Cigna Health and Life Insurance Company 900 Cottage Grove Road Bloomfield, Connecticut 06002
WELLNESS TREATMENT, HEALTH SCREENING TEST AND PREVENTIVE CARE BENEFIT RIDER
This Rider is attached to and made a part of your group insurance Policy. It is subject to the terms, conditions, limitations and exclusions contained in the policy as well as those set forth in this Rider. These benefits are not subject to a Pre- Existing Condition Limitation.
Rider Effective Date: January 01, 2024
THIS RIDER DOES NOT CONTAIN COMPREHENSIVE ADULT WELLNESS BENEFITS AS DEFINED BY WYOMING LAW.
BENEFITS
The following provisions explain the benefits available under this Rider. Please see the Schedule of Benefits for the applicability of these benefits on a class level.
We will pay the per day benefit shown in the Schedule of Benefits, if a Covered Person undergoes or receives Wellness Treatment, Health Screening Test and Preventive Care examination, immunization, or testing as set forth below, under direction of a Physician while coverage under this Rider is in force. Benefits are subject to any applicable Benefit Waiting Period, Maximum Benefit Period, and Elimination Period. NON-DUPLICATION OF BENEFITS If the Benefits under this Rider would duplicate Benefits payable under the Policy as a result of a Covered Accident, then such Benefits will only be payable under the Policy and not under this Rider.
BENEFIT WAITING PERIOD The Benefit Waiting Period as shown in the Schedule of Benefits for this Rider applies.
MAXIMUM BENEFIT PERIOD The Maximum Benefit Period is the period commencing on the first date that benefits are payable and continuing for the Maximum Period shown in the Schedule of Benefits .
WELLNESS TREATMENT
▪ Well Child Care - Office Treatment, Labs and Immunizations ▪ Osteoporosis screenings ▪ Routine gynecological exams ▪ Routine prostate exams ▪ General health exams ▪ Colorectal cancer screening ▪ Lead poisoning screening ▪ Cancer screenings and ▪ Adult immunizations
HEALTH SCREENING TEST
▪
Mammography
▪
Pap Smear for women over Age 18
▪
Flexible Sigmoidoscopy Hemoccult Stool Specimen
▪
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