source, that classify drugs or Biologics (including Biosimilars) as either brand or generic based on a number of factors. Not all products identified as a “generic” by the manufacturer, Pharmacy or your Physician may be classified as a Generic Drug under the plan. A Biosimilar may be classified as a Generic Drug for the purposes of benefits under the plan even if it is identified as a “brand name” drug by the manufacturer, Pharmacy or your Physician.
Essential Health Benefits Essential health benefits means, to the extent covered under the plan, expenses incurred with respect to covered services, in at least the following categories: ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services, including behavioral health treatment, prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventive and wellness services and chronic disease management and pediatric services, including oral and vision care.
HC-DFS846
10-16
Hospice Care Program The term Hospice Care Program means: a coordinated, interdisciplinary program to meet the physical, psychological, spiritual and social needs of dying persons and their families; a program that provides palliative and supportive medical, nursing and other health services through home or inpatient care during the illness; a program for persons who have a Terminal Illness and for the families of those persons.
HC-DFS411
01-11
Expense Incurred An expense is incurred when the service or the supply for which it is incurred is provided.
HC-DFS10
04-10
V1
Free-Standing Surgical Facility The term Free-standing Surgical Facility means an institution which meets all of the following requirements: it has a medical staff of Physicians, Nurses and licensed anesthesiologists; it maintains at least two operating rooms and one recovery room; it maintains diagnostic laboratory and x-ray facilities; it has equipment for emergency care; it has a blood supply; it maintains medical records; it has agreements with Hospitals for immediate acceptance of patients who need Hospital Confinement on an inpatient basis; and it is licensed in accordance with the laws of the appropriate legally authorized agency.
HC-DFS51
04-10
V1
Hospice Care Services The term Hospice Care Services means any services provided by: a Hospital, a Skilled Nursing Facility or a similar institution, a Home Health Care Agency, a Hospice Facility, or any other licensed facility or agency under a Hospice Care Program.
HC-DFS52
04-10
V1
Hospice Facility The term Hospice Facility means an institution or part of it which: primarily provides care for Terminally Ill patients; is accredited by the National Hospice Organization; meets standards established by Cigna; and fulfills any licensing requirements of the state or locality in which it operates.
HC-DFS11
04-10
V1
Generic Drug A Prescription Drug Product that Cigna identifies as a Generic Drug product at a book-of-business level principally based on available data resources, including, but not limited to, First DataBank or another nationally recognized drug indicator
HC-DFS53
04-10
V1
69
myCigna.com
Made with FlippingBook Online newsletter