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HomeMy WebLinkAbout25162AGREEMENT INFORMATION AGREEMENT NUMBER 25162 NAME/TYPE OF AGREEMENT CIGNA HEALTH & LIFE INSURANCE COMPANY DESCRIPTION 3RD AMENDMENT TO EMPLOYER/UNION GROUP PDP AGREEMENT/MEDICARE PART D PRESCRIPTION DRUG PLAN COVERAGE DESCRIPTION/MATTER ID: 24-1581 EFFECTIVE DATE January 1, 2024 ATTESTED BY TODD B. HANNON ATTESTED DATE 7/16/2024 DATE RECEIVED FROM ISSUING DEPT. 8/28/2024 NOTE DOCUSIGN AGREEMENT BY EMAIL ••• Cigna THIRD AMENDMENT TO EMPLOYER/UNION GROUP PDP AGREEMENT This is an Amendment to the Employer/Union Group Prescription Drug Plan ("PDP") Agreement (hereinafter "Agreement") between Cigna Health and Life Insurance Company ("CHLIC") and City of Miami ("Group"). This amendment is effective from January 1, 2024 through December 31, 2024. NOW THEREFORE, the parties hereby agree as follows: 1. Medco Containment Life Insurance Company (MCLIC) is hereby identified as a CHLIC affiliate which has contracted with the Centers for Medicare and Medicaid Services (CMS) to operate a Medicare Part D Prescription Drug Plan (PDP) and offer employer/union-only group PDP plans. MCLIC and CHLIC collectively will be referred to as Cigna Healthcare. References to Cigna and CHLIC throughout the agreement are hereby replaced with "Cigna Healthcare". 2. Pursuant to Section 1, "Term," Cigna Healthcare and Group mutually agree to renew this Agreement. The Agreement is effective as of January 1, 2024 and shall continue in effect through December 31, 2024, unless sooner terminated in accordance with Section 2, Termination. 3. Section 24 is hereby deleted in its entirety and replaced by a new Section 24 reading "Force Majeure. Cigna Healthcare shall not be liable for any failure to meet any of the obligations or provide any of the services and/or benefits specified or required under the Agreement where such failure to perform is due to any contingency beyond the reasonable control of Cigna Healthcare, its employees, officers, or directors. Such contingencies include, but are not limited to, acts or omissions of any person or entity not employed or reasonably controlled by Cigna Healthcare, its employees, officers, or directors, acts of God, fires, wars, accidents, labor disputes or shortages, health and/or public safety hazards, disease (including but not limited to any declared quarantine, outbreak, epidemic or pandemic), and governmental laws, ordinances, rules or regulations, whether valid or invalid." 4. Exhibit A, 2023 Medicare Part D Prescription Drug Plan coverage description is hereby deleted in its entirety and replaced with the 2023 Exhibit A, attached hereto. 5. Exhibit B, Group Administrative Guidelines is hereby deleted in its entirety and replaced with the Exhibit B, attached hereto. Except as modified by this Amendment, all other terms and provisions of the Agreement shall continue in full force and effect. The parties hereto have caused this Amendment to be executed in duplicate and signed by their respective officers duly authorized to do so. This Amendment may be executed in any number of counterparts, each of which so executed shall be deemed to be an original, and such counterparts shall together constitute but one and the same Amendment. The parties shall be entitled to sign and transmit an electronic signature of this Amendment (whether by facsimile, PDF or other email transmission), which signature shall be binding on the party whose name is contained therein. Any party providing an electronic signature agrees to promptly execute and deliver to the other parties an original signed Amendment upon request. Cigna Health and Life Insurance Company ("Cigna City of Miami Healthcare') By: Printed Name: Ryan Kocher Its: Medicare, Chief Growth Officer Date: July 8, 2024 DocuSigned by: 1 ' ! ese -Ukti By: 04670997-5DEA416... cigna healthcare Printed Name: Arthur Noriega, V Its: City Manager Date: July 15, 2024 I 14:25:15 EDT ocu5ignea Dy: ATTES (—Do By: �`� '.�8&._ Printed Name: Todd B Hannon Its: City Clerk Date:July 16, 2024 I 13:58:40 EDT APPROVED AS TO LEGAL FORM AND CORRECTNESS: DocuSigned by: B : r0 OJL1saV it( y E9F100240B... Printed Name: George K Wysong III Its: City Attorney APPROVED AS TO INSURANCE REQUIREMENTS AND TERMS: r— DocuSignneAd by: '. . 1�,, ��rV�IAM lL s1�lAM PL By. 946A496748064449... Printed Name: Ann -Mane Sharpe Its: Director, Risk Management Ilh\V%i cigna healthcare Exhibit A Medicare Part D Prescription Drug Plan Coverage Description GIna City of Miami - Cigna Healthcare Prescription Drug Plan SUMMARY OF BENEFITS Plan Type Cigna Prescription Drug Plan Effective Dates January 1, 2024 - December 31, 2024 Pharmacy Premium Rate $249.33 Number of Medicare Beneficiaries 203 Funding Type Fully Insured Situs State FL Benefit Option Code RXPDP Rx Formulary Enhanced Network Medicare Broad Network Pharmac Accumulation Period Benefit Description Deductible Phase Calendar Year What the Member pays Individual Deductible $0 Individual Deductible Applies to Not Applicable Member Out of Pocket Maximum Member Out of Pocket Maximum $1,000 Initial Coverage Level Initial Coverage Level (Total Drug Spend) $5,030 Retail (1-30 Day Supply) Tier 1 Tier 2 Tier 3 Tier 4 $15 $40 $60 $60 Retail (31-60 Day Supply) Tier 1 Tier 2 Tier 3 Tier 4 $30 $80 $120 Not Available - Specialty drugs only available up to 30-day Retail (61-90 Day Supply) Tier 1 Tier 2 Tier 3 Tier 4 $0 $80 $120 Not Available - Specialty drugs only available up to 30-day Long-term Care (1-31 Day Supply) Tier 1 Tier 2 Tier 3 Tier 4 $15 $40 $60 $60 Mail Order (1-30 Day Supply) Tier 1 Tier 2 Tier 3 Tier 4 $15 $40 $60 $60 Mail Order (31-60 Day Supply) Tier 1 Tier 2 Tier 3 Tier 4 $30 $80 $120 Not Available - Specialty drugs only available up to 30-day Mail Order (61-90 Day Supply) Tier 1 Tier 2 Tier 3 Tier 4 $0 $80 $120 Not Available - Specialty drugs only available up to 30-day Out of Network Coverage (Member Liability) (30 Day Supply) Same as In -Network Coverage Gap (from $5,030 in Drug Spend up to True Out -of -Pocket of $8,000) Retail (1-30 Day Supply) Tier 1 Tier 2 Tier 3 Tier 4 $15 $40 $60 $60 Retail (31-60 Day Supply) Tier 1 Tier 2 Tier 3 Tier 4 $30 $80 $120 Not Available - Specialty drugs only available up to 30-day Retail (61-90 Day Supply) Tier 1 Tier 2 Tier 3 Tier 4 $0 $80 $120 Not Available - Specialty drugs only available up to 30-day Long-term Care (1-31 Day Supply) Tier 1 Tier 2 Tier 3 Tier 4 $15 $40 $60 $60 1 of 4 2024 City of Miami - 3202272 - RXPDP - B2.xlsx cigna nr•aitnr, ;�. ��., Mail Order (1-30 Day Supply) Tier 1 Tier 2 Tier 3 Tier 4 $15 $40 $60 $60 Mail Order (31-60 Day Supply) Tier 1 Tier 2 Tier 3 Tier 4 $30 $80 $120 Not Available - Specialty drugs only available up to 30-day Mail Order (61-90 Day Supply) Tier 1 Tier 2 Tier 3 Tier 4 $0 $80 $120 Not Available - Specialty drugs only available up to 30-day Catastrophic Phase (True Out -of -Pocket) $8,000 Generic Drugs Brand Drugs $0 Copay $0 Copay Clinical Management Are the following clinical programs included or waived? Included Included Included Step Therapy Prior Authorizations Quantity Limits Specialty Drugs Specialty Drugs Limited to one month supply Opioids Opioids (all tiers)I Limited to one month supply Non -Part D Supplemental Coverage Are the following non -formulary drugs covered? No Yes Yes No Yes Yes No Fertility Drugs Prescription Vitamins Cold & Cough Preps Weight Loss/Weight Gain Erectile Dysfunction Courtesy & DESI Drugs Cosmetic Drugs including Drugs for Hair Loss Formulary Enhancements Are the following formulary enhancements covered? Adherence Package (Preventive Brand and Generic Drugs and Diabetic Drugs and Supplies) Select Drugs and Supplies at $0 Copay State Mandated Benefits None Non -Standard Benefits None See next page for Caveats and Exclusions 2 of 4 2024 City of Miami - 3202272 - RXPDP - B2.xlsx CLgna he Ith City of Miami - Cigna Healthcare Prescription Drug Plan CAVEATS, EXCLUSIONS and DEFINITIONS The Employer Part D program does not integrate with medical plan deductibles, out-of-pocket maximums, or annual maximums. Only retirees and their dependents who are entitled to Medicare Part A and/or enrolled in Part B are included in this quote. If a retiree or dependent is not entitled to Medicare Part A and/or not enrolled in Part B, then they are not eligible to join a Medicare Part D plan. Billing for this product is on a per Medicare beneficiary per month basis. Each enrollee will be set up on their own eligibility record/ID and the employer group will be charged a single per Medicare beneficiary per month premium rate. Cigna Healthcare reserves the right to adjust the benefits and/or premiums in this proposal if such adjustments are necessary to comply with current Centers for Medicare & Medicaid Services (CMS) rules and regulations. Drug Exclusions: A Medicare Prescription Drug Plan can't cover a drug that would be covered under Medicare Part A or Part B. Also, while a Medicare Prescription Drug Plan can cover off -label uses (meaning for uses other than those indicated on a drug's label as approved by the Food and Drug Administration) of a prescription drug, we cover the off -label use only in cases where the use is supported by certain reference book citations. Congress specifically listed the reference books that list whether the off -label use would be permitted (these reference books are: (1) American Hospital Formulary Service Drug Information, (2) the DRUGDEX Information System). By law, certain types of drugs, or categories of drugs, are not covered by Medicare Prescription Drug Plans. These drugs are not considered Part D drugs and may be referred to as "exclusions" or "non -Part D drugs." These drugs include: • Non-prescription drugs (or over-the-counter drugs). • Drugs when used for anorexia, weight loss, or weight gain. • Drugs when used to promote fertility. • Drugs when used for cosmetic purposes or hair growth. • Drugs when used for the symptomatic relief of cough or colds. • Prescription vitamins and mineral products, except prenatal vitamins and fluoride preparations. • Outpatient drugs for which the manufacturer seeks to require that associated tests or monitoring services be purchased exclusively from the manufacturer as a condition of sale. • Drugs, such as Viagra, Cialis, Levitra, and Caverject, when used for the treatment of sexual or erectile dysfunction. In addition, the following exclusions apply to any service that is a covered expense under this plan, but is not covered by Medicare: • Expenses for supplies, care, treatment, or surgery that are not medically necessary. • To the extent that payment is unlawful where the person resides when the expenses are incurred. • Charges which you are not obligated to pay or for which you are not billed or for which you would not have been billed except that they were covered under this plan. Definitions 1-30 Day Supply for Retail and 1-31 Day Supply for Long -Term Care Facilities (Proration): Usually, the amount for a covered prescription drug is a one -month supply. However, if the amount is less than a one -month supply for oral solid prescriptions, then the amount paid is prorated based on the actual amount received. Proration may not apply in certain circumstances as outlined in CMS guidance. Retail Example: Plan has a $10 copay for a 30 day supply. Actual day supply filled is 10 day supply. Copay is prorated as follows: $10 divided by 30 or $.3333 per day, rounded to $.33, times the day supply of 10, equals $3.30 copay owed by member. Long -Term Care Facility Example: Plan has a $10 copay for a 31 day supply. Actual day supply filled is 10 day supply. Copay is prorated as follows: $10 divided by 31 or $.3226 per day, rounded to $.32, times the day supply of 10, equals $3.20 copay owed by member. Coverage Gap: During the coverage gap stage, the member pays the plan cost share or the Medicare Part D Defined Standard, whichever is less. Employer Group Waiver Plans (EGWP) facilitate the offering of PDP plans to employer/union group health plan sponsors. Employer/union plan sponsors can contract with an insurer or directly with CMS to provide coverage for medical and/or prescription drug benefits. CMS grants certain program waivers and/or modifications for EGWP plans that do not apply to individual plans. Non -Part D Drugs: The following drug categories are excluded from CMS coverage. If a plan deductible applies, any non -Part D coverage added to the plan will not be subject to the plan deductible. The cost share for these drugs is the same as the cost -shares in the initial coverage phase based on the drug classification. • Cosmetic Drugs including Drugs for Hair Loss: drugs when used for cosmetic purposes or hair growth. • Courtesy Drugs: refers to drugs normally covered under commercial pharmacy plans but are excluded by CMS. • DESI (Drug Efficacy Study Implementation) Drugs: refers to drugs that were introduced between 1938-1962 and approved for safety but not effectiveness. DESI drugs are not "grandfathered" or generally recognized as safe and effective (GRAS/E). • Fertility Drugs: drugs used to promote fertility. • Prescription Vitamins: drugs used for prescription vitamins and mineral products, except prenatal vitamins and fluoride preparations. • Cold & Cough Preps: drugs used for symptomatic relief of cough and colds. 3 of 4 2024 City of Miami - 3202272 - RXPDP - B2.xlsx CIgn a • Weight Loss/Weight Gain: drugs used for anorexia, weight loss, weight gain. • Erectile Dysfunction: drugs used for erectile dysfunction. Opioid Drugs: Limited to 30 day supply at Retail and Mail Order Pharmacies and 31 day supply at Long Term Care Facilities. Out -of -Network Coverage: Generally, we cover drugs filled at an out -of -network pharmacy only when the plan participant is not able to use a network pharmacy. Here are the circumstances when we would cover prescriptions filled at an out -of -network pharmacy: • You travel outside the plan's service area and run out of or lose covered Part D drugs, or become ill and need a covered Part D drug and cannot access a network pharmacy. • You are unable to obtain a covered Part D drug in a timely manner within the service area because, for example, there is no network pharmacy within a reasonable driving distance that provides 24/7 service. • You are filling a prescription for a covered Part D drug and that particular drug is not regularly stocked at an accessible network retail or mail order pharmacy. • The Part D drugs are dispensed by an out -of -network institution - based pharmacy while in an emergency facility, provider -based clinic, outpatient surgery, or other outpatient setting. • Prescriptions purchased out -of -network are limited to a one -month supply. Preventive Drugs at $0 Copay: Certain Generic and certain Brand Preventive Medications identified by Cigna Healthcare that are dispensed by a retail or home delivery pharmacy are not subject to the deductible (if applicable), copay or coinsurance. Vaccines: Part D vaccines are covered at no cost to the member even when the deductible is not met. Insulin Products: Retirees won't pay more than $35 for a one -month supply of each insulin product covered by our plan even when the deductible is not met. Tier Labeling: Tier 1 — Generic Drugs Tier 2 — Preferred Brand Drugs Tier 3 — Non -Preferred Drugs Tier 4 — Specialty Drugs Cigna Healthcare products and services are provided exclusively by or through operating subsidiaries of The Cigna Group. The Cigna names, logos, and marks, including THE CIGNA GROUP and CIGNA HEALTHCARE are owned by Cigna Intellectual Property, Inc. Subsidiaries of The Cigna Group contract with Medicare to offer Medicare Advantage HMO and PPO plans and Part D Prescription Drug Plans (PDP) in select states, and with select State Medicaid programs. Enrollment in a Cigna Healthcare product depends on contract renewal. © Cigna Healthcare 2023 4 of 4 2024 City of Miami - 3202272 - RXPDP - B2.xlsx Ilh\V%i cigna healthcare Exhibit B Group Administrative Guidelines Cigna Healthcare Medicare Prescription Drug Plans Group Administrative Guide Thank you for sharing our commitment to quality care. Contents We're pleased to work with you to improve the health, well-being and peace of mind of your retirees. Our goal is to provide you with resources you need for easier plan administration. Please take some time to review the plan administration topics and refer to this Cigna HealthcaresM Medicare Prescription Drug Plans' (PDP) Group Administration Guide as needed. Terms to know Employer Group Portal Eligibility and enrollment Fully insured premium billing and payment Employer/Union Group PDP Agreement Customer communications Customer resources Claims administration Additional resources 3 4 5 12 14 15 17 18 18 CIGNA HEALTHCARE PDP GROUP ADMINISTRATIVE GUIDE Terms to know Group The term "group" throughout this document refers to employers, unions and trusts. Customer The term "customer" throughout this document refers to retirees, covered dependents, beneficiaries and individuals. Centers for Medicare & Medicaid Services (CMS) CMS is the federal agency that runs the Medicare program and regulates all plans and provisions. Additional information can be found at www.Medicare.gov or by calling I-800-MEDICARE (1-800-633-4227). Employer Group Waiver Plan (EGWP) Group Medicare Prescription Drug Plans (PDPs) are also called Employer Group Waiver Plans (EGWPs), pronounced "egg -whips." EGWPs are a type of Medicare Prescription Drug Plan offered to employees and retirees of some companies, unions or government agencies. Low Income Subsidy (LIS) People with limited income and resources may qualify for Extra Help for their prescription drug benefit. Extra Help is referred to as a Low Income Subsidy. The amount of Extra Help an individual may receive depends on their income and resources. Some people automatically qualify for Extra Help and do not have to apply for it. If they answer "yes" to any of the questions below, they automatically qualify for Extra Help and will receive a certain dollar amount that may go toward their premiums or their cost -shares: Do you have Medicare and full coverage from a state Medicaid program? Do you get Supplemental Security Income? Do you get help from your state Medicaid program paying your Medicare premiums? For example, do you belong to a Medicare Savings Program, such as the Qualified Medicare Retiree (QMB), Specified Low Income Medicare Retiree (SLMB) or Qualified Individual (QI) program? Medicare will mail a gray Loss of Deemed Status Notice to individuals in September if Social Security determines that they no longer automatically qualify for Extra Help for the coming year. Our plan will also mail a notice to encourage people to apply to determine if they still qualify for Extra Help. Customers who no longer qualify for Extra Help will receive a notice in December. If your enrollees have questions about Extra Help with prescription drug costs or need assistance completing an application, they can contact the Social Security Administration (SSA) at 1-800-772-1213 or visit www.SocialSecurity.gov. 3 CIGNA HEALTHCARE PDP GROUP ADMINISTRATIVE GUIDE Terms to know (continued) Medicare Advantage Plan (Part C) A type of Medicare plan offered by private health insurance carriers that contract with Medicare to provide Medicare Part A and Part B benefits. Cigna Healthcare is one such carrier. Medicare Prescription Drug Plan (Part D) A stand-alone drug plan offered by insurers and other private companies to people who get benefits through the Original Medicare Plan or through a Medicare Private Fee -for - Service Plan that doesn't offer prescription drug coverage. Medicare Advantage Plans may also offer prescription drug coverage that must follow the same rules as Medicare Prescription Drug Plans. Employer Group Portal Federal exemption The Medicare Modernization Act of 2003 has a very strong preemption provision. This means that in general, state laws don't apply to standard Part C and Part D benefits unless they pertain to state licensing or financial solvency of the insurer. Beginning in 2014, Part D coverage under an Employer Group Waiver Plan (EGWP) that provides customers with supplemental benefits beyond the parameters of the defined standard Part D benefit are treated as non - Medicare Other Health Insurance (OHI) that wraps around Part D. Employers/unions offering EGWPs must ensure any supplemental benefits comply with any applicable requirements for issuance under state insurance laws and/or the Employee Retirement Income Security Act (ERISA) rules. This is similar to commercial health care products that are subject to both state laws and federal laws. Certain state exemptions may apply. Go online to save time The Cigna Healthcare Medicare Employer Group Portal helps you manage your plan. From requesting replacement identification (ID) cards to having access to various reporting and plan documents, you have immediate access to information to help simplify plan administration. The Employer Group Portal will provide employers the ability to: View Group Enrollment Reports. View Group Billing Reports (Invoices). • View when a customer's ID card was last ordered/mailed. • Submit ID card replacement requests. • Submit address change requests. • View customer eligibility details, including information for access to care (enrolled, future and disenrolled in the last 12 months). • View/print plan documents and forms. Getting started To request Employer Group Portal access, provide your name and email address to your designated Medicare Client Account Manager. Soon after, you will receive an email invitation to register and access the portal at Employer.HSConnectOnline.com/Home/Login. Your Medicare Client Account Manager can provide training and/or a user guide to get you started. 4 Eligibility and enrollment Plan eligibility Only customers who are entitled to Medicare Part A and/or enrolled in Part B are eligible to enroll in a Cigna Healthcare Medicare Part D EGWP plan. If not, CMS will reject the application and the customer will not have coverage under the Cigna Healthcare Group Medicare plan. To avoid these situations, the Group must validate the customer's Medicare status by requesting their Medicare ID card. Prior to sending pre -enrollment packages, Cigna Healthcare can verify Medicare Part A and B enrollment to confirm eligibility for potential enrollees. In order to perform the verification, the following demographic information is required: Medicare Beneficiary Identifier (MBI), name, date of birth (DOB) and gender. If the Group has customers who don't meet the eligibility requirements to enroll in the Cigna Healthcare Medicare EGWP, the Group should contact their Cigna Healthcare Sales Representative to discuss possible alternative plans. There are specific sign-up periods when a customer can enroll in Medicare Part A and/or B. If the customer does not enroll during their Initial Enrollment Period or a Special Enrollment Period, they will need to enroll during the General Enrollment Period, between January I and March 31 each year. Coverage will start the first day of the month after they sign up. The customer may have to pay a higher Part A and/or Part B premium for late enrollment. A customer may not be enrolled in more than one Medicare plan at any given time. However, CMS has granted a waiver for all employer and union groups to simultaneously enroll their members in an "800 Series" Local MA -only Coordinated Care Plan (HMO, HMOPOS, PPO) and an "800 series" stand-alone prescription drug plan (PDP). CMS requires the separate medical and prescription drug carriers to work closely together with the employer sponsor to provide coordinated care and disease management services between the medical and pharmacy portions of the benefit. This coordination is similar to the kind that would be offered if the employer purchased the medical coverage and the drug coverage from a single carrier under one Medicare Advantage plan with Part D. A customer is eligible to enroll in the Cigna Healthcare Medicare EGWP as long as the enrollee permanently resides in the Cigna Healthcare Medicare service area, which includes all 50 states, the District of Columbia, Puerto Rico and the U.S. Virgin Islands. For purposes of enrollment in the Cigna Healthcare Medicare EGWP, incarcerated customers are to be considered as residing out of the plan service area, regardless of the location of the correctional facility. Customers must be U.S. citizens or lawfully present in the United States. CMS will notify Cigna Healthcare if the customer is not eligible to enroll on this basis at the time of enrollment. Cigna Healthcare will notify the Group via the Group Enrollment Report. Please reference Chapter 3 of the Medicare Prescription Drug Benefit manual found on www.CMS.gov for complete enrollment and disenrollment information. 5 CIGNA HEALTHCARE PDP GROUP ADMINISTRATIVE GUIDE Eligibility and enrollment (continued) Medicare eligibility Medicare is usually available for people age 65 or older, younger people with disabilities, and people with permanent kidney failure requiring dialysis or transplant, also known as End Stage Renal Disease (ESRD). Customers must be in a non -working status (i.e., retiree or disabled) or entitled to benefits due to a retirement status (i.e., spouse of retiree), and Medicare must be primary. Age Customers are typically eligible for Medicare at age 65. To be eligible for our plan, the customer must also meet eligibility requirements outlined in the Eligibility Policies section. For employer groups with 20 or more employees, Medicare will pay secondary if the customer has other coverage through their employer or spouse based on their current employment status. For employer groups with under 20 employees, Medicare will pay primary. Disability Customers can become Medicare eligible due to disability. To be eligible for our plan, the customer must also meet eligibility requirements outlined in the Eligibility Policies section. For employer groups with 100 or more employees, Medicare will pay secondary if the customer has other coverage through their employer or spouse based on their current employment status. For employer groups with under 100 employees, Medicare will pay primary. ESRD Customers can become Medicare eligible due to an ESRD diagnosis. If Medicare already pays primary for the customer due to age or disability and subsequently they are diagnosed with ESRD, Medicare will continue to pay as primary. If the customer becomes eligible for Medicare because of ESRD only, Medicare coverage will start the fourth month of dialysis treatments, unless certain criteria is met. Medicare will pay secondary for the first 30 months. At the end of the 30-month coordination period, the customer becomes eligible to enroll in the Employer Group Medicare Advantage plan.' If the customer turns age 65 during the 30-month coordination period, Medicare remains secondary until the end of the coordination period. CIGNA HEALTHCARE PDP GROUP ADMINISTRATIVE GUIDE Eligibility and enrollment (continued) Medicare Beneficiary Identifier (MBI) CMS requires that the customer MBI be included with each enrollment application. The MBI can be found on the customer's Medicare ID card. The Group is responsible for providing the customer's MBI to Cigna Healthcare with their enrollment application. Eligibility received without the MBI will be considered an incomplete enrollment application (see Incomplete enrollment information). The customer will not have access to care due to incomplete enrollment. As a reminder, Cigna Healthcare can verify Medicare Part A and B enrollment along with MBI for potential enrollees. See the Plan Eligibility section for more details. Enrollment information required by CMS and Cigna Healthcare for Medicare customers The Group must provide all the information required by CMS and Cigna Healthcare in order to successfully enroll the customer into the elected plan. Required information Customer name Customer DOB Customer gender Permanent residence address: > If a P.O. Box is used for the mailing address, then the Group must also provide the customer's physical address. > Enrollment applications received without the permanent residence address will be considered an incomplete application (see Incomplete Enrollment Information). > If the permanent residence address cannot be provided due to security concerns, a Permanent Residence Attestation can be provided by the client or the customer. • Customer MBI • Account number • Branch code • Benefit option code • Coverage effective date Coverage cancel date (required for all disenrollments, excluding those initiated by CMS) Highly recommended information • Phone number • Email address At certain points during the year, phone numbers and email addresses may be used for clinical care outreaches or to share plan information and updates. • Other insurance information Complete insurance details support accurate claim processing. 7 Eligibility and enrollment (continued) Eligibility format and processing The following methods are acceptable for submitting enrollments to Cigna Healthcare: Automated eligibility file CMS -compliant spreadsheet Enrollment requests via phone call or email are never allowed, even in an emergency situation. CMS requires a seven calendar -day processing time from the date completed Medicare eligibility is received by Cigna Healthcare. We will send all enrollment information to CMS. In the event an enrollment is rejected, a letter will be sent to the customer indicating the reason for the rejection. The Group will receive a Group Enrollment Report that identifies the customers who have not been accepted by CMS. Group Enrollment Report This report is generated weekly upon receipt of the CMS response file and includes all accepted enrollments, disenrollments and address changes into the plan. The report will indicate when action is required by the Group. Critical Error Report This report contains errors encountered when the eligibility file is processed. Incomplete enrollment information Enrollment information that is incomplete is not legally valid for enrollment into the Cigna Healthcare Medicare EGWP. In addition, an enrollment is not legally valid if it is later determined that the customer did not meet all of the CMS eligibility requirements. If there is missing or incorrect information, including a missing permanent residence address when a P.O. Box is provided, the customer will receive a letter instructing them to contact the Cigna Healthcare Dedicated Medicare Customer Service Team (see Section 7. Customer Resources - Phone Numbers); they can immediately update the missing information in order to expedite processing the initial enrollment. Cigna Healthcare will notify the Group of the missing information on the Group Enrollment and Critical Error Reports for the Group to update their records. The customer has 21 days to respond to the request for missing information. If a valid MBI or permanent residence address cannot be obtained within 21 days, Cigna Healthcare will send the customer a Denial of Enrollment letter and they will notify the Group that the customer must be terminated from the Cigna Healthcare Medicare EGWP on the Group Enrollment Report. The Group may choose to move customers to a non-EGWP or terminate coverage. If the information is provided after the 21 days, the customer's effective date will be postponed until the following month, when the customer's completed information is received and validated by CMS. 8 CIGNA HEALTHCARE PDP GROUP ADMINISTRATIVE GUIDE Eligibility and enrollment (continued) Effective dates CMS has sole authority to verify effective dates; however, a proposed effective date may be communicated to the customer. Effective dates will always be the first day of the month. The effective date may not be earlier than the first of the month following the month in which the customer enrollment request was made. The effective date may not be earlier than the first day of the customer's entitlement to Medicare. If a customer's enrollment is submitted with a date prior to their entitlement date, Cigna Healthcare will process the enrollment using the Medicare entitlement date. Enrollments cannot be processed earlier than three months prior to the effective date. Terminations Terminations will always be the last day of the month, including terminations resulting from the death of the customer. The disenrollment is effective the last day of the month in which the customer (or his/ her legal representative) provides notice to disenroll to the Group and the Group sends the disenrollment to Cigna Healthcare. The disenrollment date may not be earlier than the end of the month in which the customer disenrollment request was made or the customer no longer qualifies for the plan. Retroactivity Retroactive enrollments and disenrollments are not allowed, except in extraordinary circumstances (subject to audit by CMS) when the Group knew of the customer's enrollment or disenrollment intent prior to the requested effective date. The effective date may be retroactive up to, but not exceeding, three months from the date Cigna Healthcare received the request from the Group. The ability to submit limited retroactive enrollment transactions is to be used only for the purpose of submitting a retroactive enrollment made necessary due to the Group's delay in forwarding the completed enrollment request to Cigna Healthcare. Repeated retroactive requests by a Group may indicate an ongoing problem to CMS and lead to a request from CMS to review the Group's documentation of their records. CMS requires a special review process when requesting enrollment/disenrollment effective dates that are older than three months. If the Group submits a request older than three months, Cigna Healthcare will request a completed form, including the required CMS documentation: The customer's enrollment/disenrollment intent (election form, call notes, opt -out form, etc., dated prior to the requested effective date). The premium impact to the customer if the request is approved. Hardship created for the customer if the request is not approved. The reason for the Group's delay in submission to Cigna Healthcare and preventive actions to avoid future occurrences. Once received, we will review the documentation to determine if it meets CMS requirements. If it doesn't, we will work with you for alternative options. If the documentation supports the requested enrollment/ disenrollment effective date, we will submit the request to CMS for review. This review can take CMS up to 60 days. In the event that CMS denies the retroactive request, we will work with you to determine an alternative solution within CMS guidelines that minimizes customer impact. 9 CIGNA HEALTHCARE PDP GROUP ADMINISTRATIVE GUIDE Eligibility and enrollment (continued) Disenrollment/cancellation A customer may disenroll from a Medicare Part D plan only during one of the CMS -approved election periods. If the customer is enrolled in an EGWP- sponsored plan, they are not required to comply with the CMS -approved election period which allows them to submit a disenrollment at any time during the plan year. The customer must elect another Part D plan or other creditable prescription drug coverage that is at least as good as the standard Medicare prescription drug coverage or they may be subject to a late enrollment penalty. When the customer elects another Medicare Part D plan, CMS will generate an automatic disenrollment from the current Medicare Part D plan. CMS will notify Cigna Healthcare, and Cigna Healthcare will send the customer a letter and notify the Group through the Group Enrollment Report. The Group must terminate the customer from their plan upon notification from Cigna Healthcare using the date provided by CMS. This individual may not remain enrolled in the Cigna Healthcare Medicare EGWP. Cancellations may be necessary in cases of mistaken enrollment or disenrollment made by a customer. Requests for cancellations can only be accepted prior to the effective date of the enrollment or disenrollment request. If a cancellation occurs after the effective date, retroactive disenrollment and reinstatement actions may be necessary. This is only available on a very limited exception basis per CMS guidelines. See Retroactivity. CMS -initiated disenrollments CMS will automatically disenroll a customer: • Upon notification of his/her death. Disenrollments due to date of death can only be initiated by CMS. • Upon enrollment in another PDP or MAPD plan. • Who is no longer entitled to either Medicare Part A and/or B benefits.2 • For failure to pay their Part D Income -related Monthly Adjustment Amount (IRMAA) to the government. • Upon notification of a change in residence that results in the customer being outside of the service area (including incarceration). If it is determined he or she is unlawfully present in the United States. CMS -initiated reinstatements CMS will automatically reinstate a customer in the following situations: Customer was disenrolled due to enrollment in another plan and the new plan was cancelled. CMS disenrolled customer due to erroneous report of death and CMS has corrected the retiree's information. CMS disenrolled customer for failure to pay IRMAA and the customer has been approved for reinstatement due to good cause and customer fulfills requirements. Customers who have been automatically reinstated will appear on the Enrolled Members tab of the Group Enrollment Report. If the Group does not agree to the reinstatement, Cigna Healthcare will submit a disenrollment transaction to CMS. If the Group agrees to reinstate the customer, the customer will remain enrolled in the plan. For failure to pay IRMAA, if CMS notifies Cigna Healthcare prior to reinstating the customer, we will verify if the Group agrees to the reinstatement prior to providing CMS approval for the reinstatement. If the Group agrees to reinstate the customer, notification must be received within five calendar days. 10 CIGNA HEALTHCARE PDP GROUP ADMINISTRATIVE GUIDE Eligibility and enrollment (continued) Termination due to nonpayment of premiums If the Group's policy is to disenroll enrollees for failure to pay their monthly premium, the Group must apply the policy consistently across its enrollees. The Group must give an enrollee a minimum grace period and provide them with written notice prior to disenrollment. The grace period must be at least two calendar months, and it begins on the first day of the month for which the premium is unpaid. If an enrollee fails to pay his or her premium within the grace period, the enrollee can be disenrolled on the first day after the end of the grace period. The Group can attempt to collect the premium but cannot retroactively terminate the enrollee. Income -related Monthly Adjustment Amount (IRMAA) Medicare -eligible customers with Part D coverage could be assessed a higher Part D premium based on their annual income. Customers with a single annual income over $97,000 or joint income of over $194,000 will be charged additional premiums by the SSA.3 NOTE: These amounts are subject to change annually. They may either have premiums deducted from their monthly Social Security payment or if they are not receiving Social Security yet, Medicare will bill them directly. • Customers who fail to pay the additional premium will be involuntarily terminated from the plan. • IRMAA is administered by Medicare and the SSA. Cigna Healthcare is not provided any information regarding which persons are affected by IRMAA. Any questions about IRMAA should be directed to the SSA at 1-800-772-1213. IRMAA When a customer does not pay their IRMAA to the SSA, CMS will notify Cigna Healthcare that the customer must be terminated. Cigna Healthcare will then notify the Group via the Group Enrollment Report that the customer must be terminated per CMS. CMS provides an opportunity for reinstatement of customers into their Medicare Part D Plan for good cause situations. If the customer advises the Group they have a good reason for failure to pay Part D IRMAA premiums, the Group should tell the customer to contact I-800-MEDICARE (1-800-633-4227) within 60 calendar days of the disenrollment effective date to see if they qualify for a good cause reinstatement and, if so, make payment arrangements in order to get reinstated into the plan. CMS will notify Cigna Healthcare if the customer qualifies for reinstatement for good cause. Cigna Healthcare will reach out to the Group to confirm if the customer can be added back into the plan based on the Group's eligibility rules. Once the customer makes all the required payments, CMS will reinstate the customer and Cigna Healthcare will notify the Group via the Group Enrollment Report. Record retention CMS requires that Cigna Healthcare has a record of all enrollment requests. CMS guidelines require customer enrollment elections to be retained for 10 years. Additionally, the Group will maintain all records and documentation relating to enrollment for a period of 10 years from the final date of group coverage. 11 Fully insured premium billing and payment Billing invoice A separate invoice will be generated for your Cigna Healthcare Medicare plans. If there are multiple account numbers, each account number will generate a separate invoice. The invoice will include a monthly summary and a detailed roster. For Administrative Services Only (ASO) clients, please see separate ASO Companion Guide document for all billing information. Payment due date Premium is due by the end of the month. Any premium not received after the last day of the month is considered past due. Cigna Healthcare will provide notice of the unpaid premiums on the next month's invoice and may provide a separate notice of late payment if unpaid premiums are more than one month past due. Cigna Healthcare may terminate the agreement one month after it provides the Group with a notice of late payment if the Group has not paid the premiums due. Payment remittance method Eligibility -based billing or Pay as Billed (PAB) is the Cigna Healthcare remittance method. The Group will need to remit payment for Cigna Healthcare Medicare plan coverage separately from other Cigna Healthcare plans. A separate W-9 is not required for Cigna Healthcare Medicare clients with a Cigna Healthcare commercial relationship. A W-9 is required for clients with Cigna Healthcare Medicare plans only. Wire and Automated Clearing House (ACH) details Bank: Bank of America, N.A. ACH ABA Routing/Transit Number 011900571 Bank Account Number: 385015921381 Bank Account Name: Cigna Health and Life Insurance Company Bank ACH Address: 101 S Tryon Street Charlotte, NC 28255 Wire Transfer ABA: 026009593 Swift: BOFAUS3N Bank: Bank of America Bank Address: 101 West 33rd Street New York, NY 10001 ,) LIS premium adjustment Medicare provides a premium subsidy for those who qualify due to limited income or resources. CMS will notify Cigna Healthcare of any customers eligible for LIS premium adjustments. CMS will pass the adjustment on to Cigna Healthcare, and we in turn will pass the adjustment on to the Group via the monthly billing invoice. A separate detailed monthly billing adjustment report will provide the names of the applicable customers and will contain the amount of the LIS premium adjustments. The billing roster indicates the retirees who are eligible for the LIS with the adjustment code of LIS. Customers eligible for LIS and the LIS premium adjustment amounts are subject to change on a monthly basis. Retroactive LIS premium adjustments may appear on the billing roster. 12 CIGNA HEALTHCARE PDP GROUP ADMINISTRATIVE GUIDE Fully insured premium billing and payment (continued) LIS premium adjustment (continued) The Group will reduce the premium amount due up to the amount the customer contributes toward premiums by reducing the premium amount due up front. In those instances where the Group is not able to reduce the premium paid by the customer up front, Cigna Healthcare and the Group may agree that either the Group or Cigna Healthcare shall directly refund to the customer the amount of the LIS premium up to the Cigna Healthcare Group Medicare plan contribution previously collected from the customer. The Group or Cigna Healthcare is required to complete the refund on behalf of Cigna Healthcare within 45 days of the date Cigna Healthcare receives the LIS amount for the LIS-eligible customer from CMS. Any remaining portion of the subsidy amount is then applied toward the monthly customer premium paid by the Group. If the LIS premium amount for which a customer is eligible is less than the portion of the monthly premium paid by the customer, then the Group should communicate the potential financial impact to the customer in the Cigna Healthcare Medicare plan as compared to enrolling in another Part D plan with a monthly premium equal to or below the LIS premium amount. Late Enrollment Penalty (LEP) Customers may have to pay an LEP in addition to their monthly plan premium if there is a continuous period of 63 days or more at any time after the end of their Part D initial enrollment period during which they were eligible to enroll but were not enrolled in a Medicare Part D plan and were not covered under any creditable prescription drug coverage. Creditable prescription drug coverage is coverage that is at least as good as the standard Medicare prescription drug coverage. The customer may have to pay this LEP for as long as they have Medicare prescription drug coverage. The amount of the LEP may change every year. If the customer must pay an LEP, the penalty is applied when a customer joins a Medicare plan with drug coverage and has a gap in coverage of 63 days or more. The penalty amount may change each year based on the national base beneficiary premium amount. Although you can estimate, only CMS is authorized to calculate the actual amount of the penalty. CMS will inform Cigna Healthcare of the LEP amount that the customer would be responsible for paying. Cigna Healthcare will pass the penalty on to the Group via the employer monthly billing invoice. The detailed billing roster will provide the names of the applicable customers and the amount of the LEP. The Group is responsible for paying the penalty on behalf of the customer and may choose to collect the LEP amount from the customer. The amount of the LEP may change every year. If a customer has been assessed an LEP under a non -Cigna Healthcare plan and disagrees with the penalty, the customer must initiate the appeal process by contacting Medicare at I-800-MEDICARE (1-800-633-4227); TTY users should call 1-877-486-2048. The customer' will need to fill out a reconsideration request form and provide proof that they had previous creditable coverage. Cigna Healthcare is unable to assist in the appeal process when the customer did not have coverage through Cigna Healthcare. 13 CIGNA HEALTHCARE PDP GROUP ADMINISTRATIVE GUIDE Fully insured premium billing and payment (continued) Attestation Cigna Healthcare will accept an attestation from the Group that all customers submitted on the eligibility file for initial enrollment into the Cigna Healthcare Medicare EGWP were previously enrolled in a plan that provided creditable pharmacy coverage and did not have a gap in creditable coverage for 63 days or longer. If the retirees were enrolled in a Retiree Drug Subsidy filed plan, Cigna Healthcare will also accept an attestation that the customers have been notified of the opportunity to enroll and the process for opting out of coverage in the Cigna Healthcare Medicare EGWP. These attestations apply to valid and complete enrollment applications/records processed prior to the initial effective date of the plan. Enrollment requests processed after the initial effective date will receive communications regarding creditable coverage and/or Retiree Drug Subsidy as required by CMS. Employer/Union Group PDP Agreement The CMS contract addendum with Cigna Healthcare (Employer/Union-only Group Addendum) requires that Cigna Healthcare obtain written agreements from each employer or union with which it contracts for employer/union-only group PDP plans and that such agreements contain certain terms and provisions. This agreement will be provided to you by your account team and will need to be fully executed prior to the effective date. A full agreement is provided with the initial plan year, and an amendment is provided for each renewing year. CIGNA HEALTHCARE PDP GROUP ADMINISTRATIVE GUIDE Customer communications Required group communications to customers Pre -enrollment kits Group pre -enrollment kits are required to go out to all eligible customers and must be received no later than 21 days prior to the effective date for passive enrollment or 21 days before the Open Enrollment Period for active enrollment. Further, pre -enrollment kits are required to be sent to retirees as they reach the age of Medicare eligibility and meet the Group's enrollment rules. Cigna Healthcare will provide the client with a bulk shipment of pre -enrollment (or age -in) kits prior to the start of the calendar year. The client will send a kit to each retiree 60 days prior to their Medicare eligibility. Both the pre -enrollment and age -in kits will include: Pre-enrollment/Age-in letter Summary of Benefits Online Resource insert (Directory and Drug List) Information Guide • Notice of Non-discrimination and Multi -language insert Formulary Addendum Additional general plan information is available at CignaMedicare.com/group/PDPresources. See page 17 for more details. Renewal kits Group renewal kits are required to go out to all enrolled customers and must be received 15 days before the beginning of the Group's health plan Open Enrollment Period. If the Group does not have an Open Enrollment Period, then the materials are required to be received or available to review online by customers no later than 15 days before the beginning of the plan year. • Renewal cover letter • Annual Notice of Change (ANOC) • Evidence of Coverage (EOC) snapshot • Formulary Addendum for PDP • Online Resource insert (Directory and Drug List) • Privacy Practices • Notice of Non-discrimination and Multi -language insert Post -enrollment communications Upon completion of the customer's enrollment into the Cigna Healthcare Medicare EGWP, the following will be mailed to the customer within 10 calendar days from receipt of CMS confirmation of enrollment or by the last day of the month prior to the effective date, whichever is later: • Welcome letter • EOC snapshot • Online Resource insert (Directory and Drug List) • Customer Handbook • Privacy Practices • ID card (mailed separately) • Notice of Non-discrimination and Multi -language Interpreter Services Acknowledgment/Confirmation of Enrollment Acceptance letters (mailed separately) 15 CIGNA HEALTHCARE PDP GROUP ADMINISTRATIVE GUIDE Customer communications (continued) Required plan communications to customers Cigna Healthcare will provide a copy of the following items and other communications to the Group and/or broker, if requested. Acknowledgment/Confirmation of Enrollment Acceptance Notices The notices are mailed to the customer within 7 to 10 calendar days of the CMS confirmation of enrollment. The notices can be used by the customer as proof of coverage prior to receiving the ID card. Identification (ID) Card ID cards are mailed to the customer's home within 10 days of CMS confirmation of enrollment. It is required that the contract be executed prior to the effective date in order to trigger the release of ID cards to those enrolled. Replacement Cigna Healthcare Medicare ID cards can be ordered by calling the dedicated customer service team (see Customer Resources). Cigna Healthcare customers will receive a new customer identifier when moving to the Cigna Healthcare Medicare EGWP. Cigna Healthcare Medicare Plans are member -based products, which require all customers to be loaded as individual subscribers. Low Income Subsidy (LIS) Rider (if applicable) The rider is mailed to the customer's mailing address within 30 calendar days of notification from CMS that the customer qualifies for a low income subsidy. Late Enrollment Penalty (LEP) Attestation Notice This notice is mailed to the customer within 10 calendar days of receipt of application when there is a potential gap in coverage of 63 days or more, and it must be returned within 30 calendar days of the date on the form. Acknowledgment of Disenrollment Notice The notice is mailed to the customer within 10 calendar days of Cigna Healthcare receiving the disenrollment election. • Confirmation of Disenrollment Notice This notice is mailed within 7 to 10 calendar days of the CMS confirmation of disenrollment. • Explanations of Benefits (EOBs) EOBs will be produced for claim activity and will be mailed to the customer's mailing address in accordance with CMS guidelines. Research Potential Out -of -area Status Notice This notice is mailed to the customer when we receive notice (returned mail, CMS notification, etc.) that they may have moved out of the service area. The customer must confirm that they still live in the service area within six months or they will be disenrolled from the plan. Notice of Disenrollment Due to Out -of -area Status (upon new address verification from customer) This notice is mailed within 10 calendar days of Cigna Healthcare verifying that the customer has permanently moved out of the service area. Termination Letter CMS allows a Group to disenroll its customers from a Medicare plan using a group disenrollment process. The group disenrollment process must include a letter of notification of disenrollment to each customer 30 days prior to the effective date of their disenrollment from the Group -sponsored Medicare plan. This is not a complete list of all communications that may be sent throughout the plan year. There are system -generated letters that are sent to request information in order to process claims, update customer records, etc. Electronic samples of these system -generated letters can be provided upon request. 16 Customer resources Medicare Prescription Drug Plan dedicated customer service team phone number Phone number: I-800-558-9562 (TTY/TDD users should call 711) Hours of operation: October I - March 31, 7 days a week, 8 a.m. to 8 p.m. local time. April I - September 30, Monday - Friday, 8 a.m. to 8 p.m. local time. Our automated phone system may answer your call during weekends or holidays and after hours. Home Delivery with Express Scripts Pharmacy' To set up an account, retirees should have their Cigna Healthcare Medicare ID card and medication list nearby and call Express Scripts° Pharmacy at 1-877-860-0982 (TTY 711), 24 hours a day, 365 days a year. Customer web access Customers can sign in to myCigna.com®, which is a personalized website where they can: View Medicare Part D benefits Manage prescriptions Manage profiles and preferences Price a medication • View drug lists • Access Healthy Rewards®6 discount programs • Find a network pharmacy • View and print ID cards Review claim history and EOB details The CignaMedicare.com/group/PDPresources public website provides customers with access to general plan information that does not list client -specific benefits. EOC shell (the legal language of the plan) Claim forms The ability to find a pharmacy Medication therapy management • Chain pharmacy listing Quantity limit criteria • Information on how to transition to Step therapy criteria a new plan policy Prior authorization criteria Drug lists Personal medication list 17 CIGNA HEALTHCARE PDP GROUP ADMINISTRATIVE GUIDE Claims administration Claims When a manual claim is necessary (majority of providers will submit electronically), customers will need to complete a claim form to request payment. Copies of the form can be downloaded from CignaMedicare.com/ group/PDPresources, or customers can contact customer service to request a form be mailed to them. Claims should be mailed to: Pharmacy Cigna Healthcare Attn: Medicare Part D P.O. Box14718 Lexington, KY 40512-4718 Claims payment Cigna Healthcare will administer claims in accordance with the EOC document. From time to time, Cigna Medicare will reprocess or adjust claims that have been processed under the Plan for several potential reasons including, but not limited to, obtaining additional information from the customer, the customer's provider or CMS and upon identifying errors. If Cigna Healthcare reprocesses or adjusts a processed claim(s) and this results in a change to the amount due from the customer, Cigna Healthcare shall notify the customer of the change and, as applicable, refund the difference to the customer or request payment of the difference. In the case of an ASO plan, Cigna Healthcare will offset the amount of the group overpayment/underpayment in future group reconciliation reports. Additional resources Medicare website: www.Medicare.gov Cigna Healthcare website: Cigna.com Employer Group customer resources: CignaMedicare.com/Group/PDPresources Group Medicare Online Pharmacy Directory: CignaMedicare.com/Group/PDPresources Group Employer Portal: Employer.HSConnectOnline.com/home/login 18 Aso Aso cigna healthcare 1. Effective January 1, 2021, Medicare allowed individuals with an ESRD diagnosis to enroll in Medicare Advantage plans at the end of the 30-month coordination period. 2. A customer can ask Cigna Healthcare to reinstate coverage if they feel that CMS disenrolled them in error. If the Group agrees, Cigna Healthcare will reinstate coverage for the customer for a period of 60 days. If CMS systems are updated within 60 days, the reinstatement will be submitted to CMS and the customer will receive the Acknowledgment of Reinstatement letter. If CMS systems are not updated after 60 days, Cigna Healthcare will disenroll the customer back to the original disenrollment date and the customer will receive a letter to close the reinstatement request. 3. For the most up-to-date income ranges, visit https://www.Medicare.gov/Drug-Coverage-Part-D/Costs-For-Medicare-Drug-Coverage/Monthly-Premium-For-Drug-Plans. 4. CMS. Understanding Medicare Advantage & Medicare Drug Plan Enrollment Periods. CMS Product No. 11219. Page last accessed September 14, 2023. https://www.medicare.gov/Pubs/pdf/11219-Understanding-Medicare-Part-C D.pdf. 5. Express Scripts® Pharmacy is the home delivery pharmacy of EVERNORTHSM Health Services. Evernorth is a division of The Cigna Group. 6. Some discount programs are not available in all states and programs may be discontinued at any time. A discount program is NOT insurance, and customers must pay the entire discounted charge. All goods, services and discounts offered through discount programs are provided by third parties who are solely responsible for their products, services and discounts. Cigna Healthcare products and services are provided exclusively by or through operating subsidiaries of The Cigna Group. The Cigna names, logos, and marks, including THE CIGNA GROUP and CIGNA HEALTHCARE, are owned by Cigna Intellectual Property, Inc. Subsidiaries of The Cigna Group contract with Medicare to offer Medicare Advantage HMO and PPO plans and Part D Prescription Drug Plans (PDPs) in select states, and with select State Medicaid programs. Enrollment in a Cigna Healthcare product depends on contract renewal. 979317 11/23 © 2023 Cigna Healthcare Olivera, Rosemary From: Aviles, Yesenia Sent: Wednesday, August 28, 2024 2:05 PM To: Olivera, Rosemary Cc: Ewan, Nicole; Hannon, Todd Subject: Matter ID #24-1581 - Cigna Health and Life Insurance Company- Employer/Union Group Prescription Drug Plan (PDP) - Amendment No. 3 Attachments: Complete_with_Docusign_Third_Amendment_to_Gr.pdf Good afternoon, Please find attached a fully executed copy of an agreement from DocuSign that is to be considered an original agreement for your records. Thank you Regards, Yesenia Aviles Assistant to the Director, Risk Management Ph: (305) 416-1723 I Fax: (305) 416-1760 I YAviles©miami.gov 444 SW 2nd Ave, 9th Floor Miami, FL 33130 Website: Risk Management - Miami 1