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CIGNA Pre-enrollment Disclaimer
Eligibility and Enrollment Information
Enrollees must use the network pharmacies to receive plan benefits except under emergency circumstances. Enrollees must continue to pay their Medicare Part B premium if not otherwise paid for under Medicaid or by another third party.
There are no income restrictions for the Prescription Drug Plan. You may be enrolled in only one Prescription Drug Plan at a time. If enrolled in a Medicare Advantage (MA) coordinated care (HMO or PPO) plan or an MA PFFS plan that includes Medicare prescription drugs, the enrollee may not enroll in a PDP unless they disenroll from the HMO, PPO, or MA PFFS plan. Enrollees in a private fee-for-service plan (PFFS) that does not provide Medicare prescription drug coverage, or an MA Medical Savings Account, (MSA) plan may enroll in a PDP. Enrollees in a 1876 Cost plan may enroll in a PDP.
Enrollees may join only during specific times of the year. For information about enrollment periods, please call 1.800.735.1459. TTY/TDD users call 1.800.322.1451. CIGNA Medicare Rx representatives are available 8:00 AM - 8:00 PM local time, 7 days a week.
Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change on January 1, 2009. Please contact CIGNA Medicare Rx for details.
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Formulary
CIGNA’s formulary, which is a list of covered prescription drugs, represents the prescription therapies believed to be a necessary part of a quality treatment program. For a complete listing, please call 1.800.735.1459. TTY/TDD users call 1.800.322.1451. CIGNA Medicare Rx representatives are available 8:00 AM - 8:00 PM local time, 7 days a week.
CIGNA Medicare Rx will provide at least 60 days notice before removing a Part D drug from the formulary or making any changes in the preferred or tier cost sharing status of a covered Part D drug. Enrollees will be notified in one of the following ways:
- Direct written notice to affected enrollees at least 60 days prior to the effective date of the change.
- At the time an affected enrollee requests a refill of the Part D drug, we will provide the enrollee written notice of the formulary change and a 60 day supply of the Part D drug under the same terms as previously allowed.
CIGNA Medicare Rx covers both brand-name drugs and generic drugs. Generic drugs have the same active ingredient formula as a brand name drug. Generic drugs usually cost less than brand name drugs and are rated by the Food and Drug Administration (FDA) to be as safe and effective as brand name drugs.
For a complete listing of covered drugs, please call customer service at 1.800.735.1459. TTY/TDD users call 1.800.322.1451. CIGNA Medicare Rx representatives are available 8:00 AM - 8:00 PM local time, 7 days a week.
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Medicare Supplement (Medigap)
If you have a Medicare Supplement (Medigap) policy that includes prescription drug coverage, you must contact your Medigap Issuer to let them know that you have joined a Medicare Prescription Drug Plan. If you decide to keep your current Medigap supplement policy, your Medigap Issuer will remove the prescription drug coverage portion of your policy and adjust your premium. Under certain circumstances, you can also buy a different Medigap policy without prescription drug coverage sold by your Medigap Issuer. Your Medigap Issuer cannot charge you more based on any past or present health problems. Call your Medigap Issuer for details.
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Pharmacy Benefits
Members may receive prescription drugs from an In-Network Preferred Pharmacy for a one-month supply or a three-month supply. Members may receive prescription drugs from a Mail Order Pharmacy for a three-month supply.
Under emergency circumstances only, members may receive prescription drugs from an Out-of-Network Pharmacy for a limited supply only.
All network pharmacies may not be listed in this directory. Please contact us at 1.800.735.1459 (TTY/TDD users call 1.800.322.1451) for additional information.
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Mail Order Prescription Drug Service
Mail Order Prescription Drug Service is available. Benefits are only available at In-Network Preferred Pharmacies (under emergency circumstances, benefits may be obtained from Out-of-Network Pharmacies). To obtain more information about Mail Order Prescription Drug Services, please call 1.800.735.1459. TTY/TDD users call 1.800.322.1451. CIGNA Medicare Rx representatives are available 8:00 AM - 8:00 PM local time, 7 days a week.
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Disenrollment Information
Voluntary Disenrollment
You may disenroll from CIGNA Medicare Rx only during a Special Enrollment Period (SEP) or during the Annual Coordinated Election Period (AEP), which occurs November 15 through December 31 each year. SEPs include those situations where:
- You have made a change in residence outside the service area or have experienced another change in circumstances as determined by the Centers for Medicare & Medicaid Services (CMS) that causes you to no longer be enrolled in CIGNA Medicare Rx;
- You are entitled to Medicare Part A and Part B and you receive any type of assistance from the Title XIX (Medicaid) program;
- CMS or the organization has terminated CIGNA Medicare Rx’s contract for CIGNA Medicare Rx in the area in which you reside, or the organization has notified you of the impending termination of or the impending discontinuation of CIGNA Medicare Rx in the area in which you reside;
- You demonstrate that CIGNA Medicare Rx substantially violated a material provision of its contract with CMS in relation to you, or CIGNA Medicare Rx (or its agent) materially misrepresented CIGNA Medicare Rx when marketing CIGNA Medicare Rx;
- You involuntarily lose creditable coverage, including a reduction in the level of coverage so that it is no longer creditable, not including any such loss or reduction due to your failure to pay premiums;
- You were not adequately informed of the creditable status of drug coverage provided by an entity required to give such notice, or a loss of creditable coverage;
- Your enrollment or non-enrollment in CIGNA Medicare Rx is erroneous due to an action, inaction or error by a Federal Employee; or
- You meet such other exceptional conditions as CMS may provide.
During an SEP, you may discontinue enrollment in a Prescription Drug Plan (PDP) offered by a PDP sponsor or change to a different Part D plan. If you disenroll from (or are disenrolled from) CIGNA Medicare Rx, you may subsequently enroll in a new Part D plan within the SEP time period. Once you have enrolled in a new Part D plan, the SEP ends for you even if the time frame for the SEP is still in effect. You may disenroll by:
- Mailing or faxing a signed written notice to CIGNA Medicare Rx, or through CIGNA Medicare Rx’s employer group/union, where applicable;
- Calling 1.800.MEDICARE 24 hours a day/7 days a week. TTY/TDD users call 1.877.486.2048 24 hours a day/7 days a week.
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Involuntary Disenrollment
CIGNA Medicare Rx can disenroll you for the following reasons:
- A permanent change in residence making you ineligible to be an enrollee of CIGNA Medicare Rx;
- You lose entitlement to Medicare;
- You die;
- The CIGNA Medicare Rx contract is terminated, or CIGNA Medicare Rx discontinues offering a Prescription Drug Plan in the area where CIGNA Medicare Rx had previously been available. Note: CIGNA Medicare Rx is authorized by law to refuse to renew its contract with CMS. In addition, CMS also may refuse to renew the contract, and that termination or non-renewal may result in termination of your enrollment in CIGNA Medicare Rx; or
- You materially misrepresent information to CIGNA Medicare Rx regarding reimbursement for third-party coverage.
- Failure to pay plan premiums
For information about the aggregate number of CIGNA Medicare Rx grievances and exceptions; CIGNA Medicare Rx quality and performance indicators; or the financial condition of CIGNA Medicare Rx, please contact Customer Service 1.800.735.1459, 8:00 AM - 8:00 PM local time, 7 days a week. TTY users call 1.800.322.1451, 8:00 AM - 8:00 PM local time, 7 days a week.
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Last updated on: 07/05/2009
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Life Insurance plays an important role in your families financial stability.
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Enroll 2010
