robust decision - support tools, employees will be able to make appropriate trade-off decisions and select plans that best fit them and their families. In addition, Cigna participates on many third party private exchanges. We actively evaluate private exchange participation opportunities as they emerge in the market, and target our participation to those models that best align withour mission and value proposition. To date, we have committed to participate with numerous private exchanges for both active employees and retirees. We employ sales representatives to distribute our products and services through insurance brokers and insurance consultants or directly to employers, unions and other groups or individuals. We also employ representatives to sell utilization review services, behavioral health care and pharmacy management, and employee assistance services directly to insurance companies, HMOs, third party administrators and employer groups. As of December 31, 2014, our field sales force consisted of over 1,250 sales representatives in more than 132 field locations. In our Cigna-HealthSpring business, Medicare Advantage enrollment is generally a decision made individually by the customer, and accordingly, sales agents and representatives focus their efforts on in -person contacts with potential enrollees, as well as telephonic and group selling venues. Competition and Industry Developments Our business is subject to intense competition and continuing industry consolidationthat has created an even more competitive 26% 52% 8% 2% 3% 9% business environment. In certain geographic locations, some health care companies may have significant market share positions, but no one competitor dominates the health care market nationally. We expect a continuing trend of consolidation in the industry given the current economic and political environment. We also expect continued vertical integration, with the line blurring between clinicians and hospitals, and traditional insurers. Competition in the health care market exists both for employers and other groups sponsoring plans and for the employees in those instances where the employer offers its employees a choice of products from more than one health care company. Most group policies are subject to annual review by the policyholder, who may seek competitive quotations prior to renewal. We expect competition to increase in the individual market as a result of the growth in the public health insurance exchanges under Health Care Reform. Given the relatively immature individual market and limited data around claim experience, we expect some uncertainty and competitive volatility through the initial years of the exchange roll out. Some of the risk is mitigated by the government risk mitigation programs. The primary competitive factors affecting our business are quality and cost-effectiveness of service and provider networks; effectiveness of medical care management; products that meet the needs of employers and their employees; total cost management; technology; and effectiveness of marketing and sales. Financial strength of the insurer, as indicated by ratings issued by nationally recognized rating agencies, is also a competitive factor. We believe that our health advocacy capabilities, holistic approach to consumer engagement, breadth of product offerings, clinical care and medical management capabilities and array of product funding options are competitive advantages in meeting the diverse needs of our customer base. We also believe that our focus on helping to improve the health, well-being and sense of security of the customers we serve will allow us to differentiate ourselves from our competitors. 376 CIGNA CORPORATION - 2014 Form 10-K 7 PART I ITEM 1. Business Our principal competitors in the U.S.-based business are: • other large insurance companies that provide group health and life insurance products; • Blue Cross and Blue Shield organizations; • stand-alone HMOs and PPOs; • HMOs affiliated with major insurance companies and hospitals; and • national managed pharmacy, behavioral health and utilization review services companies. The primary competitors of the international health care business include U.S. and European health insurance companies with global health benefits operations. The primary competitors for our international healthcare operations in the United Kingdom and Spain are regional and local insurers. Competition also arises from smaller regional or specialty companies with strength in a particular geographic area or product line, administrative service firms and, indirectly, self -insurers. In addition to these traditional competitors, a new group of competitors has emerged. Some of these newercompetitors, such as hospitals and companies that offer web -based tools for employers and employees, are focused on delivering employee benefits and services through internet-enabled technology that allows consumers to take a more active role in the management of their health. This can . be accomplished through financial incentives, access to enhanced quality medical data and other information sharing. The effective use of our health advocacy, customer insight and physician engagement Global Supplemental Benefits capabilities, along with decision support tools (some of which are web -based) and enabling technology are critical to success in the health care industry, and we believe our capabilities in these areas will be competitive differentiators. The health insurance marketplace will continue to be shaped by Health Care Reform. In 2016, Health Care Reform expands the small group market definition to employers with 100 or less employees, subjecting insurers in this market to community rating. The results of the 2014 Congressional elections add additional uncertainty as to the effects that Health Care Reform may have going forward. See the "Regulation" section of this Form 10-K for additional information regarding Health Care Reform. On February 20, 2015, CMS issued its Advance Notice of Methodological Changes for Calendar Year 2016 for Medicare Advantage Capitation Rates, Part C and Part D Payment Policies (the "Notice"). The final terms are expected to be published on April 6, 2015. While the terms contained within the Notice are within the range of our expectations, there remain numerous open issues and substantial uncertainties regarding the final terms of the Notice. We expect that CMS will receive a significant number of comments from interested parties (including Cigna) prior to issuing the final terms; however, there can be no assurance that CMS will amend its current positions. Given the uncertainty regarding the final terms of the Notice, we cannot reliably estimate the impact on our business, revenues or results of operations in 2016 and beyond; under certain circumstances, it is possible that the impact could be materially adverse. In addition, we expect to adjust our programs and services in response to the proposed 2016 terms. Our Global Supplemental Benefits segment offers supplemental health, life and accident insurance products primarily in Asia, Europe and the United States. With local licenses and partnerships in approximately 15 countries and jurisdictions, we are able to offer products and services to local citizens and globally mobile individuals. In China, Turkey, and India, we offer products and services through joint ventures. This segment constituted 9% of our consolidated revenues for the year ended December 31, 2014. We continue to distinguish ourselves in the global supplemental health, life and accident businesses through our differentiated direct -to -consumer distribution, customer insights and marketing capabilities. We enter new markets when the opportunity to bring our product and health solutions is attractive. Over the past several years, we have continued to extend our product offerings and geographic reach. For example, in 2014, we began offering products in India through our joint venture with TTK Group. In 2012, we extended our reach in Turkey through the joint venture with Finansbank and expanded into the U.S. Medigap and supplemental lines of business through the acquisition of Great American Supplemental Benefits. Principal Products and Services Supplemental Health, Life and Accident Insurance Supplemental health, life and accident insurance products generally provide simple, affordable coverage of risks for the health and financial security of individuals. Supplemental health products provide specified payments for a variety of health risks and include personal accident, accidental death, critical illness, hospitalization, travel, dental, cancer and other dread disease coverages. We also offer customers individual private medical insurance, term and variable universal life insurance, and certain savings products. Medicare Supplement Plans We offer individual Medicare Supplement plans that provide retirees with federally standardized Medigap-style plans. Retirees may select among the various plans with specific plan options to meet their unique needs and may visit, without the need for a referral, any health care professional or facility that accepts Medicare throughout the United States. 377 8 CIGNA CORPORATION - 2014 Form 10-K PART I ITEM 1. Business Pricing and Reinsurance Premium rates for our global supplemental benefits products are based on assumptions about mortality, morbidity, customer acquisition and retention, customer demographics, expenses and target profit margins, as well as interest rates. For variable universal life insurance products, fees consist of mortality, administrative, asset management and surrender charges assessed against the contractholder's fund balance. Mortality charges on variable universal life may be adjusted prospectively to reflect expected mortality experience. Most contracts permit premium rate changes at least annually. A global approach to underwriting risk management allows for each local business to underwrite and accept risk within specified limits. Retentions are centrally managed through cost effective use of external reinsurance to limit our liability on per life, per risk, and per event (catastrophe) bases. Markets and Distribution Our supplemental health, life and accident insurance products sold in foreign countries are generally marketed through distribution partners with whom the individual insured has an affinity relationship. These products are sold primarily through direct marketing channels, such as outbound telemarketing, and in -branch bancassurance (where we partner with a bank and use the bank's sales channels to sell our insurance products). Marketing campaigns are conducted through these channels under a variety of arrangements with affinity partners, including banks, credit card companies and other financial and non -financial institutions. We also market directly to consumers via direct response television and the Internet. In certain countries, we market our products through captive and third party brokers. Our Medicare supplement product line is distributed primarily through independent agents and telemarketing directly to the consumer. South Korea represents our single largest geographic market for Global Supplemental Benefits. For information on this concentration of risk for the Global Supplemental Benefits segment's business in South Korea, see "Other Items Affecting Results of Global Supplemental Benefits" in the Global Supplemental Benefits section of the MD&A beginning on page 52 of this Form 10-K. For our supplemental health, life and accident insurance products sold in foreign markets we are increasingly exposed to geopolitical, currency and other risks inherent in foreign operations. Also, given that we bill and collect a significant portion of premiums through credit cards, a substantial contraction in consumer credit could impact our ability to retain existing policies and sell new policies, A decline in customer retention would result in both a reduction of revenue and an acceleration of the amortization of acquisition -related costs. Changes Group Disability and Life in regulation for permitted distribution channels also may impact our business or results. Competition We expect that the competitive environment for global supplemental benefits will continue to intensify as U.S., Europe and other regional - based insurance and financial services providers more aggressively pursue expansion opportunities across geographies, especially in Asia, We believe competitive factors will include branding, product and distribution innovation and differentiation, efficient management of marketing processes and costs, commission levels paid to distribution partners, the quality of claims, local network coverage, customer services and talent acquisition and retention. Additionally, in most overseas markets, perception of financial strength also will likely continue to be an important competitive factor. Our competitors are primarily locally -based insurance companies, including insurance subsidiaries of banks primarily in Asia and Europe and multi -national companies. Insurance company competitors in this segment primarily focus on traditional product distribution through captive agents, with direct marketing being secondary channels. We estimate that we have less than 2% market share of the total insurance premiums in any given market in which we operate. In the Medicare supplement business, the principal competitive factors are underwriting and pricing, relative operating efficiency, broker relations, and the quality of claims andcustomer service. Our primary competitors in this business include U.S.-based health insurance companies. Industry Developments Pressure on social health care systems, a rapidly aging population and increased wealth and education in developing insurance markets are - leading to higher demand for products providing health insurance and financial security. In the supplemental health, life and accident business, direct marketing channels continue to grow and attract new competitors with industry consolidation among financial institutions and other affinity partners. Recent Asian affinity deals have involved multinational insurers making large upfront payments to financial institutions for long term (over 10 years) exclusive regional distribution rights throughout their retail operations. Data privacy regulation has tightened in all markets, in the wake of data privacy news scandals, impacting affinity partner and customer attitudes toward direct marketing of insurance and other financial services. Our Group Disability and Life segment provides group long-term and short-term disability insurance, group life insurance, accident and specialty insurance and related services. We market these products and services in all 50 states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands and Canada. All products and services are offered by subsidiaries of Cigna Corporation. 378 CIGNA CORPORATION - 2014 Form 10-K 9 PART I ITEM 1. Business Products and Services Group Disability Long-term and short-term group disability insurance products generally provide a fixed level of income to replace a portion of wages lost because of disability. Group disability coverage is typically employer -paid or a combination of employer and employee -paid, but also may include coverage paid for entirely by employees. As part of our group disability insurance products, we also provide assistance to employees in returning to work and assistance to their employers in managing the cost of employee disability. We are an industry leader in helping employees return to work quickly, resulting in higher productivity and lower cost for employers and a better quality of life for their employees. We seek to integrate our disability insurance products with other disability benefit programs, behavioral programs, medical programs, social security advocacy, and administration of federal and state Family and Medical Leave Act (FMLA) laws and other leave of absence programs. We believe this integration provides our customers with increased efficiency and effectiveness in disability claims management, enhances productivity and reduces overall costs to employers. This integration also provides early insight into employees at risk for future disability claims. Coordinating the administration of these disability programs with medical programs offered by our health care business provides enhanced opportunities to influence outcomes, reduce the cost of both medical and disability events and improve the return to work rate. The benefits of this integrated approach also include: • using information from the health care and disability databases to help identify, treat and manage disabilities before they become chronic, longer in duration and more costly; and • proactively reaching out to assist employees suffering from a mental health or chronic condition, either as a primary condition or as a result of another condition. Our disability products and services are offered on a fully insured, experience -rated and ASO basis, although most are fully insured. As measured by 2014 premiums and fees, disability constituted approximately 49% of this segment's business. Approximately 13,800 insured disability policies covering over 7.5 million lives were in force as of December 31, 2014. Group Life Insurance Group life insurance products offered include term life and universal life. Group term life insurance may be employer -paid basic life insurance, employee -paid supplemental life insurance or a combination thereof. Group universal life insurance is an employee -paid, voluntary life insurance product in which the owner may accumulate a cash value. The cash value earns interest at rates declared from time to time, subject to a minimum guaranteed contracted rate, and may be borrowed, withdrawn, or, within certain limits, used to fund future life insurance coverage. As measured by 2014 premiums and fees, group life insurance constituted approximately 45% of this segment's business. Approximately 8,700 group life insurance policies covering over 6 million lives were in force as of December 31, 2014. Other Products and Services We also offer personal accident insurance coverage, consisting primarily of accidental death and dismemberment and travel accident insurance to employers. Group accident insurance may be employer -paid or employee -paid. In addition, we offer specialty insurance services that consist primarily of disability and life, accident, and hospital indemnity products to professional or trade associations and financial institutions. We also provide a number of voluntary products and services that are typically paid by the employee and offered at the employer's worksite. Our plans provide employers with administrative solutions designed to provide employers with a complete and simple way to manage their benefits program. Recently, we have brought to market two additional voluntary offerings — accidental injury insurance and critical illness coverage. Both products provide additional dollar payouts to employees for unexpected accidents or more serious illnesses. Pricing and Reinsurance Premiums charged for disability and term life insurance products are usually established in advance of the policy period and are generally guaranteed for one to three years and selectively guaranteed for up to five years; policies are generally subject to termination by the policyholder or by the insurance company annually. Premium rates reflect assumptions about future claims, expenses, credit risk, investment returns and profit margins. These assumptions may be based in whole or in part on prior experience of the account or on a pool of accounts, depending on the group size and the statistical credibility of the experience that varies by product. Premiums for group universal life insurance products consist of mortality and administrative charges assessed against the policyholder's fund balance. Interest credited and mortality charges for group universal life may be adjusted prospectively to reflect expected interest and mortality experience. Mortality charges are subject to maximum guaranteed rates and interest credited on cash values is subject to minimum guaranteed rates as stated in the policy: The effectiveness of return to work programs and morbidity levels will impact the profitability of disability insurance products. Our previous claim experience and industry data indicate a correlation between disability claim incidence levels and economic conditions, with submitted claims rising under adverse economic conditions, although this impact is not clear. For life insurance products, the degree to which future experience deviates from mortality and expense assumptions also affects profitability. 379 10 CIGNA CORPORATION - 2014 Farm 10-K PART I ITEM 1. Business To reduce our exposure to large individual and catastrophic losses under group life, disability and accidental death policies, we purchase reinsurance from a diverse group of unaffiliated reinsurers. Our comprehensive reinsurance program consists of excess of loss treaties and catastrophe coverage designed to mitigate earnings volatility and provide surplus protection. Markets and Distribution We market our group disability and life insurance products and services to employers, employees, professional and other associations and groups in the National, Middle Market and Select segments. In marketing these products, we primarily sell through insurance brokers and consultants and employ a direct sales force consisting of approximately 235 sales professionals in 27 office locations as of December 31, 2014. Competition The principal competitive factors that affect the Group Disability and Life segment are underwriting and pricing, the quality and effectiveness of claims management, relative operating efficiency, investment and risk management, distribution methodologies and producer relations, the breadth and variety of products and services offered, and the quality of customer service. For certain products with longer -term liabilities, such as group long-term disability insurance, the financial strength of the insurer, as indicated by ratings issued by nationally recognized rating agencies, also is a competitive factor. The principal competitors of our group disability, life and accident businesses are other large and regional insurance companies that market and distribute these or similar types of products. As of December 31, 2014, we are one of the top five providers of group disability, life and accident insurance in the United States, based on premiums. Other Operations Industry Developments Employers are expressing a growing interest in employee wellness, absence management and productivity and likewise are recognizing a strong link between employee health, productivity and their profitability. As this interest grows, we believe our healthy lifestyle and return -to -work programs and integrated family medical leave, disability and health care programs position us to deliver integrated solutions for employers and employees. We also believe that our strong disability management portfolio and fully integrated programs provide employers and employees tools to improve health status. This focus on managing the employee's total absence enables us to increase the number and likelihood of interventions and minimize disabling events. The group insurance market remains highly competitive as the rising cost of providing medical coverage to employees has forced companies to re-evaluate their overall employee benefit spending, resulting in lower volumes of group disability and life insurance business and more competitive pricing. Demographic shifts have further driven demand for products and services that are sufficiently flexible to meet the evolving needs of employers and employees who want innovative, cost-effective solutions to their insurance needs. Employers continue to shift towards greater employee participatory coverage and voluntary purchases. With our broad suite of voluntary offerings and continued focus on developing additional voluntary products and service capabilities, we believe we are well positioned to meet the needs of both employers and employees as the market shifts to become more retail -focused. Over the past few years, there has been heightened review by state regulators of the claims handling practices within the disability and life insurance industry. This has resulted in an increase in coordinated, multi -state examinations that target specific market practices in addition to regularly recurring examinations of an insurer's overall operations conducted by an individual state's regulators. We have been recently subject to such an examination. See Note 23 to the Consolidated Financial Statements for additional information. As discussed in the "Overview" section on page 1 of this Form 10-K, beginning in 2014, we combined the results of the Run-off Reinsurance segment with other immaterial segments in Other Operations. Throughout this Form 10-K, prior year information has been conformed to the current year presentation. Other Operations includes the following four businesses; Corporate -owned Life Insurance ("COLI") The principal products of the COLI business are permanent insurance contracts sold to corporations to provide coverage on the lives of certain employees for the purpose of financing employer. paid future benefit obligations. Permanent life insurance provides coverage that, when adequately funded, does not expire after a term of years. The contracts are primarily non -participating universal life policies. Fees for universal life insurance products consist primarily of mortality and administrative charges assessed against the policyholder's fund balance. Interest credited and mortality charges for universal life and mortality charges on variable universal life may be adjusted prospectively to reflect expected interest and mortality experience. To reduce our exposure to large individual and catastrophe losses, we purchase reinsurance from unaffiliated reinsurers. Run-off Reinsurance Our reinsurance operations are an inactive business in run-off mode. In February 2013, we effectively exited the GMDB and GMIB businesses by reinsuring 100% of our future exposures, net of retrocessional arrangements in place at that time, up to a specified limit. For additional information regarding this reinsurance transaction, see Note 7 to the Consolidated Financial Statements. 380 CIGNA CORPORATION - 2014 Form 10-K 11 PART I ITEM 1. Business Individual Life Insurance and Annuity and Retirement Benefits Businesses This business includes deferred gains recognized from the 1998 sale of the individual life insurance and annuity business and the 2004 sale of the retirement benefits business. For more information regarding the sale of these businesses and the arrangements that secure our reinsurance recoverables for the retirement benefits business, see Note 7 of the Consolidated Financial Statements. Investments and Investment Income Run-off Settlement Annuity Business Our settlement annuity business is a closed, run-off block of single premium annuity contracts. These contracts are primarily liability settlements with approximately 23% of the liabilities associated with payments that are guaranteed and not contingent on survivorship. For contracts that involve non -guaranteed payments, such payments are contingent on the survival of one or more parties involved in the settlement. General Accounts Our investment operations provide investment management and related services for our corporate invested assets and the insurance - related invested assets in our General Account ("General Account Invested Assets"). We acquire or originate, directly or through intermediaries, a broad range of investments including private placement and public securities, commercial mortgage loans, real estate, mezzanine, private equity partnerships and short-term investments. Investedassets also include policy loans that are fully collateralized by insurance policy cash values, Invested Assets are managed primarily by our subsidiaries and, to a lesser extent, external managers with whom our subsidiaries contract. Net investment income is included as a component of segment earnings for each of our reporting segments and Corporate. Realized investment gains (losses) are reported by segment but excluded from segment earnings. For additional information about invested assets, see the "Investment Assets" section of the MD&A beginning on page 55 and Notes 10 to 14 of our Consolidated Financial Statements. We manage our investment portfolios to reflect the underlying characteristics of related insurance and contractholder liabilities and capital requirements, as well as regulatory and tax considerations pertaining to those liabilities and state investment laws. Insurance and contractholder liabilities range from short duration health care products to longer term obligations associated with disability and life insurance products and the run-off settlement annuity business. Assets supporting these liabilities are managed in segregated investment portfolios to facilitate matching of asset durations and Regulation cash flows to those of corresponding liabilities. Investment strategy and results are affected by the amount and timing of cash available for investment, competition for investments, economic conditions, interest rates and asset allocation decisions. We routinely monitor and evaluate the status of our investments, obtaining and analyzing relevant investment -specific information and assessing current economic conditions, trends in capital markets and other factors such as industry sector, geographic and/or property -specific information. Separate Accounts Our subsidiaries or external advisors manage Separate Account assets on behalf of contractholders. These assets are legally segregated from our other businesses and are not included in General Account Invested Assets. Income, gains and losses generally accrue directly to the contractholders. As of December 31, 2014, our Separate Account assets consisted of: • $3.8 billion in separate account assets that constitute a portion of the assets of the Cigna Pension Plan; • $3.5 billion in separate account assets that support Variable Universal Life products sold as a part of our corporate -owned life insurance business, as well as through our Global Supplemental Benefits segment; and • $1.0 billion in separate account assets that support primarily health care and other disability and life products. The laws and regulations governing our business continue to increase each year and are subject to frequent change. We are regulated by state, federal and international regulatory agencies that generally have discretion to issue regulations and interpret and enforce laws and rules. These regulations can vary significantly from jurisdiction to jurisdiction, and the interpretation of existing laws and rules also may change periodically. Domestic and international governments continue to enact and consider various legislative and regulatory proposals that could materially impact the health care system. See "Regulatory and Legislative Developments" on page 13. Our insurance and HMO subsidiaries must be licensed by the jurisdictions in which they conduct business. These subsidiaries are subject to numerous state, federal and international regulations related to their business operations, including, but not limited to: • the form and content of customer contracts including benefit mandates (including special requirements for small groups); • premium rates and medical loss ratios; • the content of agreements with participating providers of covered services; • producer appointment and compensation; • claims processing and appeals; • underwriting practices; 381 12 CIGNA CORPORATION - 2014 Farm 10-K PART I ITEM 1. Business • reinsurance arrangements; • solvency/financial reporting; • unfair trade and claim practices; • protecting the privacy and confidentiality of the information received from customers; • risk sharing arrangements with providers; • reimbursement or payment levels for Medicare services; • advertising; and • the operation of consumer -directed plans (including health savings accounts, health reimbursement accounts, flexible spending accounts and debit cards). In addition, our international subsidiaries are subject to regulations in international jurisdictions where foreign insurers may be faced with more onerous regulations than their domestic competitors. The broader regulatory environment may include anti -corruption laws, economic sanctions laws, various insurance, tax, tariff and trade laws and regulations, corporate governance, employment, intellectual property and investment laws and regulation, discriminatory licensing procedures, compulsory cessions of reinsurance, required localization of records and funds, higher premium and income taxes, and requirements for local participation in an insurer's ownership. In addition, the expansion of our operations into foreign countries increases our exposure to certain U.S. laws, such as the Foreign Corrupt Practices Act of 1977 ("FCPA). See page 15 for further discussion of international regulations. The business of administering and insuring employee benefit programs in the United States, particularly health care programs, is heavily regulated by state and federal laws and administrative agencies, such as state departments of insurance, and federal agencies including HHS, CMS, the Internal Revenue Service ("IRS") and the Departments of Labor, Treasury and Justice, as well as the courts. Health savings accounts, health reimbursement accounts and flexible spending accounts also are regulated by the Department of the Treasury and the IRS. Our operations, accounts and other books and records are subject to examination at regular intervals by regulatory agencies, including state insurance and health and welfare departments, state boards of pharmacy and CMS to assess compliance with applicable laws and regulations. In addition, our current andpast business practices are subject to review by, and from time to time we receive subpoenas and other requests of information from, various state insurance and health care regulatory authorities, attorneys general, the Office of Inspector General ("OIG"), the Department of Labor and other state and federal authorities, including inquiries by, and testimony before committees and subcommittccs of the U.S. Congress regarding certain of our business practices. These examinations, reviews, subpoenas and requests may result in changes to or clarifications of our business practices, as well as fines, penalties or other sanctions. Regulatory and Legislative Developments The federal and state governments in the United States as well as governments in other countries where we do business continue to enact and consider many broad -based legislative and regulatory proposals that could materially impact various aspects of our business. Health Care Reform The Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act (collectively referred to as "Health Care Reform") mandates broad changes affecting insured and self -insured health benefit plans that impact our current business model, including our relationship with current and future customers, producers and health care providers, products, services, processes and technology. Most of the key provisions of Health Care Reform are now effective. Health Care Reform left many details to be established through regulations. While federal agencies have published proposed and final regulations with respect to most provisions, many issues remain uncertain. In addition, certain provisions of Health Care Reform have been subject to legal challenge, including the case currently pending before the U.S. Supreme Court as to whether premium subsidies are available for eligible residents in states that have not established state -based exchanges. Other provisions of Health Care Reform have been amended or delayed, such as, the employer mandate, which will be phased in during 2015 and 2016 based on employer size. The employer mandate requires employers with 50 or more full-time employees to offer health insurance that is affordable and provides minimum value (each as defined under Health Care Reform) to full-time employees and children up to age 26 or be subject to penalties. Key Provisions of Health Care Reform in Effect Various fees, including the health insurance industry tax and the reinsurance fee, were assessed beginning in 2014. The health insurance industry assessment, totaling $8.0 billion for the industry in 2014 and increasing to $13.9 billion by 2017, is not tax deductible. Our share of this industry tax is determined based on our proportion of premiums for both our commercial and government risk businesses to the industry total. The reinsurance fee is a temporary (2014-2016) fixed dollar per customer levy on all insurers, HMOs and self -insured group health plans and is tax deductible. The health insurance exchange enrollment process began on October 1, 2013 with coverage first effective in 2014. Each state has a state -based, a state and federal partnership, or a federally -facilitated health insurance exchange for individuals and small employer groups to purchase insurance coverage. Because individuals seeking to purchase health insurance coverage beginning in 2014 either on or off the exchanges are guaranteed to be issued a policy, Health Care Reform provides programs designed to reduce the risk for participating health insurance companies including: 1) a temporary (2014-2016) reinsurance program; and (2) a premium stabilization program comprised of two components: a temporary program (2014-2016) limiting insurer gains and losses, and a permanent program that adjusts premiums based on the relative health status of the customer base. See Note 2 to the Consolidated Financial Statements and the Introduction to the MD&A contained in this Form 10-K for additional information on these programs. 382 CIGNA CORPORATION -2014 Form 10-K 13 PART I ITEM 1. Business Commercial minimum medical loss ratio requirements, as prescribed by HHS, became effective in January 2011 and require payment of premium rebates to group and individual policyholders if certain annual MLRs are not met in our commercial business. In December 2014, the federal government enacted legislation that provides permanent relief from certain Health Care Reform requirements for expatriate health coverage (including the MLR requirements). For the financial impact of the commercial MLR requirements on our results, see the "Overview" section of our MD&A in this Form 10-K. Other provisions already in effect include reduced Medicare Advantage premium rates, the requirement to cover preventive services with no enrollee cost -sharing, banning the use of lifetime and annual limits on the dollar amount of essential health benefits, increasing restrictions on rescinding coverage and extending coverage of dependents to the age of 26. Health Care Reform also changed certain tax laws that effectively limit tax deductions for certain employee compensation paid by health insurers. Our Medicare Advantage and Medicare Part D prescription drug plan businesses also have been impacted by Health Care Reform in a variety of additional ways beginning in 2014, including mandated minimum reductions to risk scores, transition of Medicare Advantage "benchmark" rates to Medicare fee -for -service parity, reduced enrollment periods and limitations on disenrollment, providing "quality bonuses" for Medicare Advantage plans with a rating for four or five stars from CMS and mandated consumer discounts on brand name and generic prescription drugs for Medicare Part D plan participants in the coverage gap. Beginning in 2014, Health Care Reform requires Medicare Advantage and Medicare Part D plans to meet a minimum MLR of 85%. Under the finalized regulations promulgated by HHS, if the MLR for a CMS contract is less than 85%, we are required to pay a penalty to CMS and could be subject to additional sanctions if the MLR continues to be less than 85% for successive years. Through Health Care Reform and other federal legislation, funding for Medicare Advantage plans has been and may continue to be altered. We have substantially implemented the key provisions of Health Care Reform. Management continues to be actively engaged with regulators and policymakers with respect to rule -making. For the financial effects of certain Health Care Reform provisions, see the Overview section of our MD&A beginning on page 32 of this Form. 10-K. In addition, accounting policies around the government's risk mitigation programs are further disclosed in Note 2 to the Consolidated Financial Statements. Regulation of Insurance Companies Financial Reporting, Internal Control and Corporate Governance Regulators closely monitor the financial condition of licensed insurance companies and HMOs. States regulate the form and content of statutory financial statements, the type and concentration of permitted investments, and corporate governance over financial reporting. Our insurance and HMO subsidiaries are required to file periodic financial reports and schedules with regulators in most of the jurisdictions in which they do business as well as annual financial statements audited by independent registered public accounting firms. Certain insurance and HMO subsidiaries are required to file an annual report of internal control over financial reporting with most jurisdictions in which they do business. Insurance and HMO subsidiaries' operations and accounts are subject to examination by such agencies. We expect states to expand regulations relating to corporate governance and internal control activities of insurance and HMO subsidiaries as a result of an amendment by the National Association of Insurance Commissioners ("NAIC") to its Annual Financial Reporting Model Regulation that has elements similar to corporate governance and risk oversight disclosure requirements under federal securities laws. The NAIC formally adopted these requirements in late 2014, which apply to all U.S. insurers beginning in 2016. Guaranty Associations, Indemnity Funds, Risk Pools and Administrative Funds Most states and certain non-U.S. jurisdictions require insurance companies to support guaranty associations or indemnity funds that are established to pay claims on behalf of insolvent insurance companies. In the United States, to pay such claims, these associations levy assessments on member insurers licensed in a particular state. Certain states require HMOs to participate in guaranty funds, special risk pools and administrative funds. For additional information about guaranty fund and other assessments, see Note 23 to our Consolidated Financial Statements. Certain states continue to require health insurers and HMOs to participate in assigned risk plans, joint underwriting authorities, pools. or other residual market mechanisms to cover risks not acceptable under normal underwriting standards, although some states have eliminated these requirements as a result of Health Care Reform. Solvency and Capital Requirements Many states have adopted some form of the NAIC model solvency - related laws and risk -based capital rules ("RBC rules") for life and health insurance companies. The RBC rules recommend a minimum level of capital depending on the types and quality of investments held, the types of business written and the types of liabilities incurred. If the ratio of the insurer's adjusted surplus to its risk -based capital falls below statutory required minimums, the insurer could be subject to regulatory actions ranging from increased scrutiny to conservatorship. In addition, various non-U.S. jurisdictions prescribe minimum surplus requirements that are based upon solvency, liquidity and reserve coverage measures. During 2014, our HMOs and life and health insurance subsidiaries, as well as non-U.S. insurance subsidiaries, were compliant with applicable RBC and non-U.S. surplus rules. In 2012, the NAIC adopted the Risk Management and Own Risk and Solvency Assessment Model Act ("ORSA"). ORSA provides requirements and principles for maintaining a group solvency assessment and a risk management framework and reflects a broader approach to U.S. insurance regulation. ORSA, which includes a 14 CIGNA CORPORATION 2014 Form 10-K 383 PART I ITEM 1. Business requirement to file an annual ORSA Summary Report in the lead state of domicile, now must be adopted into law by each state. Our insurance business in the United States will be subject to these requirements that are expected to become effective in 2015. We will be prepared to file an ORSA Summary Report with our lead state regulator consistent with the requirements. Holding Company Laws Our domestic insurance companies and certain of our HMOs are subject to state laws regulating subsidiaries of insurance holding companies. Under such laws, certain dividends, distributions and other transactions between an insurance or an HMO subsidiary and its affiliates may require notification to, or approval by, one or more state insurance commissioners. Marketing, Advertising and Products In most states, our insurance companies and HMO subsidiaries are required to certify compliance with applicable advertising regulations on an annual basis. Our insurance companies and HMO subsidiaries are also required by most states to file and secure regulatory approval of products prior to the marketing, advertising, and sale of such products. Licensing Requirements Certain of our subsidiaries are pharmacies that dispense prescription drugs to participants of benefit plans administered or insured by our HMO and insurance company subsidiaries. These pharmacy- subsidiaries are subject to state licensing requirements and regulation as well as U.S. Drug Enforcement Agency registration requirements. Other laws and regulation affecting our pharmacy -subsidiaries include federal and state laws concerning labeling, packaging, advertising and adulteration of prescription drugs and dispensing of controlled substances. Certain subsidiaries contract to provide claim administration, utilization management and other related services for the administration of self -insured benefit plans. These subsidiaries may be subject to state third -party administration and other licensing requirements and regulation. Our international subsidiaries are often required to be licensed when entering new markets or starting new operations in certain jurisdictions. The licensure requirements for these subsidiaries vary by country and are subject to change. International Regulations Our operations outside the United States expose us to laws of multiple jurisdictions and the rules and regulations of various governing bodies and regulators, including those related to financial and other disclosures, corporate governance, privacy, data protection, data mining, data transfer, labor and employment, consumer protection, direct -to -consumer communications activities, anti -corruption and anti -money laundering. Foreign laws and rules may include requirements that are different from or more stringent than similar requirements in the United States. Our operations in countries outside the United States: • are subject to local regulations in the locations in which our subsidiaries conduct business, • in some cases, are subject to regulations in the locations of customers, and • in all cases, are subject to the FCPA. The FCPA prohibits offering, promising, providing or authorizing others to give anything of value to a foreign government official or employee to obtain or retain business or otherwise secure a business advantage. In many countries outside of the United States, health care professionals are employed by the government. Violations of the FCPA and other anti -corruption laws may result in severe criminal and civil sanctions as well as other penalties, and the SEC and Department of Justice have increased their enforcement activities with respect to FCPA. The UK Bribery Act of 2010 applies to all companies with a nexus to the United Kingdom. Under this act, any voluntary disclosures of FCPA violations may be shared with United Kingdom authorities, thus potentially exposing companies to liability and potential penalties in multiple jurisdictions. If our employees or agents fail to comply with applicable laws governing our international operations, we may face investigations, prosecutions and other legal proceedings and actions that could result in civil penalties, administrative remedies and criminal sanctions. See the Risk Factors section beginning on page 18 for a discussion of risks related to operating globally. Federal Regulations Employee Retirement Income Security Act and the Public Health Service Act Our domestic subsidiaries sell most of their products and services to sponsors of employee benefit plans that are governed by the Employee Retirement Income Security Act of 1974, as amended ("ERISA"). ERISA is a complex set of federal laws and regulations enforced by the IRS and the Department of Labor, as well as the courts. Our domestic subsidiaries are subject to requirements imposed by ERISA affecting claim payment and appeals procedures for individual health insurance and insured and self -insured group health plans and for the insured dental, disability, life and accident plans we administer. Our domestic subsidiaries also may contractually agree to comply with these requirements on behalf of the self -insured dental, disability, life and accident plans they administer. Many provisions of Health Care Reform impacting insured and self -insured group health plans were incorporated into ERISA. The health insurance reform provisions under ERISA were also incorporated into the Public Health Service Act and are directly applicable to health insurance issuers (i.e., health insurers and HMOs). Plans subject to ERISA also can be subject to state laws and the legal question of whether and to what extent ERISA preempts a state law has been, and will continue to be, subject to court interpretation. 384 CIGNA CORPORATION -2014 Form 10-K 15 PART I ITEM 1. Business Medicare Regulations Several of our subsidiaries engage in businesses that are subject to federal Medicare regulations, such as: • those offering individual and group Medicare Advantage (HMO) coverage; • those offering Medicare Pharmacy (Part D) products that are subject to federal Medicare regulations; and • billing of Medicare Part B claims on behalf of providers with whom we have contractual management agreements. In our Medicare Advantage business, we contract with CMS to provide services to Medicare beneficiaries pursuant to the Medicare program. As a result, our right to obtain payment (and the determination of the amount of such payments), enroll and retain members and expand into new service areas is subject to compliance with CMS' numerous and complex regulations and requirements that are frequently modified and subject to administrative discretion. Marketing and sales activities (including those of third -party brokers and agents) are also heavily regulated by CMS and other governmental agencies, including applicable state departments of insurance. We expect to continue to allocate significant resources to our compliance, ethics and fraud, waste and abuse programs to comply with the laws and regulations governing Medicare Advantage and prescription drug plan programs. Several of our subsidiaries are also subject to reporting requirements pursuant to Section 111 of the Medicare, Medicaid and SCHIP Extension Act of 2007. Federal Audits of Government Sponsored Health Care Programs Participation in government sponsored health care programs subjects us to a variety of federal laws and regulations and risks associated with audits conducted under these programs. These audits may occur in years subsequent to our providing the relevant services under audit. These risks may include reimbursement claims as well as potential fines and penalties. For example, with respect to our Medicare Advantage business, CMS and the Office of the Inspector General perform audits to determine a health plan's compliance with federal regulations and contractual obligations, including compliance with proper coding practices (sometimes referred to as "Risk Adjustment Data Validation Audits" or "RADV audits") and compliance with fraud and abuse enforcement practices through Recovery Audit Contractor ("RAC") audits in which third -party contractors conduct post -payment reviews on a contingency fee basis to detect and correct improper payments. See "Business — Global Health Care" beginning on page 2 of this Form 10-K for additional information about our participation in government health -related programs. The federal government has made investigating and prosecuting health care fraud and abuse a priority. Fraud and abuse prohibitions encompass a wide range of activities, including kickbacks for referral of customers, billing for unnecessary medical services, improper marketing, and violation of patient privacy rights. The regulations and contractual requirements in this area are complex, are frequently modified, andare subject to administrative discretion. We expect to continue to allocate significant resources to comply with these regulations and requirements and to maintain audit readiness. Privacy, Security and Data Standards Regulations The federal Health Insurance Portability and Accountability Act of 1996 and its implementing regulations ("HIPAA') imposes minimum standards on health insurers, HMOs, health plans, health care providers and clearinghouses for the privacy and security of protected health information. HIPAA also established rules that standardize the format and content of certain electronic transactions, including, but not limited to, eligibility and claims. ICD-9 is the current electronic code system for diagnosis and procedures for hospital claims. Entities subject to HIPAA are required to update their transaction formats for electronic data interchange standards and convert to new ICD-10 diagnosis and procedure codes. The effective date for ICD-10 conversion is October 1, 2015. HIPAA's privacy and security requirements were expanded by the Health Information Technology for Economic and Clinical Health Act ("HITECH") through additional contracting requirements for covered entities, the extension of privacy and security provisions to business associates, the requirement to provide notification to various parties in the event of a data breach of protected health information, and enhanced financial penalties for HIPAA violations, including potential criminal penalties for individuals. The federal Gramm -Leach -Bliley Act generally places restrictions on the disclosure of non-public information to non-affiliated third parties, and requires financial institutions, including insurers, to provide customers with notice regarding how their non-public personal information is used, including an opportunity to "opt out" of certain disclosures. State departments of insurance andcertain federal agencies adopted implementing regulations as required by federal law. A number of states have adopted data security laws and regulations, regulating data security and requiring security breach notification that may apply to us in certain circumstances. Neither HIPAA nor the Gramm -Leach -Bliley privacy regulations preempt more stringent state laws and regulations. Dodd -Frank Act and Investment -Related Regulations The Dodd -Frank Wall Street Reform and Consumer Protection Act (the "Dodd -Frank Act") provides for a number of reforms and regulations in the corporate governance, financial reporting and disclosure, investments, tax and enforcement areas. The Dodd -Frank Act established a Federal Insurance Office (the "FIO") to develop federal policy on insurance matters. While the FIO does not have authority over health insurance, it may have authority over other parts of our business, such as life insurance, Additional rulemaking by the SEC and other regulatory authorities continues. We are closely monitoring how these regulations might impact us; however, the full impact may not be known for several years until regulations become fully effective. Depending upon their nature, our investment management activities are subject to U.S. federal securities laws, ERISA and other federal and state laws governing investment related activities. In many cases, the 16 CIGNA CORPORATION - 2014 Form 10-K 385 PART I ITEM 1. Business investment management activities and investments of individual insurance companies are subject to regulation by multiple jurisdictions. Office of Foreign Assets Control Sanctions and Anti -Money Laundering We also are subject to regulation by the Office of Foreign Assets Control of the Department of the Treasury, which administers and Miscellaneous enforces economic and trade sanctions based on U.S. foreign policy and national security goals against targeted foreign countries and regimes. Certain of our products are subject to Department of the Treasury anti -money laundering regulations under the Bank Secrecy Act, In addition, we may be subject to similar regulations in non-U.S. jurisdictions in which we operate. Premiums and fees from CMS represented. 21% of our total consolidated revenues for the year ended December 31, 2014 under a number of contracts. We are not dependent on business from one or a few customers. Other than CMS, no one customer accounted for 10% or more of our consolidated revenues in 2014. We are not dependent on business from one or a few brokers or agents. In addition, our insurance businesses are generally not committed to accept a fixed portion of the business submitted by independent brokers and agents, and generally all such business is subject to approval and acceptance. We had approximately 37,200 employees as of December 31, 2014; 36,500 employees as of December 31, 2013; and 35,800 employees as of December 31, 2012. 386 CIGNA CORPORATION - 2014 Form 10-K 17 PART I ITEM 1A. Risk Factors Item 1A. Risk Factors As a large company operating in a complex industry, we encounter a variety of risks and uncertainties that could have a material adverse effect on our business, liquidity, results of operations or financial condition, You should carefully consider each of the risks and uncertainties discussed below, in Management's Discussion and Analysis of Results of Operations and Financial Condition and information contained elsewhere in this Annual Report on Form 10-K. These risks and uncertainties are not the only ones we face. Additional risks and uncertainties not presently known to us or that we currently believe to be immaterial may also adversely affect us. Our business is subject to substantial government regulation, as well as new laws or regulations or changes in existing laws or regulations that could have a material adverse effect on our business, results of operations, financial condition and liquidity. Our business is regulated at the federal, state, local and international levels. The laws and rules governing our business and related interpretations, including, among others, those associated with Health Care Reform, are increasing in number and complexity, are subject to frequent change and can be inconsistent or in conflict with each other. As a public company with global operations, we are subject to the laws of multiple jurisdictions and the rules and regulations of various governing bodies, such as those related to financial and other disclosures, corporate governance, privacy, data protection, labor and employment, consumer protection, tax and anti -corruption. We must identify, assess and respond to new trends in the legislative and regulatory environment, as well as comply with the various existing regulations applicable to our business. Existing or future laws, rules, regulatory interpretations or judgments could force us to change how we conduct our business, restrict revenue and enrollment growth, increase health care, technology and administrative costs, including capital requirements, and require enhancements to our compliance infrastructure and internal controls environment. Existing or future laws and rules also could require us to take other actions such as changing our business practices, thereby increasing our liability in federal and state courts for coverage determinations, contract interpretation and other actions. In the foreseeable future, the impact of existing regulations and future regulatory and legislative changes could materially adversely affect our business, results of operations, financial condition and cash flows by, among other things: • reducing the potential for growth in revenues and customers by disrupting the employer -based market (currently the primary market for our Commercial operating segment) if employers cease to offer health care coverage for their employees; • restricting revenue, premium and customer growth in certain products and markets or expansion into new markets; • increasing health care or other benefit costs through enhanced or guaranteed coverage requirements; • increasing operating costs through the imposition of new regulatory requirements, increased taxes and other financial assessments; • restricting our ability to increase premium rates to meet costs (including denial or delays in approval and implementation of those rates); • limiting the level of margin we can earn on premiums through mandated minimum medical loss ratios and required rebates in the event we do not meet mandated minimum ratios; • restricting our ability to participate in and derive revenue from government -sponsored programs; and • significantly reducing the level of Medicare program payments. Specifically, in the United States, significant changes are occurring in the health care system as a result of Health Care Reform. Substantially all of the key provisions of Health Care Reform are now effective. While federal agencies have published interim and final regulations with respect to certain requirements, tnany issues remain uncertain. It is difficult to predict the impact of Health Care Reform on our business due to the law's complexity, the political environment, the continuing development of implementing regulations and interpretive guidance, legal challenges and possible future legislative changes. We are unable to predict how these events will develop and what impact they will have on Health Care Reform, and in turn, on our business including, but not limited to, our relationships with current and future customers, producers and health care providers, products, services, processes and technology. Further, if we fail to effectively implement or adjust our strategic and operational initiatives, such as by reducing operating costs, adjusting premium pricing or benefit design or transforming our business model, in response to Health Care Reform and any other future legislative or regulatory changes, this failure may have a material adverse effect on our results of operations, financial condition and cash flows, including, but not limited to, our ability to maintain the value of our goodwill and other intangible assets. Our insurance and HMO subsidiaries must be licensed by and are subject to the regulations of the jurisdictions in which they conduct business. For example, health maintenance organizations and insurance companies are regulated under state insurance holding company regulations and other health care -related regulations. State regulations mandate minimum capital or restricted cash reserve requirements and subject us to assessments under guaranty fund laws and related regulations for certain obligations to claimants of insolvent insurance companies, which would expose our business to the risk of insolvency of a competitor in these states. We also participate in the emerging private exchange marketplace and the extent to which states may issue regulations that apply to private exchanges remains uncertain. In addition to the regulations discussed above, we are required to obtain and maintain insurance and other regulatory approvals to market many of our products, increase prices for certain regulated products and consummate some of our acquisitions and dispositions. Delays in obtaining or failure to obtain or maintain these approvals could reduce our revenue or increase our costs, 387 18 CIGNA CORPORATION - 2014 Form l 0-K PART I ITEM 1A. Risk Factors The health care industry also is regularly subject to negative media attention, including as a result of the political environment and the ongoing debate concerning Health Care Reform. Such publicity may adversely affect our stock price and reputation in certain markets. For more information on regulation, see "Business — Regulation" in Part I, Item 1 of this Form 1.0-K. See also the description of Health Care Reform's minimum medical loss ratio and customer rebate requirements in the "Business — Global Health Care" section beginning on page 2 of this Form 10-K. We face risks related to litigation, regulatory audits and investigations. We are routinely involved in numerous claims, lawsuits, regulatory audits, investigations and other legal matters arising in the ordinary course of business, including that of administering and insuring employee benefit programs. These could include benefit claims, breach of contract actions, tort claims, claims disputes under federal or state laws and disputes regarding reinsurance arrangements, employment and employment discrimination -related suits, anti-trust claims, employee benefit claims, wage and hour claims, tax, privacy, intellectual property and real estate disputes. In addition, we have incurred and likely will continue to incur liability for practices and claims related to our health care business, such as marketing misconduct, failure to timely or appropriately pay for or provide health care, provider network structure, poor outcomes for care delivered or arranged, provider disputes, including disputes over compensation or contractual provisions, and claims related to self -funded business. There are currently, and may be in the future, attempts to bring class action lawsuits against the industry or, absent a class action, individual plaintiffs may bring multiple claims regarding the same subject matter against us and other companies in our industry. Court decisions and legislative activity may increase our exposure for any of these types of claims. In some cases, substantial non -economic or punitive damages may be sought. We seek to procure insurance coverage to cover some of these potential liabilities, However, certain potential liabilities may not be covered by insurance, insurers may dispute coverage or the amount of insurance may be insufficient to cover the entire damages awarded. In addition, certain types of damages, such as punitive damages, may not be covered by insurance, and insurance coverage for all or certain forms of liability may become unavailable or prohibitively expensive in the future. It is possible that the resolution of current or future legal matters and claims could result in losses material to our results of operations, financial condition and liquidity. We are frequently the subject of regulatory market conduct and other reviews, audits and investigations by state insurance and health and welfare departments, attorneys general, CMS and the OIG and comparable authorities in foreign jurisdictions. With respect to our Medicare Advantage business, CMS and OIG perform audits to determine a health plan's compliance with federal regulations and contractual obligations, including compliance with proper co'ding practices and fraud and abuse enforcement practices through audits designed to detect and correct improper payments. There also continues to be heightened review by federal and state regulators of business and reporting practices within the health care and disability insuranceindustry and increased scrutiny by other state and federal governmental agencies (such as state attorney general offices) empowered to bring criminal actions in circumstances that could have previously given rise only to civil or administrative proceedings. These regulatory audits or reviews or actions by other governmental agencies could result in changes to or clarifications of our business practices, retroactive adjustments to certain premiums, significant fines, penalties, civil liabilities, criminal liabilities or other sanctions, including restrictions on our ability to operate, that could have a material adverse effect on our business, results of operation, financial condition and liquidity. A description of material pending legal actions and other legal matters is included in Note 23 to our Consolidated Financial Statements included in this Form 10-K, The outcome of litigation and other legal matters is always uncertain, and outcomes that are not justified by the evidence or existing law can occur. Future performance of our business will depend on our ability to execute our strategic and operational initiatives effectively. The future performance of our business will depend in large part on our ability to effectively implement and execute our strategic and operational initiatives including: (1) driving growth in targeted geographies, product lines, customer buying segments and distribution channels; (2) improving our strategic and financial flexibility; and (3) pursuing additional opportunities in high -growth markets with particular focus on individuals. Successfully executing these initiatives depends on a number of factors, including our ability to: • differentiate our products and services from those of our competitors; • develop and introduce new products or programs, particularly in response to government regulation and the increased focus on consumer -directed products; • grow our commercial product portfolio, including expanded participation in the public health insurance exchanges; • identify and introduce the proper mix or integration of products that will be accepted by the marketplace; • attract and retain sufficient numbers of qualified employees; • attract, develop and maintain collaborative relationships with a sufficient number of qualified partners, including physicians and other health care providers in an environment of growing shortages of primary care professionals and consolidation within the provider industry; • transition health care providers from volume -based fee for service arrangements to a value -based system; • improve medical cost competitiveness in targeted markets; • manage our medical and administrative costs effectively; • manage our balance sheet exposures effectively, including our pension funding obligations; and 388 CIGNA CORPORATION - 2014 Form 10-K 19 PART I ITEM 1A. Risk Factors • reduce our Global Health Care operating expenses to achieve sustainable benefits. If these initiatives fail or are not executed effectively, it could harm our consolidated financial position and results of operations. For example, efforts to reduce operating expenses while maintaining the necessary resources and talent pool are important and, if not managed effectively, could have long-term effects on our business by negatively impacting our ability to drive improvements in the quality of our products. For our strategic initiatives to succeed, we must effectively integrate our operations, including our acquired businesses, actively work to ensure consistency throughout the organization, and promote a global mind -set and a focus on individual customers. If we fail to do so, our business may be unable to grow as planned, or the result of expansion may be unsatisfactory. In addition, the current competitive, economic and regulatory environment requires our organization to adapt rapidly and nimbly to new opportunities and challenges. We will be unable to do so if we do not make important decisions quickly, define our appetite for risk specifically, implement new governance, managerial and organizational processes smoothly arid communicate roles and responsibilities clearly. As a global company, we face political, legal operational, regulatory, economic and other risks that present challenges and could negatively affect our multinational operations and/or our long-term growth. As a global company, our business is increasingly exposed to risks inherent in foreign operations. These risks, which can vary substantially by market, include political, legal, operational, regulatory, economic and other risks, including government intervention that we do not face in our U.S. operations. The global nature of our business and operations may present challenges including, but not limited to, those arising from: • varying regional and geopolitical business conditions and demands; • regulation that may discriminate against U.S. companies, favor nationalization or expropriate assets; • price controls or other pricing issues and exchange controls or other restrictions that prevent us from transferring funds from these operations out of the countries in which we operate or converting local currencies that our foreign operations hold into U.S. dollars or other currencies; • foreign currency exchange rates and fluctuations that may have an impact on the future costs or on future sales and cash flows from our international operations, and any measures that we may implement to reduce the effect of volatile currencies and other risks of our international operations may not be effective; • our reliance on local sales forces for some operations in countries that may have labor problems and/or less flexible employee relationships that can be difficult and expensive to terminate, or where changes in local regulation or law may disrupt business operations; • effectively managing our partner relationships in countries outside of the United States; • managing more geographically diverse operations and projects; • operating in new foreign markets that may require considerable management time before operations generate any significant revenues and earnings; • the need to provide data protection on a global basis and sufficient levels of technical support in different locations; • political instability or acts of war, terrorism, natural disasters or pandemics in locations where we operate; and • general economic and political conditions. These factors may increase in significance as we continue to expand globally, and any one of these challenges could negatively affect our operations or long-term growth. For example, due to the concentration of business in South Korea, the Global Supplemental Benefits segment is exposed to potential losses resulting from economic, regulatory and geopolitical developments in that country, as well as foreign currency movements affecting the South Korean currency, that could have a significant impact on the segment's results and our consolidated financial results. International operations also require us to devote significant resources to implement controls and systems in new markets to comply, and to ensure that our vendors and partners comply, with U.S. and foreign laws prohibiting bribery, corruption and money laundering, in addition to other regulations regarding, among other things, our products, direct -to -consumer communications, customer privacy and data protection. Violations of these laws and regulations could result in fines, criminal sanctions against us, our officers or employees, restrictions or outright prohibitions on the conduct of our business, and significant reputational harm. We must regularly reassess the size, capability and location of our global infrastructure and make appropriate changes, and must have effective change management processes and internal controls in place to address changes in our business and operations. Our success depends, in part, on our ability to anticipate these risks and manage these difficulties. Our failure to comply with laws and regulations governing our conduct outside the United States or to establish constructive relations with non-U.S. regulators could have a material adverse effect on our business, results of operations, financial condition, liquidity and long-term growth. There are various risks associated with participating in government -sponsored programs, such as Medicare, including dependence upon government funding, changes occurring as a result of Health Care Reform, compliance with government contracts and increased regulatory oversight. Through our Cigna-HealthSpring business, we contract with CMS and various state governmental agencies to provide managed health care services, including Medicare Advantage plans and Medicare- approved prescription drug plans. Revenues from Medicare programs are dependent, in whole or in part, upon annual funding from the federal government through CMS and/or applicable state or local 389 20 CIGNA CORPORATION - 2014 Form 10-K PART I ITEM 1A. Risk Factors governments. Funding for these programs is dependent on many factors outside our control, including general economic conditions, continuing government efforts to contain health care costs and budgetary constraints at the federal or applicable state or local level and general political issues and priorities, These entities generally have the right to not renew or cancel their contracts with us on short notice without cause or if funds are not available. Unanticipated changes in funding, such as the application of sequestration by the federal or state governments, could substantially reduce our revenues and profitability. The Medicare program has been the subject of recent regulatory reform initiatives, including Health Care Reform. The premium rates paid to Medicare Advantage plans are established by contract, although the rates differ depending on a combination of factors, many of whichare outside our control. Effective in 2012, Health Care Reform ties a portion of each Medicare Advantage plan's reimbursement to the plan's "star rating" by CMS, with those plans receiving a rating of three or more stars eligible for quality -based bonus payments. The star rating system considers various measures adopted by CMS, including, among other things, quality of care, preventative services, chronic illness management and customer satisfaction. Beginning in 2015, plans must have a star rating of four or higher to qualify for bonus payments. Our Medicare Advantage plans' operating results, premium revenue and benefit offerings are likely to continue to be significantly determined by their star ratings. If we do not maintain or continue to improve our star ratings, our plans may not be eligible for full -level quality bonuses, which could adversely affect the benefits that our plans can offer, reduce our customer base and/or reduce margins. Contracts with CMS and the various state governmental agencies contain certain provisions regarding data submission, provider network maintenance, quality measures, claims payment, continuity of care, call center performance and other requirements. If we fail to comply with these requirements, we may be subject to fines or penalties that could impact our profitability. In addition, any failure to comply with various state and federal health care laws and regulations, including those directed at preventing fraud and abuse in government funded programs, could result in investigations or litigation, such as actions under the federal False Claims Act andsimilar whistleblower statutes under state laws. This could subject us to fines, limits on expansion, restrictions or exclusions from programs or other agreements with federal or state governmental agencies that could adversely impact our business, cash flows, financial condition and results of operations. In addition, our Medicare Advantage and Medicare prescription drug businesses face a number of other risks including potential uncollectible receivables resulting from processing and/or verifying enrollment, inadequate underwriting assumptions, inability to receive and process correct information or increased medical or pharmaceutical costs. Actual results may be materially different than our assumptions and estimates regarding these complex and wide-ranging programs, which could have a material adverse effect on our business, financial condition and results of operations. If we fail to develop and maintain satisfactory relationships with physicians, hospitals and other health care providers, our business and results of operations may be adversely affected. We contract with physicians, hospitals and other health care providers for services rendered to our customers. Our results of operations are substantially dependent on our ability to contract for these services at competitive prices. In any particular market, physicians, hospitals and health care providers could refuse to contract, demand higher payments or take other actions that could result in higher medical costs or less desirable products for our customers. In some markets, certain providers, particularly hospitals, physician/hospital organizations and multi -specialty physician groups, may have significant or controlling market positions that could result in a diminished bargaining position for us. If providers refuse to contract with us, use their market position to negotiate favorable contracts or place us at a competitive disadvantage, our ability to market products or to be profitable in those areas could be materially and adversely affected, Our ability to develop and maintain satisfactory relationships with health care providers also may be negatively impacted by other factors not associated with us, such as changes in Medicare and/or Medicaid reimbursement levels, increasing revenue and other pressures on health care providers and consolidation activity among hospitals, physician groups and health care providers. For example, ongoing reductions by CMS and state governments in amounts payable to providers, particularly hospitals, for services provided to Medicare and Medicaid enrollees may pressure the financial condition of certain providers and, in turn, adversely impact our ability to maintain or develop new cost-effective health care provider contracts or result in a loss of revenues or customers, Recent and continuing consolidation among physicians, hospitals and other health care providers, development of accountable care organizations and other changes in the organizational structures that physicians, hospitals and health care providers choose may change the way these providers interact with us and may change the competitive landscape in which we operate. In some instances, these organizations may compete directly with us, potentially affecting the way that we price our products or causing us to incur increased costs if we change our operations to be more competitive. Our focus on developing collaborative accountable care organizations and independent practice associations or similar business arrangements with physicians and other health care providers may not achieve intended benefits, which could adversely affect our strategy or prospects. Out -of -network providers do not have an understanding with us about the amount of compensation due for their services. Some states define by law or regulation the amounts due, but in most instances it is not defined or is established by a standard that is not clearly translatable into dollar terms. In such instances, providers may believe that they were underpaid and may litigate or arbitrate their dispute with us or try to recover from our customers the difference between what we have paid them and the amount they charged us. The outcome of disputes where we do not have a provider contract may cause us to pay higher medical or other benefit costs than we projected. 390 CIGNA CORPORATION - 2014 Form 10-K 21 PART I ITEM 1A. Risk Factors We are dependent on the success of our relationships with third parties for various services and functions, including, but not limited to, pharmacy benefit management services. To improve operating costs, productivity and efficiencies, we outsource to, or enter into partnership arrangements with, third parties for selected services and functions, such as pharmacy benefit management, information technology, independent practice associations, medical management, call centers and claim services. Our operations may be vulnerable if these third parties fail to satisfy their obligations to us or if the arrangement is terminated in whole or in part for any reason or if there is a contractual dispute between us and these third parties. Even though contracts are intended to provide certain protections, we have limited control over the actions of third parties. For example, noncompliance with any privacy or security laws and regulations or any security breach involving one of our third -party vendors or a dispute between us and a third party vendor related to our arrangement could have a material adverse effect on our business, results of operations, financial condition, liquidity and reputation. In addition, with respect to outsourced services or functions to third parties in foreign jurisdictions, we also are exposed to risks inherent in conducting business outside of the United States. Outsourcing also may require us to change our existing operations, adopt new processes for managing these providers and/or redistribute responsibilities to realize the potential productivity and operational efficiencies. If there are delays or difficulties in changing business processes or our third party vendors do not perform as expected, we may not realize, or realize on a timely basis, the anticipated economic and other benefits of these relationships. This could result in substantial costs or regulatory compliance issues, divert management's attention from other strategic activities, negatively affect employee morale or create other operational or financial problems for us. Terminating or transitioning in whole or in part arrangements with key vendors could result in additional costs or penalties, risks of operational delays or potential errors and control issues during the termination or transition phase. We may not be able to find an alternative vendor in a timely manner or on acceptable terms. If there is an interruption in business or loss of access to data resulting from a termination or transition, we may not be able to meet the demands of our customers and, in turn, our business and results of operations could be unfavorably impacted. Acquisitions, joint ventures and other transactions involve risks and we may not realize the expected benefits because of integration difficulties, underperformance relative to our expectations and other challenges. As part of our growth strategy, we regularly consider and enter into strategic transactions, including mergers, acquisitions, joint ventures, licenses and other relationships (collectively referred to as "transactions"), with the expectation that these transactions will result in various benefits. Our ability to achieve the anticipated benefits of these transactions is subject to numerous uncertainties and risks, including our ability to integrate operations, resources and systems in an efficient and effective manner. We could also face challenges in implementing business plans; changes in laws and regulations or conditions imposed by regulators applicable to the business; retaining key employees; and general competitive factors in the marketplace. These events could result in increased costs, decreases in expected revenues, earnings or cash flow, and goodwill or other intangible asset impairment charges. Further, we may finance transactions by issuing common stock for some or all of the purchase price, which could dilute the ownership interests of our shareholders, or by incurring additional debt that could impact our ability to access capital in the future. In addition, effective internal controls are necessary to provide reliable and accurate financial reports and to mitigate the risk of fraud. The integration of businesses is likely to result in our systems and internal controls becoming increasingly complex and more difficult to manage. Any difficulties in assimilating businesses into our control system could cause us to fail to meet our financial reporting obligations. Ineffective internal controls also could cause investors to lose confidence in our reported financial information, which could negatively impact the trading price of our stock and our access to capital. Our business depends on our ability to effectively invest in, implement improvements to and properly maintain the uninterrupted operation and data integrity of our information technology and other business systems. Our business is highly dependent on maintaining both effective information systems and the integrity and timeliness of the data we use to serve our customers and health care professionals and to operate our business. If our data were found to be inaccurate or unreliable due to fraud or other error, or if we or the third -party service providers were to fail to maintain information systems and data integrity effectively, we could experience operational disruptions that may impact our customers and health care professionals and hinder our ability to establish appropriate pricing for products and services, retain and attract customers, establish reserves and report financial results timely and accurately and maintain regulatory compliance, among other things. Our information technology strategy and execution are critical to our continued success. Increasing regulatory and legislative mandated changes will place additional demands on our information technology infrastructure that could have a direct impact on available resources for projects more directly tied to strategic initiatives. We must continue to invest in long-term solutions that will enable us to anticipate customer needs and expectations, enhance the customer experience, act as a differentiator in the market and protect against cybersecurity risks and threats. Our success is dependent, in large part, on maintaining the effectiveness of existing technology systems and continuing to deliver and enhance technology systems that support our business processes in a cost-efficient and resource -efficient manner. We also must develop new systems to meet current market standards and keep pace with continuing changes in information processing technology, evolving industry and regulatory standards and customer needs. Failure to do so may impede our ability to deliver 391 22 CIGNA CORPORATION - 2014 Form 10-K PART I ITEM 1A. Risk Factors services at a competitive cost. Further, because system development projects are long-term in nature, they may be more costly than expected to complete and may not deliver the expected benefits upon completion. In addition, our business is highly dependent upon our ability to perform, in an efficient and uninterrupted fashion, necessary business functions, such as claims processing and payment, internet support and customer call centers, and processing new and renewal business. Unavailability, cyber-attack or other failure of one or more of our information technology or other systems could cause slower response times, resulting in claims not being processed as quickly as clients or customers desire, decreased levels of client or customer service and satisfaction, and harm to our reputation. Because our information technology and other systems interface with and depend on third - party systems, we could experience service denials if demand for such service exceeds capacity or a third -party system fails or experiences an interruption. If sustained or repeated, such business interruptions, systems failures or service denials could have material adverse effects on our business, results of operations, financial condition and liquidity. We may be subject to cyber-attacks. If we are unable to prevent or contain the effects of any such attacks, we may suffer exposure to substantial liability, reputational harm, loss of revenue or other damages. Our business depends on our clients' and customers' willingness to entrust us with their health -related and other sensitive personal information. Computer systems may be vulnerable to physical break-ins, computer viruses, programming errors, attacks by third parties or similar disruptive problems. As we increase the amount of personal information that we store and share digitally, our exposure to these data security and relatedcybersecurity risks increases, including the risk of undetected attacks, damage, loss or unauthorized disclosure or access, and the cost of attempting to protect against these risks also increases. We have implemented security technologies, processes and procedures to protect consumer identity; however, there are no assurances that such measures will be effective against all types of breaches. Events that negatively affect that trust, including failing to keep our information technology systems and our clients' and customers' sensitive information secure from attack, damage, loss or unauthorized disclosure or access, whether as a result of our action or inaction or that of our business associates or vendors, could adversely affect our reputation, membership and revenues and also expose us to mandatory disclosure to the media, litigation and other enforcement proceedings, material fines, penalties and/or remediation costs, and compensatory, special, punitive and statutory damages, consent orders and other adverse actions, any of which could adversely affect our business, results of operations, financial condition or liquidity. If we fail to comply with applicable privacy, security, and data laws, regulations and standards, our business and reputation could be materially and adversely affected. The collection, maintenance, protection, use, transmission, disclosure and disposal of sensitive personal information are regulated at the federal, state, international and industry levels and requirements are imposed on us by contracts with customers. In some cases, such laws, rules and regulations also apply to our vendors and require us to obtain written assurances of their compliance with such requirements or may hold us liable for any violations by our vendors. International laws, rules and regulations governing the use and disclosure of such information are generally more stringent than in the United States, and they vary from jurisdiction to jurisdiction. These laws, rules and requirements are subject to change. Compliance with new privacy and security laws, regulations and requirements may result in increased operating costs, and may constrain or require us to alter our business model or operations. For example, the HITECH amendments to HIPAA may further restrict our ability to collect, disclose and use sensitive personal information and may impose additional compliance requirements on our business. While we have prepared for the transition to ICD-10, if unforeseen circumstances arise, it is possible that we could be exposed to investigations and allegations of noncompliance, which could have a material adverse effect on our results of operations, financial position and cash flows. In addition, if some providers continue to use ICD-9 codes on claims after the final implementation date, we will have to reject such claims, leading to claim resubmissions, increased call volume and provider and customer dissatisfaction. Further, providers may use ICD-10 codes differently than they used ICD-9 codes in the past, potentially resulting in lost revenues under risk adjustment. During the transition to ICD-10, certain claims processing and payment information we have historically used to establish our reserves may not be reliable or available in a timely manner. If we do not adequately implement the new ICD-10 coding set, or if providers in our network do not adequately transition to the new ICD-10 coding set, our results of operations, financial position and cash flows may be materially adversely affected. Effective prevention, detection and control systems are critical to maintain regulatory compliance and prevent fraud and failure of these systems could adversely affect us. Federal and state governments have made investigating and prosecuting health care and other insurance fraud and abuse a priority. Fraud and abuse prohibitions encompass a wide range of activities, including kickbacks for referral of members, billing for unnecessary medical services, improper marketing, and violations of patient privacy rights. The regulations and contractual requirements applicable to us are complex and subject to change. In addition, ongoing vigorous law enforcement, a highly technical regulatory scheme and the Dodd -Frank Act legislation and related regulations being adopted to enhance regulators' enforcement powers and whistleblower incentives and protections mean that our compliance efforts in this area will continue to require significant resources. 392 CIGNA CORPORATION - 2014 Form 10-K 23 PART I ITEM IA, Risk Faptors Failure of our prevention, detection or control systems related to regulatory compliance or the failure of employees to comply with our internal policies, including data systems security or unethical conduct by managers and employees, could adversely affect our reputation and also expose us to litigation and other proceedings, fines and penalties. In addition, provider or customer fraud that is not prevented or detected could impact our medical costs or those of our self -insured customers, Further, during an economic downturn, we may experience increased fraudulent claims volume that may lead to additional costs due to an increase in disputed claims and litigation. Our pharmacy benefit management business and related operations are subject to a number of risks and uncertainties that are in addition to those we face in our health care business. Notwithstanding our, pharmacy benefits management services arrangement with a third -party vendor, we remain responsible to regulators and members for the delivery of pharmacy benefits. This business is subject to federal and state regulation, including federal and state anti -remuneration laws, ERISA, HIPAA and laws related to the operation of Internet and mail -service pharmacies. In addition, certain of our subsidiaries are pharmacies subject to state licensing and U.S. Drug Enforcement Agency registration requirements and laws concerning labeling, packaging, advertising and adulteration of prescription drugs and dispensing of controlled substances. Noncompliance with such regulations by us or our third -party vendor could have material adverse effects on our business, results of operations, financial condition, liquidity and reputation. Our pharmacy benefit management business also would be adversely affected by an inability to contract on favorable terms with pharmaceutical manufacturers and we could suffer claims and reputational harm in connection with purported errors by mail order or retail pharmacy businesses. In operating onsite clinics and other types of medical facilities, we may be subject to additional liability that could result in significant time and expense. In addition to contracting with physicians and other health care providers for services, we employ physicians and other health care professionals at onsite low acuity and primary care clinics that we operate for our customers, as well as certain clinics for our employees, In addition, our Cigna-HealthSpring business operates LivingWell health centers and we own and operate multispecialty health care centers, low acuity clinics and other types of centers in the Phoenix, Arizona metropolitan area that employ physicians and other health care professionals. As a direct employer of health care professionals and as an owner or operator of medical facilities, we are subject to liability for negligent acts, omissions, or injuries occurring at one of these clinics or caused by one of our employees. Even if any claims brought against us are unsuccessful or without merit, we still have to defend against such claims. The defense of any actions may result in significant expenses that could have a material adverse effect on our business, results of operations, financial condition and liquidity. We face price competition and other pressures that could result in premiums that are insufficient to cover the cost of the health care services delivered to our members and inadequate medical claims reserves. While health plans compete on the basis of many service and quality - related factors, we expect that price will continue to be a significant basis of competition. Our client and customer contracts are subject to negotiation as clients and customers seek to contain their costs, including by reducing benefits offered or elected. Alternatively, our clients and customers may purchase different types of products that are less profitable, or move to a competitor to obtain more favorable premiums. Each of these events would likely negatively impact our financial results. Further, federal and state regulatory agencies may restrict our ability to implement changes in premium rates. For example, Health Care Reform includes an annual rate review requirement to prohibit unreasonable rate increases in the individual and small group health insurance markets. Fiscal concerns regarding the continued viability of programs such as Medicare may cause decreasing reimbursement rates, delays in premium payments or insufficient increases in reimbursement rates for government -sponsored programs in which we participate. Any limitation on our ability to maintain or increase our premium or reimbursement levels, or a significant loss of membership resulting from our need to increase or maintain premium or reimbursement levels, could adversely affect our business, cash flows, financial condition and results of operations. In addition, factors such as business consolidations, strategic alliances, legislation and marketing practices will likely continue to create pressure to contain or otherwise restrict premium price increases, despite increasing medical costs. For example, the Gramm -Leach - Bliley Act gives banks and other financial institutions the ability to be affiliated with insurance companies. This may lead to new competitors with significant financial resources, Our product margins and growth depend, in part, on our ability to compete effectively in our markets, set rates appropriately in highly competitive markets to keep or increase our market share, increase membership as planned, and avoid losing accounts with favorable medical cost experience while retaining or increasing membership in accounts with unfavorable medical cost experience. Premiums in the health care business are generally set for one-year periods, based on our estimate of future health care costs over such period. Actual costs may exceed what we estimate and charge in premiums due to factors such as medical cost inflation, higher than expected utilization of medical services, new or costly treatments and technology, and membership mix. Our health care costs also are affected by external events that we cannot forecast or project and over which we have little or no control, such as influenza -related health care costs, epidemics, pandemics, terrorist attacks or other man-made disasters, natural disasters or other events that materially increase utilization of medical and/or other covered services, as well as changes in members' health care utilization patterns and provider billing practices. Our profitability depends, in part, on our ability to accurately predict and control future health care costs through 24 CIGNA CORPORATION - 2014 Form 10-K 393 PART I ITEM 1A. Risk Factors underwriting criteria, provider contracting, utilization management and product design. We record medical claims reserves on our balance sheet for estimated future payments. While we continually review estimates of future payments relating to medical claims costs for services incurred in the current and prior periods and make adjustments to our reserves, the actual health care costs may exceed the reserves we have recorded. Significant stock market or interest rate declines could result in additional unfunded pension obligations, resulting in the need for additional plan funding by us and increased pension expenses. We currently have unfunded obligations in our frozen pension plans. A significant decline in the value of the plans' equity and fixed income investments or unfavorable changes in applicable laws or regulations could materially increase our expenses and change the timing and amount of required plan funding. This could reduce the cash available to us, including our subsidiaries. We also are exposed to interest rate and equity risk associated with our pension and other post -retirement obligations. Sustained declines in interest rates could have an adverse impact on the funded status of our pension plans and our reinvestment yield on new investments. See Note 9 to our Consolidated Financial Statements for more information on our obligations under the pension plan. Significant changes in market interest rates affect the value of our financial instruments that promise a fixed return or benefit and the value of particular assets and liabilities. As an insurer, we have substantial investment assets that support insurance and contractholder deposit liabilities. Generally low levels of interest rates on investments, such as those experienced in U.S. and foreign financial markets during recent years, have negatively impacted our level of investment income earned in recent periods. Substantially all of our investment assets are in fixed interest -yielding debt securities of varying maturities, fixed redeemable preferred securities and commercial mortgage loans. The value of these investment assets can fluctuate significantly with changes in market conditions. A rise in interest rates would likely reduce the value of our investment portfolio and increase interest expense if we were to access our available lines of credit. A downgrade in the financial strength ratings of our insurance subsidiaries could adversely affect new sales and retention of current business, and a downgrade in our debt ratings would increase the cost of borrowed funds and negatively affect our ability to access capital Financial strength, claims paying ability and debt ratings by recognized rating organizations are each important factors in establishing the competitive position of insurance and health benefits companies. Ratings information by nationally recognized ratings agencies is broadly disseminated and generally used throughout the industry. We believe that the claims paying ability and financial strength ratings of our principal insurance subsidiaries are important factors in marketing our products to certain customers. Our debt ratings impact both the cost and availability of future borrowings, and accordingly, our cost of capital. Each of the rating agencies reviews ratings periodically and there can be no assurance that current ratings will be maintained in the future. A downgrade of these ratings in the future could make it more difficult to either market our products successfully or raise capital to support business growth within our insurance subsidiaries. Global market, economic and geopolitical conditions may cause fluctuations in equity market prices, interest rates and credit spreads that could impact our ability to raise or deploy capital and affect our overall liquidity. If the equity and credit markets experience extreme volatility and disruption, there could be downward pressure on stock prices and credit capacity for certain issuers without regard to those issuers' underlying financial strength. Extreme disruption in the credit markets could adversely impact our availability and cost of credit in the future. In addition, unpredictable or unstable market conditions or continued pressure in the global or U.S. economy could result in reduced opportunities to find suitable opportunities to raise capital. As of December 31, 2014, our outstanding long-term debt totaled $5.0 billion. In the event of adverse economic and industry conditions, we may be rcquircd to dedicate a greater percentage of our cash flow from operations to the payment of principal and interest on our debt, thereby reducing the funds we have available for other purposes, such as investments in ongoing businesses, acquisitions, dividends and stock repurchases. In these circumstances, our ability to execute our strategy may be limited, our flexibility in planning for or reacting to changes in business and market conditions may be reduced, or our access to .capital markets may be limited such that additional capital may not be available or may be available only on unfavorable terms. Unfavorable developments in economic conditions may adversely affect our business, results of operations and financial condition. Global economic conditions continue to be challenging. Many factors, including geopolitical issues, confidence in any economic recoveries and any future economic downturns, availability and cost of credit and other capital and consumer spending, can negatively impact expectations for the U.S. and global economies. Our results of operations could be materially and adversely affected by the impact of unfavorable economic conditions on our customers (both employers and individuals), health care providers and third -party vendors. For example: • Employers may take action to reduce their operating costs by modifying, delaying or canceling plans to purchase our products or making changes in the mix of products purchased that are unfavorable to us. 394 CIGNA CORPORATION - 2014 Form 10-K 25 PART I ITEM 1A. Risk Factors • Higher unemployment rates and workforce reductions could result in lower enrollment in our employer -based plans (including an increase in the number of employees who opt out of employer -based plans) or our individual plans. • Because of unfavorable economic conditions or Health Care Reform, employers may stop offering health care coverage to employees or elect to offer this coverage on a voluntary, employee- funded basis as a means to reduce their operating costs. • Our historical disability claim experience and industry data indicate that submitted disability claims rise under adverse economic conditions. • If customers are not successful in generating sufficient profits or are precluded from securing financing, they may not be able to pay, or may delay payment of, accounts receivable that are owed to us. • Our customers or potential customers may force us to compete more vigorously on factors such as price and service to retain or obtain their business. • A prolonged unfavorable economic environment could adversely impact the financial position of hospitals and other health care providers, potentially increasing our medical costs as these providers attempt to maintain revenue levels in their efforts to adjust to their own economic challenges. • Our third -party vendors could significantly and quickly increase their prices or reduce their output to reduce their operating costs. Our business depends on our ability to perform necessary business functions in an efficient and uninterrupted fashion. These factors could lead to a decrease in our customer base, revenues or margins and/or an increase in our operating costs. In addition, during a prolonged unfavorable economic environment, state and federal budgets could be materially and adversely affected, resulting in reduced reimbursements or payments in state and federal government programs, such as Medicare and Social Security. These state and federal budgetary pressures also could cause the government to impose new or a higher level of taxes or assessments on us, such as premium taxes on insurance companies and HMOs and surcharges or fees on select fee -for -service and capitated medical claims. Although we could attempt to mitigate or cover our exposure from such increased costs through, among other things, increases in premiums, there can be no assurance that we will be able to mitigate or cover all of such costs, which may have a material adverse effect on our business, results of operations, financial condition and liquidity. We are subject to the credit risk of our reinsurers. We enter into reinsurance arrangements with other insurance companies, primarily to limit losses from large exposures or to permit recovery of a portion of direct losses. We also may enter into reinsurance arrangements in connection with acquisition or divestiture transactions when the underwriting company is not being acquired or sold. Under all reinsurance arrangements, reinsurers assume insured losses, subject to certain limitations or exceptions that may include a loss limit. These arrangements also subject us to various obligations, representations and warranties with the reinsurers. Reinsurance does not relieve us of liability as the originating insurer. We remain liable to the underlying policyholders if a reinsurer defaults on obligations under the reinsurance arrangement. Although we regularly evaluate the financial condition of reinsurers to minimize exposure to significant losses from reinsurer insolvencies, reinsurers may become financially unsound. If a reinsurer fails to meet its obligations under the reinsurance contract or if the liabilities exceed any applicable loss limit, we will be forced to cover the claims on the reinsured policies. The collectability of amounts due from reinsurers is subject to uncertainty arising from a number of factors, including whether the insured losses meet the qualifying conditions of the reinsurance contract, whether reinsurers or their affiliates have the financial capacity and willingness to make payments under the terms of the reinsurance contract, and the magnitude and type of collateral supporting our reinsurance recoverable, such as by holding sufficient qualifying assets in trusts or letters of credit issued. Although a portion of our reinsurance exposures are secured, the inability to collect a material recovery from a reinsurer could have a material adverse effect on our results of operations, financial condition and liquidity. 26 CIGNA CORPORATION - 2014 Form 10-K 395 PART I ITEM 1B. Unresolved Staff Comments ITEM 1B. Unresolved Staff Comments None. ITEM 2. Properties Our global real estate portfolio consists of approximately 8.3 million square feet of owned and leased properties. Our domestic portfolio has approximately 6.2 million square feet in 37 states, the District of Columbia, Puerto Rico and the Virgin Islands. Our International properties contain approximately 2.1 million square feet located throughout the following countries: Belgium, Canada, China, France, Hong Kong, India, Indonesia, Kenya, Malaysia, Netherlands, New Zealand, Singapore, South Korea, Spain, Sweden, Switzerland, Taiwan, Thailand, Turkey, United Arab Emirates, and the United Kingdom. Our principal, domestic office locations, including various support operations, along with Group Disability and Life Insurance, Health ITEM 3. Legal Proceedings Services, Core Medical and Service Operations and the domestic office of our Global Supplemental Benefits business are the Wilde Building located at 900 Cottage Grove Road in Bloomfield, Connecticut (our corporate headquarters) and Two Liberty Place located at 1601 Chestnut Street in Philadelphia, Pennsylvania. The Wilde Building measures approximately 833,000 square feet and is owned, while Two Liberty Place measures approximately 462,000 square feet and is leased office space. We believe our properties are adequate and suitable for our business as presently conducted. The foregoing does not include information on investment properties. The information contained under "Litigation Matters" in Note 23 to our Financial Statements beginning on page 114 of this Form 10-K, is incorporated herein by reference. ITEM 4. Mine Safety Disclosures Not applicable. 396 CIGNA CORPORATION - 2014 Form 10-K 27 PART I EXECUTIVE OFFICERS OF THE REGISTRANT EXECUTIVE OFFICERS OF THE REGISTRANT All officers are elected to serve for a one-year term or until their successors are elected. Principal occupations and employment during the past five years are listed below. LISA R. BACUS, 50, Executive Vice President and Global Chief Marketing Officer of Cigna beginning May 2013; Executive Vice President and Chief Marketer at American Family Insurance from February 2008 until May 2013. MARK L. BOXER, 55, Executive Vice President and Global Chief Information Officer of Cigna beginning April 2011; Deputy Chief Information Officer, Xerox Corporation; and Group. President, Government Health Care, for Xerox Corporation/Affiliated Computer Services from March 2009 until April 2011. DAVID M. CORDANI, 49, Chief Executive Officer of Cigna beginning December 2009; Director since October 2009; President beginning June 2008; and Chief Operating Officer from June 2008 until December 2009. HERBERT A. FRITCH, 64, President, Cigna HealthSpring beginning January 2012; and Chairman of the Board and Chief Executive Officer of HealthSpring and its predecessor, NewQuest, LLC, from commencement of operations in September 2000 until HealthSpring was acquired by Cigna in January 2012. NICOLE S. JONES, 44, Executive Vice President and General Counsel of Cigna beginning June 2011; Senior Vice President and General Counsel of Lincoln Financial Group from May 2010 until June 2011; Vice President and Deputy General Counsel of Cigna, from April 2008 until May 2010; and Corporate Secretary of Cigna from September 2006 until April 2010. THOMAS A. McCARTHY, 58, Executive Vice President and Chief Financial Officer of Cigna beginning July 2013; Vice President of Finance with responsibility for treasury, tax, strategy and corporate development, and management of run-off reinsurance from February 2003 until July 2013; Acting Chief Financial Officer from September 2010 until June 2011, and Treasurer from July 2008 until June 2011. MATTHEW G. MANDERS, 53, President, U.S. Commercial Markets and Global Health Care Operations beginning June 2014; President, Regional and Operations from November 2011 until June 2014; President, U.S. Service, Clinical and Specialty from January 2010 until November 2011; and President of Cigna HealthCare,. Total Health, Productivity, Network & Middle Market from June 2009 until January 2010. JOHN M. MURABITO, 56, Executive Vice President, Human Resources and Services of Cigna beginning August 2003. JASON D. SADLER, 46, President, International Markets beginning June 2014; President, Global Individual Health, Life and Accident from July 2010 until June 2014, and Managing Director Insurance Business Hong Kong, HSBC Insurance Asia Limited from January 2007 until July 2010. 28 CIGNA CORPORATION - 2014 Form 10-K 397 PART II ITEM 5. Market for Registrant's Common Equity, Related Stockholder Matters and Issuer Purchases of Equity Securities PART II ITEM 5. Market for Registrant's Common Equity, Related Stockholder Matters and Issuer Purchases of Equity Securities The information under the caption "Quarterly Financial Data— Stock caption "Highlights" on page 31 of this Form 10-K. Cigna's common and Dividend Data" appears on page 115 and the number of stock is listed with, and trades on, the New York Stock Exchange shareholders of record as of December 31, 2014 appears under the under the symbol "CI". Issuer Purchases of Equity Securities The following table provides information about Cigna's share repurchase activity for the quarter ended December 31, 2014: Approximate dollar value of shares Total # of shares Average price paid Total # of shares purchased as part of that may yet be purchased as part Period purchased (1) per share publicly announced program .(2) of publicly announced program (3) October 1-31', 201.4 1,619,626' $ 89.54 1,G19,398 $ 411,255,576 November 1-30, 2014 1,014,804 $ 102.39 1,012,115 $ 307,618,626 December 1-31, 2014 1,208,630 $ 103.46 1,207,945 $ 682,648,486 Total 3,843,060 $ 97.31 3,839,458 N/A (1) Includes shares tendered by employees as payment of taxes withheld on the exercise of stock options and the vesting of restricted stock granted under the Company's equity compensation plans. Employees tendered 228 shares in October, 2,689 in November and 685 shares in December 2014. (2) Cigna has had a repurchase program for many years, and has had varying levels of repurchase authority and activity under this program. The program has no expiration date. Cigna suspends activity under this program from time to time and also removes such suspensions, generally without public announcement. In 2014, the Company repurchased 18.5 million shares for approximately $1.6billion. Remaining authorization under the program was approximately $683 million as ofDecember31, 2014, From January 1, 2015 through February25, 2015, the Company repurchased 1.9 million shares for approximately $217 million. The Company's Board of Directors increased share repurchase authority by $500 million on February 25, 2015. Remaining authorization under the program was $966 million as of February 25, 2015. (3) Approximate dollar value of shares is as of the last date of the applicable month. 398 CIGNA CORPORATION - 2014 Form 10-K 29 PART II ITEM 5. Market for Registrant's Common Equity, Related Stockholder Matters and Issuer Purchases of Equity Securities $350 — $300 — $250 — $200 — $150 — $100 — $50 — so Five Year Cumulative Total Shareholder Return* December 31, 2009 — December 31, 2014 12/31/09 12/31/10 12/31/11 12/31/12 12/31/13 12/31/14 Cigna S&P 500 Index S&P Managed Health Care, Life & Health Ins. Indexes** 12/31/09 12/31/10 12/31/11 12/31/12 12/31/13 12/31/14 Cigna" •' $ 100 $ 104 $ 119 $ " 152 `,' $ 249 , $ 293 S&P 500 Index $ 100 $ 115 $ 117 $ 136 $ 180 $ 205 S&P Managed Health Care, Life & Health Ins. Indexes** $ 100 $: 113 $ .135 $ 145" $ 218 $ 277 * Assumes that the value of the investment in Cigna common stock and each index was $100 on December 31, 2009 and that all dividends were reinvested ** Weighted average of S&P Managed Health Care (75%) and Life and Health Insurance (25%) Indexes. • 399 30 CIGNA CORPORATION - 2014 Form 10-K PART II ITEM 6. Selected Financial Data ITEM 6. Selected. Financial Data The selected financial data should be read in conjunction with Management's Discussion and Analysis of Financial Condition and Results of Operations and the Consolidated Financial Statements and accompanying notes included elsewhere herein. Highlights (Dollars in millions, except per share amounts) Revenues Premiums and fees and other revenues Net investment income - Mail order pharmacy revenues Realized investment gains•' TOTAL REVENUES Results of Ofietations; Global Health Care Global Supplernental Benefits - Group Disability and Life Other Operations1'S, . Corporate Realized investment gains .ne(of taxes Shareholders' net income Tncorne• (loss) attribtitable.to`noncontrolling int•erests' NET INCOME Shareholders' netiti ome pet share: Basic Diluted Common dividends declared per share Total assets 2014 2013 2012 2011 2010 26,308 $ 19,210 $ 18,528 1,1.44 : , 1,146 1,105 1,623 1,447 1,420 44 62 ,,,. .75 29,119 $ 21,865 $ 21,128 $ 1,517 $ 1,418 175 142 259 279 (394), . s2 (222) (329) 141 31 . 1,476 1,478 1,623 1 1,624 1,105 97 295 (94) (184) 940 84 305 111 (211) 41•50 1,260 1,261 1,279 4 1,283 5.28 $ 5.70 $ 4.65 $ 4.69 $ 5.18 $ 5.61 . ?`'$ 4.59 $ '465 $ 0.04 $ 0.04 $ 0.04 $ 0.04 $ 54,336 • '; ` $ 53,734 $ 50,627 $ 45,393 Long-term debt $ 5,014 $ 4,986 $ 4,990 $ 2,288 Shareholders"equity $ 4 $' ' 10 567 ' $ 9,769 $ 7 994 $ ` 6,356 Per share $ 38.35 $ 34.18 $ 28.00 $ 23.38 T Commori'shares oufstanding`(rn thousands),'� ': ''���-2�9 6`� • 275526 285,829 .' ; ° 285,533 '' 271,$80 Shareholders of record 7,535 7,885 8,178 8,568 Einto ees � rt r �s P Y 1� �7���,�36;500 35,800 31;400 "' . 30600 (1) Beginning in 2014, we combined the results of our run-ofreinsurance segment with Other Operations, Prior year segment information has been conformed to the current year presentation, 400 CIGNA CORPORATION - 2014 Form 10-K 31 PART II ITEM 7. Management's Discussion and Analysis of Financial Condition and Results of Operations ITEM 7. Management's Discussion and Analysis of Financial Condition and Results of Operations Index Overview 32 Consolidated Results of Operations 36 Liquidity and Capital Resources 38 Critical Accounting Estimates 42 Segment Reporting 45 Global Health Care 46 Global Supplemental Benefits 50 Group Disability and Life 52 Other Operations 54 Corporate 55 Investment Assets 55 Management's Discussion and Analysis of Financial Condition and Results of Operations (MD&A') is intended to provide information to assist you in better understanding and evaluating our financial condition and results of operations. We encourage you to read this MD?SA in conjunction with our Consolidated Financial Statements included in Part 1I, Item 8 of this Annual Report on Form 10-Kand the "Risk Factors" contained in Part Iltem 1A of this Annual Report on Form 10-K ("Form 10-K'). Unless otherwise indicated, financial information in the MD&A is presented in accordance with accounting principles generally accepted in the United States of America ("GAAP'). See Note 2 to the Consolidated Financial Statements for additional information regarding the Company's significant accounting policies. We measure the financial results of our segments using "segment earnings (loss) defined as shareholders' net income (loss) before after-tax realized investment results. In this MD&A, we also present information using adjusted income from operations on both a consolidated and segment basis. Adjusted income (loss) from operations is another measure of profitability used by our management because it presents the underlying results of operations of our businesses and permits analysis of trends in underlying revenue, expenses and shareholders' net income. Adjusted income (loss) from operations is defined as segment earnings (loss) excluding special items (described in the table on page 36 of this Form 10-K) and results of the GMIB business. This measure is not determined in accordance with GAAP and should not be viewed as a substitute for the most directly comparable GAAP measures, which are shareholders' net income on a consolidated basis and segment earnings (loss) on a segment basis. We exclude special items because management does not believe they are representative of our underlying results of operations. We also exclude the results of the GMIB business because, prior to February 4, 2013, the changes in the fair value of GMIB assets and liabilities were volatile and unpredictable. In some of our financial tables in this MD&A, we present either percentage changes or NIM" when those changes are so large as to become not meaningful, and changes in percentages are expressed in basis points (`bps'). Overview Cigna Corporation, together with its subsidiaries (either individually or collectively referred to as "Cigna," the "Company," "we," "our" or "us") is a global health services organization dedicated to a mission of helping individuals improve their health, well-being and sense of security. To execute on our mission, Cigna's strategy is to "Go Deep", "Go Global" and "Go Individual" with a differentiated set of medical, dental, disability, life and accident insurance and related products and services offered by our subsidiaries. For further information on our business and strategy, please see Item 1, "Business" in this Form 10-K. Our Segments As explained in Note 22 to the Consolidated Financial Statements, effective with the first quarter of 2014, we began combining the results of our run-off reinsurance business with other immaterial operating segments in Other Operations for segment reporting purposes. Prior year segment information has been conformed to the current year presentation. 401 32 CIGNA CORPORATION -2014 Form 10-K PART II ITEM 7. Management's Discussion and Analysis of Financial Condition and Results of Operations We present the financial results of our businesses in the following three reportable segments: . 1TtiR.: -. i d . L0 t9$,r �'C7 '41' KX, 3 iSQtne�,���`ar°�„,������>�������,���.,:fix/�sbll�Xte�Quue�ssu S . i � iFt2 l�,t�. k k k� }�¢. ^Gel. l 34(' _.tom �✓'. 5 S .' 3 i la �,, t (?�Xi; 3P'•' Ygtc. Itry& _:, h ij.ir"e� Y. Eta fY �ua.�,+", ���"z��'+��`�.�z,,`�,+�,���'�zi��,����A�s'�t'tptl'si��,�",.��'�z.�,x+�a�rs`,�w�;.a��I,v���.�,`�,a;, Global Health Care 78% Aggregates the Commercial and Government operating segments:. Commercial • Encompasses both our U.S, commercial and certain international health care businesses. ° Serves employers and their employees, including globally mobile individuals, and other groups (e.g., governmental and non -governmental organizations, unions and associations). In addition, our U.S. commercial health care business also serves individuals. • Offers insured and self -insured medical, dental, behavioral health, vision, and prescription drug benefit plans, health advocacy programs and other products and services that may be integrated as part of a comprehensive global health care benefit program. Government • Offers Medicare Advantage, Medicare Part D and Medicaid plans. Global Supplemental Benefits 9% Offers supplemental health, life and accident insurance products in selected international markets and the U.S. Group Disability and Life 11% Offers group longterm and short-term- disability, group life, accident and specialty insurance products and related services. We present the remainder of our segment results in Other Operations, consisting of the corporate -owned life insurance business ("COLI"), run-off reinsurance and settlement annuity businesses and deferred gains associated with the sales of the individual life insurance and annuity and retirement benefits businesses. Key Transactions and Other Significant Items The following is a summary of key transactions and other significant items since January 1, 2012 affecting period -to -period comparisons of our results, Run-off Reinsurance Transaction. Prior to February 4, 2013, our run-off reinsurance business had significant exposures, primarily from our guaranteed minimum death benefits ("GMDB" also known as "VADBe") and guaranteed minimum income benefits ("GMIB") businesses. Effective February 4, 2013, we entered into an agreement with Berkshire to reinsure future exposures for this business, net of existing retrocessional arrangements, up to a specified limit, for a payment of $2.2 billion. The reinsurance transaction aligned with our strategy of increasing financial flexibility by accomplishing an effective exit from the GMDB and GMIB businesses. As a result of this transaction, we recorded an after-tax charge of $507 million in the first quarter of 2013 that was reported as a special item. See Note 7 to the Consolidated Financial Statements and the Other Operations section of this MD&A for additional information. Pharmacy Benefit Management ("PBM') Services Agreement. In June 2013, we entered into a 10-year pharmacy benefit management services agreement with Catamaran Corporation. Under this agreement, we utilize their technology and service platforms, retail network contracting and claims processing services. In the second quarter of 2013, we recorded one-time transaction costs of $37 million pre-tax ($24 million after-tax) that were reported as a special item. This arrangement has produced a positive contribution to earnings in 2014 through improved clinical management, purchasing and administrative efficiencies, Organizational Efficiency Plans. We regularly evaluate ways to deliver our products and services more efficiently and at a lower cost, During 2013 and 2012, we adopted specific plans to increase our organizational efficiency, resulting in a charge of $60 million pre-tax ($40 million after-tax) in 2013 and $77 million pre-tax ($50 million after-tax in 2012. See Note 6 to the Consolidated Financial Statements for additional information. Disability Claims Regulatory Matter During the second quarter of 2013, we finalized an agreement with the Departments of Insurance for Maine, Massachusetts, Pennsylvania, Connecticut and California (together, the "monitoring states") related to our long-term disability claims handling practices. In connection with the terms of the agreement, the Company recorded a charge of $77 million before -tax ($51 million after-tax) in the first quarter of 2013. The charge was comprised of two elements: (1) $48 million of benefit costs and reserves from reassessed claims expected to be reopened, and (2) $29 million of additional costs for open claims as a result of the claims handling changes being implemented. This charge was reported in the Group Disability and Life segment. We are actively implementing the terms of the agreement and continue to communicate with the monitoring states on progress. If the monitoring states find material non-compliance 402 CIGNA CORPORATION - 2014 Form 10-K 33 PART II ITEM 7. Management's Discussion and Analysis of Financial Condition and Results of Operations with the terms of the agreement upon re-examination, we may be subject to additional fines or penalties. In addition to the monitoring states, most other jurisdictions have joined the agreement as participating, non -monitoring states. Health Care Industry Developments Health Care Reform and the implementing regulations have resulted inbroad changes that are meaningfully impacting the industry, including relationships with customers and health care providers, the design of products and services, andpricing and delivery systems. In 201.3, the industry saw government -prescribed reductions to Medicare reimbursement rates (i.e., sequestration), ongoing payment reductions for Medicare Advantage plans by the Centers for Medicare and Medicaid Services ("CMS") and changes in requirements associated with operational and performance metrics used to determine Medicare Advantage payments and benefits. For 2014, there have been further changes resulting from Health Care Reform and the implementing regulations including public exchanges, a non -deductible industry tax in addition to fees and assessments, and minimum medical loss ratio requirements for Medicare Advantage and Medicare Part D plans. Collectively, these changes have had a significant impact on our business and customers, requiring adjustments to our business model to mitigate their effects on our results of operations and cash flows. The "Regulation" section of this Form.10-K provides a detailed and up-to-date description of Health Care Reform provisions and other legislative initiatives that impact our domestic health care business, including regulations issued by CMS and the Departments of the Treasury and Health and Human Services ("HHS"), The table presented below provides a summary of the financial impacts of key provisions of Health Care Reform in 2014 and beyond. Medicare Advantage ("MA'') and Part D Program Impacts Sequestration •- MA Rates — Medical Loss Ratio (MA and Part D) itto. 111 Sequestration: As a result of sequestration, federal government reimbursement rates for MA and Part D were lowered by 2.% beginning April 1, 2013. This program is expected to run through 2023. While these rate reductions significantly impact our Government operating segment, their overall effect on consolidated net income and cash flows was immaterial in 2013 and 2014 and is expected to continue to be immaterial. MA Rates; In April 2014, CMS published its notice of final federal government reimbursement rates for calendar year 2015. Based on industry data, overall MA rates for 2015 are expected to be 2% lower than 2014 for MA carriers. Assuming a similar book of business to 2014, we would expect a 2% rate decrease to lower full -year 2015 MA premiums by approximately $100 million. We do not expect these lower rates to have a significant impact on our 2015 net income or cash flows based on our 2015 bid submissions that included adjustments to our programs and services to reflect the 2015 rates. The 2014 federal government reimbursement rates established by CMS included a variety of payment reductions to Medicare plans. Overall, these rates were reduced by approximately 6% compared with 2013. Assuming a similar book of business to 2013, we .estimated this rate decrease would lower full -year 2014 MA premiums by approximately $300 million. In 2014, premium decreases related to the CMS rate reductions have been partially mitigated through changes in member risk scores and customer enrollment mix (in total, and by county). These ratereductions, together with the impact of the health insurance industry tax, have negatively impacted margins for the Government operating segment. Medical Loss Ratio (`MLR"): Beginning in 2014, if our MLR for MA or Part D business is less than the required 85% minimum, we will be required to pay a rebate to CMS. The effect of these MLR rebates was not material to our results of operations or cash flows in 2014. 403 34 CIGNA CORPORATION - 2014 Form 10-K PART II ITEM 7. Management's Discussion and Analysis of Financial Condition and Results of Operations Health Care Reform. Taxes and Fees — Industry Tax — Reinsurance Fee Health Insurance Industry Tax: See Note 2 to the Consolidated Financial Statements for additional information. In 2014, we recognized $238 million in operating expenses for the industry tax. Because this tax is not deductible for federal income tax purposes, our effective tax rate increased in 2014, both on a consolidated basis and for the Global Health Care segment. Of the full -year tax, $134 million relates to our commercial business and the remaining $104 million relates to our Medicare business. For our commercial business, we incorporated the 2014 fees into our targeted pricing actions. For our Medicare business, although we have partially mitigated the effect of the tax through benefit changes and customer premium increases, the combination of the tax and lower MA rates in 2014 have contributed to lower margins in the Government operating segment in 2014. See the Consolidated Results of Operations and Global Health Care segment sections of this MD&A for further discussion, Reinsurance Fee: This fee is a fixed dollar per customer levy that applies to insurers and self -insured major medical plans excluding Medicare Advantage and Medicare Part D products. Proceeds from the fee will be used to fund the reinsurance program for non-grandfathered individual business sold either on or off the public exchanges beginning in 2014. For our insured business, the amount of the fee is approximately $110 million in 2014 and is tax deductible. We incorporated the 2014 fees into our targeted pricing actions. See the Global Health Care section of this MD&A for further discussion, Public Health Exchanges Risk Mitigation Programs Commercial MLR Public Health Exchanges: For 2014, we offered individual coverage on five public health insurance exchanges (Arizona, Colorado, Florida, Tennessee and Texas) Beginning in 2015, in addition to those five states, we began offering coverage on exchanges in Maryland, Georgia and Missouri. See the Global Health Cate segment section of this MD&A for further discussion around the results from our individual business. Risk Mitigation Programs: See Note 2 to the Consolidated Financial Statements for a description of these programs that commenced on January 1, 2014 along with our accounting policy. We recorded receivables of approximately $200 million after-tax in 2014 related to these programs. Commercial MLR: The effect of the commercial MLR rebate accrual was not material to our results of operations or cash flows in 2014. 404 CIGNA CORPORATION -2014 Form 10-K 35 PART II ITEM 7. Management's Discussion and Analysis of Financial Condition and Results of Operations Consolidated Results of Operations Summarized below are our results of operations on a GAAP basis. Financial Summary For the Years Ended December 31, Increase/(Decrease) Increase/(Decrease) (In millions) 2014 2013 2012 2014 vs. 2013 2013 vs. 2012 Premiums 27,2f4 $ 25,575 $ 23,017 $ 1,639 6% $ 2,558 11% Fees and other revenues ;4,141 3,601 3,291 540 15 Net investment Income ��� 11 6 t 1,164 1.,144 2 Mail orderpharmacy' revenues 2239ti 1,827 1,623 412 23 Realized investment gains ,.. 213 44 (59) (28) Total revenues 3x49 32,380 29,119 2,534 8 Global Health Care medical claims expense ; 1 1G 4 15,867 14,228 Other benefit: expenses 4,998 3,672 Mail order phainriacy costs Other operating expenses Benefits acid expenses: Income before income taxes Income taxes Net income Less: net income (loss) attributable to noncontrolling interests Shareholders' net income 1,509 1,328 7,830 7,414 30,204 . 26,642.;; ,; 2,176 2,477 853, 1,624 52 42 310 9 20 2 204 13 169 N/M 3,261 11 1,639 12 1,326 36 181 14 416 6 3,562 13 (301) (12) , (155) (18) (146) (9) (10) . N/M . 1 100 $ 1,476 $ 1,623 $ 626 42% $ (147) (9)% A reconciliation of shareholders' net income to adjusted income from operations follows: For the Years Ended December 31, Increase/(Decrease) Increase/(Decrease) 2014 2013 2012 2014 vs. 2013 2013 vs. 2012 1,476 $ 1,623. $ 626.,: 42% $ .:(147) (9)% 141 31 (35) (25) 110 N/M ,335 - 1,592 G61 50 '(257) (16) Financial Summary (In millions) Shareholders' net income Less: realized investment gains, net of taxes Segment earnings Less: GMIB and special items (after-tax): Results of GMIB business Costs associated with PBM services agreement Charge related to reinsurance transaction (See Dote 7 to the Consolidated Financial Statements) Charge for disability claims regulatory matter (See Note 23 to the Consolidated Financial Statements) Charges for organizational efficiency plans (See Note 6 to the Consolidated Financial Statements) Charges associatedwith litigation matters discussed in Note 23 to the Consolidated Financial Statements Costs associated with acquisitions (See Note 3 to the Consolidated Financial Statements) ADJUSTED INCOME FROM OPERATIONS 1t9G $ 1,932 $ 1,734. $ G4 3% $ 198 11% Other Key Consolidated Financial Data Global medical customers, excluding limited benefits (in thousands) 4 45 14,078 13,856 378 3% 222 2% Effective tax rate ,,,,,�.3•6,°�o v 32.1% 34.4% 450bps . (230)bps 405 36 CIGNA CORPORATION - 2014 Form 10-K PART II ITEM 7. Management's Discussion and Analysis of Financial Condition and Results of Operations Consolidated Results of Operations: 2014 Compared to 2013 and 2013 Compared to 2012 • Revenues: The components of revenue changes are discussed further below: • Premiums. The increase in 2014 compared with 2013 reflects premium growth in each of our ongoing reporting segments: Global Health Care, Global Supplemental Benefits and Group Disability and Life. These results are primarily attributable to rate increases to recover both medical cost trend and new taxes and fees assessed under Health Care Reform. Business growth in certain of our market segments and products, including U.S. commercial individual, stop loss and Medicaid also contributed to the increase. The increase in 2013 compared with 2012 was driven primarily by continued customer growth in targeted markets of all of the ongoing segments, and, to a lesser extent, acquisitions in late 2012 in the Global Supplemental Benefits segment. • Fees and other revenues. The increase in 2014 compared with 2013 largely resulted from growth in specialty contributions, including pharmacy and cost containment. For 2013, the growth in fees and other revenues over 2012 was due to customer growth as well as increased specialty contributions. Fees and other revenues also included pre-tax losses of $39 million in 2013 and $119 million in 2012 attributable to the hedge program associated with the GMDB and GMIB businesses prior to the reinsurance transaction with Berkshire in 2013. • Net investment income. In 2014, net investment income was flat compared with 2013, reflecting higher average investment assets offset by lower yields. The slight increase in 2013, compared with 2012, was primarily due to higher yields driven in part by higher partnership income, partially offset by lower average investment assets primarily due to sales of assets to fund the reinsurance transaction with Berkshire. • Mail order pharmacy revenues. increases in each of 2014 and 2013 compared with the prior year, primarily reflected higher prescription volume for specialty medications (injectibles) and price increases to recover pharmacy cost trend. • Realized investment results. In 2014, realized investment results decreased compared with 2013, primarily due to significantly lower gains on sales of fixed maturities that were partially offset by a gain on the sale of an equity interest in 2014. The significant increase in 2013, compared with 2012, primarily resulted from gains on the sales of real estate joint ventures and higher gains on sales of fixed maturities. Inthe first quarter of 2013,.we realized large gains on sales of fixed maturities primarily to fund the reinsurance transaction with Berkshire. See Note 14 to the Consolidated Financial Statements for additional information. • Global Health Care medical claims expense. See the Global Health Care section of this MD&A. for further discussion. • Other benefit expenses. The decrease in other benefit expenses in 2014 compared with 2013 resulted from the absence of the charges recorded in the first quarter of 2013 associated with the reinsurance agreement with Berkshire ($727 million pre-tax), partially offset by continued business growth in the Global Supplemental and Group Disability and Life segments. In 2013, the increase compared with 2012 reflected the charges recorded in the first quarter of 2013 associated with the reinsurance agreement with Berkshire and, to a lesser extent, continued business growth in the Global Supplemental and Group Disability and Life segments. • Mail order pharmacy costs. The increases in both 2014 and 2013 are due to volume increases for specialty medications (injectibles) and higher unit costs. • Other operating expenses. In 2014, the increase in other operating expenses over 2013 was largely driven by new taxes and fees assessed under Health Care Reform and business growth in all of our ongoing segments. The increase in 2013 compared with 2012 was due primarily to business growth in all of our ongoing segments. See the segment reporting section of this MD&A for additional discussion of operating expenses. • Shareholders' net income. For 2014, the significant increase in shareholders' net income compared with 2013 is largely due to the absence of the $507 million after-tax charge associated with the reinsurance agreement with Berkshire recorded in the first quarter of 2013. The decrease in shareholders' net income in 2013, compared with 2012 was also driven by this after-tax charge, partially offset by an increase in adjusted income from operations. • Adjusted income from operations. In 2014, the increase in adjusted income from operations compared with 2013 was largely driven by higher earnings in our ongoing business segments (Global Health Care, Global Supplemental Benefits, and Group Disability and Life), partially offset by higher taxes in Corporate related to Health Care Reform and the absence of favorable tax benefits recorded in the third quarter of 2013. The increase in adjusted income from operations in 2013 compared with 2012 was largely attributable to earnings growth in all of our ongoing business segments (Global Health Care, Global Supplemental Benefits, and Group Disability and Life). See the segment discussions later in this MD&A for further information. • Consolidated effective tax rate. The increase in the consolidated effective tax rate in 2014, compared with 2013, was primarily driven by the non -deductible health insurance industry tax first assessed under Health Care Reform in 2014. The consolidated effective tax rate decreased in 2013, compared with 2012, primarily driven by favorable tax benefits reported in the third quarter of 2013. See Note 19 to the Consolidated Financial Statements for additional information. • Global medical customers (excluding limited benefits). We exited the limited benefits business in 2014 as required by Health Care Reform. Excluding limited benefits customers, our medical customer base increased in both 2014 and 2013 compared with comparable prior years, primarily driven by continued growth in our targeted market segments. 406 CIGNA CORPORATION - 2014 Form 10-K 37 PART II ITEM 7. Management's Discussion and .Analysis of Financial Condition and Results of Operations Liquidity and Capital. Resources Financial Summary (In millions) 2014 2013 2012 Short-term investments 1163 $ 631 $ 154 Cash and cash equivalents $ 2,795 $ 2,978 Short-term debt}$ia4 $ 233 $ 201 Long-term debt 5,014 $ 4,986 Shareholders' equity§,t1 y7xzk $ 10,567. $ 9,769 Consolidated short-term investments decreased in 2014 compared with 2013 as a result of the Company reinvesting proceeds from maturities of short-term investments in longer -term holdings. The increase in short-term investments in 2013 compared with 2012 was driven by purchases of liquidcommercial paper and United States Government obligations. Liquidity We maintain liquidity at two levels: the subsidiary level and the parent company level. Liquidity requirements at the subsidiary level generally consist of: • claim and benefit payments to policyholders; and • operating expense requirements, primarily for employee compensation and benefits, information technology .and real estate. Our subsidiaries normally meet their operating requirements by: • maintaining appropriate levels of cash, cash equivalents and short-term investments; • using cash flows from operating activities; • selling investments; • matching investment durations to those estimated for the related insurance and contractholder liabilities; and • borrowing from the parent company. Liquidity requirements at the parent company level generally consist of: • debt service and dividend payments to shareholders; and • pension plan funding. The parent company normally meets its liquidity requirements by: • maintaining appropriate levels of cash, cash equivalents and short-term investments; • collecting dividends from its subsidiaries; • using proceeds from issuance of debt (including commercial paper) and equity securities; and • borrowing from its subsidiaries. Cash flows for the years ended December 31, were as follows: (In, millions) Net cash "provided by operating activities Net cash provided by (used hi) investing activities Net cash iised in financing activities. Cash flows from operating activities consist of cash receipts and disbursements for premiums and fees, mail order pharmacy, other revenues, investment income, taxes, benefits and expenses, and, prior to February 4, 2013, gains and losses recognized in connection with our GMDB and GMIB equity hedge programs. Because certain. income and expense transactions do not generate cash, and because cash transactions related to revenues and expenses may occur in periods different from when those revenues and expenses are recognized in shareholders' net income, cash flows from operating activities can be significantly different from shareholders' net income. Cash flows from investing activities generally consist of net investment purchases or sales and net purchases of property and equipment including capitalized software, as well as cash used to acquire businesses. Cash flows from financing activities are generally comprised of issuances and re -payment of debt at the parent company level, 2014 2013 2012 719 $ 2,350 15 $ (3,857) (930) (228) proceeds on the issuance of common stock resulting from stock option exercises, and stock repurchases. In addition, the subsidiaries report deposits to and withdrawals from investment contract liabilities (including universal life insurance liabilities) because such liabilities are considered financing activities with policyholders. Operating activities Cash flows from operating activities increased substantially in 2014 compared with 2013, primarily due to the absence of the 2013 reinsurance payments totaling $2.2 billion to Berkshire. Excluding those payments and tax benefits realized in connection with the Berkshire transaction, cash flows from operating activities in 2014 decreased by $0.6 billion, compared with 2013. This decrease was primarily related to the volume and timing of reitnbursements prescribed by government programs. 407 38 CIGNA CORPORATION - 2014 Form 10-K PART II ITEM 7. Management's Discussion and Analysis of Financial Condition and Results of Operations Cash provided by operating activities declined by $1.6 billion in 2013 compared with 2012 primarily due to reinsurance payments totaling $2.2 billion made in 2013 to Berkshire. Investing activities Cash flows from investing activities decreased by $1.8 billion in 2014 compared with 2013, primarily due to higher net purchases of fixed maturities. In 2013, net purchases of fixed maturities were lower than 2014 primarily due to funding the Berkshire transaction. Cash flows from investing activities increased by $3.9 billion in 2013.compared with 2012 primarily driven by the absence of 2012 payments to acquire HealthSpring. Financing activities Cash used in financing activities increased in 2014 compared with the same period in 2013, primarily reflecting $0.6 billion in higher repurchases of common stock. Cash used in financing activities in 2013 increased by $0.7 billion compared with 2012 primarily due to higher repurchases of common stock, Share repurchase We maintain a share repurchase program that was authorized by our Board of Directors. The decision to repurchase shares depends on market conditions and alternate uses of capital. We have repurchased, and may continue to repurchase, shares on the open market through a Rule 10b5-1 plan that permits a company to repurchase its shares at times when it otherwise might be precluded from doing so under insider trading laws or because of self-imposed trading blackout periods. We suspend activity under this program from time to time and also remove such suspensions, generally without public announcement. In 2014, we repurchased 18.5 million shares for $1.6 billion. From January 1, 2015 through February 25, 2015 we repurchased 1.9 million shares for $217 million. On February 25, 2015, the Company's Board of Directors increased share repurchase authority by $500 million. Accordingly, the total remaining share repurchase authorization as of February 25, 2015 was $966 million. In 2013, the Company repurchased 13.6 million shares for $1.0 billion and, in 2012, we repurchased 4.4 million shares for $208 million. Interest Expense Interest expense on long-term debt, short-term debt and capital leases was as follows: (In millions) interest expense The weighted average interest rate for outstanding short-term debt (primarily commercial paper) was 0.27% at December 31, 2014 and 0.41% at December 31, 2013. Capital Resources Our capital resources (primarily retained earnings and proceeds from the issuance of debt and equity securities) provide protection for policyholders, furnish the financial strength to underwrite insurance risks and facilitate continued business growth. Management, guidedby regulatory requirements and rating agency capital guidelines, determines the amount of capital resources that we maintain. Management allocates resources to new long-termbusiness commitments when returns, considering the risks, look promising and when the resources available to support existing business are adequate. We prioritize our use of capital resources to: • provide the capital necessary to support growth and maintain or improve the financial strength ratings of subsidiaries; • consider acquisitions that are strategically and economically advantageous; and • return capital to investors through share repurchase. The availability of capital resources will be impacted by equity and credit market conditions. Extreme volatility in credit or equity market conditions may reduce our ability to issue debt or equity securities. 2014 2013 2012 268 Liquidity and Capital Resources Outlook At December 31, 2014, there was approximately $400 million in cash and short-term investments available at the parent company level. In 2015, the parent company's combined cash obligations are expected to be approximately $380 million to pay for commercial paper maturities, interest, dividends and required pension contributions. We expect, based on the parent company's current cash position, current projections for subsidiary dividends, and the ability to refinance its commercial paper borrowing, to have sufficient liquidity to meet the obligations discussed above, Our cash projections may not be realized and the demand for funds could exceed available cash if our ongoing businesses experience unexpected shortfalls in earnings, or we experience material adverse effects from one or more risks or uncertainties described more fully in the Risk Factors section of this Form 10-K. In those cases, we expect to have the flexibility to satisfy liquidity needs through a variety of measures, including intercompany borrowings and sales of liquid investments. The parent company may borrow up to $1.3 billion from its insurance subsidiaries without additional state approval. As of December 31, 2014,.the parent company had approximately $165 million of net intercompany loans receivable from its insurance subsidiaries. Alternatively, to satisfy parent company Liquidity requirements we may use short-term borrowings, such as the commercial paper program, the committed revolving credit andletter of credit agreement of up to $1.5 billion subject to the maximum debt leverage covenant in its line of credit agreement. As of December 31, 2014, $1.5 billion of short-term borrowing capacity under the credit 408 CIGNA CORPORATION -2014 Form 10-K 39 PART II ITEM 7. Management's Discussion and Analysis of Financial Condition and Results of Operations agreement was available to us. Within the maximum debt leverage covenant in the line of credit agreement, we have $6.5 billion of borrowing capacity in addition to the $5.2 billion of debt outstanding. Though we believe we have adequate sources of liquidity, continued significant disruption or volatility in the capital and credit markets could affect our ability to access those markets for additional borrowings or increase costs associated with borrowing funds. We maintain a capital management strategy to retain overseas a significant portion of the earnings from our foreign operations. These undistributed earnings are deployed outside of the U.S. in support of the liquidity and capital needs of our foreign operations. As of December 31, 2014 undistributed earnings were approximately $1,8 billion. Approximately $15 million of cash and cash equivalents held overseas would, if repatriated, be subject to a charge representing the difference between the U.S. and foreign tax rates. This strategy does not materially limit our ability to meet our liquidity and capital needs in the United. States. Cash and cash equivalents in foreign operations are held primarily to meet local liquidity and surplus needs with excess funds generally invested in longer duration, high quality securities. Unfunded Pension Plan Liability. As of December 31, 2014, our unfunded pension liability was $1.1 billion, reflecting an increase of approximately $0.5 billion from December 31, 2013. The year over year increase in the unfunded liability reflected $0.6 billion in higher projected benefit obligations primarily as a result of a decrease of 75 basis points in the assumed discount rate, and changes to our mortality assumptions based on an updated pension mortality table. These impacts were partially offset by $0.1 billion in asset growth driven by pension contributions and strong asset returns. In 2015, we do not expect to make pension contributions in excess of the $5 million minimum required under the Pension Protection Act of 2006. See Note 9 for additional information regarding our pension plans, Solvency II. Our businesses in the European Union will be subject to the directive on insurance regulation, solvency and governance requirements known as Solvency II. This directive will impose economic risk -based solvency and governance requirements and supervisory rules and becomes effective in 2016, although certain EU country regulators are requiring companies to demonstrate technical capability and comply with increased capital levels in advance of this effective date. Our European insurance companies are capitalized at levels consistent with projected Solvency II requirements and in compliance with anticipated governance and technical capability requirements. Guarantees and Contractual Obligations We are contingently liable for various contractual obligations entered into in the ordinary course of business. The maturities of our primary contractual cash obligations, as of December 31, 2014, are estimated to be as follows: (In millions, on an undiscounted basis) On Balance Sheet; Insurance liabilities: Contkactholder deposit funds Future policy benefits Global `I-Iealth Care medical claims ;payable Unpaid claims and claims expenses Short-term debt Long-term debt Other long term liabilities Off -Balance Street: Purchase" obligations " Operating leases Total 6;693 $I 11,665 4,776 • 147 8,435 695 Less than 1 year 744., $; 459 2,125 1,463 147; 263 154 , 1-3 years 1,114 927 1,383 ' 121 4-5 years .777 $ 1,091 11 624 828 7_ After 5 years. 4,206 9 001 33 1,762 5,961 333 945 462 284 139 0 604 139 207 130 128 The expected future cash flows for GMDB and GMIB contracts included in the table above (within future policy benefits and other long-term liabilities) do not consider any of the related reinsurance arrangements.. On -Balance Sheet: • Insurance liabilities. Contractual cash obligations for insurance liabilities, excluding unearned premiums, represent estimated net benefit payments for health, life and disability insurance policies and annuity contracts. Recorded contractholder deposit funds reflect current fund balances primarily from universallife customers. 36,,153 $ ` 5,956 $ 5,026 ' $ 3,687 $ 21,484 Contractual cash obligations for these universal life contracts are estimated by projecting future payments using assumptions for lapse, withdrawal and mortality. These projected future payments include estimated future interest crediting on current fund balances based on current investment yields less the estimated cost of insurance charges and mortality and administrative fees. Actual obligations in any single year will vary based on actual morbidity, mortality, lapse, withdrawal, investment and premium experience. The sumof the obligations presented above exceeds the corresponding insurance and contractholder liabilities of $20 billion recorded on the balance sheet because the recorded insurance liabilities reflect discounting for interest and the recorded 409 40 CIGNA CORPORATION -2014 Form 10-K PART II ITEM 7. Management's Discussion and Analysis of Financial Condition and Results of Operations contractholder liabilities exclude future interest crediting, charges and fees. We manage our investment portfolios to generate cash flows needed to satisfy contractual obligations. Any shortfall from expected investment yields could result in increases to recorded reserves and adversely impact results of operations. The amounts associated with the sold retirement benefits and individual life insurance and annuity businesses, as well as the reinsured workers' compensation, personal accident and supplemental benefits businesses, are excluded from the table above as net cash flows associated with them are not expected to impact us. The total amount of these reinsured reserves excluded is approximately $5 billion. • Short-term debt represents commercial paper, current maturities of long -terra debt, and current obligations under capital leases. • Long-term debt includes scheduled interest payments. Capital leases are included in long-term debt and represent obligations for IT network storage, servers and equipment. • Other long-term liabilities. This table includes estimated payments for GMIB contracts, pension and other postretirement and postemployment benefit obligations, supplemental and deferred compensation plans, interest rate and foreign currency swap contracts, and certain tax and reinsurance liabilities. These items are presented in accounts payable, accrued expenses and other liabilities in our Consolidated Balance Sheets. Estimated payments of $76 million for deferred compensation, non -qualified and international pension plans and other postretirement and postemployment benefit plans are expected to be paid in less than one year. Our best estimate is that contributions to the qualified domestic pension plans during 2015 will be approximately $5 million. We expect to make payments subsequent to 2015 for these obligations, however subsequent payments have been excluded from the table as their timing is based on plan assumptions that may materially differ from actual activities. See Note 9 to the Consolidated Financial Statements for further information on pension and other postretirement benefit obligations. The above table also does not contain $26 million of liabilities for uncertain tax positions because we cannot reasonably estimate the timing of their resolution with the respective taxing authorities. See Note 19 to the Consolidated Financial Statements for the year ended December 31, 2014 for further information. Off -Balance Sheet: Purchase obligations. As of December 31, 2014, purchase obligations consisted of estimated payments required under contractual arrangements for future services and investment commitments as follows: (In millions) Fixed maturities Commercial mortgage loans Real estate Limited liability entities (other long-term investments 74 65 682 `Total investment commitments Future service commitments 82.1 124 TOTAL PURCHASE OBLIGATIONS 945 We had commitments to invest in limited liability entities that hold real estate, loans to real estate entities or. securities. See Note 11(C) to the Consolidated Financial Statements for additional information. Our estimated future service commitments primarily represent contracts for certain outsourced business processes and IT maintenance and support. We generally have the ability to terminate these agreements, but do not anticipate doing so at this time. Purchase obligations exclude contracts that are cancelable without penalty and those that do not specify minimum levels of goods or services to be purchased. Operating leases. For additional information, see Note 21 to the Consolidated Financial Statements. Guarantees We are contingently liable for various financial and other guarantees provided in the ordinary course of business. See Note 23 to the Consolidated Financial Statements for additional information on guarantees. 410 CIGNA CORPORATION - 2014 Form 10-K 41 PART II ITEM 7. Management's Discussion and Analysis of Financial Condition and Results of Operations Critical Accounting Estimates The preparation of Consolidated Financial Statements in accordance with GAAP requires management to make estimates and assumptions that affect reported amounts and related disclosures in the Consolidated Financial Statements. Management considers an accounting estimate to be critical if: • it requires assumptions to be made that were uncertain at the time the estimate was made; and • changes in the estimate or different estimates that could have been selected could have a material effect on our consolidated results of operations or financial condition. Management has discussed the development and selection of its critical accounting estimates with. the Audit Committee of our Board of Directors and the Audit Committee has reviewed the disclosures presented below. In addition to the estimates presented in the following table, there are other accounting estimates used in the preparation of our Consolidated Financial Statements, including estimates of liabilities for future policy benefits, as well as estimates with respect to unpaid claims and claim expenses, postemployment and postretirement benefits other than pensions, certain compensation accruals, and income taxes. Management believes the current assumptions used to estimate amounts reflected in our Consolidated Financial Statements are appropriate. However, if actual experience differs from the assumptions used in estimating amounts reflected in our Consolidated Financial Statements, the resulting changes could have a material adverse effect on our consolidated results of operations and, in certain situations, could have a material adverse effect on our liquidity and financial condition. See Note 2 to the Consolidated Financial Statements for further information on significant accounting policies. 411 42 CIGNA: CORPORATION - 2014 Form 10-K PART II ITEM 7. Management's Discussion and Analysis of Financial Condition and Results of Operations Balance Sheet Caption / Nature of Critical Accounting Estimate Goodwill At the acquisition date, goodwill represents the excess of the cost of businesses acquired over the fair value of their net assets. We completed our annual evaluations of goodwill for impairment during the third quarter of 2014. These evaluations were performed at the reporting unit level, based on discounted cash flow analyses. The evaluations indicated that no impairment was required. Fair value of a reporting unit was estimated using models and assumptions that we believe a hypothetical market participant would use to determine a current transaction price. The significant assumptions and estimates used in determining fair value include the discount rate and future cash flows. A range of discount rates was used, corresponding with the reporting unit's weighted average cost of capital, consistent with that used for investment decisions considering the specific and detailed operating plans and strategies within the reporting units. Projections of future cash flows were consistent with our annual planning process for revenues, claims, operating expenses, taxes, capital levels and long-term growth rates. Our Cigna-HealthSpring business (reported in the Government operating segment that is also the reporting unit) contracts with CMS and various state governmental agencies to provide managed health care services, including Medicare Advantage plans and Medicare - approved prescription drug plans. Estimated future cash flows for this business incorporated the potential effects of sequestration and Medicare Advantage reimbursement rates for 2015 and beyond as discussed in the "Overview" section of this MD&A, Revenues from the Medicare programs are dependent, in whole or in part, upon annual funding from the federal government through CMS, Funding for these programs is dependent on many factors including general economic conditions, continuing government efforts to contain health care costs and budgetary constraints at the federal level and general political issues and priorities. Goodwill as of December 31 was as follows (in millions): • 2014 — $5,989 • 2013 — $6,029 See Notes 2(H) and 8 to the Consolidated Financial Statements for additional discussion of our goodwill. Effect If Different Assumptions Used If we do not achieve our earnings objectives or the cost of capital rises significantly, the assumptions and estimates underlying these impairment evaluations could be adversely affected and result in future impairment charges that would negatively impact our operating results. Future reductions in the funding for our Medicare programs by the federal government would reduce Cigna-HealthSpring's revenues and profitability and adversely impact the fair value of the Government operating segment. The estimated fair value of each reporting unit exceeded its carrying value by a substantial marginbased on our annual evaluations of goodwill for impairment during the third quarter of 2014.. 412 CIGNA CORPORATION - 2014 Form 10-K 43 PART II ITEM 7. Management's Discussion and Analysis of Financial Condition and Results of Operations Balance Sheet Caption / Nature of Critical Accounting Estimate Accounts payable, accrued expenses and other liabilities m pension liabilities These liabilities are estimates of the present value of the qualified and nonqualified pension benefits to be paid (attributed to employee service to date) net of the fair value of plan assets. The accrued pension benefit liability as of December 31 was as follows (in millions): • 2014 — $1,099 • 2013 — $611 See Note 9 to the Consolidated Financial Statements for assumptions and methods used to estimate pension liabilities. Effect if Different AssumptionsUsed The discount rate is typically the most significant assumption in measuring the pension liability. We develop the discount rate by applying actual annualized yields at various durations from a discount rate curve constructed from high quality corporate bonds. If discount rates for the qualified and nonqualified pension plans decreased by 50 basis points, the accrued pension benefit liability would increase by approximately $240 million as of December 31, 2014 resulting in an after-tax decrease to shareholders' equity of approximately $155 million. If the December 31, 2014 fair values of domestic qualified plan assets decreased by 10%, the accrued pension benefit liability would increase by approximately $415 million as of December 31, 2014 resulting in an after-tax decrease to shareholders' equity of approximately $270 million. The impacts of these hypothetical changes on pension expense or minimum funding requirements would not be material to our results of operations, financial condition or liquidity in 2015. An increase in these key assumptions would result in impacts to, the accrued pension liability and shareholders' equity in an opposite direction, but similar amounts. Global Health Care medical claims payable Medical claims payable for the Global Health Care segment include both reported claims and estimates for losses incurred but not yet reported. Liabilities for medical claims payable as of December 31 were as follows (in. millions): • 2014 — gross $2,180; net $1,928 • 2013 — gross $2,050; net $1,856 These liabilities are presented above both gross and net of reinsurance and other recoverables and generally exclude amounts for administrative services only business. See Notes 2 and. 5 to the Consolidated Financial. Statements for additional information regarding assumptions and methods used to estimate this liability: In 2014, actual experience differed from our key assumptions as of December 31, 2013, resulting in $159 million of favorable incurred claims related to prior years' medical claims payable or 1.0% of the current year incurred claims as reported in 2013. In 2013, actual experience differed from our key assumptions as of December 31, 2012, resulting in $182 million of favorable incurred claims related to prior years' medical claims, or 1.3% of the current year incurred claims reported in 2012. Specifically, the favorable impact is due to faster than expected completion factors and lower than expected medical cost trends, both of which included an assumption for moderately adverse experience. The impact of this favorable prior year development was an increase to shareholders' net income of $53 million in 2014. The change in the amount of the incurred claims related to prior years in the medical claims payable liability does not directly correspond to an increase or decrease in shareholders' net income as explained in Note 5 to the Consolidated Financial Statements. 44 CIGNA CORPORATION - 2014 Form 10-K 413 PART II ITEM 7. Management's Discussion and Analysis of Financial Condition and Results of Operations Balance Sheet Caption / Nature of Critical Accounting Estimate Valuation of fixed maturity investments Most fixed maturities are classified as available for sale and are carried at fair value with changes in fair value recorded in accumulated other comprehensive income (loss) within shareholders' equity. Fair value is defined as the price at which an asset could be exchanged in an orderly transaction between market participants at the balance sheet date. Determining fair value for a financial instrument requires management judgment. The degree of judgment involved generally correlates to the level of pricing readily observable in the markets. Financial instruments with quoted prices in active markets or with market observable inputs to determine fair value, such as public securities, generally require less judgment. Conversely, private placements including more complex securities that are traded infrequently are typically measured using pricing models that require more judgment as to the inputs and assumptions used to estimate fair value. There may be a number of alternative inputs to select, based on an understanding of the issuer, the structure of the security and overall market conditions. In addition, these factors are inherently variable in nature as they change frequently in response to market conditions. Approximately two-thirds of our fixed maturities are public securities, and one-third are private placement securities. See Note 10 to the Consolidated Financial Statements for a discussion of our fair value measurements and the procedures performed by management to determine that the amounts represent appropriate estimates, Effect if Different Assumptions Used Typically, the most significant input in the measurement of fair value is the market interest rate used to discount the estimated future cash flows from the instrument. Such market rates are derived by calculating the appropriate spreads over comparable U.S. Treasury securities, based on the credit quality, industry and structure of the asset, If the interest rates used to calculate fair value increased by 100 basis points, the fair value of the total fixed maturity portfolio of $19.0 billion would decrease by approximately $1.2 billion. Assessment of "other -than -temporary" impairments of fixed maturities To determine whether a fixed maturity's decline in fair value below its amortized cost is other than temporary, we must evaluate the expected recovery in value and our intent to sell or the likelihood of a required sale of the fixed maturity prior to an expected recovery. To make this determination, we consider a number of general and specific factors including the regulatory, economic and market environments, length of time and severity of the decline, and the financial health and specific near term prospects of the issuer. See Notes 2 (C) and 11 to the Consolidated Financial Statements for additional discussion of our review of declines in fair value, including information regarding our accounting policies for fixed maturities. Segment Reporting For all fixed maturities with cost in excess of their fair value, if this excess was determined to be other -than -temporary, shareholders' net income for the year ended December 31, 2014 would have decreased by approximately $28 million after-tax. The following section of this MD&A discusses the results of each of our reporting segments. We measure the financial results of our segments using "segment earnings (loss)", defined as shareholders' net income (loss) before after-tax realized investment results. In the following segment discussions, we also present information using "adjusted income (loss) from operations", defined as segment earnings ) (loss) excluding special items and results of the GMIB business. Adjusted income (loss) from operations is another measure of profitability used by our management because it presents the underlying results of operations of our businesses and permits analysis of trends in underlying revenue, expenses and shareholders' net income. This measure is not determined in accordance with GAAP andshould not be viewed as a substitute for the most directly comparable GAAP measure that is shareholders' net income. We exclude special items because management does not believe they are representative of our underlying results of operations. We also exclude 414 CIGNA CORPORATION -2014 Form 10-K 45 PART II ITEM 7. Management's Discussion and Analysis of Financial Condition and Results of Operations the results of the GMIB business because, prior to the reinsurance transaction with Berkshire on February 4, 2013, the changes in the fair value of GMIB assets and liabilities were volatile and unpredictable. The gables presented below summarize results from operations by segment. Shareholders' Net Income For the Years Ended December 31, an million,) 2014 2013 2012 Increase/(Decrease) Increase/(Decrease) 2014 vs. 2013 2013 vs. 2012 Segment earnings (loss) Global Health Care Global Supplemental Benefits Group Disability and Life Other Operations Corporate Total Net realized investment gains, net of taxes Shareholders' net income Adjusted. Income (Loss) From Operations (In millions) Global Health Care Global Supplemental Benefits Group Disability and Life Other Operations Corporate Total 1,517 $ 1,418 $ 129 9% $ 99 175 142 55 31 33 259 279 58 22 (20) (394) 82 462 117 (476) (222) (329) (43) (19) 107 1,335 1,592 . 661 50 (257) 141 31 (35) (25) 110 1,476 '$ ' 1623 $ 626 42% $ (147) 7% 23 (7) N/M 33 (16) N/M '(9)% For the Years Ended December 31, Increase/(Decrease) Increase/(Decrease) 2012 2014 vs. 2013 2013 vs. 2012 2014 2013 1,572,$.. 1,480 ..$, 74 5% $ ` ` 92 `'' 6% 183 148 47 26 35 24 311 281 6 2 30 11 53 (20) (23) 35 66 (222) ; (228) ' (43) 1 (19) :L 6 3 1,932 $ 1,734 $ 64 3% $ 198 11% Global Health Cate Segment We measure the operating effectiveness of the Global Health Care segment using the following key factors: • segm.ent earnings and adjusted income from operations; • customer growth; • sal.es of specialty products; • operating expense as a percentage of segment revenues (operating expense ratio); and • .medical expense as a percentage of premiums (medical care ratio or "MCR"). 415 46 CIGNA CORPORATION - 2014 Form l.0-K PART II ITEM 7. Management's Discussion and Analysis of Financial Condition and Results of Operations Results of Operations Financial Summary (In millions) Premiums, Fees and other revenues Net investment income: Mail order pharmacy revenues Segment revente5:' Medical claims expense Mall. order pharmacy costs' Operating expenses Benefits arid expenses Income before taxes Income taxes Loss attributable to noncontrolling interest SEGMENT' EARNINGS Less: special items (after-tax) included in segment earnings: Charge for organizational efficrency plan (See Note 6 to the Consolidated Pihancral Statement's) Costs associated with PBM services agreement Costs associated with acquisitions Charge related to litigation matter ADJUSTED INCOME FROM OPERATIONS.. Realized investment gains, net of taxes Effective tax Late For the Years Ended December 31, Increase/(Decrease) Increase/(Decrease) Earnings Discussion: 2014.compared to 2013. Excluding the special items reported in 2013, segment earnings and adjusted income from operations increased in 2014, compared with 2013. This growth was primarily driven by increased specialty contributions, including strong pharmacy results, partially offset by lower earnings in our government segment primarily due to taxes and fees mandated by Health Care Reform and a higher medicalcare ratio in our Medicare Part D business. In addition, results include the impact of higher operating expenses reflecting investment spending to enhance our capabilities, and lower margins in our U.S. Comm.ercial group risk business, including our exit from the limited benefits business. Results in the U.S, commercial individual business (after considering receivables from the government risk mitigation programs) were flat. 2014 2013 2012 2014 vs. 2013 19,626 $ 17,877. $ .1,083 6% 3,518 3,321 487 14 2013 vs. 2012 $ 1,749 ' 10% 197 6 325 259 12 4 66 25 1,827 1,623 412 23 204 13 25,296 23,080 1,994 8.' 2,216 10 15,867 14,228 827 1,509 1,328 398 26 5,581 5,313 428 ' 22,957 20,869 1,653 7 2,339 822 2,211 341 15 213, 26 (1) (100) 793 5 1,639 12 181:,' 14 8 268 2,088 128 '1,418 • 129 ' 9" i 99 (42) — 24 (7)" (13) 1,572 $ . '1;480 $ 74 73 $ 9 $ (19) 35.1% • 35.9% _ 350bps 11 (24) 7, 13 ".6% (26)% $ 64 (80)bps: •:7; 5 10 6 N/M Earnings Discussion: 2013 compared. to 2012 The increase in Global Health Care's segment earnings and adjusted income from operations in 2013, compared with 2012, reflected revenue growth from a higher customer base and rate increases consistent with underlying medical cost trends. Results in 2013 also benefited from increased specialty contributions and higher net investment income. These favorable effects were partially offset by a higher MCR in Medicare Advantage in 2013 driven by lower per member government reimbursements and higher inpatient and outpatient medical costs. In 2013, results also included higher operating expenses associated with customer growth and enhancements to our capabilities, partially offset by operating cost efficiencies. 416 CIGNA CORPORATION - 2014 Form 10-K 47 PART II ITEM 7. Management's Discussion and Analysis of Financial Condition and Results of Operations Revenues The table below shows premiums by product line for the Global Health Care segment: (In millions) Guaranteed cost Experience -rated Stop loss International health care Dental Medicare Medicaid Medicare Part D Other TOTAL PREMIUMS For the years ended December 31, 2014 2013 2012 4 $ . 4,463 $ 4,256 2,292 2,022 1,907 1,672 1,752 1,648 1,139 1,005 5,639 4,969 317 207 1,387 1,421 730 677 $ 19,626 $ 17,877 Premiums. The increase in 2014 compared with 2013 was primarily driven by rate increases on most products in the Commercialsegment to recover underlying medical cost trends and taxes and fees mandated by Health Care Reform. In addition, premiums reflect customer growth in our U.S. commercial individual business, as well as in targeted markets for stop loss and Medicaid products. These increases were partially offset by a decline in group commercial risk customers including a shift fromour insured to self -insured products and our exit from the limited benefits business. Premiums increased. in 2013, compared with 2012, in the U.S. Commercial segment due to customer growth and rate increases consistent with underlying medical cost trends. In addition, Medicare Advantage premiums were higher due to timing of the HealthSpring acquisition and customer growth. Fees and other revenues. The increase in 2014, compared with 2013, largely resulted from growth in specialty contributions, including pharmacy and cost containment. In 2013, the growth in fees and other revenues compared to 2012 was due to customer growth as well as increased cost containment revenues. Net investment income. The increases in both 2014 and 2013, compared with each prior year, were due to higher assets and higher income from partnership investments, with the 2014.increase partially offset by lower yields. Benefits and Expenses Global Health Care segment benefits and expenses consist of the following: (In millions) Mail 'aidei pharmacy costs Medical claims expense Operating expenses,excluding special items • Special items TOTAI. BENEFITS AN1) EX E)VSES Selected ratios Guaranteed"cost medical care `ratio Medicare Advantage medical care ratio Medicare Parr D medical care ratio Operating expense ratio - including special items Operating expense ratio - exdudmg special items 2014 2013 2012 1,569 $ 1,328 15,867 14,228 5,497 5 217. 84 96 $ 22,957 "$ 20,869 81.5% • 84.8% 82.3% . • 22.1% .21.7% 80 2%0 80.9% 81.2% 23.0% 22...6% 417 48 CIGNA CORPORATION -2014 Form 10-K PART II ITEM 7. Management's Discussion and Analysis of Financial Condition and Results of Operations Medical claims expense. The 5% increase in 2014 compared with 2013 primarily reflects medical cost inflation and customer growth, partially offset by our exit from the limited benefits business. Medical claims expense increased 12% in 2013 compared with 2012, primarily due to medical cost inflation, the tinning of the HealthSpring acquisition, and customer growth. Higher Medicare Advantage inpatient and outpatient medical costs also contributed to the increase. The guaranteed cost medical care ratio increased slightly in 2014, compared with 2013, due to a higher medical care ratio in the U.S. individual business and the exit from the limited benefits business, offset by rate increases to cover new taxes and fees mandated by Health Care Reform. The Medicare Advantage medical care ratio decreased in 2014, compared. to 2013, reflecting improved per -customer revenues. The ratio increased. in 2013, compared with 2012, driven by lower government reimbursement rates as well as higher medical costs. The Medicare Part D medical care ratio increased in 2014, compared with 2013, primarily due to higher pharmacy costs including some impact from the mix and channel of customer drug purchases as well as increased specialty medication costs. Operating expenses, Operating expenses increased 8% in 2014 compared with 2013. Excluding the 2013 special items and the Health Care Reform taxes and fees that became effective in 2014, operating expenses increased 3% in 2014 compared with 2013. The Other Items Affecting Health Care Results Global Health Care Medical Claims Payable Medical claims payable increased 6% in 2014 compared with 2013, primarily driven by growth in the individual and stop loss books of business. Medical claims payable increased 10% in 2013 compared with 2012, primarily reflecting growth in the stop loss and HealthSpring books of business, increase primarily reflects higher volume -related expenses and greater spending to enhance our capabilities, partially offset by cost efficiencies. Operating expenses increased 5% in 2013 compared with 2012, primarily reflecting customer growth, increased spending to enhance our capabilities, including costs associated with our new PBM arrangement, and the timing of the HealthSpring acquisition, partially offset by cost efficiencies. The operating expense ratios, both including and excluding special items, are essentially flat in 2014, compared with 201.3. Excluding the Health Care Reform taxes and fees that became effective in 2014, the operating expense ratios decreased in 2014 compared with 2013, reflecting cost efficiencies and higher revenue, partially offset by higher spending to enhance our capabilities. The operating expense ratios including and excluding special items decreased in 2013, compared with 2012, primarily driven by revenue growth and cost efficiencies partially offset by higher spending to enhance our capabilities, including 2013 costs associated with our new PBM arrangement. Effective Tax Rates. The increase in the segment's effective tax rate in 2014 compared with 2013 was attributable to the 2014 health insurance industry tax that is not tax deductible. The slight decline in the effective tax rate in 2013 compared with 2012 primarily reflected the recognition of tax benefits in certain of the segment's foreign operations. Medical Customers A medical customer is defined as a person meeting any one of the following criteria: • is covered under an insurance policy or service agreement issued by the Company; • has access to the Company's provider network for covered services under their medical plan; or • has medical claims that are administered by the Company. 418 CIGNA CORPORATION - 2014 Form 10-K 49 PART II ITEM 7. Management's Discussion and Analysis of Financial Condition and Results of Operations As of December 31, estimated medical customers were as follows: (In thousands) Comm.ercial Risk: U.S, Guaranteed costs» U.S. Experience -rated International health care — Risk Total, commercial risk(') Medicare Medicaid . Total government Total risk7ii. Service, including international health care TOTAL MEDICAL CUSTOMERS (e)icluding 1 iiiited benefits) Limited. benefits 2014 2013 2012 960 946 794 786 742 744 2,496 2,476 467 426 25 23 l:8 492 449 2,988 2,925 11,090 10,931 14,078 13,856 139 189 TOTAL MEDICALCUSTOMERS (1) 2013 and 2012 exclude limited benefits customers. As required by Health Care Reform, we exited the limited benefits business effective December 31, 2013. Excluding this impact, our medical customer base increased 3% in 2014, primarily driven by continued growth in the middle market, select, individual, and government market segments, partially offset by a decline in the national market segment. Excluding limited benefits customers, medical customers increased 2% in 2013 compared to 2012, primarily reflecting continued ASO customer growth due to strong retention and sales in targeted market segments. 14,217 14,045 Global Supplemental Benefits Segment Segment Description 'The key factors affecting segment earnings and adjusted income from operations for this segment are: • premium growth, including new business and customer retention; • benefits expense as a percentage of earned premium (loss ratio); • operating expense and acquisition expense as a percentage of segment revenues (expense ratio and acquisition cost ratio); • the impact of movements in foreign currency; and • the effective tax rate. Throughout this discussion, prior period currency adjusted income from operations, revenues, and benefits and expenses are being calculated by applying the current period's exchange rates to reported results in the prior period. A strengthening U.S. Dollar against foreign currencies will decrease segment earnings, while a weakening U.S. Dollar produces the opposite effect. As described in Note 3 to the Consolidated Financial Statements, the Global Supplemental Benefits segment acquired two businesses during the second half of 2012: Great American Supplemental Benefits and Finans Emeklilik (also referred to as the "Turkey JV"). Collectively, throughout this discussion these two transactions are referred to as "the acquisitions." 419 50 CIGNA CORPORATION -2014 Farm 10-K PART II ITEM 7. Management's Discussion and Analysis of Financial Condition and Results of Operations Results of Operations Financial Summary (In millions) Prei Turns Fees and other revenues Net investment itu ome Segment revenues 1#enefit expenses' Operating expenses Total benefits aiid'expenses, Income before taxes Income taxes Income (loss) attributable to redeemable noncontrolling interest Income: attributable to othei ;ntiiicontio(ltn interest SEGMENT EARNINGS Less special items(afeer tax);lncluded=in segment earnings Charges for organizational efficiency plans (See Note 6 to the Consolidated Financial Statements) ADJ1JSTPD INCOME PROM OPERATIONS Adjusted income from operations, using actual 2014 currency exchange rates Realized investment` gains, net of taxes Effective tax rate Loss ratio . Acquisition cost ratio Expense ratio (excltidnik acquisixion costs)' - For the Years Ended December 31, Increase/(Decrease) 2014 2013 2012 2014 vs. 2013 2,496. $ 1,275 $ 348 14% 43 30 9 21 Earnings Discussion: 2014 compared to 2013. The increase in segment earnings and adjusted income from. operations was driven in part by a lower acquisition cost ratio and continuing business growth, primarily in South Korea, partially offset by a higher loss ratio drivenby a business mix shift and higher incurred claims. 2014 results also included favorable tax -related items of $21 million recorded in the third quarter of 2014 (see effective tax rate discussion below). Earnings Discussion: 2013 compared to 2012 The increase in segment earnings and adjusted income from operations was primarily driven by business growth, primarily in South Korea, lower acquisition costs in Europe reflecting a decision to cease selling activities in certain markets, and earnings of the acquisitions during the second half of 2013, partially offset by higher acquisition and benefits expenses, Revenues Premiums increased in both 2014 and 2013 compared with each prior year. When applying 2014 exchange rates to 2013 and 2012 results, premiums increased by 13% in 2014 and 25% in 2013. These increases were primarily attributable to new sales, particularly in South Korea and the U.S, reflecting both customer growth and sales 100 90 2,639 2,095 1,310 1,005 ' 1,102 911 2 412 1,91:6 227 179 366 14 234 18 .88 8 322. <, 13 44 19 (2) (4) (9) N/M 2 Increase/(Decrease) 2013 vs. 2012 $ 521 .26% 13 43 10`'.'11 190 $ 152 $ 40 21% $ 1, $ (2) " (40)% 22.0% 20.1% (430) bps 52.5% 50,9%" 180. bps 23.6% 25.1% (220) bps 182% ..18.4%! 544 26 05 30 191 21 2'6 27 39 N/M (100) 23 4`. 190 bps 160: bps (150) bps 25% N/M of higher premium products. In 2013, the increase was also due to the impact of the acquisitions in the second half of 2012. Net investment income. In 2014, net investment income increased compared with 2013, primarily due to asset growth in South Korea. Net investment income increased in 2013 compared with 2012, primarily due to the impact of the acquisitions in the second half of 2012. Benefits and Expenses Benefit expenses increased in both 2014 and 2013, compared with each prior year. Applying actual 2014 currency exchange rates to 2013 results, benefit expenses increased by 16%. These increases were primarily due to business growth and higher claims primarily in South Korea and the U.S. Applying actual 2014 currency exchange rates to prior year results, benefit expenses increased 28% in 2013, compared with 2012, primarily due to the acquisitions in the second half of 2012 and business growth. Loss ratios increased in 2014.and 2013 compared with each prior year. In 2014, the increase is due primarily to a business mix shift toward products with higher loss ratios and higher incurred claims. For 2013, the increase primarily results from the inherently higher loss ratios of the acquisitions in the second half of 2012. 420 CIGNA CORPORATION - 2014 Form 10-K 51 PART II ITEM 7. Management's Discussion and Analysis of Financial Condition and Results of Operations Operating expenses. Included in operating expenses for the Global Supplemental Benefits segment are both policy acquisition costs and other operating expenses. Overall operating expenses were higher in 2014 and 2013 compared with each prior year, reflecting increases in both policy acquisition costs and other operating expenses. For 2014, the increase in policy acquisition costs reflects higher commissions in Hong Kong, the U.K. and the U.S., primarily driven by higher sales. For 2013, the increase in policy acquisition costs was largely attributable to the acquisitions and business growth, partially offset by lower acquisitioncosts in Europe reflecting a decision to cease selling activities in certain markets during 2012. The increases in other operating expenses in both 2014 and 2013 compared with each prior year were largely driven by strategic business investments. Acquisition cost ratios decreased in both 2014 and 2013.compared with each prior year. For 2014, the decline in the ratio largely represents a shift toward higher premium products and more disciplined acquisition cost spending. The decrease in the ratio in 2013 was primarily driven by lower acquisition costs in Europe reflecting a decisionto cease selling activities in certain markets during 2012 and, to a lesser extent, the impact of the lower acquisition cost ratios associated with our supplemental benefits business in the U.S. The expense ratio (excluding acquisition costs) was flat in 2014 compared with 2013 reflecting strategic business investments largely offset by operating efficiencies. In 2013, the expense ratio decreased compared with 2012.primarily due to the lower expense ratios associated with our supplemental benefits business in. the U.S., partially offset by strategic business investments. Effective tax rates. The effective tax rate for the Global Supplemental Benefits segment decreased in 2014 compared with 2013, due to favorable tax related items reported in the third quarter of 2014, primarily the favorable effect of expanding our capital management strategy to retain a significant portion of our foreign operations' earnings overseas. Effective tax rates in 2013 and 2012 largely reflect the continuing favorable impact of this capital management strategy. Other. Items Affecting Global Supplemental Benefits Results For our Global Supplemental Benefits segment, South Korea is the single largest geographic market. South Korea generated 52% of the segment's revenues and 76% of the segment's earnings in 2014. Due to the concentration of business in South Korea, the Global Supplemental Benefits segment is exposed to potential losses resulting from economic, regulatory and geopolitical developments in that country, as well as foreign currency movements affecting the South Korean won, that could have a significant impact on the segment's results and our consolidated financial results. In South Korea and certain other geographic markets, we continue to innovate and broaden our product and channel distribution capabilities to support business growth and mitigate potential adverse effects of increased data privacy regulatory requirements and other risks to telemarketing distribution. In 2014, our Global Supplemental Benefits segment operations in South Korea represented 4% of our total consolidated revenues and 8% of shareholders' net income. Group Disability and Life Segment Key factors for this segment are: • premium growth, including new business and customer retention; • net investment income; • benefit expenses as a percentage of earned premium (loss ratio); and • other operating expense as a percentage of earned premiums and fees (expense ratio). 421 52 CIGNA CORPORATION -2014 Form 10-K PART II ITEM 7. Management's Discussion and Analysis of Financial Condition and Results of Operations Results of Operations Financial Summary (In millions) Premia`ms ' Fees and other revenues Net investment income Segment revenues Benefit expenses:, Operating expenses Total benefrts and 'expenses,,, - Income before taxes Iiicorne'taxes SEGMENT EARNINGS Less: special items(after-tax) included in segment earnings; Charge for disability claims regulatory matter (See Note 23 to the Consolidated Financial Statements) Charge fdr organizational efficiency plans (See Note 6 to the, Consolidated Financial. Statements) ADJUSTED INCOME FROM OPERATIONS Realized investment gain"s', rieC of taxes :. . Effective tax rate Loss'tatio Loss ratio, excluding special items Operating expense'"'ratio .. For the Years Ended December 31, Increase/(Decrease) Increase/(Decrease) 2014 2013 2012 2014 vs. 2013 2013 vs. 2012 3,348 $ 3,044 $ 201 6% $ ' '304 ':' '' '10% 78 65 8 10 13 20 321' 300'..; 14 4 21..;. , 7 3,747 3,409 223 6 338 10 2,621:. 2,290 95 i 331 14 10 Earnings Discussion: 2014 compared to 2013 Segment earnings increased in 2014 compared with 2013 due primarily to the absence of the $51 million after-tax charge related to a disability claims regulatory matter. See the Overview section of this MD&A for further information. The increase in adjusted income from operations reflected favorable life results, higher net investment income and a lower expense ratio partially offset by higher disability claim costs largely due to a lower discount rate. Disability claim costs were lower in 2013 in part due to the $29 million favorable after-tax effect of a higher discount rate on claims incurred in 2013, resulting from the reallocation of higher yielding assets to the disability and life portfolio that had previously supported liabilities in the run-off reinsurance business. The favorable after-tax effects of reserve reviews were $52 million in 2014 and $60 million in 2013. Earnings Discussion: 2013 compared to 2012 Segment earnings decreased in 2013 compared with 2012 primarily due to the charge associated with the disability claims regulatory matter. Adjusted income from operations increased reflecting lower disability claim costs, a lower expense ratio and higher net investment income partially offset by unfavorable life claims experience. Lower disability claim costs included the $29 million favorable after-tax effect of a higher discount rate on claims incurred during 2013 as discussed above. Results included the favorable after-tax effect of reserve reviews of $60 million in 2013 and $43 million in 2012, 766 724 31 3,387 3 Q14 126 360 395 97 101 i1d 259 279 (1) $ 311 (2) 4 27 42 373` (35) 6 12 (9) 9 39 (15)'. (13) 58 281 $ 6 40, '..`.$ , `18 '` $ (26) . 28.1% 29.4% 250bps 78i3% 75 2%'2 (180)bps 76.0% 75.2% 50bps 224% 23.3% (50)bps 22 (20) (7) 2% $ 30 (65)%•, $'' 22122%0 (130)bps 3lobps 80bps {90)bps 11% Revenues Premiums. The increases in both 2014 and in 2013 reflected new business growth due to disability and life sales and continued strong customer retention. Net investment income. The increases in both 2014 and in 2013 were primarily due to higher assets partially offset by lower yields. Benefits and Expenses Benefit expenses. The increase in 2014 compared with 2013 was due primarily to premium growth and higher disability claims costs including the effect of a lower discount rate, partially offset by the absence of the $77 million before -tax charge for the disability claims regulatory matter and favorable life results. Disability claim costs in 2013 benefited from the $40 million before -tax impact of higher discount rates driven by the reallocation of higher yielding assets to the disability and life portfolio as noted above. The favorable life results reflected lower new claim incidence. Benefit expenses included the before -tax favorable impact of reserve reviews of $75 million in 2014 compared with $84 million in 2013. The increase in benefit expenses in 2013 compared with 2012 was primarily due to the $77 million before -tax irnpact of the disability claims regulatory matter, premium growth and unfavorable life claims experience partially offset by lower disability claim costs. The unfavorable life claims experience was driven by higher new claim sizes and the lower disability claim costs were driven by discount rate changes in 2013 as discussed above and the favorable impact of reserve reviews. Benefit expenses in 2013 included the before -tax favorable impact of reserve reviews of $84 million compared with $60 mullion in 2012. 422 CIGNA CORPORATION - 2014 Form 10-K 53 PART. II ITEM 7. Management's Discussion and Analysis of Financial Condition and Results of Operations Operating expense ratio. The decrease in the operating expense ratio in both 2014 and 2013 reflected continued expense discipline. Effective tax rate. The segment's effective tax rate is generally lower than the federal tax rate of 35%, primarily due to tax-exempt interest income on bonds. The increase in the effective tax rate in 2014 compared with 2013 resulted from a decline in the proportion of the segment's income that was attributable to tax-exempt interest and, to a lesser extent, the absence of the tax benefit reported in 2013 related to the completion of IRS tax audits. The decline in the effective tax rate in 2013 compared with 2012 was due to the tax benefit reported in 2013 related to th.e completion of IRS tax audits. Other Operations Description Cigna's COLI business contributes the majority of earnings in Other Operations. In the first quarter of 2014, we combined the results of the Runoff Reinsurance segment with other immaterial segments in Other Operations, because the results are expected to be immaterial subsequent to the reinsurance transaction with Berkshire in 2013. Cigna's Other Operations segment also includes the results from the run-off settlement annuity business, as well as the remaining deferred gains recognized from the sale of the individual life insurance and annuity and retirement benefits businesses. Prior year information has been conformed to the current year presentation, Results of Operations Financial Summary (In millions) Premiums' Fees and other revenues Net investment income Segment revenues Benefit expenses Operating expenses Benefitsand expenses Income (loss) before taxes Income taxes (beneefts) SEGMENT EARNINGS (LOSS) Less: results of GMIB business Less: special items (after-tax) included in segment earnings: ADJUSTED INCOME FROM OPERATIONS Effective tax rate For the Years Ended December 31, 2014 2013 2012 Earnings Discussion: 2014 compared to 2013 Segment earnings increased significantly in 2014 compared with 2013, due primarily to the absence of the 2013 charge related to the reinsurance transaction with Berkshire, Adjusted income from operations decreased in 2014 compared with 2013, primarily reflecting the absence of the $14 million favorable impact of the 2009-2010-IRS examinations completed during the third quarter of 2013 and higher COLI claims experience in 2014. Earnings Discussion: 2013 compared to 2012 The decrease in segment results in 2013 compared with 2012 was driven largely by the 2013 charge related to the reinsurance transaction with Berkshire. The increase in adjusted income from operations in 2013, compared with 2012, primarily resulted from the absence of the 2012 reserve strengthening in the GMDB business of (101) 38 08 490 i' (24) 489 510 21 1067 377 (687) 53 15120, (631) (237) .: (394) 8 (20) 37.6% 34,4% Increase/(Decrease) Increase/(Decrease) 2014 vs. 2013 2013 vs. 2012 (16) (13)% 77 76 (82) (17) (21) (4) (64) 690 183 (38) 45 N/M 735. < 191 728 115 (756) N/M 112 (280) N/iv1 117 (476) N/M (4) (63) 507 (20) (23)% $ (770)bps 320bps (507) 35 66% N/Iv $27 million and the $14 million favorable impact of completing the 2009-2010 IRS examinations during the third quarter of 2013. See Note 19 to the Consolidated Financial Statements for additional information on the IRS examinations. Revenues Premiums reflect revenue primarily on universal and whole life insurance policies in the COLI business. Premiums increased in 2014 compared with 2013 driven primarily by strong persistency as well as the impact of higher mortality in 2014 on experience -rated business. In 2013, premiums decreased compared with 2012, due to the absence of VADBe premium in 2013 because of the reinsurance transaction, partially offset by higher COLI premium. Fees and other revenues included losses of $39 million in 2013 and $119 million in 2012 associated with a dynamic hedge program for the run-off reinsurance business that was discontinued in 2013 with 423 54 CIGNA CORPORATION -2014 Form 10-K PART II ITEM 7. Management's Discussion and Analysis of Financial Condition and Results of Operations the effective exit from the GMDB and GMIB businesses. Excluding this hedge activity, other revenues were slightly lower in both 2014 and 2013 compared with each prior year, primarily due to the continued decline in deferred gain amortization related to the sold retirement benefits and individual life insurance and annuity businesses. Net investment income decreased in 2014 and, to a much more significant degree, in 2013.compared with each prior year. These decreases were primarily due to lower average yields and the selling or reallocating of investment assets in 2013 as a result of the reinsurance transaction with Berkshire. Benefits and expenses Benefit expenses decreased. in 2014 compared with 2013 primarily due to the absence of the $727 million charge resulting from the Corporate Description Berkshire transaction as well as GMDB activity prior to the transaction, partially offset by higher claims experience in the COLI business. Excluding the $727 million charge resulting from the Berkshire transaction, benefit expenses decreased in 2013 compared with 2012 largely due to the GMDB activity prior to the Berkshire transaction, that was favorable in early 2013 and unfavorable in 2012. Operating expenses decreased in 2014 compared with 2013 primarily due to the absence of expenses associated with the Berkshire transaction and lower ongoing expenses subsequent to the transaction. Operating expenses in 2012 included GMIB fair value gains of $(41) million. Excluding this GMIB activity, operating expenses increased in 2013 compared with 2012 primarily due to expenses associated with the Berkshire transaction. Corporate reflects amounts not allocated to operating segments, such as net interest expense (defined as interest on corporate debt less net investment income on investments not supporting segment operations), interest on uncertain tax positions, certain litigation matters, intersegment eliminations, compensation cost for stock options, expense associated with our frozen pension plans and certain overhead and project costs. Financial Summary (In millions) Segment loss Less: special items (after-tax) included in segment loss: Cost associated with HealthSpring acquisition (See Note 3 to the Consolidated Financial Statements) Charge. related to a litigation matter discussed in Note 23 to the Consolidated Financial: Statements AD USTED LOSS FROM OPERATIONS Realized"tnvestmeriC gams, net of taxes Corporate's segment loss and adjusted loss from operations increased in 2014 compared with 2013, primarily due to an increase in taxes related to certain employee stock compensation costs that are not deductible for income tax purposes under Health Care Reform. For the Years Ended December 31, 2014 2013 2012 $ (222) $ (329) $ (43) , . (19)% $ 107 ,' 33% — (33) (68) Increase/(Decrease) Increase/(Decrease) 2014 vs. 2013 2013 vs. 2012 33 3% The decrease in Corporate's segment loss in 2013 compared with 2012 is primarily attributable to the absence of special item costs associated with both litigation matters and the HealthSpring acquisition in 2012. Investment Assets The following table presents our invested asset portfolio, excluding separate account assets, as of December 31, 2014 and 2013. Additional information regarding our investment assets and related accounting policies is included in Notes 2, 10, 11, 12, 13, 14 and 17 to the Consolidated Financial Statements. (In millions) Fixed maturities Equity securities Commercial mortgage loans; Policy loans Otherlorig-term investments, Short-term investments TOTAL' , . 2014 2013 16,486 141 2,252 1,485 1,370 631 22,365 424 CIGNA CORPORATION - 2014 Form 10-IC 55 PART II ITEM 7. Management's Discussion and Analysis of Financial Condition and Results of Operations Fixed Maturities Investments in fixedmaturities include publicly traded andprivately placed debt securities, mortgage and other asset -backed securities, and preferred stocks redeemable by the investor. These investments are classified as available for sale and are carried at fair value on our balance sheet. Additional information regarding valuation methodologies, key inputs and controls is included in Note 10 of the Consolidated Financial Statements. The following table reflects our fixed maturity portfolio by type of issuer as of December 31, 2014 and 2013. (In millions) Federal government and agency State and local government Foreign government Corporate Mortgage -backed Other asset -backed TOTAL 2013 jr $ 880 2,144 1,444 10,981 153 884 N,s,9d $ 16,486 2014 The fixed maturity portfolio increased approximately $2.5 billion during 2014, reflecting increased investment in fixed maturities and the impact of decreased market yields on asset valuations. Although overall asset values are well in excess of amortized cost, there are specific securities with amortized cost in excess of fair value by $42 million in aggregate as of December 31, 2014. See Note 11 to the Consolidated Financial Statements for further information, As of December 31, 2014, $17.1 billion, or 90%, of the fixed maturities in our investment portfolio were investment grade (Baa and above, or equivalent), and the remaining $1.9 billion were below investment grade. The majority of the bonds that are below investment grade are rated at the higher end of the non -investment grade spectrum. These quality characteristics have not materially changed during the year. Our investment in state and local government securities, with an average quality rating of Aa2 is diversified by issuer and geography with no single exposure greater than $28 million. We assess each issuer's credit quality based on a fundamental analysis of underlying financial information and do not rely solely on statistical rating organizations or monoline insurer guarantees. We invest in high quality foreign government obligations, with an average quality rating of .Aa3 as of December 31, 2014, These Commercial Mortgage Loans Our commercial mortgage loans are fixed rate loans, diversified by property type, location and borrower. Loans are secured by high quality commercial properties and are generally made at less than 75% of the property's value at origination of the loan. Property value, debt service coverage, quality, building tenancy and stability of cash flows are all important financial underwriting considerations. We hold no direct residential mortgage loans and do not securitize or service mortgage loans. We completed an annual in-depth review of our commercial mortgage loan portfolio during the second quarter of 2014. This review included an analysis of each property's year-end 2013 financial statements, rent rolls, operating plans and budgets for 2014, a physical inspection of the property and other pertinent factors. Based on property values and cash flows estimated as part of this review and subsequent fundings and repayments, the portfolio's average loan -to -value ratio improved to 63% at December 31, 2014,.from investments are primarily concentrated in Asia consistent with the geographic distribution of our international business operations. Foreign government obligations also include $218 million of investments in European sovereign debt, none of which are in countries with significant political or economic concerns (Portugal, Italy, Ireland, Greece, and Spain). Corporate fixed maturities include private placement investments of $5.2 billion that are generally less marketable than publicly -traded bonds. However, yields on these investments tend to be higher than yields on publicly -traded bonds with comparable credit risk. We perform a credit analysis of each issuer, diversify investments by industry and issuer and require financial and other covenants that allow us to monitor issuers for deteriorating financial strength and pursue remedial actions, if warranted. Corporate fixed maturities include $343 million of investments in companies that are domiciled or have significant business interests in Italy, Ireland, and Spain. These investments have an average quality rating of Baa2 and are diversified by industry sector, including approximately 2% invested in financial institutions. Corporate fixed maturities also include investments in the energy and natural gas sector of $1.4 billion that have an average quality rating of Baa and are diversified by issuer with no single exposure greater than $45 million. 64% as of December 31, 2013, reflecting a modest increase in values for high quality commercial real estate. The portfolio's average debt service coverage ratio also improved, increasing to 1.66 at December 31, 2014 from 1.62 as of December 31, 2013. See Note 11 to the Consolidated Financial Statements for further information. Commercial real estate capital markets remain most active for well leased, quality commercial real estate located in strong institutional investment markets. The vast majority of properties securing the mortgages in our mortgage portfolio possess these characteristics. While commercial real estate fundamentals continued to improve, the improvement has varied across geographies and property types. The commercial mortgage loan portfolio contains approximately 80 loans, including five impaired loans with a carrying value totaling $166 million that are classified as problem or potential problem loans. Two of these loans totaling $86 million, net of $4 million in reserves, are current based on restructured terms and three loans totaling 425 56 CIGNA CORPORATION - 2014 Form 10-K PART II ITEM 7. Management's Discussion and Analysis of Financial Condition and Results of Operations $80 million, net of $8 million in reserves, are current. All of the remaining loans continue to perform under their contractual terms. We have $247 million of loans maturing in the next twelve months. Given the quality and diversity of the underlying real estate, positive debt service coverage and significant borrower cash investment averaging 30%, we remain confident that the vast majority of borrowers will continue to perform as expected under the contract terms. Other Long-term Investments Other long-term investments of $1.5 billion primarily include investments in security partnership and real estate funds as well as direct investments in real estate joint ventures. The funds typically invest in mezzanine debt or equity of privately held companies (securities partnerships) and equity real estate. Given our subordinate position in the capital structure of these underlying entities, we assume a higher level of risk for higher expected returns. To mitigate risk, investments are diversified across approximately 110 separate partnerships, and approximately 65 general partners who manage one or more of these partnerships. Also, the funds' underlying investments are diversified by industry sector or property type, and geographic region. No single partnership investment exceeds 6% of our securities and real estate partnership portfolio. Although the total fair values of investments exceeded their carrying values as of December 31, 2014, the fair value of our ownership interest in certain funds that are carried at cost was Less than carrying value by $17 million. We expect to recover our carrying value over the average remaining life of these investments of approximately 5 years. Given the current economic environment, future impairments are possible; however, management does not expect those losses to have a material effect on our results of operations, financial condition or liquidity. See Note 11 to the Consolidated Financial Statements for further information regarding Other Long-term Investments. Problem and Potential Problem Investments "Problem" bonds and commercial mortgage loans are either delinquent by 60 days or more or have been restructured as to terms, including concessions by us for modification of interest rate, principal payment or maturity date. "Potential problem" bonds and commercial mortgage loans are considered current (no payment more than 59 days past due), but management believes they have certain characteristics that increase the likelihood that they may become problems. The characteristics management considers include, but are not limited to, the following: • request from the borrower for restructuring; • principal or interest payments past due by more than 30 but fewer than 60 days; • downgrade in credit rating; • collateral losses on asset -backed securities; and • for commercial mortgages, deterioration of debt service coverage below 1.0 or value declines resulting in estimated loan -to -value ratios increasing to 100% or more. We recognize interest income on problem bonds and commercial mortgage loans only when payment is actually received because of the risk profile of the underlying investment. The amount that would have been reflected in net income if interest on non -accrual investments had been recognized in accordance with the original terms was not significant for 2014.or 2013. The following table shows problem and potential problem investments at amortized cost, net of valuation reserves and write -downs: December 31, 2014 December 31, 2013 (In millions) Problem'boncL Problem commercial mortgage loans« Foreclosed real estate TOTAL PROBLEM INVESTMENTS Potential; problem bonds Potential problem commercial mortgage loans TOTALPROBLEM INVESTMENTS Gross Reserve Net Gross Reserve Net 38 29 67 30 $ (9) $_ 21 135 (8) 127 165 $ (17) 148 (1) Other long-term investments included $7 million at December 31, 2013 of restructured loans that were previously reported in commercial mortgage loans. Net problem and potential problem investments representing approximately 1% of total investments, excluding policy loans at December 31, 2014, increased by approximately $30 million from December 31, 2013,.primarily due to the addition of one commercial mortgage loan to problem investments. Included in realized investment gains (losses) were increases in valuation reserves related to commercial mortgage loans and other -than -temporary impairments on fixed maturities and partnership investments of $52 million. See Note 11 to the Consolidated Financial Statements for further information. Investment Outlook Although financial markets in the United State's continuedto stabilize during 2014, they have more recently been impacted by continuing global uncertainty. Fixed income asset values have appreciated broadly since the beginning of the year, however the changes in valuation have varied amongst investment sectors depending on perceived risk in the global markets. Future realized and unrealized investment results will be driven largely by market conditions that exist when a transaction occurs or at the reporting date. These future conditions are not reasonably predictable. We believe that the vast majority of our fixed maturity investments will continue to perform under their contractual terms and that the commercial mortgage loan portfolio is positioned to perform well due to its solid aggregate loan -to -value ratio and strong debt service coverage. Based on our strategy to match the duration of invested assets to the duration of insurance and contractholder liabilities, we expect to hold a significant portion of these assets for the long term. Although future impairment losses resulting from credit deterioration and interest rate movements remain possible, we do not expect these losses to have a material adverse effect on our financial condition or liquidity. 426 CIGNA CORPORATION - 2014 Form 10-K 57 PART II ITEM 7, Management's Discussion and Analysis of Financial Condition and Results of Operations Market Risk Financial Instruments Our assets and liabilities include financial instruments subject to the risk of potential losses from adverse changes in market rates and prices. Our primary market risk exposures are: • Interest -rate risk on fixed-rate, medium -term instruments. Changes in market interest rates affect the value of instruments that promise a fixed return and our employee pension liabilities. • Foreign currency exchange rate risk of the U.S. dollar primarily to the South Korean won, Euro, British pound, Chinese yuan renminbi and Taiwan dollar. An unfavorable change in exchange rates reduces the carrying value of net assets denominated in foreign currencies. Our Management of Market Risks We predominantly rely on three techniques to manage our exposure to market risk: • Investment/liability matching. We generally select investment assets with characteristics (such as duration, yield, currency and liquidity) that correspond to the underlying characteristics of our related insurance and contractholder liabilities so that we can match the investments to our obligations. Shorter -term investments support generally shorter -term life and health liabilities. Medium -term, fixed-rate investments support interest -sensitive and health liabilities. Longer -term investments generally support products 'with longer pay out periods such as annuities and long-term disability liabilities. • Use of local currencies for foreign operations. We generally conduct our international business through foreign operating entities that maintain assets and liabilities in local currencies. While this technique does not reduce foreigncurrency exposure on our net assets, it substantially limits exchange rate risk to those net assets. • Use of derivatives. We generally use derivative financial instruments to minimize certain market risks. In 2014, we entered into interest rate swap contracts to convert a portion of our interest rate exposure on long-term debt from fixed rates to variable rates to more closely align interest expense with interest income received on our cash equivalent and short-term investment balances. See Notes 2(C) and 12 to the Consolidated Financial Statements for additional information about financial instruments, including derivative financial instruments. Effect of Market Fluctuations The examples that follow illustrate the adverse effect of hypothetical changes in market rates or prices on the fair value of certain financial instruments including: • a hypothetical increase in market interest rates, primarily for fixed maturities and commercial mortgage loans, partially offset by liabilities for long -terra, fixed-rate debt; and • a hypothetical strengthening of the U.S. dollar to foreign currencies, primarily for the net assets of foreign subsidiaries denominated in a foreign currency. Management believes that actual results could differ materially from these examples because: • these examples were developed using estimates and assumptions; • changes in the fair values of all insurance -related assets and liabilities have been excluded because their primary risks are insurance rather than market risk; • changes in the fair values of investments recorded using the equity method of accounting and Liabilities for pension and other postretirement and postemployment benefit plans (and related assets) have been excluded, consistent with the disclosure guidance; and • changes in the fair values of other significant assets and liabilities such as goodwill, deferred policy acquisition costs, taxes, and various accrued liabilities have been excluded; because they are not financial instruments, their primary risks are other than market risk. The effects of hypothetical changes in market rates or prices on the fair values of certain of our financial instruments, subject to the exclusions noted above (particularly insurance liabilities), would have been as follows as of December 31: Market scenario for certain non -insurance financial instruments (in millions) 100 basis point Increase in 'u retest rates . 10% strengthening in U.S. dollar to foreign currencies The effect of a hypothetical increase in interest rates was determined by estimating the present value of future cash flows using various models, primarily duration modeling. The impact of a hypothetical increase to interest rates at December 31, 2014 was greater than that at December 31, 2013 reflecting increased asset purchases as well as valuation increases resulting from lower market yields of fixed maturities during 2014. The effect of a hypothetical strengthening of the U.S. dollar relative to the foreign currencies held by us was estimatedto be 10% of the U.S. Loss in fair value 2014 2013 $.585 $ 285 dollar equivalent fair value. Our foreign operations hold investment assets, such as fixed maturities, cash, and cash equivalents, that are generally invested in the currency of the related liabilities. Due to the increase in 2014 of the amount of these investments that are primarily denominated in the South Korean won, the effect of a hypothetical 10% strengthening in the U.S. dollar to foreign currencies at December 31, 2014 was greater than that effect at December 31, 2013. 58 CIGNA CORPORATION - 2014 Form 10-K 427 PART II ITEM 7A. Quantitative and Qualitative Disclosures About Market Risk ITEM 7A. Quantitative and Qualitative Disclosures About Market° Risk The information contained under the caption "Market Risk" in the MD&A section of this Form 10-K is incorporated by reference, 428 CIGNA CORPORATION o 2014 Form 10-K 59 ITEM 8. Financial Statements and Supplementary Data pwc Report of Independent Registered Public Accounting Firm To the Board of Directors and Shareholders of Cigna Corporation In our opinion, the accompanying consolidated balance sheets and the related consolidated statements of income, comprehensive income, changes in total equity and cash flows present fairly, in all material respects, the financialposition of Cigna Corporation and its subsidiaries at December. 31., 2014 and 2013, and the results of their operations and their cash flows for each of the three years in the period ended December 31, 2014 in conformity with accounting principles generally accepted in the United States of America. Also in our opinion, the Company maintained, in all material respects, effective internal control over financial reporting as of December 31, 2014, based on criteria established in Internal Control — Integrated Framework 2013 issued by the Committee of Sponsoring Organizations .of the Treadway Commission (COSO). The Company's management is responsible for these financial statements, for maintaining effective internal control over financial reporting and for its assessment of the effectiveness of internal control over financial reporting, included in Management's Annual Report on Internal Control over Financial. Reporting appearing under Item 9A.. Our responsibility is to express opinions on these financial statements and on the Company's internal control over financial reporting based on our integrated audits. We conducted our audits in accordance with the standards of the Public Company Accounting Oversight Board (United States). Those standards require that we plan and perform the audits to obtain reasonable assurance about whether the financial statements are free of material misstatement and whether effective internal control over financial reporting was maintained in all material respects. Our audits of the .financial statements included examining, on a test basis, evidence supporting the amounts and disclosures in the financial statements, assessing the accounting principles used and significant estimates made by management and evaluating the overall financial statement presentation. Our audit of internal control over financial reporting included obtaining an understanding of internal control over financial reporting, assessing the risk that a material weakness exists, and testing and evaluating the design and operating effectiveness of internal control based on the assessed risk. Our audits also included performing such other procedures as we considered necessary in the circumstances. We believe that our audits provide a reasonable basis for our opinions. A company's internal control over financial reporting is a process designed to provide reasonable assurance regarding the reliability of financial reporting and the preparation of financial statements for external purposes in accordance with generally accepted accounting principles. A company's internal control over financial reporting includes those policies and procedures that (i) pertain to the maintenance of records that, in reasonable detail, accurately and fairly reflect the transactions and dispositions of the assets of the company; (ii) provide reasonable assurance that transactions are recorded as necessary to permit preparation of financial statements in accordance with generally accepted accounting principles, and that receipts and expenditures of the company are being made only in accordance with authorizations of management and directors of the company; and (iii) provide reasonable assurance regarding prevention or timely detection of unauthorized acquisition, use, or disposition of the company's assets that could have a material effect on the financial statements. Because of its inherent limitations, internal control over financial reporting may not prevent or detect misstatements. Also, projections of any evaluation of effectiveness to future periods are subject to the risk that controls may become inadequate because of changes in conditions, or that the degree of compliance with the policies or procedures may deteriorate. /s/ PricewaterhouseCoopers LLP PricewaterhouseCoopers LLP Philadelphia, Pennsylvania February 26, 2015 429 60 CIGNA CORPORATION - 2014 Form 10-K PART II ITEM 8. Financial Statements and Supplementary Data Cigna Corporation Consolidated Statements of Income (In millions, except per share amounts) For the years ended December 31, Revenues.• Premiums Fees and other revenues • Net investment income Mail order pharmacy tevenues. Realized investment gains (losses): Other-than-tempgrary impairments' on fixed maturities Other realized investment gains Total realized'lnvestmerit gains TOTAL REVENUES Benefits and Expenses Global Health Care medical claims expense Other benefit expenses Mail order pharmacy costs Other operating expenses. TOTAL BENEFITS AND EXPENSES Income before Income Taxes Income taxes: Current Deferred TOTAL TAXES 2014 2013 2012 Net Income Less: Net Income (Loss) Attributable to Noncontrolling Interests SHAREHOLDERS' NET INCOME Shareholders' Net Income, Per Share:`. Basic Diluted Dividends Declared Per Share The accompanying Notes to the Consolidated Financial Statements are an integral part of these statements. 25,575 3,601 1,164 224 15,867 4,998 1,509 7,830' 30,204 2,176 5.28 5,18 0.04 23,017 9,291 1,144 1,623 55 44 29,119 14,228 3,672 1,328 7,44 26,642 2,477 719 134 853 1,624 1 1,623 5.70 5.61 0.04 430 CIGNA CORPORATION-2014 Form 10-K 61 PART II ITEM 8. Financial Statements and Supplementary Data Cigna Corporation Consolidated Statements of Comprehensive Income (In millions) For the years ended December 31, Shareholders' net income. Shareholders' other comprehensive income (loss): Net unrealized appreciation (depreciation) on securities Net unrealized appreciation (depreciation), derivatives Net translation of foreign currencies Postretirement benefits liability adjustment Shareholders', other coiprehensive income (loss) Shareholders' comprehensive income Comprehensive income attributable to noncoitrolling interests: • Net income attributable to redeemable noncontrolling interests Net loss attributable to` othetnoncontrolitttg intetest Other comprehensive income (loss) attributable to redeemable noncontrolling interests Other comprehsive i enntone attributable to other noncontrolltng interest TOTAL COMPREHENSIVE INCOME The accompanying Notes to the Consolidated Financial Statements are an integral part of these statements. 2014 2013 2012 1,476 $ 1,623 (410) 147 9 13 • 539 151. (5) 66 (92) '116 ,627 1,739 1,610 $ 1,742 431 62 CIGNA CORPORATION - 2014 Form :10-K PART II ITEM 8, Financial Statements and Supplementary Data Cigna Corporation Consolidated Balance Sheets (In millions, exceptper share amounts) As of December 31, ASSETS Investments: Fixed maturities, at fait Value (ainOrtizect cost, $17,278; $15;273): Equity securities, at fair value (cost, $199; $146) .COrrilnereial nthrtga.ge. loans : • Policy loans Other long-term investments Short-term investments Total investments Cash and cash equivalents Premiums, accounts and notes receivable net Reinsurance recoverables Deferred policy' acquisition costs Property and equipment Deferred Income taxts, net Goodwill Other assets5 including other lntang'tbles Separate account assets TOTAL ASSETS LIABILITIES COntraerliOider''ClePOSit fundo Future policy benefits Global Health Care medical claims payable Total insurance and contractholder liabilities Accounts payable, accrued expenses and other liabilities Short-term debt Long,teiin debt Separate account liabilities TOTAL LIABILITIES:: .; Contingencies — Note 23 Recleeinable noricatittolli4 interests SHAREHOLDERS' EQUITY COinirion stock (par value per share, $0J5:shares issued, 296, 366; authorized, 600) Additional paid -in capital ALUinulated other comprehensivelost Retained earnings LeSS; treasury stock, at Cost TOTAL SHAREHOLDERS' EQUITY Noncontrolling interest Total equity Total liabilities snd equity. SHAREHOLDERS' EQUITY PER SHARE The accompanying Notes to the Consolidated Financial Statements are an integral part of these statements. 2014 2013 16,486 141 2,252 1,485 1,370 631 22365 2,795 1,991 7,299 i,395 1,464 92 6,029 2,654 8,252 $ —.54,336 8,470 9,306 2,050 580 24,704 .5,456 233 5,01.4 8,252 Vbv Mo,P-11 96 92 3,356 (520) 13,676 (6,037) 10,567 14 10,581 54,336 38.35 432 CIGNA CORPORATION -2014 Form 10-K 63 PART II ITEM 8. Financial Statements and Supplementary Data Cigna Corporation Consolidated Statements of Changes in Total Equity (In ndllions, except per share amounts) , . Balance at January 1, 2012. 2012 Activity: Effect of issuing stock for ninployee benefit plans Effects of acquisition of joint venture Other comprehensive incdrne Net income Common dividends declared. (per share : $0,04) Repurchase of common stock BALANCE AT-bECEMBNIt'51;--jOi2 2013 Activity: a, Effect of issusng sio6ktoinUaPitiVen'henefit plans Effects of acquisition ofjoint venture Othet comprehensive incosne (loss) Net income Common riividenas $0.04) : • Repurchase of commonstock._,, Distribution to 'UOti&iiitibllirkiiiternil : BALANCE AT DECEMBER 31, 2013 Accumulated Additional Other Effect of issuing stock for employee benefit plans „ • Other comprehensive 'income - : - Net income (loss) COMMon dividends 'deCiared (per share: '$0.04) Repurchase of common stock Retirement of treasuiy sfodc Capital contribution by noncontrollinginterest • Redeemable Common Paid -in Comprehensive Retained Treasury Shareholders' Noncontrolling Total Noncontrolling Stock Capital Loss Earnings Stock Equity Interest Equity Interest $ 92 $ 3,188 $ (787) 10,787 $(5,286) $ 7,994 $ $ 7,994 $ •, 107 (69) 217 255 • 116 116 1,623 1,623 (11) (11) ' (208) (208) 92 3,295 (671) 12330 (5,277) .• 9,769 61 (119) 243 255 111 116 2 1,623 1 (11) (208) 9,769 114 14 14 6 151 151 151 (19) 1,476 1,476 1,476 2 ` (11) • f11) (11) (1,003) (1,003) (1,003) ,(7) (520) 13,676 (6,037) -,4011144* — Pakit6W 10,567 96 BALANCE AT DECEMBER 31, 2014 ftfi74iifr2Tr' 1664 The accompanying Notes to the Consolidated Financial Statements are an integralpart of these statements. Atnalii* lianfiffnint ACAT*764).$1 433 64 CIGNA CORPORATION -2014 Form 10-K PART II ITEM 8, Financial Statements and Supplementary Data Cigna Corporation Consolidated Statements of Cash Flows (In millions) For the years ended December 31, 2014 2013 2012 a.,41i Flows frOin 0Peting Activiti4 '--: ' -,..' ' ,'•.:. ' •, ' . ' Net income Acitifs4netit.S to reconcile net inCoineto net, cash provided: by oPerating•adr.ivitieS: • •• . ''.: • Depreciation and amortization 597 560 Ralliedhiveunetit gains . • . • •" ;:„.', -:::- 1.. :', "-.:::, ' :.:, •-•:: : .:.. ': (1)1•:••.-- ' ,", -. (44) Deferred income taxes 197 134 Net changes. in assets and lianilities'net: of nOn.:,./.;eitiitg effects: !. '''. ' . - '' .. .., ....: ,,, : ._ , . •:.. _ ... Premiums, accounts and notes receivable L. (110) (71) Reinsurance recoverables : . ..- • ., - • • 369 .:- . 62 Deferred policy acquisition costs (227) (159) Other assets 5y .,4:'1'.':'-'•:::'3-:';',Ci.•405,-• ', ',--: :-. i.•'-' .-;:.;:ri:..[;31. Insurance liabilities',i1,040 245 - ' AedoittSparahle, accrued expenses and 'other liabilities-',,',:',,..1c',' A „, .-.,..1.,,'•!-(4$3) ,„:'...,.:',...-J: , (132) Current income taxes 1. (56) 29 ..;' CaShlied to exit the Rnit,off ReinSiiratidel3usineSs''' - ''..': , , -: , •-•:' • .:.,..,:.- --. : • " -,-,.,.,-.- A••-,•. .".',.'..(.2;196)'•.-• ''-' -:-'''':•''''''.!' — Proceeds from sales of mortgage loans held for sale 61 '',-:'•-•,r,-",-:.:.'(82)-..:.•'.':' • :-- -..:' --...i., '10 9.1 719 2,350 .4111:r,..." ..-.-,,,..:!::.:-.': :•-,-:;.'-:- r ' •.,.:'.. :'..: NET CASH PROVIDED BY OPERATING ACITV111ES Proceeds from investments sold: EiXed.inaturities'and "equity Seeurities•:".. "••-' Investment maturities and repayments: Fixed maturities and equity securities • • • - • Commercial mortgage loans , : „ n., , , - - • , • .. Other Sales,inai-urities and repayineniS(primarily short-term and other long-term investnientS)::,,--i-'...•:- • .: Investments purchased or originated: • Commercial mortgage loans Property and equipment purchases cash Other, net NET CASH pRaviiitti-BY t:(UED 'INVittiqt ACTIVITIES ( : Cash Flows from Financing Activities : Withdrawals and benefit payments from contractholder deposit funds Net ehailgein Repayment of long-term debt Repurchase of ommon stock: • " 1,478 $ 1,624 591 , 1,621 • 1,507 653 722 831 (3,062) - • (2,334) (58) (364) (1,930) • (821) (527) (408) - 0.0 • . (3,581) (42) — 15• (3,857) 1,399 1,337 (1,358) (1,264) (101) 98 (15) (326) _ (208) Issuance of common stock 150 121 CariiiinM'Clividefids Pcl'•,,'' . ';,":":. •::::,1,-':l)::•;,•-: ,:-,. •:-i,.':•.;i•:•-iii":,"-,- •:::-',1 -: •ri:',-,'",,,i.::-.., •- - . ,... ::, • ,,•:•.:::,,l,,-,:'., (1.1.).. •,-•.:-•;-. :•::::, :, • ' (11) Other, net 9 25 NET CASII USED IN FINANCING ACTIVITIES- ':'.!::.-: ••: ..: , . .:•:' ''•1,'114414 i :: '2 :c.f... ';:::(930): ''' : ' • ' :::::: '(228) . Effect of foreign currency rate changes on cash and cash equivalents 13 23 Na ..ct6i:Weiri'Ci'sfii: and6.-sh equivalents .- -;::'":',...:"'I'°•.::::::.':...:::'-';.:.'''.. '.- , , .,:r-'-..- ' .-: '.:':.':-..''(18)..• ' -'' : ''' ''' (1i712) Cash and cash equivalents, January 1, „., -it.,..- 2J795 2,978 4,690 42�;' • ' : : 479'..'.• . f ' . ... 2,978 Cash and cash eqUiValents, December 31, Supplemental Disclosure of Cash Information: Income aice'paid,, net of refunds Interest paid The accompanying Notes to the Consolidated Financial Statements are an integral part of these statements. 434 519 $ 655 265 $ 248 CIGNA CORPORATION -2014 Form 10-K 65 PART II ITEM S. Financial Statements and Supplementary Data Notes to the Consolidated Financial Statements NOTE 1 Description of Business Cigna Corporation, together with its subsidiaries (either individually or collectively referred to as "Cigna," the "Company," "we," "our" or "us") is a global health services organization dedicated to a mission of helping individuals improve their health, well-being and sense of security. To execute on our mission, Cigna's strategy is to "Go Deep", "Go Global" and "Go Individual" witha differentiated set of medical, dental, disability, life and accident insurance and related products and services offered by our subsidiaries. The majority of these products are offered through employers and other groups (e.g. governmental and non -governmental organizations, unions and associations). Cigna also offers commercial health and dental insurance, Medicare and Medicaid products and health, life and accident insurance coverages to individuals in the U.S. and selected international markets. In addition to its ongoing operations described above, Cigna also has certain run-off operations. NOTE 2 Summary of Significant Accounting Policies A. Basis of Presentation The Consolidated Financial Statements include the accounts of Cigna Corporation and its subsidiaries. Intercompany transactions and accounts have been eliminated in consolidation. These Consolidated Financial Statements were prepared in conformity with accounting principles generally accepted in the United States of America ("GAAP"). Amounts recorded in the Consolidated Financial Statements necessarily reflect management's estimates and assumptions about medical costs, investment valuation, interest rates and other factors. Significant estimates are discussed throughout these Notes; however, actual results could differ from those estimates. The impact of a change in estimate is generally included in earnings in the period of adjustment. Certain reclassifications have been made to prior year amounts to conform to the current presentation. Beginning in the first quarter of 2014, the Company combined the results of its run-off reinsurance business with Other Operations for segment reporting purposes. See Note 22 for additional information. Variable interest entities. As of December 31, 2014 and 2013, the Company determined it was not a primary beneficiary in any material variable interest entities. B. Recent Accounting Changes Accounting for Health Care Reform's Risk Mitigation Programs. Beginning in 2014, as prescribed by the Patient Protection and Affordable Care Act (referred to as "Health Care Reform"), programs went into effect to reduce the risk for participating health insurance companies selling coverage on the public exchanges. • A three-year (2014-2016) reinsurance program is designed to provide reimbursement to insurers for high cost individual business sold on or off the public exchanges. The reinsurance entity established by the U.S. Department of Health and Human Services ("HHS") is funded by a per -customer reinsurance fee assessed on all insurers, HMOs and self -insured group health plans, excluding certain products such as Medicare Advantage and Medicare Part D. Only non-grandfathered individual plans are eligible for recoveries if claims exceed a specified threshold, up to a reinsurance cap. Reinsurance contributions associated with non-grandfathered individual plans are reported as a reduction in premium revenue, and estimated reinsurance recoveries are established with an offsetting reduction in Global Health Care medical claims expense. Reinsurance fee contributions for other insured business are reported in other operating expenses. Final recoverable amounts are determined and settled with HHS in the year following the policy year. • A premium stabilization program is comprised of two components: 1) a permanent component that reallocates funds from insurers with lower risk populations to insurers with higher risk populations based on the relative risk scores of participants in non-grandfathered plans in the individual and small group markets, both on and off the exchanges. We estimate our receivable or payable based on the risk of our members compared to the risk of other members in the same state and market, considering data obtained from industry studies; and 2) a temporary (2014-2016) component designed to limit insurer gains and losses by comparing allowable medical costs to a target amount as defined by HHS. This programapplies to individual and small group qualified health plans, operating on and off the exchanges. Variances from the target amount exceeding certain thresholds may result in amounts due to or due from HHS. For the premium stabilization program, the Company records receivables or payables as adjustments to premium revenue based on. our year-to-date experience when the amounts are reasonably estimable and collection is reasonably assured. Final revenue adjustments are determined by HHS in the year. following the policy year. Revenue from Contracts with Customers (Accounting Standards Update (`ASU") 2014-09). In May 2014, the Financial Accounting Standards Board ("FASB") issued new revenue recognition guidance that will apply to various contracts with customers to provide goods or services, including the Company's non -insurance, administrative services contracts. It will not apply to certain contracts within the 435 66 CIGNA CORPORATION - 2014 Form 10-K PART II ITEM 8, Financial Statements and Supplementary Data scope of other GAAP, such as insurance contracts. This new guidance introduces a model that requires companies to estimate and allocate the expected contract revenue among distinct goods or services in the contract based on relative standalone selling prices. Revenue is recognized as goods or services are delivered. This new method replaces the current GAAP approach of recognizing revenue that is fixed and determinable primarily based on contract terms. In addition, extensive new disclosures will be required including the presentation of additional categories of revenues and information about related contract assets and liabilities. This new guidance must be implemented on January 1, 2017;.early adoption is not permitted. The Company may choose to adopt these changes through retrospective restatement with or without using certain practical expedients or with a cumulative effect adjustment on adoption. The Company continues to monitor developing implementation guidance and evaluate these new requirements for its non -insurance customer contracts to determine the method of implementation and any resulting estimated effects on the financial statements. Amendments to the Consolidation Analysis (ASU 2015-2). In February 2015, the FASB issued guidance to improve targeted areas of consolidation guidance for legal entities such as limited partnerships, limited liability companies and securitization structures. In addition to reducing the number of consolidation models, the new standard aims to simplify and improve U.S. GAAP by placing more emphasis on risk of loss when determining a controlling financial interest, This new standard is effective beginning on January 1, 2016, with early adoption permitted. The Company is evaluating this guidance for applicable legal entities to determine any resulting estimated effects on the financial statements. Fees Paid to the Federal Government by Health Insurers (ASU 2011-06). Effective January 1, 2014,.the Company adopted the FASB's accounting guidance for the health insurance industry assessment (the "tax") mandated by Health Care Reform. This non -deductible tax is being levied based on a ratio of an insurer's net health insurance premiums written for the previous calendar year compared to the U.S, health insurance industry total. As required by the guidance, the Company reports a liability at the beginning of each year in accounts payable, accrued expenses and other liabilities and a corresponding deferred cost in other assets, including other intangibles based on a preliminary assessment of the full year. The Company recognizes the tax in operating expenses on a straight line basis and reduces the deferred cost correspondingly. For full -year 2014,.the Company recognized $238 million in operating expenses for the tax. As of December 31, 2014, there were no such remaining balances in deferred costs or accounts payable, accrued expenses and other liabilities. This accounting will be reflected for the 2015 tax beginning in the first quarter of 2015. Investment Company Accounting (ASU 2013-08), Effective January 1, 2014, the Company adopted the FASB's amended accounting guidance to change the criteria for reporting as an investment company, clarify the fair value measurement used by an investment company and require additional disclosures. This guidance also confirms that parent company accounting for an investment company should reflect fair value accounting. While this guidance applies to certain of the Company's security and real estate partnership investments, its adoption did not have a material impact on the Company's financial statements, Reporting of Amounts Reclassi, fled Out of Accumulated Other Comprehensive Income (`'1OCI") (ASU 2013-02). Effective January 1, 2013, the Company adopted new requirements to disclose the effect of items reclassified out of AOCI into net income for each individual line item impacted in the statement of income. See Note 17 for the Company's disclosures. Disclosures about OffsettingAssets and Liabilities (ASU2011-11). The FASB's new requirements to disclose information related to certain investments on both a gross and net basis became effective January 1, 2013. The Company had no transactions or arrangements subject to these new disclosure requirements. C. Investments Fixed maturities and equity securities. Fixed maturities (including bonds, mortgage and other asset -backed securities and preferred stocks redeemable by the investor) and most equity securities are classified as available for sale and are carried at fair value with changes in fair value recorded in accumulated other comprehensive income (loss) within shareholders' equity. The Company records impairment losses in net income for fixed maturities with fair value below amortized cost that meet either of the following conditions: • If the Company intends to sell or determines that it is more likely than not to be required to sell these fixed maturities before their fair values recover, an impairment loss is recognized for the excess of the amortized cost over fair value. • If the net present value of projected future cash flows of a fixed maturity (based on qualitative and quantitative factors, including the probability of default, and the estimated timing and amount of recovery) is below the amortized cost basis, that difference is recognized as an impairment loss. For mortgage and asset -backed securities, estimated future cash flows are also based on assumptions about the collateral attributes including prepayment speeds, default rates and changes in value. Commercial mortgage loans. These loans are made exclusively to commercial borrowers at a fixed rate of interest. Commercial mortgage loans are carried at unpaid principal balances or, if impaired, the lower of unpaid principal or fair value of the underlying real estate. If the fair value of the underlying real estate is less than unpaid principal of an impaired loan, a valuation reserve is recorded. Commercial mortgage loans are considered impaired when it is probable that the Company will not collect amounts due according to the terms of the 'original loan agreement. The Company monitors credit risk and assesses the impairment of loans individually and on a consistent basis for all loans in the portfolio. The Company estimates the fair value of the underlying real estate using internal valuations generally based on discounted cash flow analyses. Certain commercial mortgage loans without valuation reserves are considered impaired because the Company will not collect all interest due according to the terms of the original agreements; however, the Company expects to recover the unpaid principal because it is less than the fair value of the underlying real estate. 436 CIGNA CORPORATION - 2014 Form 10-K 67 PART II ITEM 8. Financial Statements and Supplementary Data Policy loans. Policy loans are carried at unpaid principal balances plus accumulated interest, the total of which approximates fair value. The loans are collateralized by life insurance policy cash values and therefore have no exposure to credit loss. Interest rates are reset annually based on an index. Other long-term investments. Other long-term investments include investments in unconsolidated entities. These entities include certain limited partnerships and limited liability companies holding real estate, securities or loans. These investments are carried at cost plus the Company's ownership percentage of reported income or loss in cases where the Company has significant influence, otherwise the investment is carried at cost. Income from certain entities is reported on a one quarter lag depending on when their financial information is received. Other long-terminvestments are considered impaired, and written down to their fair value, when cash flows indicate that the carrying value may not be recoverable. Fair value is generally determined based on a discounted cash flow analysis. Other long-term investments also include investment real estate carried at depreciated cost less any impairment write downs to fair value when cash flows indicate that the carrying value may not be recoverable. Depreciation is generally recorded using the straight-line method based on the estimated useful life of each asset. Investment real estate as of December 31, 2014 and 2013 is expected to be held longer than one year and includes real estate acquired through the foreclosure of commercial mortgage loans. Additionally, other long-term investments include interest rate and foreign currency swaps carried at fair value. See Note 12 for information on the Company's accounting policies for these derivative financial instruments. Short-term investments. Security investments with maturities of greater than 90 days but less than one year from time of purchase are classified as short-term, available for sale and carried at fair value, which approximates cost. Derivative financial instruments. The Company applies hedge accounting when derivatives are designated, qualified and highly effective as hedges. Effectiveness is formally assessed and documented at inception and each period throughout the life of a hedge using various quantitative methods appropriate for each hedge, including regression analysis and dollar offset. Under hedge accounting, the changes in fair value of the derivative and the hedged risk are generally. recognized together and offset each other when reported in shareholders' net income. The Company accounts for derivative instruments as follows: • Derivatives are reported on the balance sheet at fair value with changes in fair values reported in shareholders' net income or accumulated other comprehensive income. • Changes in the fair value of derivatives that hedge market risk related to future cash flows and that qualify for hedge accounting are reported in accumulated other comprehensive income ("cash flow hedges"). • Changes in the fair value of a derivative instrument may not always equal changes in the fair value of the hedged item (referred to as "hedge ineffectiveness"). The Company generally reports hedge ineffectiveness in realized investment gains and losses. • On early termination, the changes in fair value of derivatives that qualified for hedge accounting are reported in shareholders' net income (generally as part of realized investment gains and losses). Net investment income. When interest and principal payments on investments are current, the Company recognizes interest income when it is earned. The Company recognizes interest income on a cash basis when interest payments are delinquent based on contractual terms or when certain terms (interest rate or maturity date) of the investment have been restructured. Investment gains and losses. Realized investment gains and losses are based on specifically identified assets and result from sales, investment asset write -downs, changes in the fair values of certain derivatives and changes in valuation reserves on commercial mortgage loans. Unrealized gains and losses on fixed maturities and equity securities carried at fair value and certain derivatives are included in accumulated other comprehensive income (loss), net of deferred income taxes and amounts required to adjust future policy benefits for the run-off settlement annuity business. D. Cash and Cash Equivalents Cash equivalents consist of short-term investments with maturities of three months or less from the time of purchase. The Company reclassifies cash overdraft positions to accounts payable, accrued expenses and other liabilities when the legal right of offset does not exist. E. Premiums, Accounts and Notes Receivable and Reinsurance Recoverables Premiums, accounts and notes receivable and reinsurance recoverables are reported net of allowances for doubtful accounts and unrecoverable reinsurance of $105 million as of December 31, 2014 and $47 million as of December 31, 2013. The Company estimates these allowances for doubtful accounts and unrecoverable reinsurance using management's best estimates of collectability, taking into consideration the age of the outstanding amounts, historical collection patterns and other economic factors. F. Deferred Policy Acquisition Costs Costs eligible for deferral include incremental, direct costs of acquiring new or renewal, insurance and investment contracts and other costs directly related to successful contract acquisition. Examples of deferrable costs include commissions, sales compensation and benefits, policy issuance and underwriting costs and premium 68 CIGNA CORPORATION - 2014 Form 10-K 437 PART II ITEM 8. Financial Statements and Supplementary Data taxes. The Company records acquisition costs differently depending on the product line. Acquisition costs for: • Universal life products are deferred and amortized in proportion to the present value of total estimated gross profits over the expected lives of the contracts. • Supplemental health, life and accident insurance (primarily individual products) and group health and accident insurance products are deferred and amortized, generally in proportion to the ratio of periodic revenue to the estimated total revenues over the contract periods. • Other products are expensed as incurred. Deferred policy acquisition costs also include the value of business acquired with the supplemental benefits business in 2012. Each year, deferred policy acquisition costs are tested for recoverability. For universal life and other individual products, management estimates the present value of future revenues less expected payments. For group health and accident insurance products, management estimates the sum of unearned premiums and anticipated net investment income less future expected claims and related costs. If management's estimates of these sums are less than the deferred costs, the Company reduces deferred policy acquisition costs and records an expense. The Company recorded amortization for policy acquisition costs of $289 million in 2014, $255 million in 2013 and $218 million in 2012 in other operating expenses. G. Property and Equipment Property and equipment is carried at cost less accumulated depreciation. Whenapplicable, cost includes interest, real estate taxes and other costs incurred during construction. Also included in this category is internal -use software that is acquired, developed or modified solely to meet the Company's internal needs, with no plan to market externally. Costs directly related to acquiring, developing or modifying internal -use software are capitalized. The Company calculates depreciation and amortization principally using the straight-line method generally based on the estimated useful life of each asset as follows: buildings and improvements, 10 to 40 years; purchased software, one to five years; internally developed software, three to seven years; and furniture and equipment (including computer equipment), three to 10 years. Improvements to leased facilities are depreciated over the lesser of the remaining lease term or the estimated life of the improvement. The Company considers events and circumstances that would indicate the carrying value of property, equipment or capitalized software might not be recoverable. If the Company determines the carrying value of any of these assets is not recoverable, an impairment charge is recorded. See Note 8 for additional information. H. Goodwill Goodwill represents the excess of the cost of businesses acquired over the fair value of their net assets. The resulting goodwill is assigned to those reporting units expected to realize cash flows from the acquisition, allocated to reporting units based on relative fair values and reported in the Global Health Care segment ($5.7 billion) and the Global Supplemental Benefits segment ($331 million). The Company evaluates goodwill for impairment at least annually during the third quarter at the reporting unit level and writes it down through results of operations if impaired, Fair value of a reporting unit is generally estimated based on a discounted cash flow analysis using assumptions that the Company believes a hypothetical market participant would use to determine a current transaction price. The significant assumptions and estimates used in determining fair value include the discount rate and future cash flows. A range of discount rates is used that corresponds with the reporting unit's weighted average cost of capital, consistent with that used for investment decisions considering the specific and detailed operating plans and strategies within the reporting units. Projections of future cash flows for the reporting units were consistent with our annual planning process for revenues, claims, operating expenses, taxes, capital levels and long-term growth rates. Cash flows for the Cigna-HealthSpring business incorporate the effects of sequestration and 2015 government reimbursement rates. In 2014, the resulting discounted cash flow analyses indicated that estimated fair values for the reporting units significantly exceeded their carrying values, including goodwill and other intangibles. See Note 8 for additional information. I. Other Assets, including Other Intangibles Other assets primarily consist of guaranteed minimum income benefits ("GMIB") assets and various insurance -related assets. The Company's other intangible assets include purchased customer and producer relationships, provider networks and trademarks. The fair value of purchased customer relationships and the amortization method were determined using an income approach that relies on projected future net cash flows including key assumptions for the customer attrition rate and discount rate. The Company amortizes other intangibles on an accelerated or straight-line basis over periods from 3 to 30 years. Management revises amortization periods if it believes there has been a change in the length of time that an intangible asset will continue to have value. Costs incurred to renew or extend the terms of these intangible assets are generally expensed as incurred. See Notes 8 and 10 for additional information. J. Separate Account Assets and Liabilities Separate account assets and liabilities are contractholder funds maintained in accounts with specific investment objectives. The assets of these accounts are legally segregated and are not subject to claims that arise out of any of the Company's other businesses. These separate account assets are carried at fair value with equal amounts for related separate account liabilities. The investment income, gains and losses of these accounts generally accrue to the contractholders and, together with their deposits and withdrawals, are excluded from the Company's Consolidated Statements of Income and Cash Flows. Fees and charges earned for mortality risks, asset management or administrative services and are reported in either premiums or fees and other revenues. 438 CIGNA CORPORATION - 2014 Form 10-K 69 PART II ITEM 8. Financial Statements and Supplementary Data K. Contractholder Deposit Funds Liabilities for contractholder deposit funds primarily include deposits received from customers for investment -related and universal life products and investment earnings on their fund balances. These liabilities are adjusted to reflect administrative charges and, for universal life fund balances, mortality charges. In addition, this caption includes: 1) premium stabilization reserves under group insurance contracts representing experience refunds left with the Company to pay future premiums; 2) deposit administration funds used to fund non -pension retiree insurance programs; 3) retained asset accounts; and 4) annuities or supplementary contracts without significant life contingencies. Interest credited on these funds is accrued ratably over the contract period. L. Future Policy Benefits Future policy benefits represent the present value of estimated future obligations under long-term life and supplemental health insurance policies and annuity products currently in force. These obligations are estimated using actuarial methods and prirnarily consist of reserves for annuity contracts, life insurance benefits, guaranteed minimum death benefit ("GMDB") contracts (see Note 7 for additional information) and certain health, life and accident insurance products of our Global Supplemental Benefits segment. Obligations for annuities represent specified periodic benefits to be paid to an individual or groups of individuals over their remaining lives. Obligations for life insurance policies and GMDB contracts represent benefits to be paid to policyholders, net of future premiums to be received. Management estimates these obligations based on assumptions as to premiums, interest rates, mortality or morbidity, future claim adjudication expenses and surrenders, allowing for adverse deviation as appropriate. Mortality, morbidity and surrender assumptions are based on the Company's own experience and/or published actuarial tables. Interest rate assumptions are based on management's judgment considering the Company's experience and future expectations, and range from 0.1% to 10.0%. Obligations for the run-off settlement annuity business include adjustments for realized and unrealized investment returns consistent with requirements of GAAP when a premium deficiency exists. M. Unpaid Claims and Claims Expenses Liabilities for unpaid claims and claim expenses are estimates of future payments under insurance coverages (primarily long-term disability, life and health) for reported claims and for losses incurred but not yet reported. When estimates of these liabilities change, the Company immediately records the adjustment in benefits and expenses. The Company consistently estimates incurred but not yet reported losses using actuarial principles and assumptions based on historical and projected claim incidence patterns, claim size and the expected payment period. The Company recognizes the actuarial best estimate of the ultimate liability within a level of confidence, consistent with actuarial standards of practice that the liabilities be adequate under moderately adverse conditions. The Company's liability for disability claims reported but not yet paid. is the present value of estimated future benefit payments over the expected disability period. The Company projects the expected disability period by using historical resolution rates combined with an analysis of current trends and operational factors to develop current estimates of resolution rates. Using the Company's experience, expected claim resolution rates may vary based upon the anticipated disability period, the covered benefit period, cause of disability, benefit design and the policyholder's age, gender and income level. The gross monthly benefit is reduced (offset) by disability income received under other benefit programs, such as Social Security Disability Income, workers' compensation, statutory disability or other group benefit plans. For offsets not yet finalized, the Company estimates the probability and amount of the offset based on the Company's experience over the past three to five years. The Company discounts certain unpaid claim liabilities because benefit payments are made over extended periods. Substantially all of these liabilities are associated with the group long-term disability business. Discount rate assumptions for that business are based on projected investment returns for the asset portfolios that support these liabilities and range from 4.1% to 5.5%. Discounted liabilities were $3.9 billion at December 31, 2014 and $3.5 billion at December 31, 2013. N. Global Health Care Medical Claims Payable Medical claims payable for the Global Health Care segment include reported claims, estimates for losses incurred but not yet reported and liabilities for services rendered by providers as well as liabilities under risk -sharing and quality management arrangements with providers. The Company uses actuarial principles and assumptions consistently applied each reporting period and recognizes the actuarial best estimate of the ultimate liability within a level of confidence. This approach is consistent with actuarial standards of practice that the liabilities be adequate under moderately adverse conditions. The liability is primarily calculated using "completion factors" developed by comparing the claim incurral date to the date claims were paid. Completion factors are impacted by several key items including changes in: 1) electronic (auto -adjudication) versus manual claim processing, 2) provider claims submission. rates, 3) membership and 4) the mix of products. The Company uses historical completion factors combined with an analysis of current trends and operational factors to develop current estimates of completion factors. The Company estimates the liability for claims incurred in each month by applying the current estimates of completion factors to the current paid claims data. This approach implicitly assumes that historical cornpletion rates will be a useful indicator for the current period. For the more recent months, the Company relies on medical cost trend analysis that reflects expected claim payment patterns and other relevant operational considerations. Medical cost trend is primarily impacted by medical service utilization and unit costs that are affected by changes in the level and mix of medical benefits offered, including inpatient, outpatient and pharmacy, the impact of copays and 70 CIGNA CORPORATION - 2014 Form 10-K 439 PART II ITEM 8. Financial Statements and Supplementary Data deductibles, changes in provider practices and changes in consumer demographics and consumption behavior. For each reporting period, the Company compares key assumptions used to establish the medical claims payable to actual experience. When actual experience differs from these assumptions, medical claims payable are adjusted through current period shareholders' net income. Additionally, the Company evaluates expected future developments and emerging trends that may impact key assumptions. The estimation process involves considerable judgment, reflecting the variability inherent in forecasting future claim payments. These estimates are highly sensitive to changes in the Company's key assumptions, specifically completion factors and medical cost trends. O. Redeemable Noncontrolling Interest The Company offers products and services in Turkey and India through joint venture entities. The redeemable noncontrolling interest on our consolidated balance sheet represents our joint venture partners' preferred and common stock interests in these entities. Our joint venture partners may, at their election, require the Company to purchase their redeemable noncontrolling interests. We also have the right to require our joint venture partners to sell their redeemable noncontrolling interests to us. The redeemable noncontrolling interests were recorded at fair value on the dates of purchase. When the estimated redemption value for a redeemable noncontrolling interest exceeds its carrying value, an adjustment to increase the redeemable noncontrolling interest is recorded and its effect is included in shareholders' net income per share. P. Accounts Payable, Accrued Expenses and Other Liabilities Accounts payable, accrued expenses and other liabilities consist principally of liabilities for pension, other postretirement and postemployment benefits (see Note 9), GMIB contracts (see Note 10), self -insured exposures, management compensation, cash overdraft positions and various insurance -related liabilities, including experience -rated refunds, the minimum medical loss ratio rebate accrual under Health Care Reform and reinsurance contracts. Legal costs to defend the Company's litigation and arbitration matters are expensed when incurred in cases where the Company cannot reasonably estimate the ultimate cost to defend. In cases where the Company can reasonably estimate the cost to defend, a liability for these costs is accrued when the claim is repotted. Q. Translation of Foreign Currencies The Company generally conducts its international business through foreign operating entities that maintain assets and liabilities in local currencies that are generally their functional currencies. The Company uses exchange rates as of the balance sheet date to translate assets and liabilities into U.S. dollars. Translation gains or losses on functional currencies, net of applicable taxes, are recorded in accumulated other comprehensive income (loss). The Company uses average monthly exchange rates during the year to translate revenues and expenses into U.S. dollars. R. Premiums and Related Expenses Premiums for group life, accident and health insurance and managed care coverages are recognized as revenue on a pro rata basis over the contract period. Benefits and expenses are recognized when incurred, and for our Global Health Care business, medical claims expense is presented net of pharmaceutical manufacturer rebates. For experience -rated contracts, premium revenue includes an adjustment for experience -rated refunds which is calculated according to contract terms and using the customer's experience (including estimates of incurred but not reported claims). Premium revenue also includes an adjustment to reflect the estimated effect of rebates due to customers under the commercial minimum medical loss ratio provisions of Health Care Reform. These rebates are settled in the year following the policy year. Premiums received for the Company's Medicare Advantage Plans and Medicare Part D products from customers and the Centers for Medicare and Medicaid Services ("CMS") are recognized as revenue ratably over the contract period. CMS provides risk -adjusted premium payments for Medicare Advantage Plans and Medicare Part D products, based on the demographics and health severity of enrollees. The Company recognizes periodic changes to risk -adjusted premiums as revenue when the amounts are determinable and collection is reasonably assured. Additionally, Medicare Part D includes payments from CMS for risk sharing adjustments. The risk sharing adjustments that are estimated quarterly based on claim experience, compare actual incurred drug benefit costs to estimated costs submitted in original contracts and may result in more or less revenue from CMS. Final revenue adjustments are determined and. settled with CMS in the year following the contract year. Premium. revenue also includes an adjustment to reflect the estimated effect of rebates due to CMS under the Medicare Advantage and Medicare Part D minimum medical loss ratio provisions of Health Care Reform. Premiums for individual life, accident and supplemental health insurance and annuity products, excluding universal life and investment -related products, are recognized as revenue when due. Benefits and expenses are matched with premiums. Revenue for universal life products is recognized as follows: • Net investment income on assets supporting universal life products is recognized as earned. • Charges for mortality, administration and policy surrender are recognized in premiums as earned. Administrative fees are considered earned when services are provided. Benefits and expenses for universal life products consist of benefit claims in excess of policyholder account balances. Expenses are recognized when claims are submitted, and income is credited to policyholders in accordance with contract provisions. The unrecognized portion of premiums received is recorded as unearned premiums. 440 CIGNA CORPORATION - 2014 Form 10-IC 71 PART II ITEM 8. Financial Statements and Supplementary Data S. Fees, Related Expenses and Mail Order Pharmacy Revenues and Costs Contract fees for administrative services only (ASO") programs and pharmacy programs and services are recognized in fees and other revenues as services are provided, net of pharmaceutical manufacturer rebates payable to clients and estimated refunds under performance guarantees. In some cases, the Company provides performance guarantees associated with meeting certain service standards, clinical outcomes or financial metrics. If these service standards, clinical outcomes or financial metrics are not met, the Company may be financially at risk up to a stated percentage of the contracted fee or a stated dollar amount. The Company establishes deferred revenues for estimated payouts associated with these performance guarantees. Approximately 12% of ASO fees reported' for the year ended December 31, 2014 were at risk, with reimbursements estimated to be approximately 1%. Expenses associated with these programs and services are recognized in other operating expenses as incurred, net of pharmaceutical rebates from manufacturers. Revenue for investment -related products is recognized as follows: • Net investment income on assets supporting investment -related products is recognized as earned. • Contract fees based upon related administrative expenses are recognized in fees and other revenues as they are earned ratably over the contract period. Benefits and expenses for investment -related products consist primarily of income credited to policyholders in accordance with contract provisions. Mail order pharmacy revenues and the cost of prescriptions are recognized as each prescription is shipped. T. Stock Compensation The Company records compensation expense for stock awards and options over their vesting periods primarily based on the estimated fair value at the grant date. For stock options, fair value is estimated using an option -pricing model, whereas for restricted stock grants and units, fair value is equal to the market price of the Company's common stock on the date of grant. Compensation expense for strategic performance shares is recorded over the performance period. For strategic performance shares with payment dependent on a market condition, fair value is determined at th.e grant date using a Monte Carlo simulation model and not subsequently adjusted regardless of the final outcome. For strategic performance shares with payment dependent on performance conditions, expense is initially accrued based on the most likely outcome, but evaluated for adjustment each period for updates in the expected outcome. At the end of the performance period, expense is adjusted to the actual outcome (number of shares awarded times the share price at the grant date). U. Participating Business The Company's participating life insurance policies entitle policyholders to earn dividends that represent a portion of the earnings of the Company's Life insurance subsidiaries. Participating insurance accounted for approximately 1% of the Company's total life insurance in force at the end of 2014, 2013 and 2012. V. Income Taxes Deferred income tax assets and liabilities are recognized for differences between the financial and income tax reporting bases of the underlying assets and liabilities and established based upon enacted tax rates and laws. Deferred income tax assets are recognized when available evidence indicates that realization is more likely than not. The deferred income tax provision generally represents the net change in deferred income tax assets and liabilities during the year, exclusive of amounts reported as adjustments to accumulated other comprehensive income or amounts initially recorded due to business combinations. The current income tax provision generally represents the estimated amounts due on the various income tax returns for the year reported plus the effect of any uncertain tax positions. Uncertain tax positions are evaluated in accordance with the model set forth in FASB guidance. Income tax provisions related to the Company's foreign operations are generally determined based upon the local country income tax rate. Note 19 contains detailedinformation about the Company's income taxes. W. Earnings Per Share The Company computes basic earnings per share using the weighted - average number of unrestricted common and deferred shares outstanding. Diluted earnings per share also includes the dilutive effect of outstanding employee stock options and unvested restricted stock granted after 2009 using the treasury stock method and the effect of strategic performance shares. 441 72 CIGNA CORPORATION -2014 Form 10-K PART II ITEM 8. Financial Statements and Supplementary Data NOTE 3 Acquisitions and Dispositions The Company may from time to time acquire or dispose of assets, subsidiaries or lines of 'business. The three significant transactions described below were completed in 2012. The combined pro forma effect of these transactions was not material to the Company's 2012 consolidated revenue and net income. A. Joint Venture Agreement with Finansbank On November 9, 2012, the Company acquired 51% of the total shares of Finans Eineklilik ve Hayat A.S. ("Finans Em.eklilik"), a Turkish insurance company for a cash purchase price of approxitnately $116 million. Finans Emeklllik operates in life insurance, accident insurance and pension product markets. Results of this business and the related goodwill and intangible assets (see Note 8 for additional information) are reported in the Global Supplemental Benefits segment. The redeemable noncontrolling interest is classified as temporary equity in the Company's Consolidated Balance Sheet because Finansbank has the right to require the Company to purchase its 49% interest for the value of its net assets and the inforce business in 15 years. B. Acquisition of Great American Supplemental Benefits Group On August 31, 201.2, the Company acquired Great American Supplemental Benefits Group, one of the largest providers of supplemental health insurance products in the U.S. for a cash purchase price of $326 million. Results of this business and the related goodwill and intangible assets (see Note 8 for additional information) are reported in the Global Supplemental Benefits segment. C. Acquisition of HealthSpring, Inc. On January 31, 2012 the Company acquired the outstanding shares of HealthSpring, Inc. ("HealthSpring") for $55 per share in cash and Cigna stock awards, representing a cost of approximately $3.8 billion. At the time of the acquisition, HealthSpring provided. Medicare Advantage coverage in 15 states and the District of Columbia, as well as a large, national stand-alone Medicare prescription drug business. Results of this business and the related goodwill and intangible assets (see Note 8 for additional information) are reported in the Global Health Care segment. During 2012, the Company recorded $53 million pre-tax ($40 million after-tax: $7 million in Global Health Care and $33 million in Corporate) of acquisition -related costs in other operating expenses. During the three years ended December 31, 2014, the Company entered into other acquisition and divestiture transactions, the results of which were not material to the Company's results of operations, liquidity or financial condition. 442 CIGNA CORPORATION - 2014 Form 10-K 73 PART II ITEM 8. Financial Statements and Supplementary Data NOTE 4 Earnings Per Share Basic and diluted earnings per share were computed as follows: (Shares in thousands, dollars in millions, except per share amounts) • 2014 Shareholders' net income Shares Weighted average Common stock equivalents 2013 Basic Effect of Dilution Diluted Shareholders net income 1,47( 1,476 Shares Weighted average Common stock equivalents :279,296 5,389 79,296 5,389 Total shares 279,296 5;389 284,685 EPS 2012 5.28 (0.10) 5.18 Shareholders' net income Shares Weighted average Common stock equivalents Total shares 1,623 $ — $ 1,623 284,819 ',4,711 284,819 4,711 284,819 4;711 289,530 EPS. 5 70 $ (009) 5.61 The following outstanding employee stock options were not included in the computation of diluted earnings per share because their effect was anti -dilutive. (In millions) 2014 2013 2012 Anti -dilutive options 0.9 2.5 443 74 CIGNA CORPORATION - 2014 Form 10-K PART II ITEM 8. Financial Statements and Supplementary Data NOTE 5 Global Health Care Medical Claims Payable Medical claims payable for the Global Health Care segment reflects estimates of the ultimate cost of claims that have been incurred but not yet reported, those that have been reported but not yet paid (reported claims in process), and other medical expenses payable that is primarily comprised of accruals for incentives and other amounts payable to health care professionals and facilities, as follows: (In millions) Incurred but not yet reported Reported claims in process Physician incentives and other medical expense payable. MEDICAL CLAIMS PAYABLE 2014 2013 1,615 355 80 180 $ 2,050 Activity in medical claims payable was as follows: (In millions) Balance at January:1, • Less: Reinsurance and other amounts recoverable Balance at January 1; net Acquired net: Incurred claims related to:. Current year Prior years Total incurred Paid. claims related to:. Current year Ptiot years Total paid Balance at December 31, net. Add: Reinsurance and other amounts recoverable Balance at December 31, Reinsurance and other amounts recoverable reflect amounts due from reinsurers and policyholders to cover incurred but not reported and pending claims for minimum premium products and certain ASO business where the right of offset does not exist. See Note 7 for additional information on reinsurance. For the year ended December 31, 2014, actual experience differed from the Company's key assumptions resulting in favorable incurred claims related to prior years' medical claims payable of $159 million, or 1.0% of the current year incurred claims as reported for the year ended December 31, 2013, Actual completion factors accounted for $61 million, or 0.4%, while actual medical cost trend resulted inthe remaining $98 million, or 0.6%. For the year ended December 31, 2013, actual experience differed from the Company's key assumptions, resulting in favorable incurred claims related to prior years' medical claims payable of $182 million, or 1.3% of the current year incurred claims as reported for the year ended December 31, 2012. Actual completion factors accounted for $74 million of favorability, or 0.5%, while actual medical cost trend resulted in the remaining $108 million, or 0.8%. The impact of prior year development on shareholders' net income was $53 million for the year ended December 31, 2014 compared with $77 million for the year ended December 31, 2013, The 2014 2013 ,856 242 1,614 2012 1,305 249 1,056 504 14,428 (200) 14,228 4,267 12,854 1,358 1,320 15,625 1,856 194 $ 2,050 14,174 1,614 242 $ .... 1,856 favorable effect of prior year development for both years primarily reflects low utilization of medical services, The change in the amount of the incurred claims related to prior years in the medical claims payable liability does not directly correspond to an increase or decrease in the Company's shareholders' net income recognized for the following reasons: First, the Company consistently recognizes the actuarial best estimate of the ultimate liability within a level of confidence, as required by actuarial standards of practice that require the liabilities be adequate under moderately adverse conditions, As the Company establishes the liability for each incurral year, the Company ensures that its assumptions appropriately consider moderately adverse conditions. When a portion of the development relates to a release of the prior year's provision for moderately adverse conditions, the Company does not consider that amount as impacting shareholders' net income to the extent that it is offset by an increase determined appropriate to address moderately adverse conditions for the current year incurred claims. Second, as a result of the medical loss ratio ("MLR") provisions of Health Care Reform, changes in medical claim estimates due to prior year development may be offset by a change in the MLR rebate accrual, 444 CIGNA CORPORATION - 2014 Form 10-K 75 PART II ITEM 8. Financial Statements and Supplementary Data Third, changes in reserves for the Company's retrospectively experience -rated business for accounts in surplus do not usually impact shareholders' net income because such amounts are generally offset by a change in the liability to the policyholder. An account is in surplus when the accumulated premium received exceeds the accumulated medical costs and administrative charges, including profit charges. NOTE 6 Organizational Efficiency Plans The Company is regularly evaluating ways to deliver its products and services more efficiently and at a lower cost. During 2013 and 2012, the Company adopted specific plans to increase its organizational efficiency as follows: 2013 Plan. During the fourth quarter of 2013, the Company committed to a plan to increase its organizational efficiency and reduce costs through a series of actions that includes employee headcount reductions. As a result, the Company recognized charges in other operating expenses of $60 million pre-tax ($40 million after-tax) Summarized below is the activity for the 2013 plan described above. (In millions) Fourth quarter 2013 charge- Less: 2013 payments The determination of liabilities for Global Health Care medical claims payable requires the Company to make critical accounting estimates. See Note 2(N) for further information about the assumptions and estimates used to establish this liability. in the fourth quarter of 2013, primarily for severance costs. The Company expects most of the severance to be paid by the end of 2015. 2012 Plan. During the third quarter of 2012, in connection with the execution of its strategy, the Company committed to a series of actions to further improve its organizational alignment, operational effectiveness, and efficiency. As a result, the Company recognized charges in other operating expenses of $77 million pre-tax ($50 million after-tax) in the third quarter of 2012 consisting primarily of severance costs. The costs associated with this plan were substantially paid as of March 31, 2014. Severance 1 Real estate Total $ 13 $ 60 1 2 Balance, December 31; 2013 Less: 2014 payments 46 26 12 2 5.8 28 Balance, December 31, 2014 NOTE 7 Reinsurance 20 10 $' 30 The Company's insurance subsidiaries enter into agreements with other insurance companies to assume and cede reinsurance. Reinsurance is ceded primarily to limit losses from large exposures and to permit recovery of a portion of direct or assumed Losses. Reinsurance is also used in acquisition and disposition transactions when the underwriting company is not being acquired. Reinsurance does not relieve the originating insurer ,of liability. The Company regularly evaluates the financial condition of its reinsurers and monitors concentrations of its credit risk. Effective Exit of GMDB and GMIB Business On February 4, 2013, the Company entered into an agreement with Berkshire Hathaway Life Insurance Company of Nebraska ("Berkshire") to effectively exit the GMDB and GMIB businesses via a reinsurance transaction. Berkshire reinsured 100% of the Company's future claim payments in these businesses, net of retrocessional arrangements existing at that time. The reinsurance agreement is subject to an overall limit with approximately $3.7 billion remaining. This transaction resulted in an after-tax charge to shareholders' net income in the first quarter of 2013 of $507 million ($781 million pre-tax reported as follows: $727 million in other benefit expenses; $45 million in GMIB fair value loss; and $9 million in other operating. expenses). The payment to Berkshire under the agreement was $2.2 billion and was funded from the sale of investment assets, tax benefits related to the transaction and available parent cash. Because this effective exit was accomplished via a reinsurance contract, the amounts related to the reinsured GMDB and GMIB contracts cannot be netted, so the gross assets and liabilities must continue to be measured and reported. The following disclosures provide further context to the methods and assumptions used to determine these assets and liabilities. GMDB The Company estimates this liability with an internal model based on the Company's experience and future expectations over an extended period, consistent with the long-term nature of this product. Because the product is premium deficient, the Company records increases to the reserve if it is inadequate based on the model. Prior to the reinsurance transaction with Berkshire, any such reserve increases were recorded as a charge to shareholders' net income. Reserve increases after the reinsurance transaction are expected to have a corresponding 445 76 CIGNA CORPORATION - 2014 Form 10-K PART II ITEM 8, Financial Statements and Supplementary Data increase in the recorded reinsurance recoverable, provided the increased recoverable is not capped due to the overall Berkshire limit (including the GMIB assets). The Company's dynamic hedge programs were discontinued at the time of the Berkshire reinsurance transaction in 2013. These hedge programs generated' losses (included in Other Revenues) of $32 million in 2013, and $105 million in 2012, Activity in future policy benefit reserves for the GMDB business was as follows: (In millions) Balance at January 1, Add: Unpaid claims Less Reinsurance and otjrec amounts recoverable Balance at January 1, net Add: Incurred ben efts Less: Paid benefits (including the $1,647 payment for Berkshire reinsurance transaction) Ending balance, net Less: Unpaid claims Add: Reinsurance did other amounts recover Balance at December 31, 2014 1,090 $ 24 42 1,072 699 1,674 97 18 1,317 $ 1,396 $ 1,090 2013 2012 1,170 40 53 1,157 17 102 1,072 24 42 Benefits paid and incurred are net of ceded amounts, including the impact of the 2013 reinsurance transaction with Berkshire. The ending net retained reserve as of December 31, 2014 and December 31, 2013 covers ongoing administrative expenses, as well as the few claims retained by the Company. Prior to 2013, incurred benefits reflected the favorable or unfavorable impact of a rising or falling equity market on the liability, and included reserve strengthening of $43 million in 2012. The majority of the exposure arises under annuities that guarantee that the benefit received at death will be no less than the highest historical account value of the related mutual fund investments on a contractholder's anniversary date. Under this type of death benefit, the Company is liable to the extent the highest historical anniversary account value exceeds the fair value of the related mutual fund investments at the time of a contractholder's death. The table below presents the account value, net amount at risk and average attained age of underlying contractholders for guarantees assumed by the Company in the event of death. The net amount at riskis the amount that the Company would have to pay if all contractholders died as of the specified date. Unless the Berkshire reinsurance limit is exceeded, the Company should be reimbursed in full for these payments. (Dollars in millions, excludes impact of reinsurance ceded) Account' `value Net amount at risk Average attained age of contractholders (weighted by exposure). Number of contractholders 2014 Tj 2013 14,062 3,023 73 390,000 446 CIGNA CORPORATION -2014 Form 10-K 77 PART II ITEM 8. Financial Statements and Supplementary Data Effects of Reinsurance The following table presents direct, assumed and ceded premiums for both short -duration and long -duration insurance contracts. It also presents reinsurance recoveries that have been netted against direct benefits and expenses in the Company's Consolidated Statements of Income. (In millions) Premiums Short -duration contracts: Direct Assumed Ceded Long -duration co Direct Assumed Ceded: • Individual life Insurance and annuity' Other TOTAL Reinsurance recoveries Individual life insurance and annuity business sold TOTAL 2014 2013 2012 $ 23,056 $ 20,792 394 385 (252) . (216) 23,198 20,961 2,222 86 (176) (186) (115) (66) 2 37T 2,056 $ 25,575 $ 23,017 335 316 (18) 201 $ 317 $ 517 Recoveries were higher in 2014 primarily due to the absence of the 2013 activity related to the Berkshire transaction, including the initial payment. The increase in long -duration assumedpremiums in 2013 largely results from the acquisition of Great American Supplemental Benefits in 2012. The effects of reinsurance on written premiums for short -duration contracts were not materially different from the recognized premium amounts shown in the table above. 78 CIGNA CORPORATION - 2014 Form 10-K 447 PART II ITEM 8. Financial Statements and Supplementary Data Reinsurance Recoverables The majority of the Company's reinsurance recoverables resulted from acquisition and disposition transactions in which the underwriting company was not acquired. Components of the Company's reinsurance recoverables are presented below: (In millions) GIVIDB Individual Life and Annuity (sold in 1998) Retirement Benefits Business (sold in 2004) Supplemental Benefits Business (2012 acquisition) Global Health Care, Global Supplemental Benefits, Group Disability and Life Berkshire Other Lincoln National Life and Lincoln Life & Annuity of New York Prudential Retirement Insurance and Annuity Great American Life 1,147 $ 1,276 100% were secured by assets in a trust. 39 41 96% were secured by assets in a trust or letter of credit. 3,817 3,905 Both companies' ratings were sufficient to avoid triggering a contractual obligation to fully secure the outstanding balance. 1,092 1,200 100% were secured by assets in a trust. 336 363 99% were secured by assets in a trust. Various 561 407 Recoverables were from more than 80 reinsurers used in the ordinary course of business. Balances ranged from less than $1 million up to $167 million, with 9% secured by assets in trusts or letters of credit. Other run-off reinsurance Various 88 107 100% of this balance was secured by assets in a trust, and other deposits. Total reinsurance recoverables $ 7,080 $ 7,299 Over 90% of the Company's reinsurance recoverables were from companies that are rated A or higher by Standard & Poor's at December 31, 2014. The Company reviews its reinsurance arrangements and establishes reserves against the recoverables in the event that recovery is not considered probable. As of December 31, 2014, the Company's recoverables were net of a reserve of $4 million. The Company bears the risk of loss if its reinsurers and retrocessionaires do not meet or are unable to meet their reinsurance obligations to the Company. NOTE 8 Goodwill, Other Intangibles, and Property and Equipment Goodwill is primarily reported in the Global Health Care segment ($5.7 billion) and, to a lesser extent, the Global. Supplemental Benefits segment ($331 million), Activity in Goodwill during 2014 and 2013.was as follows: (In millions) Balance at January l Goodwill acquired: Finals Emeklllk >: Other Impact, of foreign currency translation Balance at December 31, 2014 2013 6,001 33 (8) $ 6,029 448 CIGNA CORPORATION - 2014 Form 10-IC 79 PART II ITEM 8. Financial Statements and Supplementary Data Other intangible assets were comprised of the following at December 31: (Dollars in millions) 2014 Customer relationships Other Total reported in other assets, including other intangibles Value of business acquired (reported in deferred policy acquisition costs) Internal -use software (reported in property and equipment) TOTAL OTHER INTANGIBLE ASSETS Cost Accumulated Amortization Net Carrying Value 2013 .. Customer relationships Other ,' 1,289 324 635 76 654 248 Total reported in other assets, including other ,intangibles Value of business acquired (reported in deferred policy acquisition costs) Internal -use software (reported in property and _equipment) TOTAL OTHER INTANGIBLE ASSE'rS 1,613 168 1,942 $ 3,723 711 20 1,307 2,038 9b2 148 635 $ 1,685 Property and equipment was comprised of the following as of December 31: (Dollars in millions) 2014 Internal -use software Otherpropertyand equipment Cost Accumulated Amortization Net Carrying Value TOTAL PROPERTY AND EQUIPMENT 2013 Internal -use software Other property and equipment TOTAL PROPERTY AND EQUIPMENT Other property and equipment includes assets recorded under capital leases with a cost of $84 million, accumulated amortization. of $36 million, and a net carrying value of $48 million as of December 31, 2014. Other property and equipment includes assets recorded under capital leases with a cost of $306 million, accumulated amortization of $16 million, and a net carrying value of $290 million 1,942, 1 747 918...'r 1,307 635 „829 $ 3,689 $ 2,225 $ 1,464 as of December 31, 2013. The reduction in assets recorded under capital leases in 2014, compared with the prior year, was primarily related to the Company's purchase of a building in South Korea that it had previously leased. Current capital lease agreements are for equipment and generally have a term of 48 months withthe equipment returned to the lessor at the end of the term. Depreciation and amortization was comprised of the following for the years ended December 31: (Dollars in millions) Internal -use software Other property and equipment Value'of business acquired treported in deferred policy acquisition costs) . Other intangibles TOTAL DEPRECIATION AND AMORTIZATION 2014 2013 225 160 19 193 $ . '597 2012 144 205 560 Other property and equipment includes amortization on assets recorded under capital leases of $20 million in 2014 and $16 million in 2013. The Company estimates annual pretax amortization for intangible assets, including internal -use software, over the next five calendar years to be as follows: $425 million in 2015, $348 million in 2016, $237 million in 2017, $154 million in 2018, and $129 million in 2019. 449 80 CIGNA CORPORATION -2014 Form 10-K PART II ITEM 8, Financial. Statements and Supplementary Data NOTE 9 Pension and Other Postretirement Benefit Plans A. Pension and Other Postretirement Benefit Plans The Company and certainof its subsidiaries provide pension, health care and life insurance defined benefits to eligible retired employees, spouses and other eligible dependents through various domestic and foreign plans. The effect of its foreign pension and other postretirement benefit plans is immaterial to the Company's results of operations, liquidity and financial position. The Company froze its defined benefit postretirement medical plan in the first quarter of 2013 and its primary domestic pension plans in 2009. As further discussed in Note 23, the Company and the Cigna Pension Plan are defendants in a class action lawsuit that has yet to be resolved. When the parties agree on a final plan amendment, the pension benefit obligation will be updated to reflect additional benefits resulting from this litigation. In the first quarter of 2013,.the Company also announced a change in the cost sharing arrangement with retirees for pharmacy subsidy payments received from the U.S. Government effective January 1, 2014, resulting in a reduced other postretirement benefit obligation of $57 million. This reduction was recorded in accumulated other comprehensive income, net of deferred taxes, resulting in an after-tax increase to shareholders' equity of $37 million. The Company measures the assets and liabilities of its domestic pension and other postretirement benefit plans as of December 31. The following table summarizes the projected benefit obligations and assets related to the Company's domestic and international pension and other postretirement benefit plans as of, and for the year ended, December 31: (In millions) Change in benefit obligation Benefit obligation, January 1 Service cost Interest cost (train) loss from past experience Effect of plan amendment Benefits paid from plan assets Benefits paid other Curtailment Benefit. obligation, December 31 Change in plan assets Fair value of plan assets, January 1 Actual return on plan assets , Benefits paid Contributions Fair value of plan assets, December 31 Funded Status Pension Benefits Other Postretirement Benefits 2014 2013 2014 2013 The postretirement benefits liability adjustment included in accumulated other comprehensive loss consisted of the following as of December 31: (In millions) Unrecognized net gaiti‘(loss) Unrecognized prior service cost POSTRETIREMENT BENEFITS LIABILITY ADJUSTMENT During 2014, the Company's postretirement benefits liability adjustment increased by $656 million pre-tax ($426 million after-tax) resulting in a decrease to shareholders' equity. The increase in the Pension Benefits Other Postretirement Benefits 2014 2013 (1,696) (5) $ ` (1,701) 2014 liability was primarily due to a change in the mortality assumption (as discussed further in the assumptions section of this note) and a decrease in the discount rate. 450 CIGNA CORPORATION -2014Form 10-K 81 PART II ITEM 8. Financial. Statements and Supplementary Data Pension benefits, The Company's pension plans were underfunded by $1.1 billion in 2014.and $0.6 billion in 2013.and had related accumulated benefit obligations of $5.3 billion as of December 31, 2014 and $4,7 billion, as of December 31, 2013. The Company funds its qualified pension plans at least at the minimum amount required by the Employee Retirement Income Components of net pension cost for the years ended December 31 (In millions) Service cost Interest cost Expected long-term return on ,plan assets Amortization of: Net loss from pas experieliee Settlement loss NET. PENSION COST The Company expects to recognize pre-tax losses of $70 m.illion in 2015 from amortization of past experience. This estimate is based on a weighted average amortization period for the frozenand inactive plans that is based on the average expected remaining life of plan participants of approximately 29 years. Security Act of 1974 and the Pension Protection Act of 2006. For 2015, the Company expects to make minimum required contributions totaling approximately $5 million. Future years' contributions will ultimately be based on a wide range of factors including but not limited to asset returns, discount rates, and funding targets. were as follows: 2014 2013 2012 • 3 198 (20) 74 58 — 6 (14) $ (5) Other postretirement Unfunded retiree health benefit plans had accumulated benefit obligations of $206 million at December 31, 2014 and $190 million at December 31, 2013. Retiree life insurance plans had accumulated benefit obligations of $129 million as of December 31, 2014 and $133 million as of December 31, 2013. Components of net other postretirement benefit cost for the years ended December 31 were as follows: (In millions) Service cost Interest cost Expected long-term `retu"rn on plan as"sets , Amortization of: Prior service cost` Curtailment gain 2014 2013 2012 2 12 16 (1) (1) (12) NET OTHER POSTRETIREMENT BENEFIT COST The Company expects to recognize $3 million pre-tax gains related to amortization of prior service cost and no pre-tax gains from amortization of past experience in 2015. The amortization period is based onan average expected remaining life of plan participants of 29 years. The estimated rate of future increases in the per capita cost of health care benefits is 6.75% in 2015, decreasing by 0.25% per year to 4.75% in 2023 and beyond. This estimate reflects the Company's current claim experience and management's estimate that rates of growth will decline in the future. A 1% increase or decrease in the estimated rate in 2014 would have no impact on postretirement benefit costs, and $1 million on the postretirement benefit. obligation. Plan assets. The Company's current target investment allocation percentages (50% fixed. income, 25% public equity securities, and 25% in other investments, including securities partnerships, hedge funds and real estate) are developed by management as guidelines, although the fair values of each asset category are expected to vary as a result of changes in market conditions. The Company would expect to further reduce the allocation to equity securities and move further into fixed income investments as funding levels improve. As of December 31, 2014, pension plan assets included $3.8 billion invested in the separate accounts of Connecticut General Life Insurance Company ("CGLIC") and Life Insurance Company of North America, that are subsidiaries of the Company, as well as an additional $361 million invested directly in funds offered by the buyer of the retirement benefits business. 451 82 CIGNA CORPORATION - 2014 Form 10-K . PART II ITEM 8. Financial Statements and Supplementary Data The fair values of plan assets by category and by the fair value hierarchy as defined by GAAP are as follows. See Note 10 for further details regarding how the Company determines fair value, including the level within the fair value hierarchy and the procedures the Company uses to validate fair value measurements. December 31, 2014 (In millions) Plan assets at fair value: ' Fixed maturities: Federal government and agency: Corporate Mortgage and other asset -backed Fund investments and pooled separate accounts(1) TOTAL: FIXED, MATURI TIES Equity securities: 17lotnesttc ' International, including funds and pooled separate accounts') TOTAL EQUITI'SECURITIES Real estate, including pooled separate accounts') Commercial mortgage loans Securities partnerships Iieclge finds Guaranteed deposit account contract Cash equivalents Total Quoted Prices in Significant Active Markets for Significant Other Unobservable Identical Assets Observable Inputs Inputs (Level 1) (Level 2) (Level 3) Il 7 TOTAL PLAN ASSETS AT FAIR VALUE (1) A pooled separate account has several participating benefit plans and each owns a share of the total pool of investments. December 31, 2013 (In millions) Plan assets at fair .value, Fixed maturities: Federal,. government and agency Corporate Mortgage aiid other asset -licked ; Fund investments and pooled separate accou TOTAL FIXEDMATURITIES ' Equity securities: Donpestic so) International, including funds and pooled separate accounts(' TOTAL EQUItT SECURITIES .::. Real estate, including pooled separate accounts' Conimericial mortgage loans' ?_ . Securities partnerships Hedge hinds Guaranteeddeposit account contract Cash equivalents Quoted Prices in Active Markets for Identical Assets (Level 1) 187 Significant Other Observable Inputs (Level 2) TOTAL PLAN ASSETS AT FAIR VALUE $ 1,011 $ (1) A pooled separate account has several participating benefit plans and each owns a share of the total pool of investments. 1,764 124 Significant Unobservable Inputs (Level 3) Total 725 24 749 5 23 1,019 3 1,022 1,79E 124 , 1,957 35 859 7 318 t2 ,1,177 251 251 88 88 304 304 3 0 360 44 44 G9 $ 1,121 $ 4,089 452 CIGNA CORPORATION - 2014 Form 10-K 83 PART II ITEM 8. Financial Statements and Supplementary Data Plan assets in Level 1 include exchange -listed equity securities. Level 2 assets primarily include: • fixed income and international equity funds priced using their daily net asset value that is the exit price; and • fixed maturities valued using recent trades of similar securities or pricing models as described below. Plan assets classified in Level 3 include investments primarily in securities partnerships, equity real estate and hedge funds generally valued based on the pension plan's ownership share of the equity of the investee including changes in the fair values of its underlying investments. The following table summarizes the changes in pension plan assets classified in Level 3 for the years ended December 31, 2014 and December 31, 2013. Actual return on plan assets in this table may include changes in fair value that are attributable to both observable and unobservable inputs. (In millions) Ba�ance at;Jant aty 1;. 2014 Actual return on plan assets: Assets still held at the reporting date Assets sold during the period TOTAL .ACTUAL RETURN ON PLAN ASSETS Fixed Maturities & Equity Securities Real Estate & Mortgage Securities Loans Partnerships Guaranteed Deposit Account Hedge Funds Contract mil Purchases, sales, settlements, net Transfers into/out od Level Balance at December 31, 2014 (In millions) Balance at' January 1, 2013 Actual return on plan assets: Assets still held at the tepoting date Assets sold during the period TOTAL ACTUAL ETHIN ON PLAN ASSETS Purchases, sales, settlements, net Transfers into/out of Level 3 Fixed Maturities Real Estate & Equity & Mortgage Securities Loans 25 (2). Guaranteed Deposit Securities Account Partnerships Hedge Funds Contract 352 $.,, 328 $. 327 $ 29 29. (42) (40) 38 3E (5) Total 7 (4) 84 7 91, (66) (2) Balance at December 31, 2013 74 $ 339 304 $ 360 $ 44 $ 1,121 Assumptions forpension and other postretirement benefit plans. Management determined the present value of the projected benefit obligation and the accumulated other postretirement benefit obligation and related benefit costs based on the following weighted average assumptions as of and for the years ended December 31: 2014 2013 Discount rate: Pension benefit obligation Other postretirement benefit obligation Pension benefit cost Other postretirement benefit cost Expected long-term return on plan assets: Pension benefit cost Other postretirement benefit cost Based on a 2014 study of the Company's mortality experience over the past several years, it was determined that the new Society of Actuaries mortality table and projection scale published in the fourth quarter of 4.50% 4.00% 3.50% 3.25% 8.00%0 ?.OU 5.00% 2014 should be adopted for the Company's defined benefit pension and other postretirement plans as of December 31, 2014. 453 84 CIGNA CORPORATION - 2014 Form 10-K PART II ITEM 8. Financial Statements and Supplementary Data In measuring the benefit obligation, the Company sets discount rates by applying actual annualized yields at various durations from a discount rate curve to the expected cash flows of the pension and other postretirement benefits Liabilities. The discount rate curve, is constructed using an array of bonds in various industries throughout the domestic market for high quality bonds, but only selects those for the curve that have an above average return at each duration. The bond portfolio used to construct the curve is monitored to ensure that only high quality issues are included. The Company believes that this curve is representative of the yields that the Company is able to achieve in its plan asset investment strategy. As part of its discount rate setting process, the Company reviewed alternative indices and determined that they were not materially different than the result produced by the curve used. Expected long-term rates of return on plan assets were developed considering actual long-term historical returns, expected long-term market conditions, plan asset mix and management's investment strategy, that continues a significant allocation to domestic and foreign equity securities as well as real estate, securities partnerships and hedge funds. Expected long-term market conditions take into consideration certain key macroeconomic trends including expected domestic and foreign GDP growth, employment levels and inflation. The expected return assumption was considered reasonable for 2014. The Company will reconsider its expected return assumption for 2015 given some changes in asset mix and re-evaluation of future return expectations among various asset classes. To measure pension costs, the Company uses a market -related asset valuation for domestic pension plan assets invested in non -fixed income investments. The market -related value of these pension assets recognizes the difference between actual and expected long-term returns in the portfolio over 5 years, a method that reduces the short-term impact of market fluctuations on pension. cost. At December 31, 2014, the market -related asset value was approximately $3.9 billion compared with a market value of approximately $4.2 billion. Benefit payments. The following benefit payments, including expected future services, are expected to be paid in: (In millions) 2015 2016 2017 .• .;..,.. 2018 2019 2020-2024 Pension Benefits $' 399 334 $ 336 337 338 $ 1,631 Other Postretirement Benefits 31. 30 29 28 27 115 B. 401(k) Plans The Company sponsors a 401(k) plan in which the Company matches a portion of employees' pre-tax contributions. Another 401(k) plan with an employer match was frozen in 1999. Participants in the active plan may invest in various funds that invest in the Company's common stock, several diversified stock funds, a bond fund or a fixed -income fund. In conjunction with the action to freeze the domestic defined benefit pension plans, effective January 1, 2010, the Company increased its matching contributions to 401(k)1 plan participants. The Company may elect to increase its matching contributions if the Company's annual performance meets certain targets. The Company's expense for these plans was $98 million for 2014, $91 million for 2013 and $78 million for 2012. 454 CIGNA CORPORATION - 2014 Form 10-K 85 PART II ITEM 8. Financial Statements and Supplementary Data NOTE 10 Fair Value Measurements The Company carries certain financial instruments at fair value in the financial statements including fixed maturities, equity securities, short-term investments and derivatives. Other financial instruments are measured at fair value under certain conditions, such as when impaired. Fair value is defined as the price at which an asset could be exchanged in an orderly transaction between market participants at the balance sheet date. A liability's fair value is defined as the amount that would be paid to transfer the liability to a market participant, not the amount that would be paid to settle the liability with the creditor. The Company's financial assets and liabilities carried at fair value have been classified based upon a hierarchy defined by GAAP. The hierarchy gives the highest ranking to fair values determined using unadjusted quoted prices in active markets for identical assets and liabilities (Level 1) and the lowest ranking to fair values determined using methodologies and models with unobservable inputs (Level 3). An asset's or a liability's classification is based on the lowest level of input that is significant to its measurement. For example, a financial asset or liability carried at fair value would be classified in. Level 3 if unobservable inputs were significant to the instrument's fair value, even though the measurement may be derived using inputs that are both observable (Levels 1 and 2) and unobservable (Level 3). The Company estimates fair values using prices from third parties or internal pricing methods. Fair value estimates received from third- party pricing services are based on reported trade activity and quoted market prices when available, and other market information that a market participant may use to estimate fair value. The internal pricing methods are performed by the Company's investment professionals and generally involve using discounted cash flow analyses, incorporating current market inputs for similar financial instruments with comparable terms and credit quality, as well as other qualitative factors. In instances where there is little or no market activity for the same or similar instruments, fair value is estimated using methods, models and assumptions that the Company believes a hypothetical market participant would use to determine a current transaction price. These valuation techniques involve some level of estimation and judgment that becomes significant with increasingly complex instruments or pricing models. The Company is responsible for determining fair value, as well as the appropriate level within the fair value hierarchy, based on the significance of unobservable inputs. The Company reviews methodologies, processes and controls of third -party pricing services and compares prices on a test basis to those obtained from other external pricing sources or internal estimates. The Company performs ongoing analyses of both prices received from third -party pricing services and those developed internally to determine that they represent appropriate estimates of fair value. The controls completed by the Company and third -party pricing services include reviewing to ensure that prices do not become stale and whether changes from prior valuations are reasonable or require additional review. The Company also performs sample testing of sales .values to confirm the accuracy of prior fair value estimates. Exceptions identified during these processes indicate that adjustments to prices are infrequent and do not significantly impact valuations. 86 CIGNA CORPORATION - 2014 Form 10-K 455 PART II ITEM 8. Financial Statements and Supplementary Data Financial Assets and Financial Liabilities Carried at Fair Value The following tables provide information as of December 31, 2014 and 2013 about the Company's financial assets and liabilities carried at fair value. Separate account assets that are also recorded at fair value on the Company's Consolidated Balance Sheets are reported separately under the heading "Separate account assets" as gains and losses related to these assets generally accrue directly to policyholders. December 31, 2014 (In millions) Financial assets at fair value: Fixed maturities: Federal, government and agency State and local government Foreign government CorporateMdrrgage-backed Other asset -backed Total fixed maturities(t) Equity securities Subtotal Short-term investments GM1B assets(2) Other derivative assets(3) TOTAL FINANCIAL ASSETS AT FAIR VALUE, EXCLUDING Financial liabilities at fair value: GMIB liabilities Other derivative liabilities(3) Quoted Prices in Active Markets for Identical Assets (Level 1) Significant Other Observable Inputs (Level 2) Significant Unobservable Inputs (Level 3) Total TOTAL. FINANCIAL LIABILITIES ATFAIR VALUE, (1) Fixed maturities included $756 million of net appreciation required to adjust future policy benefits for the run-off settlement annuity business including $65 million of appreciation for securities class: fled in Level 3. (2) The GMIB assets represented retrocessional contracts in place from three external reinsurers that cover the exposures on these contracts. (3) Other derivative assets included$5 million of interestrate and foreign currency swaps qual f ing as cash flow hedges and $1 million of interest rate swaps qualifyingas fair value hedges, Other derivative liabilities reflected interest rate and foreign currency swaps qualifying as cash flow hedges. See Note 12 for additional information. 456 CIGNA CORPORATION - 2014 Form 10-K 87 PART II ITEM 8. Financial Statements and Supplementary Data December 31, 2013 (In millions) Financial assets at fair value: Fixed maturities: Federal government and agency State and local government Foreign government _ .. Corporate Mortgage -backed Other asset -backed Quoted Prices is Active Markets for Significant Other Identical Assets Observable Inputs (Level 1) (Level 2) 297 $ Significant Unobservable Inputs (Level 3) 583 $ 2,144 1,421 10,476 152 282 23 505 1 602 Total $ 880 2,144 1,444 10,981 153 884 Total fixed rnatnritiesii} Equity securities Subtotal Short-term investments GMIB assetst2} 297 15,058 1,131 16,486 74 59 141 8 Other derivative assetso} TOTAI FINANCIAL ASSETS AT FAIR VALiJE, EXCLUDING SEPARATE ACCOUNTS Financial liabilities at fair value: GMIB ltablhtres Other derivative liabilitiest3} 305 ' ' 15,132 1,190 ''16,627 631 751. 631 751 3 305 '< $ 15,76E ;. $ 1,941 $ 18,012 16 741 16 TOTAL FINANCIAL LIABILITIES AT FAIR. VALUE (1) Fixed maturities included $458 million of net appreciation required to adjust future policy benefits for the run-off settlement annuity business including $60 million of appreciation for securities classified in Level 3. The. GMLB assets represented retrocessional contracts in place from three external reinsurers that cover the exposures on these contracts. Other derivative assets reflected interest rate and foreign currency swaps qualling as cash flow hedges. Other derivative liabilities included $15 million of interest rate and foreign currency swaps qualifying as cash flow hedges and $1 million of interest rate and foreign currency swaps not designated as accounting hedges. See Note 12 for additional information. (2) (3) Level 1 Financial Assets Inputs for instruments classified in Level 1 include unadjusted quoted prices for identical assets in active markets accessible at the measurement date. Active markets provide pricing data for trades occurring at least weekly and include exchanges and dealer markets. Assets in Level 1 include actively -traded U.S. government bonds and exchange -listed equity securities. Given the narrow definition of Level 1 and the Company's investment asset strategy to maximize investment returns, a relatively small portion of the Company's investment assets are classified in this category, Level 2 Financial Assets and Financial Liabilities Inputs for instruments classified in Level 2 include quoted prices for similar assets or liabilities in active markets, quoted prices from those willing to trade in markets that are not active, or other inputs that are market observable or can be corroborated by market data for the term of the instrument. Such other inputs include market interest rates and volatilities, spreads and yield curves. An instrument is classified in Level 2 if the Company determines that unobservable inputs are insignificant. Fixed maturities and equity securities. Approximately 94% of the Company's investments in fixed maturities and equity securities are classified in Level 2 including most public and private corporate debt and equity securities, federal agency and municipal bonds, non -government mortgage -backed securities and preferred stocks. Because many fixed maturities do not trade daily, third -party pricing services and internal methods often use recent trades of securities with similar features and characteristics. When recent trades are not available, pricing models are used to determine these prices. These models calculate fair values by discounting future cash flows at estimated market interest rates. Such market rates are derived by calculating the appropriate spreads over comparable U.S. Treasury securities, based on the credit quality, industry and structure of the asset. Typical inputs and assumptions to pricing models include, but are not limited to, a combination of benchmark yields, reported trades, issuer spreads, liquidity, benchmark securities, bids, offers, reference data, and industry and economic events. For mortgage - backed securities, inputs and assumptions may also include characteristics of the issuer, collateral attributes, prepayment speeds and credit rating. Nearly all of these instruments are valued using recent trades or pricing models. Less than 1% of the fair value of investments classified in Level 2 represents foreign bonds that are valued using a single unadjusted market -observable input derived by averaging multiple broker -dealer quotes, consistent with local market practice. Short-term investments are carried at fair value which approximates cost. On a regular basis the Company compares market prices for 457 88 CIGNA CORPORATION - 2014 Form 10-IC PART II ITEM 8. Financial Statements and Supplementary Data these securities to recorded amounts to validate that current carrying amounts approximate exit prices. The short-term nature of the investments and corroboration of the reported amounts over the holding period support their classification in Level 2. Other derivatives classified in Level 2 represent over-the-counter instruments such as interest rate and foreign currency swap contracts. Fair values for these instruments are determined using market observable inputs including forward currency and interest rate curves and widely published market observable indices. Credit risk related to the counterparty and the Company is considered when estimating the fair values of these derivatives. However, the Company is largely protected by collateral arrangements with counterparties and determined that no adjustment for credit risk was required as of December 31, 2014 or December 31, 2013. Level 2 also includes exchange -traded interest rate swap contracts. Credit risk related to the clearinghouse counterparty and the Company is considered minimal when estimating the fair values of these derivatives because of upfront margin deposits and daily settlement requirements. The nature and use of these other derivatives are described in Note 12. Level 3 Financial Assets and Financial Liabilities Certain inputs for instruments classified in Level 3 are unobservable (supported by little or no market activity) and significant to their resulting fair value measurement. Unobservable inputs reflect the Company's best estimate of what hypothetical market participants would use to determine a transaction price for the asset or liability at the reporting date. The Company classifies certain newly issued, privately -placed, complex or illiquid securities, as well as assets and liabilities relating to GMIB, in Level 3, Approximately 5% of fixed maturities and equity securities are priced using significant unobservable inputs and classified in this category. Fair values of other asset and mortgage -backed securities, corporate and government .fixedmaturities are primarily determined using pricing models that incorporate the specific characteristics of each asset and related assumptions including the investment type and structure, credit quality, industry and maturity date in comparison to current market indices, spreads and liquidity of assets with similar characteristics. For other asset and mortgage -backed securities, inputs and assumptions for pricing inay also include collateral attributes and As of December 31, 2014 (Fair value in millions) Fixed maturities; Other asset and .mortgage -backed. securities Corporate and government fixed maturities Total fixed maturifies . Equity securities Subtotal Pricing exemption securi.tiesttt Total Level 3 securities:.: prepayment speeds. Recent trades in the subject security or similar securities are assessed when available, and the Company may also review published research, as well as the issuer's financial statements; in its evaluation, Quantitative Information about Unobservable Inputs The following tables summarize the fair value and significant unobservable inputs used in pricing Level 3 securities that were developed directly by the Company as of December 31, 2014 and 2013. The range and weighted average basis point amounts for fixed maturity spreads (adjustment to discount rates) and price to earnings multiples for equity investments reflect the Company's best estimates of the unobservable adjustments a market participant would make to calculate the fair values. Other asset and mortgage -backed securities. The significant unobservable inputs used to value the following other asset and mortgage -backed securities are liquidity and weighting of credit spreads. When there is limited trading activity for the security, an adjustment for liquidity is made as of the measurement date that considers current market conditions, issuer circumstances and complexity of the security structure. An adjustment to weight credit spreads is needed to value a more complex bond structure with multiple underlying collateral and no standard market valuation technique. The weighting of credit spreads is primarily based on the underlying collateral's characteristics and their proportional cash flows supporting the bond obligations. The resulting wide range of unobservable adjustments in the table below is due to the varying liquidity and quality of the underlying collateral, ranging from high credit quality to below investment grade. Corporate and government fixed maturities. The significant unobservable input used to value the following corporate and government fixed maturities is an adjustment for liquidity. When there is limited trading activity for the security, an adjustment is needed to reflect current market conditions and issuer circumstances. Equity securities. The significant unobservable input used to value the following equity securities is a multiple of earnings before interest, taxes, depreciation and amortization (EBITDA). These securities are comprised of private equity investments with limited trading activity and therefore a ratio of EBITDA is used to estimate value based on company circumstances and relative risk characteristics. Fair Value (1) The fair values for these securities use single, unadjusted non -binding broker quotes not developed directly by the Company. Unobservable Adjustment Unobservable to Discount Rates Input Rage (Weighted Average) 458 CIGNA CORPORATION - 2014 Form 10-K 89 PART II ITEM 8. Financial Statements and Supplementary Data As of December 31, 2013 (Fair value in millions) Fixed maturities: Other asset and mortgage -backed securities Corporate and government fixed maturities Fair Value $ 593 416 Unobservable Adjustment Unobservable to Discount Rates Input Range (Weighted Average) Liquidity Weighting of credit spreads Liquidity 60 - 620 (170) 120 2,090 (290) 80 - 930 (310) Total fixed maturities Equity securities Subtotal Pricing exemption securities') 1,009 59 1068 122 Price -to -earnings multiples 4.2 - 9.8 (8.1) Total Level 3 securities' $ 1,190 (1) The fair values for these securities use single, unadjusted non -binding broker quotes not developed directly by the Company. Significant increases in fixed maturity spreads would result in a lower fair value measurement whole decreases in these inputs would result in a higher fair value measurement. Significant decreases in equity price to earnings multiples would result in a lower fair value measurement while increases in these inputs would result in a higher fair value measurement. Generally, the unobservable inputs are not interrelated and a change in the assumption used for one unobservable input is not accompanied by a change in the other unobservable input. See the preceding discussion regarding the Company's valuation processes and controls. Guaranteed minimum income benefit contracts. As discussed in Note 7, the Company effectively exited the GMIB business in 2013. Although these GMIB assets and liabilities must continue to be reported as derivatives at fair value, the only assumption that is expected to impact future shareholders' net income is the risk of non-performance. This assumption reflects a market participant's view of (a) the risk of the Company not fulfilling its GMIB obligations (GMIB liabilities) and (b) the credit risk that the reinsurers do not pay their obligations (GMIB assets). As of December 31, 2014, there were three reinsurers for GMIB, with collateral securing 70% of the balance. The Company reports GMIB liabilities and assets as derivatives at fair value because cash flows of these liabilities and assets are affected by equity markets andinterest rates, but are without significant life insurance risk and are settled in lump sum payments. Under the terms of these written and purchased contracts, the Company periodically receives and pays fees based on either contractholders' account values or deposits increased at a contractual rate. The Company will also pay and receive cashdepending on changes in account values and interest rates when contractholders first elect to receive minimum income payments. The Company estimates the fair value of the assets and liabilities for GMIB contracts by calculating the results for many scenarios run through a model utilizing various assumptions that include non-performance risk, among other things. The non-performance risk adjustment is incorporated by adding an additional spread to the discount rate in the calculation of both (a) the GMIB liabilities to reflect a market participant's view of the risk of the Company not fulfilling, its GMIB obligations, and (b) the GMIB assets to reflect a market participant's view of the credit risk of the reinsurers, after considering collateral. Other assumptions that affect GMIB assets and liabilities include capital market assumptions (including market returns, interest rates and market volatilities of the underlying equity and bond mutual fund investments) and future annuitant behavior (including mortality, lapse, and annuity election rates). As certain assumptions used to estimate fair values for these contracts are largely unobservable (primarily related to future annuitant behavior), the Company classifies GMIB assets and liabilities in Level 3. The Company regularly evaluates each of the assumptions used in establishing these assets and liabilities. Significant decreases in assumed lapse rates or spreads used to calculate non-performance risk, or increases in assumed annuity election rates, wouldresult in higher fair value measurements. A change in one of these assumptions is not necessarily accompanied by a change in another assurnption. GMIB liabilities are reported in the Company's Consolidated Balance Sheets in accounts payable, accrued expenses andother liabilities. GMIB assets associated with these contracts represent net receivables in connection with reinsurance that the Company has purchased from three external reinsurers and are reported in the Company's Consolidated Balance Sheets in other assets, including other intangibles. Changes in Level 3 Financial Assets and Financial Liabilities Carried at Fair Value The following tables summarize the changes in financial assets and financial liabilities classified in Level 3 for the years ended December 31, 2014 and 2013. Separate account asset changes are reported separately under the heading "Separate account assets" as the changes in fair values of these 459 90 CIGNA CORPORATION - 2014 Form 10-K PART II ITEM 8. Financial Statements and Supplementary Data assets accrue directly to the policyholders. Gains and losses reported in these tables may include net changes in fair value that are attributable to both observable and unobservable inputs. (In millions) Balance at January,l', 2014 Gains (losses) included in shareholders' net income: GMIB fair value gain/(loss) Other Total gains• (losses) included in shareholders net oie n1e Gains included in other comprehensive income Gains• requited to ad)ust future policy benefits for settlement annuities�ti Purchases, sales, settlements: Purchases Sales Settlements Total purchases, sales and settlements Transfers into/(out of) Level 3: Transfers into Level 3 Transfers out of Level 3, Total transfers into/(out of) Level 3 Balance at December 31, 2014 Total gains (losses) included in shareholders' net income attributable to instruments held at the reporting date (1) Amounts do not accrue to shareholders, (In millions) Balance' at January I, 2013 Gains (losses) included in shareholders' net income: GMIS fair value`gatn/(loss). Other Total gains (losses) ncluded iu shareholders', net income Losses included in other comprehensive income Losses regitited to adjust future policy .benefits for settlement annuities('. Purchases, sales, settlements; Purchases .. Sales Sertlenlents Total purchases, sales, and settlements Trnsfers'nto/(out of) Level 3; • Transfers into Level 3 Transfers out of Level 3 ; Fixed Maturities & Equity Securities GMIB Assets GMJB Liabilities GMIB Net Fixed Maturities & Equity Securities ;35J;; 16 16. (19) (50) :'• lQ' (64) (121) :. (75) GMIB Assets (380) 17 (363).,. ..: 492 GMIB Liabilities (1,170) 380 (23) • 357. 72 72 GMIB Net • (548) (6) (6) 564 564 115 (148);. Total transfers into/(out of) Level 3 (33) Balance ar Decemher 31; 2013 Total gains (losses) included in shareholders' net income attributable to instruments held at the reporting date (1) Amounts do not accrue to shareholders. 751:. . $ (363) $ (741) 357 10 (6) 460 CIGNA CORPORATION -2014 Form 10-K 91 PAR.0 II ITEM 8. Financial Statements and Supplementary Data As noted in the tables above, total gains and losses included in shareholders' net income are reflected in the following captions in the Consolidated Statements of Income: • Realized investment gains (losses) and net investment income for amounts related to fixed maturities and equity securities and realized investment gains (losses) for the impact of changes in non-performance risk related to GMIB assets and liabilities beginning February 4, 2013, similar to hedge ineffectiveness; and • Other operating expenses for amounts related to GMIB assets and liabilities (GMIB fair value gain/loss), except for the impact of changes in non-performance risk subsequent to February 4, 2013. In the tables above, gains and losses included in other comprehensive income are reflected in net unrealized appreciation (depreciation) on securities in the Consolidated Statements of Comprehensive Income. Reclassifications impacting Level 3 financial instruments are reported as transfers into or out of the Level 3 category as of the beginning of the quarter in which the transfer occurs. Therefore gains and losses in income only reflect activity for the period the instrument was classified in Level 3. Transfers into or out of the Level 3 category occur when unobservable inputs, such as the Company's best estimate of what a market participant would use to determine a current transaction price, become more or less significant to the fair value measurement. For the years ended December 31, 2014 and 2013, transfers between Level 2 and Level 3 primarily reflect the change in significance of the unobservable inputs used to value certain public and private corporate bonds, principally related to liquidity of the securities and credit risk of the issuers. Because GMIB reinsurance arrangements remain in effect at the reporting date, the Company has reflected the total gain or loss for the period as the total gain or loss included in income attributable to instruments still held at the reporting date. However, the Company reduces the GMIB assets and liabilities resulting from these reinsurance arrangements when annuitants lapse, die, elect their benefit, or reach the age after which the right to elect their benefit expires. Separate account assets Fair values and changes in the fair values of separate account assets generally accrue directly to the policyholders and are excluded from the Company's revenues and expenses. At December 31, separate account assets were as follows: Quoted Prices in Active Markets for Identical Assets (Level 1) 2014 (In millions) Guaranteed separate' accounts (See Note 23) Non -guaranteed separate accounts“) TOTAL° SEPARATE ACCOUNT ASSETS Significant Significant Other Unobservable Observable Inputs Inputs (Level 2) (Level 3) 18 Total (1) As of December 31, 2014, non guaranteed separate accounts included $3.8 billion in assets supporting the Company's pension plans, including $1.1 billion classified in Level 3. Quoted Prices in Significant Active Markets for Significant Other Unobservable 2013 Identical Assets Observable Inputs Inputs (In millions) (Level 1) (Level 2) (Level 3) Guaranteed separate accounts `(See Note 23) $ 264 '.'$ 284 Non -guaranteed separate accounts (r) 1,844 4,825 TOTAL SEPARATE ACCOUNT ASSETS • . $ '2,10$ ; $ 5,109` 1,035 (1) As of December 31, 2013, non -guaranteed separate accounts included $3.8 billion in assets supporting the Company's pension plans, including $983 million classified in Level 3. 9) Separate account assets in Level 1 primarily include exchange -listed equity securities. Level 2 assets primarily include: • corporate and structured bonds valued using recent trades of similar securities or pricing models that discount future cash flows at estimated market interest rates as described above; and 1,035 Total 548 7,704 8,252 • actively -traded institutional and retail mutual fund investments and separate accounts priced using the daily net asset value which is the exit price. Separate account assets classified in Level 3 include investments primarily in securities partnerships, real estate and hedge funds generally valued based on the separate account's ownership share of the equity of the investee including changes in the fair values of its underlying investments. 461 92 CIGNA CORPORATION - 2014 Form 10-K PART II ITEM 8. Financial Statements and Supplementary Data The following table summarizes the change in separate account assets reported in Level 3 for the years ended December 31, 2014 and 2013. (In millions) Balance at January 1 Policyholder gains (I) Purchases; issuances, settlements; Purchases Sales Settlements Total purchases, sales and seiilements Transfers into/(out of) Level 3: .Transfers into Level 3 Transfers out of Level 3 Total transfers into/(out of) Level 3; • Balance at December 31 2014 2013 1,005 82 • 173 (14) (209) (50) (1) Included in this amount were gains of $85 million attributable to instruments still held at December 31, 2014 and gains of $76 million attributable to instruments still held at December 31, 201.3. Assets and Liabilities Measured at Fair Value under Fair Value Disclosures for Financial Instruments Not Certain Conditions Some financial assets and liabilities are not carried at fair value each reporting period, but may be measured using fair value only under certain conditions, such as investments in real estate entities and commercial mortgage loans when they become impaired. Impaired real estate entities and commercial mortgage loans representing less than 1% of total investments were written down to their fair values, resulting in realized investment losses of $10 million, after-tax in 2014 and $12 million, after-tax in 2013. (In millions) Commercial hortgage loans i'i Contractholder deposit funds, excluding universal life products Long tent debt, including cuerent`maturities„ eXeludtng 'capital leases ..' The fair values presented in the table above have been estimated using market information when available. The following valuation methodologies and inputs are used by the Company to determine fair value. Commercial mortgage loans. The Company estimates the fair value of commercial mortgage loans generally by discounting the contractual cash flows at estimated market interest rates that reflect the Company's assessment of the credit quality of the Loans. Market interest rates are derived by calculating the appropriate spread over comparable U.S. Treasury rates, based on the property type, quality rating and average life of the loan. The quality ratings reflect the relative risk of the loan, considering debt service coverage, the loan -to -value ratio and other factors. Fair values of impaired mortgage loans are based on the estimated fair value of the underlying collateral generally determined using an internal discounted cashflow model. The fair value measurements were classified in Level 3 because the cash flow models incorporate significant unobservable inputs. Carried at Fair Value The following table includes the Company's financial instruments not recorded at fair value that are subject to fair value disclosure requirements at December 31, 2014 and 2013. Financial instruments that are carried in the Company's Consolidated Financial Statements at amounts that approximate fair value are excluded from the following table. Classification in Fair Value HIerarchy Level 3 Level 3 Level 2 December 31, 2014 Fair Carrying Value Value December 31, 2013 Fair Carrying Value Value 2,338 $ 2,252 $ 1,081 $ 1,072 93 t $ : 5,550 , ; .$. 4,997 Contractholder deposit funds, excluding universal life products. Generally, these funds do not have stated maturities. Approximately 60% of these balances can be withdrawn by the customer at any time without prior notice or penalty. The fair value for these contracts is the amount estimated to be payable to the customer as of the reporting date, which is generally the carrying value. Most of the remaining contractholder deposit funds are reinsured by the buyers of the individual life and annuity and retirement benefits businesses. The fair value for these contracts is determined using the fair value of these buyers' assets supporting these reinsured contracts. The Company had reinsurance recoverables equal to the carrying value of these reinsured contracts. These instruments were classified in Level 3 because certain inputs are unobservable (supported by little or no market activity) and significant to their resulting fair value measurement. Long-term debt, including current maturities, excluding capital leases. The fair value of long-term debt is based on quoted market prices for recent trades. When quoted market prices are not available, fair value is estimatedusing a discounted cash flow analysis and the Company's estimated current borrowing rate for debt of similar terms 462 CIGNA CORPORATION - 2014 Form 10-K 93 PART II ITEM 8. Financial Statements and Supplementary Data and remaining maturities. These measurements were classified in Level 2 because the fair values are based on quoted market prices or other inputs that are market observable or can be corroborated by market data. NOTE 11 Investments Fair values of off -balance -sheet financial instruments were not material as of December 31, 2014 and 2013. A. Fixed Maturities and Equity Securities The amortized cost and fair value by contractual maturity periods for fixed maturities were as follows at December 31, 2014: (In millions) Due in one year of Less Due after one year through five years Due after :five years 'through ten years Due after ten years. . Mortgage and othet'asset-backed 'securities TOTAL Amortized Fair Cost Value L. 52 $ 1,166 5,681 6,051 6,531 6,891 3,267 4,140 647 735 $ 17,278 $ 18,983 Actual maturities of these securities could differ from their contractual maturities used in the table above. This could occur because issuers may have the right to call or prepay obligations, with or without penalties, or because in certain cases the Company may have the option to unilaterally extend the contractual maturity date. Gross unrealized appreciation (depreciation) on fixed maturities by type of issuer is shown below. (In millions) Federal ghvernnr.ent'and agency State and local government Foreign governtneiit Corporate Ivlottgag-balked Other asset -backed December 31, 2014 Amortized Unrealized Unrealized Fair Cost Appreciation Depreciation Value a74 8 i8 (In millions) Federal government and agency. State and local government Foreign goverment' Corporate Mortgage -backed Other asset -backed TOTAL . The above table includes investments with a fair value of $3.1 billion supporting liabilities of the Company's run-off settlement annuity business, with gross unrealized appreciation of $758 million and gross unrealized depreciation of $2 million at December 31, 2014. Such unrealized amounts are reported in future policy benefitliabilities rather than accumulated other comprehensive income. At December 31, 2013, investments supporting this business had a fair value of $2.6 billion, gross unrealized appreciation of $478 million and gross unrealized depreciation of $20 million. 1,983 1,392 10,306 153 799 December 31, 2013 (6) 2,144 (12), 1,444 749 (74) 10,981 (3) . 153 87 (2) 884 �99) n:$ 16,486 167 As of December 31, 2014, the Company had commitments to purchase $74 million of fixed maturities, all of which bear interest at a fixed market rate. Review of declines in fair value. Management reviews fixed maturities with a decline in fair value from cost for impairment based on criteria that include: • length of time and severity of decline; • financial health and specific near term prospects of the issuer; 463 94 CIGNA CORPORATION - 2014 Form 10-K PART II ITEM 8. Financial Statements and Supplementary Data • changes in the regulatory, economic or general market environment of the issuer's industry or geographic region; and • the Company's intent to sell or the likelihood of a required sale prior to recovery. The table below summarizes fixed maturities with a decline in fair value from amortized cost as of December 31, 2014. These fixed maturities are primarily corporate securities with a decline in fair value that reflects an increase in market yields since purchase. (Dollars in millions) Fixed maturities: One year or less: Irtvestrnent grade Below investment grade More than one year: Investment grade Belowinvcstmett grade i There were no available for sale equity securities with a significant unrealized loss reflected in accumulated other comprehensive income at December 31, 2014. Equity securities also include hybrid investments consisting of preferred stock with call features that are carried at fair value with changes in fair value reported in other B. Commercial Mortgage Loans Mortgage loans held by the Company are made exclusively to commercial Loans are generally issued at a fixed rate of interest and are secured by properties. At December 31, commercial mortgage loans were distributed among the following property types and geographic regions: (In millions) Property type Office buildings Apartment buildings' Industrial Hotels Retail facilities Other TOTAL Geographic region. Pacific South Atlantic New England Central Middle Atlantic Mountain TOTAL At December 31, 2014, scheduled commercial mortgage loan maturities were as follows (in millions): $247 in 2015, $533 in 2016, $229 in 2017, $179 in 2018 and $893 thereafter, Actual maturities could differ from contractual maturities for several reasons: borrowers may have the right to prepay obligations with or without prepayment penalties; the maturity date may be extended; and loans may be refinanced. 2014 .11:0474 December 31, 2014 Fair Value Amortized Unrealized Number Cost Depreciation of Issues $ 999 $ 1,010 293 $ 307 256 $ 264 78 $ ; 87 . (14) (8) (9) 251 236 93 22 realized investment gains (losses) and dividends reported in net investment income. As of December 31, 2014, fair values of these securities were $57 million and amortized cost was $69 million. As of December 31, 2013, fair values of these securities were $56 million and amortized cost was $68 million. borrowers and are diversified by property type, location and borrower. high quality, primarily completed andsubstantially leased operating 2013 761 321 450 407 285 28 2,252 805 56.4 379 260 201 43 $ 2,252 As of December 31, 2014, the Company had commitments to extend credit under commercial mortgage loan agreements of $65 million. Credit quality. The Company regularly evaluates and monitors credit risk, beginning with the initial underwriting of a mortgage loan and continuing throughout the investment holding period. Mortgage origination professionals employ an internal credit quality rating system designed to evaluate the relative risk of the transaction at origination that is then updated each year as part of the annual 464 CIGNA CORPORATION - 2014 Form 10-K 95 PART II ITEM 8. Financial Statements and Supplementary Data portfolio loan review. The Company evaluates and monitors credit quality on an ongoing basis, classifying each loan as a loan in good standing, potential problem loan or problem loan. Quality ratings are based on our evaluation of a number of key inputs related to the loan, including real estate market -related factors such as rental rates and vacancies, and property -specific inputs such as growth rate assumptions and lease rollover statistics. However, the two most significant contributors to the credit quality rating are the debt service coverage and loan -to -value ratios. The debt service coverage ratio measures the amount of property cash flow available to meet annual interest and principal payments on debt, with a ratio below 1.0 indicating that there is not enough cash flow to cover the required loan payments. The loan -to -value ratio, commonly expressed as a percentage, compares the amount of the loan to the fair value of the underlying property collateralizing the loan. The following tables summarize the credit risk profile of the Company's commercial mortgage loan portfolio based on loan -to -value and debt service coverage ratios, as of December 31, 2014 and 2013: (In millions) December 31, 2014 Debt Service Coverage Ratio Loan -to -Value Ratios 1.30x or Greater 1.20x Below 50% ` f, • 50% to 59% 60°fo to 69%.'. 70% to 79% 80% to 894/o 90% to 100% o 1.29x 1.10x to 1.19x 1.00x to 1.09x Less than 1.00x Total TOTAL (In millions) Loan -to -Value Ratios Belo* 50% 50% to 59% 60% to 69% 70% to 79% 80% to 8990 90% to 100% TOTAL • December 31, 2013 Debt Service Coverage Ratio 1.30x or Greater 1.20x to 1.29x $ 314 581 438 79 • 65 131 16 113 42 1.10x to 1.19x $ - 29' ' `34 58 302 $ 121 ''s 1.O0x to 1.09x 18 28 50 102 Less than 1.00x Total $ . - 730 24 507 — 192 143. >' `312 83 191 2,252 The Company's annual in-depth review of its commercial mortgage loan investments is the primaiy mechanism for identifying emerging risks in the portfolio. The most recent review was completed by the Company's investment professionals in the second quarter of 2014 and included an analysis of each underlying property's most recent annual financial statements, rent rolls, operating plans, budgets, a physical inspection of the property and other pertinent factors. Based on historical results, current leases, lease expirations and rental conditions in each market, the Company estimates the current year and future stabilized property income and fair value, and categorizes the investments as loans in good standing, potential problem loans or problem loans. Based on property valuations and cash flows estimated. as part of this review, and considering updates for loans where material changes were subsequently identified, the portfolio's average loan -to -value ratio improved slightly to 63% at December 31, 2014 from 64% at December 31, 2013. The portfolio's average debt service coverage ratio was estimated to be 1.66 at December 31, 2014, a modest improvement from 1.62 at December 31, 2013. The Company will reevaluate a loan's credit quality between annual reviews if new property information is received or an event such as delinquency or a borrower's request for restructure causes management to believe that the Company's estimate of financial performance, fair value or the risk profile of the underlying property has been impacted. During 2013, the Company restructured its subordinate interest in two cross -collateralized pools of industrial loans totaling $31 million by extending the maturity dates and reducing the interest rates. This modification was considered a troubled debt restructuring and the loans were classified as problem mortgage loans because the borrower was experiencing financial difficulties and an interest rate concession was granted. No valuation reserves were required because the fair values of the underlying properties exceeded the carrying values of the outstanding loans. Certain other loans were modified during 2014 and 2013. However, these were not considered troubled debt restructures and the impact of such modifications was not material to, the Company's results of operations, financial condition or liquidity. 465 96 CIGNA CORPORATION - 2014 Form 10-K PART II ITEM 8. Financial Statements and Supplementary Data Potential problem mortgage loans are considered current (no payment more than 59 days past due), but exhibit certain characteristics that increase the likelihood of future default such as the deterioration of debt service coverage below 1.0, estimated loan -to -value ratios increasing to 100% or more, downgrade in quality rating and requests from the borrower for restructuring. In addition, loans are considered potential problems if principal or interest payments are past due by more than 30 but less than. 60 days. Problem mortgage loans are either in default by 60 days or more or have been restructured as to terms, which could include concessions on interest rate, principal payment or maturity date. The Company monitors each problem and potential problem mortgage loan on an ongoing basis, and updates the loan categorization and quality rating when warranted, Problem and potential problem mortgage loans, net of valuation reserves, totaled $208 million at December 31, 2014 and $158 million at December 31, 2013. At December 31, 2014 and December 31, 2013, industrial loans located in the South Atlantic region represented the most significant component of problem and potential problem mortgage loans. Impaired commercial mortgage loans. The carrying value of the Company's impaired commercial mortgage loans and related valuation reserves were as follows: (In millions) Itirpaired corrimercial rnortgage.loans with valuation 'reserves Impaired commercial mortgage loans with no valuation reserves The average recorded investment in impaired loans was $155 million during 2014 and $127 million during 2013. Because of the risk profile of the underlying investment, the Company recognizes interest income on problem mortgage loans only when payment is actually received, Interest income that would have been reflected in net 2014 2013 Gross Reserves Net Gross Reserves (8) 31 — 12b $ (8) Net 81 31 112 income if interest on non -accrual commercial mortgage loans had been received in accordance with the original terms was not significant for 2014 or 2013. Interest income on impaired commercial mortgage loans was not significant for 2014 or 2013. See Note 2 for further information on impaired commercial mortgage loans. The following table summarizes the changes in valuation reserves for commercial mortgage loans: (In millions) Reserve balance, Jaruarg 1,,' Increase in valuation reserves Charge -offs upon sales and repayments, riet of recoveries RESERVE BALANCE, DECEMBER 31, C. Other Long -Term Investments As of December. 31, other long-term investments consisted of the following: (In millions) lfeal estate' rnvestme 0 Securities partnerships Other 'TOTAL ' Real estate investments and securities partnerships with a carrying value of $264 million at December 31, 2014 and $217 million at December 31, 2013 were non -income producing during the preceding twelve months, As of December 31, 2014, the Company had commitments to contribute: • $207 million to limited liability entities that hold either real estate or loans to real estate entities that are diversified by property type and geographic region; and 2014 2013 7 4 :(3) $ 8 2014 2013 .'90.9 357 104 ,370 • $476 million to entities that hold securities diversified by issuer and maturity date. The Company expects to disburse approximately 40% of the committed amounts in 2015. D. Short -Term Investments and Cash Equivalents Short-term investments and cash equivalents included corporate securities of $509 million, federal government securities of $274 million and money market funds of $33 million as of 466 CIGNA CORPORATION - 2014 Form 10-K 97 PART II ITEM 8. Financial Statements and Supplementary Data Instrument Interest rate swaps '< Foreign currency swaps Combination interest rate and foreign curteniy swaps TOTAL December 31, 2014. The Company's short-term investments and cash equivalents as of December 31, 2013 included corporate securities of $2.2 billion, federal government securities of $323 million and money market funds of $35 million. NOTE 12 Derivative Financial Instruments E. Concentration of Risk As of December 31, 2014 and 2013, the Company did not have a concentration of investments in a single issuer or borrower exceeding 10% of shareholders' equity. The Company uses derivative financial instruments to manage the characteristics of investment assets (such as duration, yield, currency and liquidity) to meet the varying demands of the related insurance and contractholder liabilities (such as paying claims, investment returns and withdrawals) and to hedge interest rate risk of its long-term debt. The Company has written and purchased Guaranteed Minimum Income Benefit (GMIB) reinsurance contracts in its run-off reinsurance business that are accounted for as freestanding derivatives. The Company also used derivative financial instruments to manage the equity, foreign currency, and certain interest rate risk exposures of its run-off reinsurance business until the time of the Berkshire reinsurance transaction in 2013. For information on the Company's accounting policy for derivative financial instruments, see Note 2. Derivatives in the Company's separate accounts are excluded from the following discussion because associated gains and losses generally accrue directly to separate account policyholders. Collateral and termination features. The Company routinely monitors exposure to credit risk associated with derivatives and diversifies the portfolio among approved dealers of high credit quality to minimize this risk. As of December 31, 2014,.the Company had $21 million incash on deposit representing the upfront margin required for the Company's centrally -cleared derivative instruments. Certain of the Company's over-the-counter derivative instruments contain provisions requiring either the Company or the counterparty to post collateral or demand immediate payment depending on the amount of the net liability position and predefined financial strength or credit rating thresholds. Collateral posting requirements vary by counterparty. The net liability positions of these derivatives were not material as of December 31, 2014 or 2013. Investment Cash Flow Hedges. Purpose. The Company uses interest rate, foreign currency, and combination (interest rate and foreign currency) swap contracts to hedge the interest and foreign currency cash flows of its fixed maturity bonds to match associated insurance liabilities. Accounting policy. Using cash flow hedge accounting, fair values are reported in other long-term investments or other liabilities. Changes in fair value are reported in accumulated other comprehensive income and amortized into net investment income or reported in other realized investment gains and losses as interest or principal payments are received. Cash flows. Under the terms of these various contracts, the Company periodically exchanges cash flows between variable and fixed interest rates and/or between two currencies for both principal and interest. Foreign currency and combination swaps are primarily Euros, Australian dollars, Canadian dollars, Japanese yen and British pounds and have terms for periods of up to seven years. Net interest cash flows are reported in operating activities. Volume of activity. The following table provides the notional values of these derivative instruments as of December 31: Notional Amount (In millions) 2014 2013 The following table provides the effect of these derivative instruments on the financial statements for the indicated periods: Fair Value Effect on the Financial Statements (1n millions) Other Long -Term Investments (2) As of December 31, Instrument 2014 2013 Interestrate swaps Foreign currency swaps Combination interest rate and foreign currency swaps Accounts Payable, Accrued Expenses and Other Liabilities (2) As of December 31, 2014 2013 TOTAL $ 3 $ 15 (1) Other comprehensive income fir foreign currency swaps excludes amounts required to adjust future policy benefits for the run-off settlement annuity business. (2) There were no amounts offset in the Consolidated Balance Sheets at December 31, 2014 or 2013. Gain (Loss) Recognized in Other Comprehensive Income (2) For the years ended December 31, 2014 2013 1 10 $ 9 467 98 CIGNA CORPORATION: 2014 Form 10-K PART II ITEM 8. Financial Statements and Supplementary Data For the years ended December 31, 2014.and 2013, the amounts of gains (losses) reclassified from accumulated other comprehensive incom.e into shareholders' net income were not material. No amounts were excluded from the assessment of hedge effectiveness and no gains (losses) were recognized due to hedge ineffectiveness, Interest Rate Fair Value Hedges. Purpose. Beginning in 2014, the Company entered into centrally - cleared interest rate swap contracts to convert a portion of the interest rate exposure on its long-term debt from fixed to variable rates to more closely align interest expense with interest income received on its cash equivalent and short-term investment balances. The variable rates are benchmarked to LIBOR. Accounting Policy. Using fair value hedge accounting, the fair values of the swap contracts are reported in other assets or other liabilities. As the critical terms of these swaps match those of the long-term debt being hedged, the carrying value of the hedged debt is adjusted to reflect changes in its fair value driven by LIBOR. The effects of those adjustments on other operating expenses are offset by the effects of corresponding changes in the swaps' fair value, including interest expense for the difference between the variable and fixed interest rates. Cash flows. Under the terms of these contracts, the Company provides upfront margin and settles fair value changes and net interest between variable and fixed interest rates daily with the clearinghouse. Net interest cash flows are reported in operating activities. NOTE 13 Variable Interest Entities Volume of activity. As of December 31, 2014, the notional value of these derivative instruments was $750 million. As of December 31, 2014, the effects of these derivative instruments on the Consolidated Financial Statements were not material. Guaranteed Minimum Income Benefits (GMIB). Purpose. The Company's run-off reinsurance business has written reinsurance contracts with issuers of variable annuity contracts that provide annuitants with certain guarantees of minimum income benefits resulting from the level of variable annuity account values compared with a contractually guaranteed amount ("GMIB liabilities"). According to the contractual terms of the written reinsurance contracts, payment by the Company depends on the actual account value in the underlying mutual funds and the level of interest rates when the contractholders elect to receive minimum income payments. The fair value effects of GMIB contracts on the financial statements are included in Note 10 and their volume of activity is included in Note 23. Further information on these contracts is also presented in Note 7. Cash flows on these contracts are reported in operating activities. When the Company becomes involved with a variable interest entity and when the nature of the Company's involvement with the entity changes, to determine if the Company is the primary beneficiary and must consolidate the entity, it evaluates: • the structure and purpose of the entity; • the risks and rewards created by and shared through the entity; and • the entity's participants' ability to direct its activities, receive its benefits and absorb its losses. Participants include the entity's sponsors, equity holders, guarantors, creditors and servicers. In the normal course of its investing activities, the Company makes passive investments in securities that are issued by variable interest entities for which the Company is not the sponsor or manager. These investments are predominantly asset -backed securities primarily collateralized by foreign bank obligations or mortgage -backed securities. The asset -backed securities are largely fixed-rate debt securities issued by trusts that hold perpetual floating-rate subordinated notes issued by foreign banks. The mortgage -backed securities are senior interests in pools of commercial or residential mortgages created and held by special-purpose entities to provide investors with diversified exposure to these assets. The Company owns senior securities issued by several entities and receives fixed-rate cash flows from the underlying assets in the pools. To provide certain services to its Medicare Advantage customers, the Company contracts with independent physician associations ("IPAs") that are variable interest entities. Physicians provide health care services to the Medicare Advantage customers and the Company provides medical management and administrative services to the IPAs, The Company is not the primary beneficiary and does not consolidate these entities because either: • it has no power to direct the activities that most significantly impact the entities' economic performance; or • it has neither the right to receive benefits nor the obligation to absorb losses that could be significant to these variable interest entities. The Company has not provided, and does not intend to provide, financial support to these entities that is not contractually required. The Company performs ongoing qualitative analyses of its involvement with these variable interest entities to determine if consolidation is required. The Company's maximum potential exposure to loss related to the investment entities is limited to the aggregate carrying amount of its investments of $762 million as of December 31, 2014 reported in fixed maturities and equity securities; the Company's combined ownership interests are insignificant relative to the total principal amounts issued by these entities. The Company's maximum exposure to loss related to the IPA arrangements is limited to the liability for incurred but not reported claims for the Company's Medicare Advantage customers. These liabilities are not material and are generally secured by deposits maintained by the IPAs. 468 CIGNA CORPORATION - 2014 Form 10-K 99 PART II ITEM 8. Financial Statements and Supplementary Data NOTE 14 Investment Income and Gains and Losses A. Net Investment Income The components of pre-tax net investment income for the years ended December 31 were as follows: (be millions) Fixed maturities Equity securities Commercial mortgage loans Policy loans Other long-term investments Short-term investments and cash Total investment income Less investment expenses NET INVESTMENT INCOME 2014 2013 2012 823 $ 843 6 4 174 192 74 74 101 57 22 14 1,200 1,184 36 40 1164 $ ..1,144 Net investment income for separate accounts that is excluded from the Company's revenues was $225 million for 2014, $232 million for 2013, and $181 million for 2012. B. Realized Investment Gains and Losses The following realized gains and losses on investments for the years ended December 31 exclude amounts required to adjust future policy benefits for the run-off settlement annuity business. (In millions) Fixed maturities Equity securities Commercial mortgage loans: Other investments, including derivatives Realized investment gains, before income taxes ' Less income taxes NET REALIZED INVESTMENT. GAINS Included in these realized investment gains (losses) were pre-tax asset write -downs as follows: (In millions) Credit related (1) Other TOTAL 2014 2013 2012 113 $ 48 8 4 (3) (9) 95 1 213 44 72 13 $ 141 ''$ 2014 2013 2012 (8) $ ,,.(20) (21) (2) (29) ,i $ .(22). (I) Credit -related losses include other -than -temporary declines in fair value of equity securities, increases in valuation reserves on commercial mortgage loans and asset write -downs related to investments in real estate entities. In 2014 and 2013, realized investment gains in other investments, including derivatives, primarily represented gains on sale of real estate properties held in joint ventures. Realized investment gains that are excluded from the Company's revenues for the years ended December 31 were as follows: (In millions) Separate accounts Investment gains required to adjust future policy benefits for the run-off settlement annuity business 2014 2013 2012 $ 417 $ 206 $ 9 $ 21 469 100 CIGNA CORPORATION - 2014 Form 10-IC PART II ITEM 8. Financial Statements and Supplementary Data Sales information for available -for -sale fixed maturities and equity securities for the years ended December 31 were as follows: (In millions) Proceeds from sates Gross gains on sales Gross fosses on sales , , NOTE 15 Debt 20142013 2012 $ L775 $ 591 $ 102 $ 37 $ 4 $ (In millions) Short Commercial paper Old', including ca'pita reaSeis, TOTAL SHORT-TERM DEBT Long term Uncollateralized debt: $600Millidri;2.75% Notei dis 2016 $250 million, 5.375% Notes due 2017 $131 million, 6.35% Note S due 2018 $251 million, 8.5% Notes due 2019 $250 million, 4.375% Notes due 2020',(). $300 million, 5.125% Notes due 2020(1) $78 tnillic,n, 6.37% Notes due 2021 $300 million, 4.5% Notes due 2021(1) $750 million, 4% Notes due 2022' • $100 million, 7.65% Notes due 2023 $17 million, 8.3% Notes dtie 2023 $300 million, 7.875% Debentures due 2027 $83 million, 8.3% Stepi Down Notes duo 2033 $500 million, 6.15% Notes due 2036 $300 Million, 5.875% Witos due 2041 $750 million, 5.375% Notes due 2042 Other, including capital icasos =.• TOTAL LONG-TERM DEBT • 2014 2013 P-4 $ 100 133 233 600 250 131 251 249 299 78 299 744 100 17 300 83 500 298 750 65 $ 5,014 (1) In 2014, the Company entered into interest rate swap contracts hedging a portion of these fixed-rate debt instruments. See Note 12 for fiother information about the Company's interest rate risk management and these derivative instruments. In December 2014, the Company entered into an updated revolving credit and letter of credit agreement for $1.5 billion, that permits up to $500 million to be used for letters of credit. This agreement extends through December 2019 and is diversified among 16 banks, with three banks each having 12% of the commitment and the remainder spread among 13 banks. The credit agreement includes options, subject to consent by the administrative agent and the committing banks, to increase the commitment amount to $2 billion and to extend the term past December 2019. The credit agreement is available for general corporate purposes, including for the issuance of letters of credit. This agreement has certain covenants, including a financial covenant requiring the Company to maintain a leverage ratio of total consolidated debt -to -consolidated capitalization (each as defined in the credit agreement) at or below 0.50. As of Decernber 31, 2014, the Company had $6.5 billion of borrowing capacity within the maximum debt coverage covenant in the agreement, in addition to the $5.2 billion of debt outstanding. Letters of credit outstanding as of December 31, 2014 totaled $23 million. The Company was in compliance with its debt covenants as of December 31, 2014. Maturities of long-term debt, excluding capital leases, are as follows (in millions): $25 in 2015, $600 in 2016, $250 in 2017, $131 in 2018, $251 in 2019 and the remainder in years after 2019. Maturities of debt under capital lease arrangements are as follows (in millions); $22 in 2015, $22 in 2016, $11 in 2017, $4 in 2018, none in 2019 and the remainder in years after 2019. Interest expense on long-term and short-term debt was $265 million in 2014, $270 million in 2013, and $268 million in 2012. 470 CIGNA CORPORATION - 2014 Form 10-K 101 PART II ITEM 8. Financial Statements and Supplementary Data NOTE 16 Common and Preferred Stock As of December. 31, the Company had issued the following shares: (Shares in thousands) Common: Par value $0.25 600,000 shares authorized Outstanding — January 1, Issued for stock option and other benefit plans Repurchase of common stock Outstanding - December 31, Treasury stock ISSUED DECEMBER,31, The Company maintains a share repurchase program, authorized by its Board of Directors. Under this program, we may repurchase shares from time to time, depending on market conditions and alternate uses of capital. We may suspend activity under our share repurchase program from time to time and may also remove such suspensions, generally without public announcement. We may also repurchase shares at times when we otherwise might be precluded from doing so under insider trading laws or because of self-imposed trading black -out periods by using a Rule 10b5-1 trading plan. In 2014, the Company repurchased 18.5 million shares for $1.6 billion. The Company repurchased 13.6 million shares for 2014 2013 2012 285,829 285,533 3,319 4,695 (13,622) (4,399) 275,526 285,829 90,619 80,316 366,145 366,145 $1.0 billion during 2013 and 4.4 million shares for $208 million during 2012. In 2014, the Company retired 70 million shares of treasury stock. This transaction had no effect on total shareholders' equity. The Company has authorized a total of 25 million shares of $1 par value preferred stock. No shares of preferred stock were outstanding at December 31, 2014, 2013 or 2012. 471 102 CIGNA CORPORATION - 2014 Form 10-K PART II ITEM 8. Financial Statements and Supplementary Data NOTE 17 Accumulated Other Comprehensive Income (Loss) Accurnulated other comprehensive loss excludes atnounts required to adjust fixture policy benefits for the run-off settlement annuity business and a portion of deferred acquisition costs associated with the corporate ownedlife insurance business. As required by GAAP, the Company parenthetically identifies the income statement line item affected by reclassification adjustments in the table below, Changes in the components of accumulatedother comprehensive loss were as follows: (In millions) 2014 Net unrealized appreciation securities, January 1, Net unrealized appreciation on securities arising during the year Reclassification adjustment for (gains),included'iu1 shareholders' net income (realized investment gains) Net unrealized appreciation, securities arising during the year Net unrealized appreciation, securities, Deceinbcr 31, J• Net unrealized depreciation, derivatives, January 1, Net unrealized appreeciation, derivatives arising during the'.' year .. Net unrealized depreciation, derivatives, December 31, Net transladori of foreign currencies, JauuatyI,• Net translation of foreign currencies arising during the year Net translation of foreign currencies, December 31, Postretirement benefits liability adjustment, January 1, Reclaasif%cation adjustment for amortization of net losses;:itoin past; experience' and prior; service costs (other i operating expenses):: • Reclassification adjustment for settlement (other operating Total reclassification adjustment to shareholders' net income (other operating expenses)' Net change due to valuation update Net postretir`ement benefits liability adjustment arising during the year Postretirement benefits liability adjustment, December 31, Tax (Expense) Pre -Tax Benefit After -Tax 472 CIGNA CORPORATION - 2014 Form 10-K 103 PART II ITEM 8. Financial Statements and Supplementary Data 2012 (In millions) 2013 Net unrealized appreciation, securities, January 1, Net unrealized depreciation on securities arising during the year Reclassification adjustment for (gains) included in shareholders' net income (realized investment gains) Net unrealized depreciation, securities arising during the year Tax (Expense) Pre -Tax Benefit After -Tax 1,352 $ (465) $ 887 (498) 166 (332) (121) 43 (78) (619) 209 (410) Net unrealized appreciation, securities, December 31, Net unrealized depreciation, derivatives, January 1, Net unrealized appreciation, derivatives, "arising during the year Net unrealized depreciation, derivatives, December 31, Net translation'of foreign currencies, January 1, Net translation of foreign currencies, arising during the year 733 $ (256) $ 477 (43) $ 15 $ (28) (5) 9 (29) $ 10 $ (19) (22) .. ... 1 91 13 69 13 Net translation of,foreign c rrencies, December 31, Postretirement benefits liability adjustment, January 1, Reclassification adjustment for.aniortizatioit of net losses from past experience and prior service costs (other operating expenses) '. Reclassification adjustment for curtailment gain (other operating expenses) Total reclassification adjustment to shareholders' net income' (other operating expenses) Net change due to valuation update and plan amendments Net Postretirement benefits liability adjustment arising during the year Postretirement benefits liability adjustment, December 31, (19) 779 (9) 7 (18) (273) 82 (1,599) (12) 33 506 $ (1,630) $ 291) .539 570 $ (1,060) Tax (In millions) (Expense) Pre -Tax Benefit Net Unrealized appreciation,' securities January 1, $ 1,133 :;$ (393). $ 74Q Net unrealized appreciation on securities arising during the year 271 (90) 181 Reclas'"sifrcaeion adjustment for`. (gains)included in net income (realized lnvestu eht gains)" (52) ' '18 (34) Net unrealized appreciation, securities arising during the year 219 (72) -1,352 .: $ (465) (36) $ 13 (7) Net unrealized appreciation, securities; December 31, - Net unrealized depreciation, derivatives, January 1, Net unrealized depreciation, derivatives `aiismg during the year . .• Net unrealized depreciation, derivatives, December 31, Net translation of foreign currencies, .January ], Net translation of foreign currencies arising during the year (43) $ 15 13 $ (j0)' 78 91 $ (22) $ r :': 69 Net translation of foreign currencies, December 31$ Postretirement benefits liability adjustment, January 1, Reclassification adjustment for amortization of net losses from past experience and prior service costs and settlement charges (other operating expenses) Net change due to valuation update and plan amendments Net postretrrtment benefits liability adjustment arising during the year Postretirement benefits liability adjustment, December 31, NOTE 18 Shareholders' Equity and Dividend Restrictions After -Tax (2,331) (12) 52 :' .(18) (181) (129),;: (2,460) (28) 3 66 824 $ (1,507) 34 55 (126) 37 " (92) 861 $ (1,599) State insurance departments and foreign jurisdictions that regulate certain of the Company's subsidiaries prescribe accounting practices (differing in some respects from GAAP) to determine statutory net income and surplus. The Company's life insurance and HMO company subsidiaries are 473 104 CIGNA CORPORATION - 2014 Form 10-K PART II ITEM 8. Financial Statements and Supplementary Data regulated by such statutory requirements. The statutory net income of the Company's life insurance and HMO subsidiaries for the years ended, and their statutory surplus as of December 31, were as follows: (In millions) Net income Surplus The minimum statutory surplus required by regulators for the Company's life insurance and HMO company subsidiaries was approximately $2.5 billion as of December 31, 2014. A.s of December 31, 2014, statutory surplus for each of the Company's life insurance and HMO subsidiaries is sufficient to meet the minimum required by regulators. For one of the Company's foreign insurance subsidiaries, the regulatory authority has permitted deferral of certain policy acquisition costs that increased statutory capital and surplus by approximately $0.2 billion as of December 31, 2014. There were no other permitted practices for the Company's insurance subsidiaries that significantly differed from prescribed regulatory accounting practices. As of December 31, 2014, the Company's life insurance and HMO subsidiaries hadinvestments on deposit with state departments NOTE 19 Income Taxes 2014 2013 2012 I,631 ' $ 1,520 $ 6,316 $ 6,109 of insurance and other regulatory bodies with statutory carrying values of approximately $0.4 billion. The Company's life insurance and HMO subsidiaries are also subject to regulatory restrictions that limit the amount of annual dividends or other distributions (such as loans or cash advances) insurance companies may extend to the parent company without prior approval of regulatory authorities. The maximum dividend distribution that the Company's life insurance and HMO subsidiaries may make during 2015 without prior approval is approximately $1.0 billion, Restricted net assets of the Company as of December 31, 2014, were approximately $8.8 billion. Certain life insurance subsidiaries of the Company are permitted to loan up to approximately $1.0 billion to the parent company without prior approval. A. Income Tax Expense The components of income taxes for the years ended December 31 were as follows: (In millions) Ctu'renttaxes income taxes Foreign income State income taxes Deferred taxes (benefits) U S , income taxes, . , Foreign income taxes State income taxes, 2014 r•. 2013 2012 604 72 43 719 si 1.31 46 4 (1) (1) 197 134 TOTAL INCOME TAXES $ 698 Total income taxes for the years ended December 31 were different from the amount computed using the nominal federal income tax rate of 35% for the following reasons: (In millions) Tax expense at nomtnal (ate-- i Effect of undistributed foreign earnings Flealth. 'insurance uidustry tax State income tax (net of federal income tax benefit) Other TOTAL INCOME TAXES 2014 2013 2012 761 $ 867 (42) (37) 27 28 (48) :' (5) $ 698 $ 853 Consolidated pre-tax income from the Company's foreign operations was approximately 10% in 2014, 12% in 2013 and 8% in 2012.. Effective Tax Rates The consolidated effective tax rate of 36.6% in 2014 has increased from historical levels due to the health insurance industry tax that took effect in 2014 and that is not deductible for federal income tax 474 CIGNA CORPORATION - 2014 Form 10-K 105 PART II ITEM 8. Financial Statements and Supplementary Data purposes. Other matters having a significant impact on the effective tax rate included: • Undistributed foreign earnings. As part of its global capital management strategy, the Company's foreign operations retain a significant portion of their earnings overseas. These undistributed earnings are deployed outside of the U.S. in support of the liquidity and capital needs of our foreign operations. The Company does not intend to repatriate these earnings to the U.S. and as a result, income taxes are provided using the respective foreign jurisdictions' tax rate. The Company has accumulated undistributed foreign earnings of $1.8 billion as of December 31, 2014. If the Company B. Deferred Income Taxes intended to repatriate these foreign earnings to the U.S„ the Company's consolidated balance sheet would have included an additional $218 million of deferred tax liabilities as of December 31, 2014. • Completion of .IRS examinations/other 2013 impacts. In 2013, the Internal Revenue Service ("IRS") completed its examination of the Company's 2009 and 2010 tax years, resulting in an increase to shareholders' net income of $18 million. In addition, income tax expense was reduced in 2013 due to certain other tax benefits related to the Company's foreign operations. Deferred income tax assets and liabilities as of December 31 are as follows: (In millions) Deferred tag assets Employee and retiree benefit plans Other insurance and contractholder liabilities Policy acquisition expenses Other accrued liabilities, Other Deferred tax assets before valuation allowance' Valuation allowance for deferred tax assets Deferred tax assets, "net of valuation, allowance Deferred tax liabilities Depreciation and ainortizatiori. Foreign operations, net Unrealized appreciation bn investments and foreign currency translation Total deferred tax liabilities NET DBPERRED :INa014iE 't : ASSETS Management believes that future results will be sufficient to realize the Company's deferred tax assets. Substantially all of the Company's deferred tax benefits may be carried forward indefinitely. As of December 31, 2014, net operating lass related benefits were $71 million, the majority of which relate to foreign jurisdictions and do not expire. The Company establishes a valuation allowance when it 2014 2013 422 407 142 157 128 1,256 (49) 1207 determines that realization of a deferred tax asset does not meet the more likely than not standard. Valuation allowances have been established against certain federal, foreign and state deferred tax assets, generally due to the requirement to assess them on a separate entity basis. C. Uncertain Tax Positions A reconciliation of unrecognized tax benefits for the years ended December 31 is as follows: (In millions) Balance at' Januar 1, Decrease due to prior year positions Increase due to current'Year positions , Reduction related to lapse of applicable statute of limitations BALANCE AT DE ,EMBER 31, . Unrecognized tax benefits increased $9 million in 2014.of which $6 million impacted shareholders' net income. The prior year decrease was primarily attributable to completion of an IRS examination. 2014 2013 (35) 2012 52 (5) ,7 (3) 51 The Company classifies net interest expense on uncertain tax positions as a cornponent of income tax expense, but excludes this amount from the liability for uncertain tax positions. The Company's liability for net interest was immaterial at December 31, 2014, 2013 and 2012. 475 106 CIGNA CORPORATION - 2014 Form 10-K PART II ITEM 8. Financial Statements and Supplementary Data D. Other Tax Matters In 2013, the IRS completed its examination of the Company's 2009 and 2010 tax years, resulting in two issues that could not be resolved at the examination level. The Company subsequently filed a formal protest challenging the IRS positions on the two disputed matters. The IRS previously withdrew its challenge relating to the first of these matters, and the parties have since agreed on a resolution of the second matter. The resolution of these matters did not materially impact shareholders' net income. NOTE 20 Employee Incentive Plans The People Resources Committee ("the Committee") of the Board of Directors awards stock options, restricted stock, deferred stock and strategic performance shares to certain employees. The Committee has issued common stock instead of cash compensation and dividend equivalent rights to a very limited extent, as part of restricted and deferred stock units. The Company issues shares from Treasury stock for option exercises, awards of restricted stock grants and payment of The IRS began its examination of the Company's 2011 and 2012 tax years in the third quarter of 2014 that is expected to continue through 2015. The Company conducts business in numerous state and foreign jurisdictions, and may be engaged in multiple audit proceedings at any given time. Generally, no further state audit activity is expected for tax years prior to 2010, and prior to 2008 For foreign audit activity. strategic performance shares, deferred stock units and restricted stock units. In connection with the HealthSpring acquisition on January 31, 2012, HealthSpring employees' awards of options and restricted shares of HealthSpring stock were rolled over to Cigna stock options and restricted stock. Unless otherwise indicated, information in this footnote includes the effect of the HealthSpring rollover awards. Compensation cost and related tax benefits for these awards were as follows: (I millions) Compensatio Tax benefits Cost 2014 2013 2012 $ 88 $. 98 $ 25 $ 26 The Company had the following number of common stock shares available for award at December 31: 10.3 million in 2014, 13.2 million in 2013 and 8.4 million in 2012. Stock options. The Company awards options to purchase the Company's common stock at the market price of the stock on the grant date. Options vest over periods ranging from one to five years and expire no later than 10 years from grant date. The table below shows the status of, and changes in, common stock options during the last three years: (Options in thousands) Outsta<tclixg - January. 1 Granted Exercised Expired or canceled OUTSTANDING DECEMBER, 31. • Options exercisable at year-end 2014 2013 2012 Options Weighted Average Exercise Price Options '951 $ 1,890 (3,Yp7) (384) $ 7,350 4,217 $ Weighted Average Exercise Price 36.29 58.84 34.99 43.86 42.24 35.84 Options 3,446 $ (3,740j (336) $ 5,731 $ Weighted Average Exercise Price 33.92 28.29 22.72 37.85 36.29 34.93 Compensation expense of $32 million related to unvested stock options at December 31, 2014 will be recognized over the next two years (weighted average period). The table below summarizes information for stock options exercised during the last three years: (In millions) Intrinsic'value of options exercised Cash received for options exercised Excess tax benefits realized from options. exercised 2014 2013 2012 $ 105. $ 95 $ 109 $ 85 $ 23 $ 15 476 CIGNA CORPORATION • 2014 Form 10-K 107 PART II ITEM 8. Financial Statements and Supplementary Data The following table summarizes information for outstanding common stock options at December 31, 2014: Options Options Outstanding Exercisable Number (in thousands) Total intrinsic value (in millions) Weighted average exercise price. Weighted average remaining contractual life The weighted average fair value of options granted under employee incentive plans was $23.56 for 2014, $19.84 for 2013 and $14.99 for 2012 (excluding the HealthSpring rollover options issued in 2012) using the Black-Scholes option -pricing model and the assumptions presented in the following table. Dividend yield . . Expected volatility Risk .free interest rate Expected option life The expected volatility reflects the Company's past daily stock price volatility. The Company does not consider volatility implied in the market prices of traded options to be a good indicator of future volatility because remaining maturities of traded options are less than one year. The risk -free interest rate is derived using the four-year U.S. Treasury bond yield rate as of the award date for the primary grant. Expected option life reflects the Company's historical experience. Restricted stock, The Company awards restricted stock to its employees or directors with vesting periods ranging from two to five years. These awards are generally in one of two forms: restricted stock grants or restricted stock units. Restricted stock grants are the most widely used form of restricted stock award and are used for 2014 2013 2012 01% •0.14 40.0% 40.0% 0.7% ,z 0.8% 4.5 years 4.5 years substantially all U.S.-based employees receiving such awards. Recipients of restricted stock grants accumulate dividends and can vote during the vesting period, but forfeit their awards and accumulated dividends if their employment terminates before the vesting date. Awards of restricted stock units are generally limited to overseas employees. A restricted stock unit represents a right to receive a common share of stock when the unit vests. Recipients of restricted stock units are entitled to accumulate hypothetical dividends, but cannot vote during the vesting period. They forfeit their units and accumulated dividends if their employment terminates before the vesting date. The table below shows the status of, and changes in, restricted stock grants and units during the last three years: 2014 2013 2012 (Awards in thousands) Outstanding : Jahu'ary 1 Awarded Vested. Forfeited OFTTSTANDING DECEIVER 31 The fair value of vested restricted stock was: $85 million in 2014, $94 million in 2013 and $66 million in 2012. At the end of 2014, approximately 3,400 employees held 2.1 million restricted stock grants and units with $54 million of related compensation expense to be recognized over the next three years (weighted average period). Strategic Performance Shares. The Company awards strategic performance shares to executives and certain other key employees Grants/Units Weighted Average Fair Value at Award Date Grants/Units Weighted Average Fair Value at Award Date Weighted Average Fair Value at Grants/Units Award Date 3500 4,246 ..$ ,28.88 59.36 1,563 $ 44.37 30.24 (1,485) $ 27.60 39.46 (260) $ 33.61 41,56 4,064 "$• 35.00 generally with a performance period of three years. Strategic performance shares are divided into two broad groups: 50% are subject to a market condition (total shareholder return relative to industry peer companies) and 50% are subject to performance conditions (revenue growth and cumulative adjusted net income). These targets are set by the Committee. At the end of the performance period, holders of strategic performance shares will be awarded anywhere from 0 to 200% of the original grant of strategic performance shares in Cigna common stock. 108 CIGNA CORPORATION - 2014 Form 10-K 477 PART II ITEM 8. Financial Statements and Supplementary Data The table below shows the status of, and changes in, strategic performance shares during the last three years: (Awards in thousand) Outstanding Jahtiai l Awarded Vested` Forfeited OUTSTANDING'- DECEMBER 31; ` 2014 2013 2012 Weighted Average Fair Value at Grants/Units Award Date The fair value of vested strategic performance shares was $57 million in 2014 and $42 million in 2013. No strategic performance shares vested in 2012. At the end of 2014, approximately 1,200 employees held 1.5 million strategic performance shares and $32 million of related compensation NOTE 21 Leases and Rentals Grants/Units 1,600` 616 (448) (196) 1,572 Weighted Average Fair Value at Award Date 4L92 Weighted Average Fair Value at Grants/Units Award Date 834 $ 39.45 59.84 842 $ 44.49 36.88 $ 47,52 (76) $ 43,39 49.67 1,600 $ 41.92 expense is expected to be recognized over the next two years. For strategic performance shares subject to a performance condition, the amount of expense may vary based on actual performance in 2015 and 2016. The Company's operating leases are primarily for office space. Some of these leases include renewal options and other incentives that are amortized over the life of the lease. Office space leases active in 2014 had terms ranging from 1 month to 18 years. Rental expenses for operating leases amounted to $150 million in 2014, $137 million in 2013 and $144 million in 2012. As of December 31, 2014, future net minimum rental payments under non -cancelable operating leases NOTE 22 Segment Information Beginning in the first quarter of 2014, the Company combined the results of its run-off reinsurance business with other immaterial operating segments in Other Operations. Prior year segment information has been conformed to the current presentation. The financial results of the Company's businesses are reported in the following segments: Global Health Care aggregates the Commercial and Government operating segments due to their similar economic characteristics, products and services and regulatory environment: • The Commercial operating segment encompasses both the U.S, commercial and certain international health care businesses serving employers and their employees, other groups, and individuals. Products and services include medical, dental, behavioral health, vision, and prescription drug benefit plans, health advocacy programs and other products and services to insured and self -insured customers. • The Government operating segment offers Medicare Advantage and Medicare Part D plans to seniors and Medicaid plans. Global Supplemental Benefits includes supplemental health, life and accident insurance products offered in selected international markets and in the U.S. Group Disability and Life provides group long-term and short-term disability, group life, accident and specialty insurance products and related services. Other Operations consist of • corporate -owned life insurance ("COLI"); were approximately $605 million, payable as follows (in millions): $140 in 2015, $120 in 2016, $87 in 2017, $71 in 2018, $59 in 201.9 and $128 thereafter. The Company also has capital lease arrangements. See Note 8 and Note 15 for further information on assets recorded under capital leases and the related obligations. • run-off reinsurance business that is predominantly comprised of GMDB and GMIB business that was effectively exited through reinsurance with Berkshire in 2013; • deferred gains recognized from the 1998 sale of the individual life insurance and annuity business and the 2004 sale of the retirement benefits business; and • run-off settlement annuity business. Corporate reflects amounts not allocated to other segments, such as net interest expense (defined as interest on corporate debt less net investment income on investments not supporting segment operations), interest on uncertain tax positions, certain litigation matters, intersegment eliminations, compensation cost for stock options, expense associated with its frozen pension plans, and certain corporate project and overhead costs. The Company measures the financial results of its segments using "segment earnings (loss)", defined as shareholders' net income (Joss) before after-tax realized investment results. The Company determines segment earnings (loss) consistent with accounting policies used in preparing the consolidated financial statements, except that amounts included in Corporate are not allocated to segments. The Company allocates certain other operating expenses, such as systems and other key corporate overhead expenses, on systematic bases. Income taxes are generally computed as if each segment were filing a separate income tax return. The Company does not report total assets by segment because this is not a metric used to allocate resources or evaluate segment performance. 478 CIGNA CORPORATION - 2014 Form 10-K 109 PART II ITEM 8. Financial Statements and Supplementary Data Summarized segment financial (In millions) Global Health Care Premiums: Guaranteed cost Experience -rated Stop loss International health care Dental • Medicare Medicaid Medicare Part D Other information for the years ended December 31, was as follows: Total premiums Fees and other 'revenues Mail order pharmacy revenues 1\14:i.westinent income• Segment revenues Income taxes SegMent':eaniitiga, Global Supplemental Benefits PreMithris • Fees and other revenues Net investment income Segment revenues 15e0iedidtiOtihiicf arnortization Income taxes Equity in in -Come of investeeS Segment earnings Group Disabiity aiid Life Premiums: - • Life '• Disability Other Total Fes d Other revenues Net investment income Segment revenues • Depreciation and amortization Income taxes • ' Segment earnings Other Operations Premiums Fees and other -,reenues Net investment income . Segment reverthet Depreciation and amortization • . •. Income taxes (benefits) Segment earnings (loss) 2014 2013 2012 $ 4,463 •$ 4,-256 2,292 2,022 1,907 1,672 1,752 1,648 1,139 ' 1,005 5,639 4,969 1,387 1,421 730 677 • 19,626 17,877 :-'•••;•• 1,827 1,623 i'•••••••;325 • .•''';;;"••;--'•,•",:-':••2i9 • :: $ 25,296 $ 23,080 $ 822 $ 793 2,496 •$ 1,975 43 30 $ 2,639 $ 2,095 50 29 $ 50 $ 36 $ 17 $ 10 $ 175 $ 142 1,539 1,348 3,3483,044 321.:: 300 ....$ 14 $ 11 $ 259 $ 279 $ 105 408 490 $ 1 $ $ (394) .$ 82 479 110 CIGNA CORPORATION - 2014 Form 10-K PART II ITEM 8. Financial Statements and Supplementary Data (In millions) Corporate Other revenues and eliminations Net Investment income Segment revenues Depreciation and amortization: Income tax benefits Segment loss Realized investment gains Realized investment gains Income taxes Realized. investment gains, net of taxes Total Premiums Fees and other revenues Mail order pharmacy revenues Net investment income Realizedanvestmetit gams ::.. • Total revenues Depreciation and amortization... Income taxes Segment`earntngs :. ' � ` Realized investment gains, net of taxes Shareholders` nee income 2014 2013 (14) $ 2012 (24) 10 5 (4) $ (19) (110) $ (222): $ 3 (148) (329) 213 $ 44 72 13 141. $' 31 25,575 $ 23,017 3,601 3,291 1,827 . 1,623 1,164 1,144 213' 44 32,380 $ 29,119 597 $ 560 $ 698 $ 853 $ 1,335 $ 1,592 $ 141 $ 31 $ 1 t76 $ 1,623 Revenue from external customers includes premiums, fees and other revenues, and mail order pharmacy revenues. The following table presents these revenues by product type for the years ended December 31: (In millions) Medtcnl„ Disability Supplemental Health, Life,' and Accident Mail order pharmacy Qther, TOTAL 2014 2013 2012 22,933 $ ' 20,973 1,616 1,413 4322 , 3,680 1,827 1,623 305 : 242 £tA $ 31,003 $ 27,931 Foreign and U.S. revenues from external customers for the 3 years ended December 31 are shown below. In the periods shown, no foreign country contributed more than 5% of consolidated revenues from external customers. (In millions) U,S Foreign TOTAL 2014 2013 2012 27,868 $ ; 25,217 3,135 2,714 31,003 27,931 As a percentage of consolidated revenues, premiums from CMS were 21% in 2014 and 22% in both 2013 and 2012. These amounts were reported in the Global Health Care segment. 480 CIGNA CORPORATION - 2014 Form 10-K 111 PART II ITEM 8. Financial Statements and Supplementary Data NOTE 23 Contingencies and Other Matters The Company, through its subsidiaries, is contingently liable for various guarantees provided in the ordinary course of business. A. Financial Guarantees: Retiree and Life Insurance Benefits Separate account assets are contractholder funds maintained in accounts with specific investment objectives. The Company records separate account liabilities equal to separate account assets. In certain cases, the Company guarantees a minimum level of benefits for retirement and insurance contracts writtenin separate accounts. The Company establishes an additional liability if management believes that the Company will be required to make a payment under these guarantees. The Company guarantees that separate account assets will be sufficient to pay certain life insurance or retiree benefits. The sponsoring employers are primarily responsible for ensuring that assets are sufficient to pay these benefits and are required to maintain assets that exceed a certain percentage of benefit obligations. This percentage varies depending on the asset class within a sponsoring employer's portfolio (for example, a bond fund would require a lower percentage than a riskier equity fund) and thus will vary as the composition of the portfolio changes. If employers do not maintain the required levels of separate account assets, the Company or an affiliate of the buyer of the retirement benefits business (see Note 7 for additional :information), has the right to redirect the management of the related assets to provide for benefit payments. As of December 31, 2014, employers maintained assets that exceeded the benefit obligations. Benefit obligations under these arrangements were $496 million as of December 31, 2014 and approximately 13% of these are reinsured by an affiliate of the buyer of the retirement benefits business. The remaining guarantees are provided by the Company with minimal reinsurance from third parties. There were no additional liabilities required for these guarantees as of December 31, 2014. Separate account assets supporting these guarantees are classified in Levels 1 and 2 of the GAAP fair value hierarchy. See Note 10 for further information on the fair value hierarchy. The Company does not expect that these financial guarantees will have a material effect on the Company's consolidated results of operations, liquidity or financial condition. B. ° Guaranteed Minimum Income Benefit Contracts Under these guarantees, the future payment amounts are dependent on underlying mutual fund investment values and interest rate levels prior to and at the date of annuitization election that must occur within 30 days of a policy anniversary after the appropriate waiting period. Therefore, the future payments are not fixed and determinable under the terms of these contracts. Accordingly, the Company calculated exposure, without considering retrocessional coverage, using the following hypothetical assumptions as a proxy for maximum potential undiscounted future payments. • no annuitants surrendered their accounts; • all annuitants lived to elect their benefit; • all annuitants elected to receive their benefit on the next available date (2015 through 2020); and • all underlying mutual fund investment values remained at the December 31, 2014 value of $1.1 billion with no future returns. Using these hypothetical assumptions, GMIB exposure is $754 million. The recorded liability for GMIB is calculated using fair value assumptions. The Company has retrocessional coverage in place that covers the exposures on these contracts. See Notes 7, 10 and 12 for further information on GMIB contracts. C. Certain Other Guarantees The Company had indemnification obligations to lenders of up to $208 million as of December 31, 2014, related to borrowings by certain real estate joint ventures that the Company either records as an investment or consolidates. These borrowings, that are nonrecourse to the Company, are secured by the joint ventures' real estate properties with fair values in excess of the loan amounts and mature at various dates beginning in 2015 through 2021. The Company's indemnification obligations would require payment to lenders for any actual damages resulting from certain acts such as unauthorized ownership transfers, misappropriation of rental payments by others or environmental damages. Based on initial and ongoing reviews of property management and operations, the Company does not expect that payments will be required under these indemnification obligations. Any payments that might be required could be recovered through a refinancing or sale of the assets. In some cases, the Company also has recourse to partners for their proportionate share of amounts paid. There were no liabilities required for these indemnification obligations as of December 31, 2014. As of December 31, 2014, the Company guaranteed that it would compensate the lessors for a shortfall of hp to $41 million in the market value of certain leased equipment at the end of the lease. Guarantees of $16 million expire in 2016.and $25 million expire in 2025. The Company had liabilities for these guarantees of $7 million as of December 31, 2014. The Company had indemnification obligations as of December 31, 2014 in connection with acquisition, disposition and reinsurance transactions. These indemnification obligations are triggered by the breach of representations or covenants provided by the Company, such as representations for the presentation of financial statements, actuarialmodels, the filing of tax returns, compliance with law or the identification of outstanding litigation. These obligations are typically subject to various time limitations, defined by the contract or by operation of law, such as statutes of limitation. In some cases, the maximum potential amount due is subject to contractual limitations based on a percentage of the transaction purchase price, while in other cases limitations are not specified or applicable. The Company does not believe that it is possible to determine the maximum potential 481 112 CIGNA CORPORATION - 2014 Form 10-K • PART II ITEM 8. Financial Statements and Supplementary Data amount due under these obligations, because not all amounts due under these indemnification obligations are subject to limitation. There were no liabilities for these indemnification obligations as of December 31, 2014. The Company does not expect that these guarantees will have a material adverse effect on the Company's consolidated results of operations, financial condition or liquidity. D. Guaranty Fund Assessments The Company operates ina regulatory environment that may require the Company to participate in assessments under state insurance guaranty association laws. The Company's exposure to assessments for certain obligations of insolvent insurance companies to policyholders and claimants is based on its share of business written in the relevant jurisdictions. For the year ended December 31, 2014 and 2013, charges related to guaranty fund assessments were immaterial to the Company's results of operations. The Company is aware of an insurer that is in rehabilitation. In 2012, the state court denied the regulator's amended petitions for liquidation and set forth specific requirements and a deadline for the regulator to develop a plan of rehabilitation without liquidating the insurer. The regulator has appealed the court's decision. If the actions taken in the rehabilitation plan fail to improve this insurer's financial condition, or if the state court's ruling is overturned on appeal, this insurer may be forced into insolvency In that event, the Company would be required to pay guaranty fund assessments related to this insurer. Due to the uncertainties surrounding this matter, the Company is unable to estimate the amount of any potential guaranty fund assessments and is monitoring the situation. E. Legal and Regulatory Matters The Company is routinely involved in numerous claims, lawsuits, regulatory audits, investigations and other legal matters arising, for the most part, in the ordinary course of managing a health services business. These actions may include benefit disputes, breach of contract claims, tort claims, provider disputes, disputes regarding reinsurance arrangements, employment and employment discrimination -related suits, employee benefit claims, wage and hour claims, privacy, intellectual property claims and real estate related disputes. There are currently, and may be in the future, attempts to bring class action lawsuits against the industry. The Company also is regularly engaged in IRS audits and may be subject to examinations by various state and foreign taxing authorities. Disputed income tax matters arising from these examinations, including those resulting in litigation, are accounted for under the FASB's guidance for uncertain tax positions. Further information on income tax matters can be found in Note 19. The business of administering and insuring health services programs, particularly health care and group insurance programs, is heavily regulated by federal and state laws and administrative agencies, such as state departments of insurance and the U.S. Departments of Health and Human Services, Treasury, Labor and Justice, as well as the courts, Health care regulation and legislation in its various forms, including the implementation of Health Care Reform, other regulatory reform initiatives, such as those relating to Medicare programs, or additional changes in existing laws or regulations or their interpretations, could have a material adverse effect on the Company's business, results of operations and financial condition. In addition, there is heightened review by federal and state regulators of the health care, disability and life insurance industry business and related reporting practices. Cigna is frequently the subject of regulatory market conduct reviews and other examinations of its business and reporting practices, audits and investigations by state insurance and health and welfare departments, state attorneys general, the CMS and the Office of Inspector General ("OIG"). With respect to Cigna's Medicare Advantage business, the CMS and OIG perform audits to determine a health plan's compliance with federal regulations and contractual obligations, including compliance with proper coding practices (sometimes referred to as Risk Adjustment Data Validation audits or RADV audits), that may result in retrospective adjustments to payments made to health plans. Regulatory actions can result in assessments, civil or criminal fines or penalties or other sanctions, including loss of licensing or exclusion from participating in government programs. As a global company, Cigna is also subject to the laws, regulations an.d. rules of the foreign jurisdictions in which it conducts business. Foreign laws and rules, and regulatory audit and investigation practices, may differ from or be more stringent than, similar requirements in the United States. Regulation, legislation and judicial decisions have resulted in changes to industry and the Company's business practices, financial liability or other sanctions and will continue to do so in the future, When the Company (in the course of its regular review of pending litigation and legal or regulatory matters) has determined that a material loss is reasonably possible, the matter is disclosed. In accordance with GAAP, when litigation and regulatory matters present loss contingencies that are both probable and estimable, the Company accrues the estimated loss by a charge to income. The amount accrued represents the Company's best estimate of the probable loss at the time, If only a range of estimated losses can be determined, the Company accrues an amount within the range that, in the Company's judgment, reflects the most likely outcome; if none of the estimates within that range is a better estimate than any other amount, the Company accrues the minimum amount of the range. In cases when the Company has accrued an estimated loss, the accrued amount may differ materially from the ultimate amount of the loss. In many proceedings, it is inherently difficult to determine whether any loss is probable or even possible or to estimate the amount or range of any loss. The Company provides disclosure in the aggregate for material pending litigation and legal or regulatory matters, including accruals, range of loss, or a statement that such information cannot be estimated. As a litigation or regulatory matter develops, the Company monitors the matter for further developments that could affect the amount previously accrued, if any, and updates such amount accrued or disclosures previously provided as appropriate. The outcome of litigation and other legal or regulatory matters is always uncertain, and unfavorable outcomes that are not justified by the evidence or existing law can occur. The Company believes that it has valid defenses to the matters pending against it and is defending itself vigorously. Except as otherwise noted, the Company believes 482 CIGNA CORPORATION - 2014 Form 10-K 113 PART II ITEM 8. Financial Statements and Supplementary Data that the legal actions, regulatory matters, proceedings and investigations currently pending against it should not have a material adverse effect on the Company's results of operation, financial condition or liquidity based upon current knowledge and taking into consideration current accruals. The Company had pre-tax reserves as of December 31, 2014.of $189 million ($123 million after-tax) for the matters discussed below. Due to numerous uncertain factors presented in these cases, it is not possible to estimate an aggregate range of loss (if any) for these matters at this time. In light of the uncertainties involved in these matters, there is no assurance that their ultimate resolution will not exceed the amounts currently accrued by the Company. An adverse outcome in one or more of these matters could be material to the Company's results of operations, financial condition or liquidity for any particular period. Litigation Matters Amara cash balance pension plan litigation. In December 2001, Janice Amara filed a class action lawsuit in the U.S. District Court for the District of Connecticut against Cigna Corporation and the. Cigna Pension Plan (the "Plan") on behalf of herself and other similarly situated participants in the Plan affected by the 1998 conversion to a cash balance formula. The plaintiffs allege various ERISA violations, including, that the Plan's cash balance formula discriminates against older employees; that the conversion resulted in a wear -away period (when the pre -conversion accrued benefit exceeded the post -conversion benefit); and that the Plan communications contained inaccurate or inadequate disclosures about these conditions. In 2008, the District Court (1) found for plaintiffs on the disclosure claim only; (2) affirmed the Company's right to convert to a cash balance plan prospectively beginning in 1998; and (3) required the Company to pay pre-1998 benefits under the pre -conversion traditional annuity formula and post-1997 benefits under the post -conversion cashbalance formula. The Second Circuit upheld this decision. In 2011, the Supreme Court reversed the lower court decisions in this matter and returned the case to the District Court, which ordered the Company to pay substantially the same benefits as had been ordered in 2008 and denied the Company's motion to decertify the class. The parties again appealed, with the plaintiffs challenging the District Court's denial of their request to return to the prior annuity benefit plan formula, and Cigna and the Plan appealing the District Court's order and the denial of a motion to decertify the class. In December 2014, the Second Circuit upheld the District Court ruling. In January 2015, the plaintiffs filed a petition for re -hearing with the Second Circuit. The Company will continue to vigorously defend its position. Ingenix. In April 2004, the Company was sued in a number of putative nationwide class actions alleging that the Company improperly underpaid claims for out -of -network providers through the use of data provided by Ingenix, Inc., a subsidiary of one of the Company's competitors. These actions were consolidated .into Franco v. Connecticut General .Life Insurance Company, et al., pending in the U.S. District Court for the District of New Jersey. The consolidated amended complaint, filed in 2009 on behalf of subscribers, health care providers and various medical associations, asserted claims related to benefits and disclosure under ERISA, the Racketeer Influenced and Corrupt Organizations ("RICO") Act, the Sherman .Antitrust Act and New Jersey state law and seeks recovery for alleged underpayments from 1998 through the present. Other major health insurers have been the subject of, or have settled, similar litigation. In September 2011,.the District Court (1) dismissed all claims by the health care provider and medical association plaintiffs for lack of standing; and (2) dismissedthe antitrust claims, the New Jersey state law claims and the ERISA disclosure claim. In January 2013 and again in April 2014, the District Court denied separate motions by the plaintiffs to certify a nationwide class of subscriber plaintiffs. The Third Circuit denied plaintiff's request for an immediate appeal of the January 2013 ruling. As a result, the case is proceeding on behalf of the named plaintiffs only. In June 2014, the District Court granted the Company's motion for summary judgment to terminate all claims,. and denied the plaintiffs' partial motion for summary judgment. In July 2014, the plaintiffs appealed all of the District Court's decisions in favor of the Company, including the class certification decision, to the Third Circuit. The Company will continue to vigorously defend its position. Regulatory Matters Disability claims regulatory matter. During the second quarter of 2013, the Company finalized an agreement with the Departments of Insurance for Maine, Massachusetts, Pennsylvania, Connecticut and California (together, the "monitoring states") related to an examination of the Company's long-term disability claims handling practices. The agreement requires, among other things; (1) enhanced claims handling procedures related to documentation and disposition; (2) monitoring the Company's implementation of these procedures during a two-year period following the execution date of the. agreement; and (3) a reassessment of claims denied or closed during a two-year prior period, except California for which the reassessment period is three years. In connection with the terms of the agreement, the Company recorded a charge of $77 million before -tax ($51 million after-tax) in the first quarter of 2013. The charge is comprised of two elements: (1) $48 million of benefit costs and reserves from reassessed claims expected to be reopened, and' (2) $29 million in additional costs for open claims as a result of the claims handling changes being implemented. The Company is actively implementing the terms of the agreement and continues to communicate with the monitoring states on progress. If the monitoring states find material non-compliance with the agreement upon re-examination, the Company may be subject to additional costs and penalties. Most other jurisdictions have joined the agreement as participating, non -monitoring states. 483 114 CIGNA CORPORATION - 2014 Form 10-K PART II ITEM 8. Financial Statements and Supplementary Data Quarterly Financial Data (unaudiw The following unaudited quarterly financial data is presented on a consolidated basis for each of the years ended December 31, 2014 and December 31, 2013. Quarterly financial results necessarily rely heavily on estimates. This and certain other factors, such as the seasonal nature of portions of the insurance business, suggest the need to exercise caution in drawing specific conclusions from quarterly consolidated results. (In millions, except per share amounts) Consolidated Results 2014 Total revenues Income before income taxes Shareholders' net income Shareholders' net income per share: Basic Diluted 2013 Total revenues Income before income taxes Shareholders' net income. Shareholders het incgme' per'share: Basic Diluted: Stock and Dividend Data 2014 Price range of common stock — high — low Dividends declared per common share 2013 Price range of common stock - high S3.99 7�.64 $ 73.13 $ 84,68 $ 88.57 1 $ 61,88 '$ 71.12 $ Dividends declared per common share $6 03,04 $ — $ — $ — (1) The first quarter of 2013 includes an after-tax gain of$25 million for the GMIB business, an after-tax charge of$507 million for the reinsurance transaction with Berkshire to effectively exit the Run-off' Reinsurance business, and an after-tax charge of $51 million related to the disability claims regulatory matter in the Group Disability and Life segment. (2) The second quarter of 2013 includes an after-tax charge of $24 million for the Pharmacy Benefits Manager (PBM) partnering agreement with Catamaran, (3) The fourth quarter of 2013 includes an after-tax charge of $40 million far an organizational efficiency plan. Three Months Ended March 31 8,183, _S 74,. 57(1) June 30 Sept. 30 7,98Q . $ 767 .- 505V ) 0.20 1 79 0.20 1.76 • Dec. 31 8,066 $ 8,151 799, 536 553 361(3) 1.99 1.95 1,.32 1.29 484 CIGNA CORPORATION - 2014 Form 10-K 115 PART II ITEM 9. Changes in and Disagreements with Accountants on Accounting and Financial Disclosure ITEM 9. Changes in and Disagreements with Accountants on Accounting and Financial Disclosure None. ITEM 9A. Controls and Procedures A. Disclosure Controls and Procedures Based on an evaluation of the effectiveness of Cigna's disclosure controls and procedures conducted under the supervision and with the participation of Cigna's management, Cigna's Chief Executive Officer. and Chief Financial Officer concluded that, as of the end of the period covered by this report, Cigna's disclosure controls and procedures are effective to ensure that information required to be disclosed by Cigna in the reports that it files or submits under the Exchange Act is recorded, processed, summarized and reported, within the time periods specified in the SEC's rules and forms. B. Internal Control Over Financial Reporting Management's Annual Report on Internal Control over Financial Reporting Management of Cigna Corporation is responsible for establishing and maintaining adequate internal controls over financial reporting. The Company's internal controls were designed to provide reasonable assurance to the Company's management and Board of Directors that the Company's consolidated published financial statements for external purposes were prepared in accordance with accounting principles generally accepted in the United States. The Company's internal control over financial reporting includes those policies and procedures that: (i) pertain to the maintenance of records that, in reasonable detail, accurately and fairly reflect the transactions and dispositions of the assets and liabilities of the Company; (ii) provide reasonable assurance that transactions are recorded as necessary to permit preparation of financial statements in accordance with accounting principles generally accepted in the United States, and that receipts andexpenditures of the ITEM 9B. Other Information None. Company are being made only in accordance with authorization of management and directors of the Company; and (iii) provide reasonable assurance regarding prevention or timely detection of unauthorized acquisitions, use or disposition of the Company's assets that could have a material effect on the financial statements. Because of its inherent limitations, internal control over financial reporting may not prevent or detect misstatements. Management assessed the effectiveness of the Company's internal controls over financial reporting as of December 31, 2014. In making this assessment, management used the criteria set forth by the Committee of Sponsoring Organizations of the Treadway Commission ("COSO") in Internal Control -Integrated Framework (2013). Based on management's assessment and the criteria set forth by COSO, it was determined that the Company's internal controls over financial reporting are effective as of December 31, 2014. The Company's independent registered public accounting Firm, PricewaterhouseCoopers, has audited the effectiveness of the Company's internal control over financial reporting, as stated in their report located on page 60 in this Form 10-IC. 485 116 CIGNA CORPORATION - 2014 Form 10-K PART III ITEM 10. Directors and Executive Officers of the Registrant A. Directors of the Registrant The information under the captions "Corporate Governance Matters — Process for Director Elections," "— Board of Directors' Nominees," "— Directors Who Will Continue in Office" and "— Board Meetings and Committees" (as it relates to Audit Committee disclosure) in Cigna's definitive proxy statement related to the 2015 annual meeting of shareholders is incorporated by reference. B. Executive Officers of the Registrant See PART I — "Executive Officers of the Registrant" on page 28 in this Form 10-K. C. Code of Ethics and Other Corporate Governance Disclosures Cigna's Code of Ethics is the Company's code of business conduct and ethics, and applies to Cigna's directors, officers (including the Chief Executive Officer, Chief Financial Officer and Chief Accounting Officer) and employees. The Code of Ethics is posted on the Corporate Governance section found on the "About Cigna" page of the Company's website, www.cigna.com. In the event the Company substantively amends its Code of Ethics or waives a provision of the Code, Cigna intends to disclose the amendment or waiver on the Corporate Governance section of the Company's website. In addition, the Company's corporate governance guidelines ,(Board Practices) and the charters of its board committees (Audit, Corporate Governance, Executive, Finance and People Resources) are available on the Corporate Governance section of the Company's website. These corporate governance documents, as well as the. Code of Ethics, are available in print to any shareholder who requests them. D. Section 16(a) Beneficial Ownership Reporting Compliance The information under the caption "Ownership of Cigna Common Stock — Section 16(a) Beneficial Ownership Reporting Compliance" in Cigna's definitive proxy statement related to the 2015 annual meeting of shareholders is incorporated by reference. ITEM 11. Executive Compensation The information under the captions "Corporate Governance Matters — Non -Employee Director Compensation," "Compensation Matters Report of the People Resources Committee," "— Compensation Discussion and Analysis" and "— Executive Compensation Tables" in Cigna's definitive proxy statement related to the 2015 annual meeting of shareholders is incorporated by reference. 486 CIGNA CORPORATION - 2014 Form 10-K 117 PART III ITEM 12. Security Ownership of Certain Beneficial Owners and Management and Related Stockholder Matters ITEM 12. Security Ownership of Certain Beneficial Owners and Management and Related Stockholder Matters The following table presents information regarding Cigna's equity compensation. plans as of December 31, 2014: Plan Category Equity Compensation Plans Approved by Security Holclexs Equity Compensation Plans Not Approved by Security Holders Totdd' (a) (r) Securities To Be Issued Upon Exercise Of Outstanding Options, Warrants And Rights 692,08 (b) (2) Weighted Average Exercise Price Per Share Of Outstanding Options, Warrants And Rights (c) (3) Securities Remaining Available For Future Issuance Under Equity Compensation Plans (Excluding Securities Reflected In Column (a)) 6,584 92,0 ,616 584, (1) Includes, in addition to outstanding stock options, 169,963 restricted stock units, 9Z745 deferred shares and 3,093,054 strategic performance shares, which are reported at the maximum 200% payout rate. Also includes 724,329 shares of common stock underlying stock option awards granted under the HealthSpring, Inc. Amended and Restated2006Equity Incentive Plan and 18,776 shares of common stock underlying stock option awards granted under the NewQuest Holdings, Inc. 2005 Stock Option Plan, each of which was approved by the applicable company's shareholders before Cigna'.r acquisition of HealthSpring in January 2012. (2) The weighted -average exercise price is based only on outstandingstock options. The outstandingstock options assumed due to Cigna's acquisition ofHealthSpring, Inc. have a weighted -average exercise price of $17.74, Excluding these assumed options results in a weighted -average exercise price of $55.69. (3) Includes 285,176 shares of common stock available as of the close of business December 31, 2014 for future issuance under the Cigna Directors Equity Plan and 10,331,408 shares of common stock available as of the close of business on December 31, 2014 for future issuance under the Cigna Long -Term Incentive Plan. The information under the captions "Ownership of Cigna Common Stock — Stock held by Directors, Nominees and Executive Officers" and "Ownership of Cigna Common Stock — Largest Security Holders" in Cigna's definitive proxy statement related to the 2015 annual meeting of shareholders is incorporated by reference. ITEM 13. Certain Relationships and Related Transactions The information under the captions "Corporate Governance Matters — Director Independence" and "— Certain Transactions" in Cigna's definitive proxy statement related to the 2015 annual meeting of shareholders is incorporated by reference. ITEM 14. Principal Accounting Fees and Services The information under the captions "Audit Matters -• Policy for the Pre -Approval of Audit and Non -Audit Services" and "— Fees to Independent Registered Public Accounting Firm" in Cigna's definitive proxy statement related to the 2015 annual meeting of shareholders is incorporated by reference. 487 118 CIGNA CORPORATION - 2014 Form 10-K PART 1Y ITEM 15. Exhibits and Financial Statement Schedules (a) (1) The following Financial Statements appear on pages 60 through 114 Report of Independent Registered Public Accounting Firm. Consolidated Statements of Income for the years ended December 31, 2014, 2013 and 2012.. Consolidated Statements of Comprehensive Income for the years ended. December 31, 2014, 2013 and 2012, Consolidated Balance Sheets as of December 31, 2014 and 2013. Consolidated Statements of Changes in Total Equity for the years ended December 31, 2014, 2013 and. 2012. Consolidated Statements of Cash Flows for the years ended December 31, 2014, 2013 and 2012. Notes to the Consolidated Financial Statements. (2) The financial statement schedules are listed in the Index to Financial Statement Schedules on page FS'-1. 488 CIGNA CORPORATION - 2014 Form 10-K 119 PART IV ITEM 15. Signatures Signatures Pursuant to the requirements of Section 13 or 15(d) of the Securities Exchange Act of 1934, the registrant has duly caused this report to be signed on its behalf by the undersigned, thereunto duly authorized. CIGNA CORPORATION Date: February 26, 2015 By:. /s/ Thomas A. McCarthy Thomas A. McCarthy Executive Vice President and Chief Financial Officer (Principal Financial Officer) Pursuant to the requirements of the Securities Exchange Act of 1934, this report has been signed below by the following persons on behalf of the registrant: and in the capacities indicated as of February 26, 2015. Signature Title Chief Executive Officer and Director (Principal Executive Officer) Executive Vice President and Chief Financial Officer::: (Principal Financial Officer) Vice President and Chief Accounting Officer (Principal Accounting Officer) Is/ David M Cordani David M. Cordani /s/ Thomas A, McCarthy Thomas A. McCarthy /s/ Mari T Hoeltzel. Mary T. Hoeltzel /s/ Eric J. Foss Eric J. Foss Is/ Michelle D. Gass Michelle D. Gass Is/ Isaiah Harris, Jr.. Isaiah Harris, Jr. Is/ Jane E. Henney, M.D. Jane E. Henney, M.D. /s/ Roman Mariinez_N Roman Martinez IV is/ John M. Partridge John M. Partridge /s/ James"E. Rogers James E. Rogers /s/ Eric C. Wiseman Eric C. Wiseman /si Donna P. Zarcone Donna F. Zarcone /s/ William D Collars ;. Director Director Chairman of the Board • Director Director Director Director Director William D. Zollars Directo Director 489 120 CIGNA CORPORATION - 2014 Form 10-K INDEX TO FINANCIAL STATEMENT SCHEDULES ITEM 15. Exhibits and Financial Statement Schedules Cigna Corporation and Subsidiaries INDEX TO FINANCIAL STATEMENT SCHEDULES PAGE Report of Independent Registered Public Accounting Firm on Financial Statement Schedules FS-2 Schedules I — Summary of Investments — Other Than Investments in Related Parties as of December 31, 2014 FS-3 II — Condensed Financial Information of Cigna Corporation (Registrant) FS-4 III — Supplementary Insurance Information FS-9 IV — Reinsurance FS-11 V — Valuation and Qualifying Accounts and Reserves FS-12 Schedules other than those listed above are omitted because they are not required or are not applicable, or the required information is shown in the financial statements or notes thereto. 490 CIGNA CORPORATION - 2014 Form 10-K PS-1 PART IV ITEM 15. Report of Independent Registered Public Accounting Firm on Financial Statement Schedules pwc Report of Independent Registered Public Accounting Firm on Financial Statement Schedules To the Board of Directors and Shareholders of Cigna Corporation Our audits of the consolidated financial statements and of the effectiveness of internal control over financial reporting referred to in our report dated February 26, 2015 (which report and consolidated financial statements are included under Item 8 in this Annual Report on Form 10-K) also included an audit of the financial statement schedules listed in Item 15(a)(2) of this Form 10-K. In our opinion, these financial statement schedules present fairly, in all material respects, the information set forth therein when read in conjunction with the related consolidated financial statements. /s/ PricewaterhouseCoopers LLP Philadelphia, Pennsylvania February 26, 2015 491 • FS-2 CIGNA CORPORATION - 2014 Form 10-K PART IV ITEM 15. Exhibits and Financial Statement Schedules Cigna Corporation and Subsidiaries Schedule I -- Summary of Investments — Other Than Investments in Related Parties December 31, 2014 Type of Investment (In millions) Fixed maturities: Bonds: United States government and government agencies and authorities • States, municipalities and political subdivisions Foreign governntents - Public utilities All other corporate bonds Asset backed securities: . Mortgage -backed Other asset -backed Redeeni'able preferred stocks" TOTAL FIXED MATURITIES Equity securittes; ' i Common stocks; Indnstrlal,. mscellatxeous and all other Non -redeemable preferred stocks TOTAL EQUITY SECURITIES Commercial mortgage loans on real estate Policy loans' Other long-term investments Short-term investments TOTAL INVESTMENTS Cost 608 1,682 1,824' ' 1,940. 437 447 12,042 • 13,012 Fair Value 83 564 38 17,278 11,1 88 199 2,081 1438, 1,494 163 $ 22,653 954 1,856 85 650 18,983 76 189 Amount at which shown in the Consolidated Balance Sheet 954 1,856 1,94Q 447 13,012 85 650 39• 18,983 76 189 2,081 1,438 1,488 163 24,342 492 CIGNA CORPORATION -2014 Form 10-K FS-3 PART IV ITEM 15. Exhibits and Financial Statement Schedules Cigna Corporation and Subsidiaries Schedule II — Condensed Financial Information of Cigna Corporation — (Registrant) Statements of Income (In millions) Operating expenses: Interest Intercompany interest Other TOTAL OPERATING EXPENSES Loss before income taxes Income tax benefit Loss of parent company Equity iri income of subsidiaries SHAREHOLDERS' NET INCOME Shareholders' other comprehensive income (loss) Net unrealized appreciation (depreciation) on securities Net unrealized appreciation (depreciation,), derivatives Net translation of foreign currencies Postiedremen't benefits ltabdity adjustment, For the years ended December 31, 2014 2013 2012 69 335' (335)„ 1,476 Shareholders' other comprehensive income (loss) (4) 151 SHAREHOLDERS' COMPREHENSIVE INCOME See Notes to Financial Statements on the following pages, 262 190 452 (452) (143) (309) 1;932 1,623 147 (5) 66 (92) 116 493 FS-4 CIGNA CORPORATION - 2014 Form 10-K PART IV ITEM 15. Exhibits and Financial Statement Schedules Cigna Corporation and Subsidiaries Schedule II — Condensed Financial Information of Cigna Corporation (Registrant) Balance Sheets (In millions) ASSETS: • • ' • ", Cash and cash equivalents Investments in subsidiaries . Intercompany Other assets TOTAL ASSETS Intercompany • Short-term debt • Long-term debt Other liabilities , TOTAL LIABILITIES SHAREHOLDERS' EQUITY: , • ' ' Common stock (shares issued, 296; authorized, 600) Additional paid -In capital Accumulated other comprehensive loss Retained earnings • Less treasury stock, at cost TOTAL SHAREHOLDERS' EQUITY TOTAL LIABILITIES AND SHAREHOLDERS' EQUITY See Notes to Financial Statements on the fbllowing pages. f• As of December 31, 2014.. •-• •-• • - • $ 2013 16,932 40 435 $ 17,407 1,043 .1 .."t. • 100 4,871 826 6,840. 92 , 3,356 (520) 13,676 ...„; (6,037) iteglialuott# • :r....:10;567 tatatiVitigar$ 17,407 494 CIGNA CORPORATION - 2014 Form 10-K FS-5 PART IV ITEM 15. Exhibits and Financial Statement Schedules Cigna Corporation and Subsidiaries Schedule II — Condensed Financial Information of Cigna Corporation (Registrant) Statements of Cash Flows For the years ended December 31, (In millions) Cash Flows from Operating Activities. Shareholders' Net Income Adjustments to reconcile Sharchoicler'S' net income to net cash provided by operating activities: Equity in income of subsidiaries Dividends received • • • ' Other liabilities Other, net - Net cash provided by operating activities 98 340 Cash Flows.froM Itriesting • Other, net (19) Net : Cash provided ' Cash Flows from Financing Activities: Net -Change n amounts due to / Venn ffdiates Net change in short-term debt Issuance of Ceinuri.on stock. - Common dividends paid Repurchase of cothmon stock Net cash used in financing activities Net increase (decrease) in eitiliia.CaSh equivalents Cash and cash equivalents, beginning of year Cash and cash Oubialents; end ofyear See Notes to Financial Statements on the following pages. Pr 2014 2013 2012 1,476 $ 1,623 (1,702) (1,932) 506 671 (245) (213) (100) 100 • (it) (11) 00, (213) (115) 115 115 495 FS-6 CIGNA CORPORATION - 2014 Form 10-K PART IV ITEM 15. Exhibits and Financial Statement. Schedules Cigna Corporation and Subsidiaries Schedule II ®- Condensed Financial Information of Cigna Corporation (Registrant) Notes to Condensed Financial Statements The accompanying condensed financial statements should be read in conjunction with the Consolidated Financial Statements and the accompanying notes thereto contained in this Form 1.0-K. Note 1— For purposes of these condensed financial statements, Cigna Corporation's (the "Company") wholly -owned and majority -owned subsidiaries are recorded using the equity basis of accounting. Note 2 — Short-term and long-term debt consisted of the following at December 31: an millions) Short term Commercial Paper TOTAL SHORT-TERM DEBT, Long-term: Uncollateralized debt: $600 million, 2.75% Notes due 2016 $250 million, 5.375% Notes: due 2017 $131 million, 6.35% Notes due 2018 $251 minion, 8.5% Notes due 2019 $250 million, 4.375% Notes due 2020(1) $300 million, 5.125% Notes due 202Q(0 $300 million, 4.5% Notes due 2021(1> $750 million, 4% Notes due 2022 $100 million, 7.65% Notes due 2023 $17 tttillion, 8.3%Notes due 2023. $300 million, 7.875% Debentures due 2027 $83 million, 8 3%Step Dowii Notes due 2033 $500 million, 6.15% Notes due 2036 $300 million, 5.875% Notes due 2041 $750 million, 5.375% Notes due 2042 TOTAL LONG-TERM DEBT (1) In 2014, the Company entered into interest rate swap contracts hedging a portion of these fixed-rate debt instruments, In December, 2014, the Company entered into an updated revolving credit and letter of credit agreement for $1.5 billion, that permits up to $500 million to be used for letters of credit. This agreement extends through December 2019 and is diversified among 16 banks, with three banks each having 12% of the commitment and the remainder spread among 13 banks. The credit agreement includes options, subject to consent by the administrative agent and the committing banks, to increase the commitment amount to $2 billion and to extend the term past December 2019. The credit agreement is available for general corporate purposes, including for the issuance of letters of credit. This agreement has certain covenants, including a financial covenant requiring the Company to maintain a leverage ratio of total consolidated debt -to -consolidated capitalization. (each as defined in the credit agreement) at or below 0.50. As of December 31, December 31, 2014 December 31, 2013 100 100 600 250 131 251 249 299 299 744 100 17 300 83 500 298 750 4,871 2014, the Company had $6.5 billion of borrowing capacity within the maximum debt coverage covenant in the agreement, in addition to the $5.2 billion of debt outstanding. Letters of credit outstanding as of December 31, 2014 totaled $23 million. The Company was in compliance with its debt covenants as of December 31, 2014. Maturities of debt are as follows (in millions): none in 2015, $600 in 2016, $250 in 2017, $131 in 2018, $251 in 2019 and the remainder in years after 2019. Interest expense on long-term and short-term debt was $258 million in 2014, $264 million in 2013, and $262 million in 2012. Interest paid on long-term and short-term debt was $252 million in 2014, $259 million in 2013, and $242 million in 2012. 496 CIGNA CORPORATION - 2014 Form 10-K FS-7 PART IV ITEM 15. Exhibits and Financial Statement Schedules Note 3 — Intercompany liabilities consist primarily of loans payable to Cigna Holdings, Inc. of $877 million as of December 31, 2014 and $1,043 million as of December 31, 2013. Interest was accrued at an average monthly rate of 0.52% for 2014 and 0.59% for 2013. Note 4 —As of December 31, 2014, the Company had guarantees and similar agreements in place to secure payment obligations or solvency requirements of certain wholly -owned subsidiaries as follows: • The Company has arranged for bank letters of credit in the amount of $4 million to provide collateral in support of its indirect wholly - owned subsidiaries. • Various indirect, wholly -owned subsidiaries have obtained surety bonds in the normal course of business. If there is a claim on a surety bond andthe subsidiary is unable to pay, the Company guarantees payment to the company issuing the surety bond. The aggregate amount of such surety bonds as of December 31, 2014 was $79 million. • The Company is obligated under a $6 million letter of credit. required by the insurer of its high -deductible self-insurance programs to indemnify the insurer for claim liabilities that fall within deductible amounts for policy years dating back to 1994. • The Company also provides solvency guarantees aggregating $34 million under state and federal regulations in support of its indirect wholly -owned medical HMOs in several states. • The Company has arranged a $13 million letter of credit in support of Cigna Europe Insurance Company, an indirect wholly -owned subsidiary. The Company has agreed to indemnify the banks providing the letters of credit in the event of any draw. Cigna Europe Insurance Company is the holder of the letters of credit. • The Company has agreed to indemnify payment of losses included in Cigna Europe Insurance Company's reserves on the assumed reinsurance business transferred from ACE. As of December 31, 2014, the reserve was $22 million. In 2014, no payments have been made on these guarantees and none are pending The Company provided other guarantees to subsidiaries that, in the aggregate, do not represent a material . risk to the Company's results of operations, liquidity or financial condition. FS-8 CIGNA CORPORATION - 2014 Form 10-K 497 (This page has been left blank intentionally.) 498 PART IV ITEM 15. Exhibits and Financial Statement Schedules Cigna Corporation and Subsidiaries Schedule III — Supplementary Insurance Information (In millions) Segment Year Ended December 31, 2014: Global Health Care Global Supplemental Benefits Group Disability and Life Other Operations Corporate Deferred policy acquisition costs TOTAL -' 0 Future policy benefits and contractholder deposit funds Medical claims payable and unpaid claims Unearned premiums Year Ended December 31, 2013: Global Health Care Global Supplemental Benefits Group Disability arid Life Other Operations Corporate` i97 ' $ : 2050 c :.$ 116 2,525 305 419 1,615 3,739 • 23 13,439 260 22 (6). • TOTAL Year Ended December 31, 2012: Global Health Care Global Supplerental Benefits Group Disability and Life Other •Operations' Corporate 1,395 19 1,113 1 65 17,776 6,348 $ 580 175 $ 1,856 $ 111 2,227 366 388 1,599 3,482 26 13,772 295 24 — (21) TOTAL 8. 5,918 • 549 499 FS-9 CIGNA CORPORATION - 2014 Form 10-K PART IV ITEM 15. Exhibits and Financial Statement Schedules Premiums (i) Yeac•Ended Decembei 31, 2014 Global Health Care r>; Global, Supplemental Benefits Group Disability and Life Other. Operations Corporate Net investment income (2) Benefit expenses (1)(3) Amortization of deferred policy acquisition expenses Other operating expenses (4) TOTAI 87 Year Ended December 31., 2013: Giohal Health Gate Global Supplemental Benefits Group Disability acid Life.;, Other Operations Corpor"ate.. , ., TOTAL Year• Ended December 31, 2012 Global Health Care Global Supplemental Benefits Group Disability and Life Other Operations Corporate TOTAL 19626 ; $ 325 2,496 100 3348 321 105 408 10 15,.867 1,310 2,621 , 1,067 25,575 $ 1,164 $ 20,865 17,877 $ 259 '•• 1,9,75 • 90 3,044 300 121 :' 14,228 1,005 2,290 490 377 5 178 7,021 924 •;1 .-765 46 328 7 255 9,084 68 $. 6,573 141 770 3 721 G 2 458 '23,017 $ ' 1,144 $ 17,900 $ 218 $ 8,524 (1) Amounts presented are shown net of the effects of reinsurance: See Note 7 to the Consolidated Financial Statements included in this Form 10-K. (2) The allocation of net investment income is based upon the investment year method the identification of certain portfolios with specific segments, or a combination of both, (3) Benefit expenses include Global Health Care medical claims expense and other benefit expenses. (4) Other operating expenses include mail order pharmacy costs and other operating expenses, and excludes amortization of deferred policy acquisition expenses, 500 CIGNA CORPORATION - 2014 Form 10-K FS-10 PART IV ITEM 15. Exhibits and Financial Statement Schedules Cigna Corporation and Subsidiaries Schedule IV — Reinsurance (In millions) Year Ended December. 31, 2014: Life insurance in force Premiums Life insurance and annuities Accident and health insurance TOTAL Year Eried Deeemher 3i, 2013;• Life insurance in force Gross amount Percentage Ceded to other Assumed from of amount companies other companies Net amount assumed to net 781,053 $ 59,003 3,459 $ 725,509 4 0.5% Premiums: Life insurance and annuities Accident and health insurance' • TOTAL Year Ended December'31, 2012: Life insurance in force 2,140 $_ 23,401 25,541 710,140 279 $ 264 543 $ 48,702 28 $ 1,889 549 23,686 577 $ 25,575 4,435 $ 665,873 1.5% 2.3% 2.3% 0.7% Premiums Life insurance and annuities Accident and health insurance TOTAL 2,013 $ 268 21,00.1' .200 23,014 $ 468 $ 29 $ 1,774 1.6% 442 21,243:- ; 21% 471 $ 23,017 2.1% FS-11 CIGNA CORPORATION - 2014 Form 10-K 501 PART IV ITEM 15. Exhibits and Financial Statement Schedules Cigna Corporation and Subsidiaries Schedule V Valuation and Qualifying Accounts and Reserves Charged Charged Balance at (Credited) (Credited) (In millions) beginning of to costs and to other Other Balance at Description Year expenses accounts deductions(1) end of year 2014: Investment asset valuation reserves: Commercial mortgage loans Allowance for doubtful accounts: Premiums, accounts and notes receivable Deferred tax asset valuation allowance Reinsurance recoverables 2013: Investment asset valuation reserves; Commercial mortgage loans Allowance for doubtful accounts: Premiums, accounts and notes receivable Deferred tax asset: valuationallowance Reinsurance recoverables 7 $ 51 $ 42 $. 4 $ 4 $. N,, . $ — $ (2) $ 7 $ — $ — $ (3) . $ 8 (6) $ 43 — $ -49 - $ 4 Investment asset valuation reserves: Commercial mortgage loans $ 19 $ 10 $ — $ (22) $ 7 Allowance for doubtful accounts: Premiums, accounts and notes receivable $ 45 $ 4 $ 1 $ 1 $ 51 Deferred tax asset valuation allowance $ 45 $ 4 $ (7) $ — $ 42 Reinsurat ce recoverables. • '$ , ;:. .5 $ . (1) $ .. — .` $ — $r, 4 (1) Amounts for commercial mortgage loans primarily reflect charge-o fs upon sales and repayments, as well as transfers to foreclosed real estate. 2012 amount also includes restructures reclassified to Other Long-term Investments. 502 CIGNA CORPORATION - 2014 Form 10-K FS-12 (This page has been left blank intentionally.) 503 PART IV ITEM 15, Exhibits and Financial Statement Schedules Index to Exhibits Number Description Method of Filin 3,1 Restated Certificate of Incorporation of the registrant as last 1 ilcd as Exhibit 3.1 to the registrant's Form 10-Q for the quarterly amended October 28, 2011 period ended September 30, 2011 and %neorporated herein by 3.2 By -Laws of the registrant as last amended and restated December 6, Filed as Exhibit 3.2 to the registrant's Form 10-K for the year ended 2012 December 31, 2012 and incorporated herein by reference, 4,1(a) Indenture dater; Au16, 2006 Between Cigna Fi Corporation and la ed s Exhibit 4,1(a) to the registrants Form 10-K for the year U,S, .Bank Natiogustnal Association ended December° 31,,:2012 and incorporated herein by reference, -: (b) Supplemental Indenture No. 1 dated November 11, 2006 between Filed as Exhibit 4,1(6) to the registrant's Form 10-K for the year Cigna Corporation and U.S.Bank National Association ended December 31, 2012 and incorporated herein by reference. (c) Supplemental Indenture No 2 dared March 15, 2008 between Cigna Filed as Exhibit 4 1(c) to the registrants Bonn:,}Q-,Q for the Corporation and US,Bank 1' tional Association quarterly period ended March 31 2011 and incorporated herein by, :t;. .. "reference (d) Supplemental Indenture No. 3 dated March 7, 2008 between Cigna Filed as Exhibit 4,1 to the registrant's Form 8-K on March 10, 2008 Corporation and U S Bank National Association and incorporated herein by reference, (e) Supplemental Indenture N0 4 dated May 7s' 20Q9 between Cigna Exh Filed as ibit 99 2, to the registrants Form 8-IK on May 12, 2009 Corporation: and. U $ Bank National Association and incorporated herein by reference , (f) Supplemental Indenture No. 5 dated May 17, 2010 between Cigna Filed as Exhibit 99.2 to the registrant's Form 8-K on May 28, 2010 Corporation and U.S. Bank National Association and incorporated herein by reference. (g) Supplemental Incienttiue No 6 dated December 8; 2010 between Filed as Exhibit 99.2-to•the registrant's Form 8-K bn December 9, .Cigna .Corporation and CJ,S: Bank National Association 2010 and 'incorporated herein: liy rreference,; (h) Supplemental Indenture No, 7 dated March 7, 2011 between Cigna Filed as Exhibit 99.2 to the registrant's Form 8-K on March 8, 2011 Corporation and U S. Bank National Association and incorporated herein by reference. (i) • $upplemental Indenture" No 8, dated Noveinber)10, 2011 between ' Filed as Exhibit 4.1 to•the tegi'straht's Form 8-K on November 14, Cigna: Corporation and U,S. Bank National Associated•: 2011 and incorporated herein; ,by. reference, . 4.2 ' Indenture dated January 1, 1994 between Cigna Corporation and Filed as Exhibit 4,2 to the registrant's Form 10-K for the year ended Marine Midland Bank December 31, 2009 and incorporated herein by reference. 4,3 Indenture dated; June 30;;;1988 between Cigna Corporation and Filed as Exhibit 4,3 to the registrant's Form 10-K for the year ended Batiices Trust k December 31,-2009'and incorporated herein by reference. Exhibits 10.1 through 10.31 are identified as compensatory plans, management contracts or arrangements pursuant to Item 15 of Form 10-K. 10.1 Deferred Coinpensation,Plan. for. Director`s of Cigna Corporation, as Filed as Exhibit 10,1., to the registrant's. Form 10-1< for the year amended and restated January 1;.1997 ' ended December 31 20I.1'and incorporated herein by reference, 10.2 Deferred Compensation Plan of 2005 for Directors of Cigna Filed as Exhibit 10.2 to the registrant's Form 10-K for the year Corporation, amended and restated effective April 28, 2010 ended December 31, 2010 and incorporated herein by reference. 10.3 Cigna.`Goipotation nm NoEployee Director Compensation Program Filed as Eidiibit 10 i'to the registrant's Form 1Q Q for the quarterly amended 04 restated effective February 26r 2014 " period ended Mardi; 31, 2014.acid Incorporated herein by reference. 10.4 Cigna Restricted Share Equivalent Plan for Non -Employee Directors Filed as Exhibit 10,4 to the registrant's Form 10-K for the year as amended and restated effective January 1, 2008 ended December 31, 2012 and incorporated herein by reference. 10.5 Cigna'Corpn anon Drrecfor Ecniity Flan ,• Filed as .F.ichibit 10 3•.to the registrant's Form 10 0 for the quarterly period ended Maran ch` 31, 2010'dincorporated herein by reference. 10,6 Cigna Corporation Stock Plan, as amended and restated through July Filed as Exhibit 10.7 to the registrant's Form 10-K for the year 2000 ended December 31, 2009 and incorporated herein by reference. 10.7 (a) Cigna Stock Unit Plant as' amended. and restated effective July 22, Filed as .Exhibit 10 1;_to the registrant's Form iQ Q for the quarterly. 2008.:; period ended September $0 20Q8 and incotpocaxed herein by reference. (b) Amendment No, 1 to the Cigna Stock Unit Plan, as amended and Filed as Exhibit 10.3 to the registrant's Form 10-Q for the quarterly restated effective July 22, 2008 period ended June 30, 2010 and incorporated herein by reference, 10,8 Cigna Executive -Severance Benefits Plan as amended and restated Filed as Exhibs 10,2 to the registrant's Form 10-Q for the. quarterly effective April 27, 2010 period ended June, 303' 2010 and incorporated Herein by reference. 10,9 Description of Severance Benefits for Executives in Non -Change of Filed as Exhibit 10.10 to the registrant's Form 10-K for the year Control Circumstances ended December 31, 2009 and incorporated herein by reference. 10,10 Cigna Executive Incentive Flan amended and. restated as of Filed as Exhibit 10 1i to the regiserants Form 10Q for the quarterly January 12t 201:2 period ended Mardi 31, 2•012 and incorporated laeein by reference; 10.11 (a) Cigna Long -Term Incentive Plan as amended and restated effective as Filed as Exhibit 10,2 to the registrant's Form 10-Q for the quarterly of April 28, 2010 period ended March 31, 2010 and incorporated herein by reference. (b) Amendment No, 1 to the Cigna Long -Term Incentive Plan as : Filed as Exhibit 10,1; to the registrant's )form 10; Q for the quarterly amended and restated effective as of April 28, 2010 period ended; Jnne 30 ,2010 and incorporated herein by reference, ;. (c) Amendment No, 2 to the Cigna Long -Term Incentive Plan as Filed as Exhibit 10.1 to the registrant's Form 10-Q for the quarterly amended and restated effective as of April 28, 2010.period ended March 31, 2011 and incorporated herein by reference. 10.12 Cigna Deferred Compensation Plan, as .amended and restated , Filed as Exhibit 10,14 to the; registrants Form 10:-K for t1e year. •y October 24, 2001 ended December 31i 2011'andincorporated herein by reference. 10.13 Cigna Deferred Compensation Plan of 2005 effective as of Filed as Exhibit 10.15 to the registrant's Form 10-K for the year January 1, 2005 ended December 31, 2012 and incorporated herein by reference. 504 CIGNA CORPORATION - 2014 Form 10-K E-1 PART N ITEM 15. Exhibits and Financial Statement Schedules Number Description 10.14 (a) Cigna Supplemental Pension Plan as amended and restated effective August 1, 1998 Amendment No. 1 to the Cigna Supplemental Pension Plan, amended and restated effective as of September 1, 1999 Amendment No. 2 dated December 6, 2000 to the Cigna Supplemental Pension Cigna Supplemental Pension Plan of 2005 effective as of January 1,. 2005 Amendment No. 1 to the Cigna Supplemental Pension Plan of 2005 10,16 Cigna Supplemental 401(k) Plan effective January 1, 2010 10.17 Description of Cigna Corporation FinancialServices Program 10.18 Form of Cigna Long -Term Incentive Plan: Nonqualified Stock Option Grant Agreement 10.19 Form of Cigna Long -Term Incentive; Plan, Restricted Stock Grant Agreement 10.20 Form of Cigna Long -Term Incentive Plan: Restricted Stock Unit Grant Agreement 10,21 Form of Cigna Long -Term Incentive Plan Strategic Performance..: Share Grant Agreement , '"'' 10,22 Schedule regarding Amended Deferred Stock Unit Agreements effective December 31, 2008 with John M. Murabito and Form of Amended Deferred Stock Unit Agreement Nicole Jones' Offer of Employment' dated April 27, 2011 10.23 10,24 Matthew Manders' Promotion Letter dated June 2, 2014 10.25 Thomas A. IvlcCarthys Offer Letterdated May p 2013. 10.26 (a) Retention Agreement with Herbert Frisch dated October 24, 2011 (b) Agreement dated December 7 2011.with Herbert Frisch 4t (c) Retention Agreement with Herbert Fritch dated September 15, 2014. HeahhSpring, the Amended and Restated 2006 Equity Incentive: Plan (the. `HealthSpring Equity, Incentive Plan ) 10,27 10.28 10 29 10,30 10,31 10,32 12 21 23 31.1 HealthSpring Equity Incentive Plan; Form of Restricted Share Award HealthSpring Equity Incentive Plan Form of Non -Qualified Stock Option l�gteetatent Ralph Nicoletti's Offer of Employment dated April 27, 2011 Agreement and Release with Ralph J Nicoletti dated July 10, 2013 Master Transaction Agreement, dated February 4, 2013 among Connecticut General Life Insurance Company, Berkshire Hathaway Life Insurance Company of Nebraska and, solely for purposes of Sections 3.10, 6.1, 6.4, 6.6, 6.9 and Articles II, \, VII, and VIII, thereof, National Indemnity Company (including the Forms of Retrocession Agreement, the Collateral Trust Agreement, the Security and Conrail Agreement, the Surety Policy and the ALC Model Purchase Option Agreement as exhibits) Computation of Ratios of. Earnings to Fbce<l.'Charges Subsidiaries of the Registrant Consent of Independent tegisterel'Public Accouhting%Firm Certification of Chief Executive Officer of Cigna Corporation pursuant to Rule 13a-14(a) or Rule 15d-14(a) of the Securities Exchange Act of 1934 31.2 , Certification of'Ghief Financial Officer of Cigna Corporation pursuant to Rule 13a',14'(a) or Rule, J 5d 14'(a)of the Securities Excharige Act` of 1934 ' 32,1 Certification of Chief Executive Officer of Cigna Corporation pursuant to Rule 13a-14(b) or Rule 15d-14(b) and 18 U,S.C. Section 1350 Method of Filing Filed as Exhibit 10.15(a) to the registrant's Form 10-K for the year ended December 31, 2009 and incorporated herein by reference. Filed as Exhibit 10.15(6) to the registrant's Form 10-K for the year ended December 31, 2009 and incorporated herein by reference. Filed as Exhibit 10.16(c) to the registrant's Form:10-K for the year ended December 31 2011 and incorporated herein by reference. Filed as Exhibit 10.15 to the registrant's Form 10-K for the year ended. December 31, 2007 and incorporated herein by reference. •Filed as Exhibit 1.0,1 to the registrant's Form 10 •Q for the quarterly period ended June 30 .2009 .and incorporated herein by reference. Filed as Exhibit 10,17 to the registrant's Form 10-K for the year ended December 31, 2009 and incorporated herein by reference. Filed as Exhibit 10.18 to, the registrant's Form 10-1C for the year ended December 31,'2009 and incorporated herein by reference. Filed as Exhibit 10.2 to the registrant's Form 10-Q for the period ended March 31, 2014 and incorporated herein by reference, Filed as Exhibit 10,3 to the registrant's Form 10 Q. for the period ended March 31, 2014 and incorporated herein by'r.'eference Filed as Exhibit 10.4 to the registrant's Form 10-Q for the period ended March 31, 2014 and incorporated herein by reference. • Filed as Fxh bit 10 5 to the reg"istrants Form 10 Q-,for the period • ended March 31 2014 and Incorporated he"rein by` reference. Filed as Exhibit 10.20 to the registrant's Form 10-K for the year ended December 31, 2008 and incorporated herein by reference. Filed as Exhubit 10 2 to the registrants Form 10 Q for the period ended March 31, ;2012 and in`c'orporared`hetein by"reference. Filed as Exhibit 10.1 to the registrant's Form 8-K filed on June 4, 2014 and incorporated herein by reference Filed as Exhibit 10.1 to the registrant's Form $-K filed on may 13, 2013 aril i corpor'ated herein by.reference. • Filed as Exhibit 10,1 to the registrant's Form. 10-Q for the period ended March 31, 2013 and incorporated herein by reference, Filed as Exhibit 10 2 fo the registrants Form 1Q Q for the period 'ended Match 31 `2013 and incorporated, :hcrein by`reference; Filed as Exhibit 10.1 to the registrant's Form. 8-K filed on September 19 2014 and incorporated herein by reference. Filed,as Exhibit 10 3 o the registrants Form 10•Q for the period ended Ivlarch 3.1, 20`f3 and lncorPor'ated •Herein b'y reference; Filed as Exhibit 10.4 to the registrant's Form 10-Q for the period ended March 31, 2013 and incorporated herein by reference. Filed as Exlibif 10 5 to the registrants Porm 10 Q for the period ended March 31, 2013 andincorporatedherein by'reference " Filed as Exhibit 10.1 to the registrant's Form 8-K filed on May 31, 2011 and incorporated herein by reference Filed as Exhibit 101to the `regist rant Form 8-1C, filed 'on July 17, 2013 and incorporated hereinby reference: Filed as Exhibit 10.29 to the registrant's Forrn 10-K for the year ended December 31, 2012 and incorporated herein by reference. Filed herewith. Filed herewith. Filed herewith. Filed herewith. Filed herewith. Furnished herewith. 505 E-2 CIGNA CORPORATION - 2014 Form 10-K PART IV ITEM 15. Exhibits and Financial Statement Schedules Number 32.2 101 Description Method of Filing Certification of Chief Financial Officer of Cigna, Corporation pursuant to Rule 13a-14(b) or Rule 15d-14(b) and 18 U.S.C. Section 1350; The following materials from Cigna Corporation's Annual Report on Form 10-K for the year ended December 31, 2014, formatted in XBRL (Extensible Business Reporting Language); (i) the Consolidated Balance Sheets; (ii) the Consolidated Statements of Income; (iii) the Consolidated Statements of Comprehensive Income; (iv) the Consolidated Statements of Cash Flows; (v) the Consolidated Statements of Changes in Total Equity; (vi) the Notes to Consolidated Financial Statements and (vii) Financial Statement Schedules I, II, III, IV and V. Furnished herewith. Filed herewith. The registrant will furnish to the Commission upon request of any other instruments defining the rights of holders of long-term debt. Shareholders may obtain copies of exhibits by writing to Cigna Corporation, Shareholder Services Department, 1601 Chestnut Street, Philadelphia, PA 19192. 506 CIGNA CORPORATION - 2014 Form 10-K E-3 PART IV ITEM 15. Exhibits and Financial Statetnent Schedules EXHIBIT 12 Cigna Corporation — Computation of Ratio of Earnings to Fixed Charges (Dollars in millions) Year Ended December 31, Income before income taxes Adjustments; • Income from equity investee (Income) loss attributable to noncontrolling interests Income before income taxes, as adjusted Fixed charges included in income; Interest eXPense.• • • '•• • • • Interest portion of rental expense Interest credited to contramholders • Income available for fixed charges RATIO OF EARNINGS TO FIXED CHARGES: 2014 2013 2012 2011 2010 $ 2,176 $ 2,477 $ 1,876 $ 1,802 (17) (10) • (15) (18) (3) (1) (1) (4) 41_ $ ;1,780 '40 -• . . $ • 270 -$ .268 $ - ,202 $ • 182 38 43 38 42 5 • . • "4 ..•-••:• • - 5 $ 313 $ 315 $ 245 $ 229 2,469 $ 2,781 $ 2,105 $ 2,009 7.9 8.8 8.6 8.8 507 E-4' CIGNA CORPORATION - 2014 Form 10-K PART IV ITEM 15. Exhibits and Financial Statement Schedules Exhibit 21 Subsidiaries of the Registrant Listed below are subsidiaries of Cigna Corporation as of December 31, 2014 with their jurisdictions of organization. Those subsidiaries not listed would not, in the aggregate, constitute a "significant subsidiary" of Cigna Corporation, as that term is defined. in Rule 1-02(w) of Regulation S-X, Entity Name Jurisdiction Allegiance Life & Health Insurance Company, Inca Allegiance Re, Inc. American Retirement Life Insurance Company Benefits Management Corp. Bravo Health Mid-Atlantie,< Inc, Bravo Health of Pennsylvania, Inc. Bravo Health, LLC Central Reserve Life Insurance Company Ceres Sales of Ohio, LLC • Cigna & CMB Life Insurance Company Limited Cigna Alder Holdings, LLC Cigna Apac Holdings Limited Cigna Arbor Life Instil -mice Company_• Cigna Beechwood Holdings, MTS Cigna Behavioral Health of California,. Inc. Cigna Behavioral Health of Texas, Inc. Cigna Behavioral.: Health, Inc. Cigna Bellevue Alpha, LLC Cigna: Benefits Financing; Inc, Cigna Brokerage & Marketing (Thailand) Limited Cigna Chestntit Holdings; Cigna Corporate Services, LLC Cigna Data Services (Shanghai) Company Limited Cigna Dental Health of California, Inc. Cigna Dental Health of Colorado, Inc.. Cigna Dental Health of Delaware, Inc. Cigna Dental Health of Florida, Inc; Cigna Dental Health of Illinois, Inc. Cigna Dental Health, of Kansas; Inc, Cigna Dental Health of Kentucky, Inc. Cigna Dental Health of Maryland, Inc; Cigna Dental Health of Missouri, Inc. Cigna Dental Health of New Jersey, Inc Cigna Dental Health of North Carolina, Inc. Cigna Dental Health of Ohio, Inc:. . Cigna Dental Health of Pennsylvania, Inc. Cigna Dental Health of °Iecas, Inc: Cigna Dental Health of Virginia, Inc, Cigna Dental Health Plait ofArizona,?Inc Cigna Dental Health, Inc. Cigna Elmwood Holdings, SPRL Cigna Europe Insurance Company S.A.-N.V. Cigna European Services (DK) Limited Cigna Finans Emeldilik ve Hayat A.S. Cigna Global Holdings, ine:' Cigna Global Insurance Company Limited Cigna Global Reinsurance Company, Ltd, , Cigna Health and Life Insurance Company Cigna Health Coiporatioh ':' Cigna Health Management, Inc. Cigna Health Solutions, India Pvt. Ltd. Cigna Healthcare Holdings, Inc. Cigna Healthcare Mid -Atlantic, Inc. Cigna Healthcare of Arizona, Inc. Cigna Healthcare of California, Inc. Cigna Healthcare of Colorado, Inc, Montana Montana Ohio Montana Maryand: Pennsylvania Delaware'_ Ohio Ohio China Delaware Bermuda Connecticut Belgium California Texas Minnesota Delaware Delaware: Thailand United Kingdom Delaware China California Colorado. Delaware Florida`;' Illinois Kansas Kentucky Maryland Missouri •,' Nevi Jersey North Carolina Ohio Pennsylvania Texas Virginia 'Arizona Florida Belgium:' Belgium United: Kingdom Turkey Delaware Guernsey, C.I Berniuda Connecticut Delaware Delaware India Colorado Maryland Arizona California Colorado 508 CIGNA CORPORATION - 2014 Form 10-K E-5 PART IV ITEM 15. Exhibits and Financial Statement Schedules Entity Name Cigna Healthcare of Connecticut, Inc. Cigna Healthcare of Florida, Inc. Cigna Healthcare of Georgia, Inc. Cigna Healthcare of Illinois, Inc. Cigna Healthcare of Indiana, Inc. Cigna Healthcare of Maine, Inc. Cigna Healthcare of Massachusetts, Inc. Cigna Healthcare of New Hampshire, Inc, Cigna Healthcare of New Jersey, Inc. Cigna Healthcare of New York, Inc. Cigna Healthcare of North Carolina,: Inc. Cigna Healthcare of Pennsylvania, Inc. Cigna Healthcare of South Carolina, Inc. Cigna Healthcare of St. Louis, Inc. Cigna Healthcare of Tennessee, Inc. Cigna Healthcare of Texas, Inca Cigna Healthcare of Utah, Inc. Cigna HLA Technology Services Company Limited Cigna Holdings Overseas, Inc:'• Cigna Holdings, Inc. Cigna Hong Kong Holdings Company Lunrted Cigna Insurance Public Company Limited Cigna Insurance Services (Europe) Limited Cigna Intellectual Property, Inc. Cigna International Corporation Cigna International Health Services BVBA Cigna International Services Rustralia Pty itd . Cigna Investment Group, Inc. Cigna Investments, lnc, Cigna Life Insurance Company of Canada Cigna Life Insurance Company of Europe S.A.- N.V. Cigna Life Insurance Cornpany of New York Cigna Life Insurance New Zealand Limited ' Cigna Linden Holdings Inc. Cigna Myrtle• Holdings, Cigna Nederland Alpha Cooperatief U.A. Cigna Nederland jieta N,V Cigna Nederland Gamma N.V. Cigna Palmetto Holdings, Ltd. Cigna Poplar Holdings Inc y� Cigna Saioo Benefits Service :'ALL . Cigna Sequoia Holdings SPRL Cigna Taiwan Life Asstirance"Company Limited CignaTTK Health Insurance Company Limited Cigna Wahrut Holdings, Ltd;: Cigna Worldwide General Insurance Company Limited Cigna Worldwide Insurance Company Cigna Worldwide Life Insurance Company Limited Connecticut General Corpi ration Connecticut General Life Insurance Company FirsrAssist Admiiiistratron Lunited FirstAssist Group Holdings Limited FirstAssist Group Limited FirstAssist Legal Protection Limited Great -West Healthcare Of Tliinors, Inc. Healthsource, Inc, HealthSpring, Inc; HealthSpring of Alabama, Inc HealthSpring of Florida, Inc.! HealthSpring Life & Health Insurance Company, Inc. HealthSpring Management, inc. Jurisdiction Connecticut. Florida Georgia Illinois Indiana Maine Massachusetts New Hampshire New Jersey . New York North Carolina Pennsylvania South Carolina Missouri Tennessee Texas Utah Hong Kong Delaware Delaware Hong Koig Thailand United Kingdom Delaware Delaware. Belgium Australia Delaware Delaware Canada Belgium New York New Zealand Delaware Malta Netherlands Netherlands, ' Netherlands ;Bermuda Delaware Bahrain i` Belgium Taiwan '. India Umted_ Kingdotn Hong Kong Delaware" . Hong Kong Connecticut Connecticut United Kingdom United Kingdom Ironed Kingdom :' United Kingdom 111inors New Hampshire > Delaware Alabama Florida Texas Tennessee 509 E-6 CIGNA CORPORATION - 2014 Form 10-K PART IV ITEM 15. Exhibits and Financial Statement Schedules LINA Life Insurance Company of Korea Loyal American Life. Insurance Company MCC Independent Practice Association of New York, Inc. NewQuest, LLC: Provident American Life and Health Insurance Company PT Asuransi Cigna RHP (Thailand) Limited Tel Deng,: Inc. Tel Drug of Pennsylvania, LLC Teinpie Insurance Coinp'any Limited United Benefit Life Insurance Company Vanbreda International LLC Vanbreda International SDN. BHD. Vielife Holdings Limited Vielife Limited Entity Name Jurisdiction HealthSpring of Tennessee, Inc. Tennessee KDM Thailand. Limited Thailand Life Insurance Company of North America Pennsylvania LINA Financial SeMce Korea Korea Ohlt New York Texas Ohio Indonesia Thailand South Dakota Pennsylvania Bermuda Ohio Florida Malaysia `United Kingdom United Kingdom 510 CIGNA CORPORATION - 2014 Form 10-K E-7 PART IV ITEM 15. Exhibits and Financial Statement Schedules EXHIBIT 23 Consent of Independent Registered Public Accounting Firm We hereby consent to the incorporation by reference in the Registration Statement on Form S-3 (No. 333-183238) and Form S-8 (No. 333-179307, No, 333-166583, No. 333-163899, No. 333-147994, No. 333-64207, No. 333-129395, No. 333-107839, No. 333-90785, No. 333-22391, No. 033-60053 /s/ PricewaterhouseCoopers LLP Philadelphia, Pennsylvania February 26, 2015 and No. 033-51791) of Cigna Corporation of our reports dated February 26, 2015 relating to the financial statements, the financial statement schedules and the effectiveness of internal control over financial reporting, which appear in this Form 10-K. 511 E-8 CIGN.A CORPORATION - 2014 Form 10-K PART IV ITEM 15. Exhibits and Financial Statement Schedules EXHIBIT 31.1. Certification I, DAVID M. CORD.ANI, certify that: 1. I have reviewed this Annual Report on Form 10-K of Cigna Corporation; 2. Based on my knowledge, this report does not contain any untrue statement of a material fact or omit to state a material fact necessary to make the statements made, in light of the circumstances under which such statements were made, not misleading with respect to the period covered by this report; 3. Based on my knowledge, the financial statements, and other financial information included in this report, fairly present in all material respects the financial condition, results of operations and cash flows of the registrant as of, and for, the periods presented in this report; 4. The registrant's other certifying officer(s) and I are responsible for establishing and maintaining disclosure controls and procedures (as defined in Exchange Act Rules 13a-15 (e) and. 15d-15(e)) and internal control over financial reporting (as defined in Exchange Act Rules 13a-15(f) and 15d-15(f)) for the registrant and have: a) designed such disclosure controls and procedures, or caused such disclosure controls and procedures to be designed under our supervision, to ensure that material information relating to the registrant, including its consolidated subsidiaries, is made known to us by others within those entities, particularly during the period in which this report is being prepared; b) designed such internal control over financial reporting, or caused such internal control over financial reporting to be designed under our supervision, to provide reasonable assurance regarding the reliability of financial reporting and /s/ David M. Cordani the preparation of financial statements for external purposes in accordance with generally accepted accounting principles; c) evaluated the effectiveness of the registrant's disclosure controls and procedures and presented in this report our conclusions about the effectiveness of the disclosure controls and procedures, as of the end of the period covered by this report based on such evaluation; and d) disclosed in this report any change in the registrant's internal control over financial reporting that occurred during the registrant's most recent fiscal quarter (the registrant's fourth fiscal quarter in the case of an annual report) that has materially affected, or is reasonably likely to materially affect, the registrant's internal control over financial reporting; and 5. registrant's other certifying officer(s) and I have disclosed, based on our most recent evaluation of internal control over financial reporting, to the registrant's auditors and the audit committee of the registrant's board of directors (or persons performing the equivalent functions): a) all significant deficiencies and material weaknesses in the design or operation of internal control over financial reporting which are reasonably likely to adversely affect the registrant's ability to record, process, summarize and report financial information; and b) any fraud, whether or not material, that involves management or other employees who have a significant role in the registrant's internal control over financial reporting. The Chief Executive Officer Date: February 26, 2015 512 CIGNA. CORPORATION - 2014 Form 10-K E-9 PART IV ITEM 15, Exhibits and Financial Statement Schedules EXHIBIT 31.2 Certification I, THOMAS A. MCCARTH'Y, certify that: I. I have reviewed this Annual Report on Form 10-K of Cigna Corporation; 2. Based on my knowledge, this report does not contain any untrue statement of a material fact or omit to state a material fact necessary to make the statements made, in light of the circumstances under which such statements were made, not misleading with respect to the period covered by this report; 3. Based on my knowledge, the financial statements, andother financial information included in this report, fairly present in all material respects the financial condition, results of operations and cash flows of the registrant as of, and for, the periods presented in this report; 4. The registrant's other certifying officer(s) and I are responsible for establishing and maintaining disclosure controls and procedures (as defined in Exchange Act Rules 13a-15(e) and 15d-15(e)) and internal control over financial reporting (as defined in Exchange Act Rules 13a-15(f) and 15d-15(f)) for the registrant and have: a) designed such disclosure controls and procedures, or caused such disclosure controls and procedures to be designed under our supervision, to ensure that material information relating to the registrant, including its consolidated subsidiaries, is made known to us by others within those entities, particularly during the period in which this report is being prepared; b) designed such internal control over financial reporting, or caused such internal control over financial reporting to be designed under our supervision, to provide reasonable assurance regarding the reliability of financial reporting and /s/ Thomas A. McCarthy the preparation of financial statements for external purposes in accordance with generally accepted accounting principles; c) evaluated the effectiveness of the registrant's disclosure controls and procedures and presented in this report our conclusions about the effectiveness of the disclosure controls and procedures, as of the end of the period covered by this report based on such evaluation; and d) disclosed in this report any change in the registrant's internal control over financial reporting that occurred during the registrant's most recent fiscal quarter (the registrant's fourth fiscal quarter in the case of an annual report) that has materially affected, or is reasonably likely to materially affect, the registrant's internal control over financial reporting; and 5. The registrant's other certifying officer(s) and I have disclosed, based on our most recent evaluationof internal control over financial reporting, to the registrant's auditors andthe audit committee of the registrant's board of directors (or persons performing the equivalent functions): a) all significant deficiencies and material weaknesses in the design or operation of internal control over financial reporting which are reasonably likely to adversely affect the registrant's ability to record, process, summarize and report financial information; and b) any fraud, whether or not material, that involves management or other employees who have a significant role inthe registrant's internal control over financial reporting. Date: Chief .Financial Officer February 26, 2015 513 E-10 CIGNA CORPORATION -20.14 Farm 10-K PART IV ITEM 15. Exhibits and Financial Statement Schedules EXHIBIT 32.1 Certification of Chief Executive Officer of Cigna Corporation pursuant to 18 U.S.C. Section 1350 I certify that, to the best of my knowledge and belief, the Annual Report on Form 10-K of Cigna Corporation for the fiscal period ending December 31, 2014 (the "Report"): (1) complies with the requirements of Section 13(a) or 15(d) of the Securities Exchange Act of 1934; and (2) the information contained in the Report fairly presents, in all material respects, the financial condition and results of operations of Cigna Corporation. /s/ David M. Cordani David M. Cordani Chief Executive Officer February 26, 2015 514 CIGNA CORPORATION - 2014 Form 10-K E-11 PART IV ITEM 15. Exhibits and Financial Statement Schedules EXHIBIT 32.2 Certification of Chief Financial Officer of Cigna Corporation pursuant to 18 U.S.C. Section 1350 I certify that, to the best of my knowledge and belief, the Annual Report on Form 10-K of Cigna Corporation for the fiscal period ending December 31, 2014 (the "Report"): (1) complies with the requirements of Section 13(a) or 15(d) of the Securities Exchange Act of 1934; and (2) the information contained in the Report fairly presents, in all material respects, the financial condition and results of operations of Cigna Corporation. /sl Thomas A. McCarthy Thomas A. McCarthy Chief Financial Officer February 26, 2015 515 E-12 CIGNA CORPORATION - 2014 Form 10-K. (This page has been left blank intentionally.) 516 (This page has been left blank intentionally.) 517 STAY CONNECTED ®Ci �0(� gna® 900 COTTAGE GROVE ROAD BLOOMFIELD, CT 06002 CIGNA, M 1. ; Please note that this Business Tax Receipt expires on September 30th of the effective year listed herein. Ensuring renewal by October lst is the responsibility of the business entity. For further information you may call: (305) 416.1570 Or (305) 416- 1918. Favor de tomar nota que este Recibo de. Impuesto pare Negocio se vence el 30 de Septiembre do atio indicado. Asegurar la renovacion para el Iro de Octubre es la responsabilid.ad del negocio. Para Inas informacion puede Hamar al; (305) 416-1570 o (306) 416-1918. Souple pran not ke Resi Enpo pou Biznis-sa ap exspire 30 Septan-m ane sa men-m nan lis la. Se responsabllte dirijan Biznis sa pou li renouvle-1 Pwemie Okteb kap vini Si ou bezwen pits enfOrnasiyon sou zafe sa , pa bliye role nen (305) 4164570 ou byen (305) 416-1918. Po -Sr THia :poovmlar IN A-00NgpipOtis.::, PLACE -rufe.- 6., ourkt, (CitV Of attlt N01 TROISea4rAt3itg OR yAL:1(). 0:4401,03.A01:*$, • FIN0205i:00AVNION Ti DO NOT PAY CITY :04.,miks4L444-:,-.N,ZAV.Otri, 0:9:rvi'•MtA01;:FL 33130, 01-(040004164.0.1k • ' , Effective Year OctI 2014:Thor Sep. 30 :2015,. , . • , . RECEIPT FOR .CIGNA115,A1111ANOt•IFE ISSUED. Nov 10, 2014 TOTAL. ptiPAID 481;00 ACCOUNT NUMBER 90689 RECEIPT NUMBER 1430 NAME OF BUSINESS CIGNA HEALTH AND LIFE DEA CIONA HEALTH AND LIFE LOCATION IS HEREBY IN COMPLIANCE TO ENGAGE IN OR MANAGE THE OPERATION OF: INSURANCE COMPANY OR ASSOCIATION Jose M. Fernandez Finance Director Thig:tko.(44:0'04;141.0Ifig-.$0 WIVo.10.(4por].00 000jk#0:00-00.t.(0'ifigowmioroulowd the -31.110thut i,0001"40:004)12400.40.4-...0.00fitio . Toottio:fip. ow;00006Cidit 520 Si desea recibir este Aviso Sabre Practicas de Privacidad en espanol, por favor flame a Servicios a Clientes en el numero que se encuentra en su tarjeta deidentificacion de Cigna HealthCare. Notice of Privacy Practices Cigna HealthCare This notice describes how medical information about you, as a customer of Cigna healthcare, may be used and disclosed, and how you can get access to this information. Our Privacy Commitment Thank you for giving us the opportunity to serve you. In the normal course of doing business — providing medical care to you — Cigna Healthcare creates records about you and the treatment and services we provide to you. The information we collect is called Protected Health Information ('PHI"). We take our obligation to keep your PHI secure and confidential very seriously. We are required by federal and state law to protect the privacy of your PHI and to provide you with this Notice about how we safeguard and use it. When we use or give out ("disclose") your PHI, we are bound by the terms of this Notice. This Notice applies to all electronic or paper records we create, obtain, and/or maintain that contain your PHI. How We Protect Your Privacy We understand the importance of protecting your PHI. We restrict access to your PHI to authorized workforce members who need that information for your treatment, for payment purposes and/or for health care operations. We maintain technical, physical and administrative safeguards to ensure the privacy of your PHI. To protect your privacy, only authorized and trained workforce members are given access to our paper and electronic records and to non-public areas where this information is stored. Workforce members are trained on topics including: • Privacy and data protection policies and procedures including how paper and electronic records are labeled, stored, filed and accessed, • Technical, physical and administrative safeguards in place to maintain the privacy and security of your PHI. Our corporate Privacy Office monitors how we follow the policies and procedures, and educates our organization on this important topic. GOYOU" HowWe Use and Disclose Your PHI Uses of PHI without your authorization We may disclose your PHI without your written authorization if necessary while providing your health benefits. We may disclose your PHI for the following purposes: • Treatment: — To share with nurses, doctors, pharmacists, optometrists, health educators and other health care professionals so they can determine your plan of care. — To help you obtain services and treatment you may need — for example, ordering lab tests and using the results. — To coordinate your health care and related services with a different health care facility or professional. • Payment: — To obtain payment of premiums for your coverage. — To make coverage determinations — for example, to speak to a health care professional about payment for services provided to you. — To coordinate benefits with other coverage you may have —for example, to speak to another health plan or insurer to determine your eligibility or coverage. — To obtain payment from a third party that maybe responsible for payment, such as a family member. — To otherwise determine and fulfill our responsibility to provide your health benefits — for example, to administer claims. • Health care operations: — To provide customer service. — To support and/or improve the programs or services we offer you. ittla It.; Cigna® 840751 a 03/12 521 1 — To assist you in managing your health — for example, to provide you with information about treatment alternatives to which you may be entitled. — To support another health plan, insurer, or healthcare professional who has a relationship with you, so that it can improve the programs it offers you — for example, for case management. We may also disclose your PHI without your written authorization for other purposes, as permitted or required by Iaw. This includes: • Disclosures to others involved in your health care. — If you are present or otherwise available to direct us to do so, we may disclose your PHI to others, for example, a family member, a close friend, or your caregiver. - If you are in an emergency situation, are not present, or are incapacitated, we will use our professional judgment to decide whether disclosing your PHI to others is in your best interests. If we do disclose your PHI in a situation where you are unavailable, we would disclose only information that is directly relevant to the person's involvement with your treatment or for payment related to your treatment. We may also disclose your PHI in order to notify (or assist in notifying) such persons of your location, your general medical condition or your death. — We may disclose your child's PHI to your child's other parent. • Disclosures to your employer as sponsor of your health plan. We may disclose your PHI to your employer or to a company acting on your employer's behalf, so that entity can monitor, audit and otherwise administer the employee health plan in which you participate.Your employer is not permitted to use the PHI we disclose for any purpose other than administration of your benefits. See your employer's health plan documents for information on whether your employer receives PHI and, if so, the identity of the employees who are authorized to receive your PHI. • Disclosures to vendors and accreditation organizations. We may disclose your PHI to: — Companies that perform certain services we've requested. For example, we may engage vendors to help us to provide information and guidance to customers with chronic conditions like diabetes and asthma. — Accreditation organizations such as the National Committee for Quality Assurance (NCQA) for quality measurement purposes. Please note that before we share your PHI, we obtain the vendor's or accreditation organization's written agreement to protect the privacy of your PHI. • Communications. Except as permitted by law, we will not use your PHI for marketing purposes without your prior written authorization. • Health or safety. We may disclose your PHI to prevent or lessen a serious and imminent threat to your health or safety, or the health or safety of the general public. • Public health activities. We may disclose your PHI to: — Report health information to public health authorities authorized by law to receive such information for the purpose of preventing or controlling disease, injury or disability, or monitoring immunizations. — Report child abuse or neglect, or adult abuse, including domestic violence, to a government authority authorized bylaw to receive such reports. — Report information about a product or activity that is regulated by the U.S. Food and Drug Administration (FDA) to a person responsible forthe quality, safety or effectiveness of the product or activity. — Alert a person who may have been exposed to a communicable disease, if we are authorized by law to give this Notice. • Health oversight activities. We may disclose your PHI to: — A government agency that is legally responsible for oversight of the health care system or for ensuring compliance with the rules of government benefit programs, such as Medicare or Medicaid. — Other regulatory programs that need health information to determine compliance. • Research. We may disclose your PHI for research purposes, but only according to and as allowed by law. • Compliance with the law. We may use and disclose your PHI to comply with the law. • Judicial and administrative proceedings. We may disclose your PHI in a judicial or administrative proceeding or in response to a valid legal order. • Law enforcement officials. We may disclose your PHI to the police or other law enforcement officials, as required by law or in compliance with a court order or other process authorized by law. • Government functions. We may disclose your PHI to various departments of the government such as the U.S. military or the U.S. Department of State as required bylaw. • Workers'compensation. We may disclose your PHI when necessary to comply with workers'compensation laws. 522 2 Uses of PHI that require your authorization Other than for the purposes described above, we must obtain your written authorization to use or disclose your PHI. For example, we will not supply PHI to a prospective employer without your prior written authorization. Uses and disclosures of certain PHI deemed"Highly Confidential!' For certain kinds of PHI, Federal and state law may require enhanced privacy protection. These would include PHI that is: • Maintained in psychotherapy notes. • About alcohol and drug abuse prevention, treatment and referral. • About HIV/AIDS testing, diagnosis or treatment. • About venereal and/or communicable disease(s). • About genetic testing. We can only disclose this type of specially protected PHI with your prior written authorization except when specifically permitted or required by law. Cancellation.You may cancel ("revoke") a written authorization you gave us before. The cancellation, submitted to us in writing, will apply to future uses and disclosures of your PHI. It will not impact disclosures made previously, while your authorization was in effect. Your Individual Rights You have the following rights regarding the PHI that Cigna Healthcare creates, obtains, and/or maintains about you. • Right to request restrictions. You may ask us to restrict the way we use and disclose your PHI for treatment, payment and health care operations, as explained in this Notice. We are not required to agree to the restrictions, but we will consider them carefully. If we do agree to the restrictions, we will abide by them. • Right to receive confidential communications. You may ask to receive Cigna HealthCare communications containing PHI by alternative means or at alternative locations. We will accommodate reasonable requests whenever feasible. • Right to inspect and copy your PHI. You may ask in advance to review or receive a copy of your PHI that is included in certain paper or electronic records we maintain. If you request copies, we may charge you for copying and mailing costs. Under limited circumstances, we may deny you access to a portion of your records. You may request that we disclose or send a copy of your PHI to a Health Information Exchange (HIE). • Right to amend your records. You have the right to ask us to correct your PHI contained in our electronic or paper records if you believe it is inaccurate. If we determine that the PHI is inaccurate, we will correct it if permitted by law. If a health care facility or professional created the information that you want to change, you should ask them to amend the information. • Right to receive an accounting of disclosures. Upon your request, we will provide a list of the disclosures we have made of your PHI for a specified time period. However, the list will exclude: — Disclosures you have authorized. — Disclosures made earlier than six years before the date of your request (in the case of disclosures made from an electronic health record, this period may be limited to three years before the date of your request). — Disclosures made for treatment, payment, and health care operations purposes except when required by law, — Certain other disclosures that are excepted by law. If you request an accounting more than once during any 12-month period, we will charge you a reasonable fee for each accounting report after the first one. • Right to name a personal representative. You may name another person to act as your Personal Representative. Your representative will be allowed access to your PHI, to communicate with the health care professionals and facilities providing your care, and to exercise all other HIPAA rights on your behalf. Depending on the authority you grant your representative, he or she may also have authority to make health care decisions for you. • Right to receive a paper copy of this Notice. Upon your request, we will provide a paper copy of this Notice, even if you have already received one, as described in the Notice Availability and Duration section later in this Notice. 523 3 Actions You May Take Contact Cigna HealthCare. If you have questions about your privacy rights, believe that we may have violated your privacy rights, or disagree with a decision that we made about access to your PHI, you may contact us at the following address or telephone number: Privacy Office Cigna PO Box 188014 Chattanooga, TN 37422 Telephone Number: 800.762.9940 For certain types of requests, you must complete and mail to us the applicable form, which is available, either by Customer Service at the telephone number printed on your Cigna HealthCare Customer ID card or by going to our website (httpJ/www.Cigna.com/priivacy/privacy_healthcare_forms.html). Contact a government agency. If you believe we may have violated your privacy rights, you may also file a written complaint with the Secretary (the"Secretary") of the U.S. Department of Health and Human Services ("HHS"). Your complaint can be sent by email, fax, or mail to the HHS' Office for Civil Rights ("OCR"), For more information, go to the OCR website (http://www.hhs.gov/ocr/privacy/hipaa/ complaints). We will provide you with the contact information for the OCR regional manager in your area if you request it from our Privacy Office. We will not take any action against you if you exercise your right to file a complaint, either with us or with the Secretary. Notice Availability and Duration Notice availability. A copy of this Notice is available by calling Customer Service at the telephone number printed on your Cigna HealthCare Customer ID card or by going to our website (http://Cigna.com/privacy/privacy_healthcare.html). Right to change terms of this Notice. We may change the terms of this Notice at any time, and we may, at our discretion, make the new terms effective for all of your PHI in our possession, including any PHI we created or received before we issued the new Notice. If we change this Notice, we will update the Notice on our website and, if you are enrolled in a Cigna benefit plan at that time, we will send you the new Notice, as required. In addition you can request a copy of this Notice by calling Customer Service at the telephone number printed on your Cigna HealthCare Customer ID card. Effective date. This Notice is effective as of April 14,2003, and updated as of March 1, 2011. -)0(@®B Cigna. "Cigna"is a registered service mark, and the'Tree of Life"logo and"GOYOU"are 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, Cigna Health and Life Insurance Company, Cigna Behavioral Health, Inc., Cigna Health Management, Inc., and HMO or service company subsidiaries of Cigna Health Corporation and Cigna Dental Health, Inc, 840751 a 03/12 02012 Cigna, 45. 524