Breast ultrasound;
CA 15-3 (blood test for breast cancer); CA125 (blood test for ovarian cancer); CEA (blood test for colon cancer);
Chest X-ray;
Serum Protein Electrophoresis (blood test for myeloma); and Thermography Infectious Disease Immunization (any FDA approved Vaccine to protect against a pandemic level infectious disease, as declared or defined by the Centers for Disease Control) PREVENTIVE CARE EVENTS Patient Protection and Affordable Care Act (PPACA) required preventive health services as recommended by the following expert medical and scientific bodies: o the U.S. Preventive Services Task Force (USPSTF); o the Advisory Committee on Immunization Practices (ACIP); o the Health Resources and Services Administration’s (HRSA’s) Bright Futures Project; and o HRSA and the Institute of Medicine (IOM) committee on women’s clinical preventive services. Detailed information is available at: https://www.healthcare.gov/coverage/preventive-care-benefits/ Exclusion(s) The Common Exclusions section of the Policy does not apply to this Rider. RENEWABILITY/TERMINATION OF COVERAGE This Rider is renewable. However, this Rider shall automatically terminate on the earliest of the following dates: 1. the date the Covered Person’s coverage ends for any reason under the Policy to which this Rider is attached; 2. the last day of the period for which premium is paid for this Rider, subject to the Policy’s Grace Period provision; or 3. the end of the period for which premium is paid for coverage under the Policy, to which this Rider is attached, subject to the Policy’s Grace Period provision. PORTABILITY PROVISION Coverage under this Rider is portable. Coverage may only be ported if the Covered Person elects to port coverage under the Policy. REINSTATEMENT If the Employee applies for reinstatement of insurance under the Policy, the Employee may apply to reinstate this Rider at that time.
CIGNA HEALTH AND LIFE INSURANCE COMPANY
Geneva Campbell Brown, Corporate Secretary
Julia M.Huggins Senior Vice President of US Markets President CHLIC
WPB-GCI-02-7000-1.WY
Cigna Health and Life Insurance Company
32
Made with FlippingBook. PDF to flipbook with ease