• Annual routine ophthalmological exam including refraction
12) The following Rider form(s) is/are not available:
ACCIDENTAL DEATH AND DISMEMBERMENT RIDER DISABILITY INCOME RIDER CRITICAL ILLNESS INSURANCE RIDER TERM LIFE INSURANCE RIDER
Wisconsin residents:
1) Under the General Definitions section, item 2 of the second paragraph of the Dependent child definition includes adopted child as follows:
2. adopted child, beginning with any waiting period pending finalization of the child’s adoption. It also means the legally adopted child of the Employee’s Spouse or domestic partner/Partner to a Civil Union provided the child is living with, and is financially dependent upon the Employee;
2) Under the Disability Income Rider, the Pre-existing Condition Limitation is revised to include the following:
However, if the Covered Person discloses a Sickness on the enrollment form and coverage is issued without specifically excluding that Sickness, the Pre-existing Condition limitation does not apply to that Sickness.
Alabama, Alaska, Arkansas, Arizona, California, Connecticut, Delaware, District of Columbia, Florida, Georgia, Hawaii, Illinois, Indiana, Iowa, Kansas, Kentucky, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Jersey, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, Puerto Rico, Rhode Island, South Carolina, Tennessee, Utah, Virginia, Virgin Islands and Wisconsin Residents:
The Pre- Existing Condition Limitation Period can’t exceed 6 months/12 months.
CIGNA HEALTH AND LIFE INSURANCE COMPANY
Geneva Campbell Brown Corporate Secretary
Julia M.Huggins Senior Vice President of US Markets President CHLIC
GHIP 00-3000.00
R08/22
61
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