Condition-Specific Care The Condition-Specific Care benefit supports programs that are designed to help guide your care and may reduce your out- of-pocket costs related to select Medically Necessary preauthorized services, supplies, and/or surgical procedures. Contact Cigna at the phone number on your ID card for information about the programs available under the Condition- Specific Care benefit. For the program you are interested in, a list of services, supplies, and/or surgical procedures included under the program will be provided to you. In order to be eligible for Condition-Specific Care benefits, you must enroll in an available program prior to receiving services, supplies, and/or surgical procedure(s) covered under the program; fulfill your responsibilities under the program; receive your care from a designated provider for the program; and this plan must be your primary medical plan for coordination of benefits purposes. To enroll in the program, contact Cigna at the phone number on your ID card. If all requirements are met, and subject to plan terms and conditions, the preauthorized services, supplies, and/or surgical procedure(s) will be payable under the plan as shown in the Condition-Specific Care benefit in The Schedule. Charges for covered expenses not included in the preauthorized services, supplies, and/or surgical procedure(s) are payable subject to applicable Copayments, Coinsurance, and Deductible if any. If you choose to not actively enroll in the program, do not complete the program participation requirements, or utilize a provider who is not designated for the program, charges for covered expenses are payable subject to applicable Copayments, Coinsurance, and Deductible if any. Condition-Specific Care Travel Services Charges made for non-taxable travel expenses for transportation and lodging, incurred by you in connection with a preapproved procedure or service under the program are covered subject to the following conditions and limitations: • You are the recipient of a preapproved procedure or service under the program. • The service and/or procedure is received from a designated provider for the program. • You need to travel more than a 60-mile radius from your primary residence. The term recipient is defined to include a person receiving authorized procedures or services under the program. The travel benefit is designed to offset the recipient’s travel expenses, including charges for: transportation to and from the procedure or service site; and lodging while at, or traveling to and from the procedure or service site.
In addition, the travel benefit is designed to offset travel expenses for charges associated with the items above for one companion to accompany you. The term companion includes your spouse, a member of your family, your legal guardian, or any person not related to you, but actively involved as your caregiver who is at least 18 years of age. The following are specifically excluded travel expenses: any expenses that if reimbursed would be taxable income, travel costs incurred due to travel within a 60 mile radius of your home, depending on the procedure being performed; food and meals; laundry bills; telephone bills; alcohol or tobacco products; and charges for transportation that exceed coach class rates.
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Home Health Care Services Charges for skilled care provided by certain health care providers during a visit to the home, when the home is determined to be a medically appropriate setting for the services. A visit is defined as a period of 2 hours or less. Home Health Care Services are subject to a maximum of 16 hours in total per day. Home Health Care Services are covered when skilled care is required under any of the following conditions: • the required skilled care cannot be obtained in an outpatient facility. • confinement in a Hospital or Other Health Care Facility is not required. • the patient’s home is determined by Cigna to be the most medically appropriate place to receive specific services. Covered services include: • skilled nursing services provided by a Registered Nurse (RN), Licensed Practical Nurse (LPN), Licensed Vocational Nurse (LVN) and an Advanced Practice Registered Nurse (APRN). • services provided by health care providers such as physical therapist, occupational therapist and speech therapist. • services of a home health aide when provided in direct support of those nurses and health care providers. • necessary consumable medical supplies and home infusion therapy administered or used by a health care provider. Note: Physical, occupational, and other Outpatient Therapy Services provided in the home are covered under the Outpatient Therapy Services benefit shown in The Schedule.
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