ININDEPO052023 Cigna
1-2024
helped by a reduction of obesity or weight, or any program, product or medical treatment for
weight reduction or any expenses of any kind to treat obesity, weight control or weight reduction.
58. Routine physical exams or tests that do not directly treat an actual Illness, Injury or condition.
This includes reports, evaluations, or hospitalization not required for health reasons; physical
exams required for or by an employer or for school, or sports physicals, or for insurance or
government authority, and court ordered, forensic, or custodial evaluation
s, except as
otherwise specifically stated in this Policy.
59. Therapy or treatment intended primarily to improve or maintain general physical condition
or for the purpose of enhancing job, school, athletic or recreational performance, including but
not limited to routine, long term, or maintenance care which is provided after the resolution of
the acute medical problem and when significant therapeutic improvement is not expected.
60. Educational services except for Diabetic Self-Management Training Programs, treatment for
Autism, or as specifically provided or arranged by Cigna Healthcare.
61. Nutritional counseling or food supplements, except as stated in this Policy.
62. Exercise equipment, comfort items and other medical supplies and equipment not
specifically listed as Covered Services in the “Comprehensive Benefits: What the Policy Pays
For” section of this Policy. Excluded medical equipment includes, but is not limited to: air
purifiers, air conditioners, humidifiers; treadmills; spas; elevators; supplies for comfort, hygiene
or beautification; disposable sheaths and supplies; correction appliances or support appliances
and supplies such as stockings, and consumable medical supplies other than ostomy supplies
and urinary catheters, including, but not limited to, bandages and other disposable medical
supplies, skin preparations and test strips except as otherwise stated in this Policy.
63. Physical, and/or Occupational Therapy/Medicine except when provided during an inpatient
Hospital confinement or as specifically stated in the benefit schedule and under “Rehabilitative
Therapy Services (Physical Therapy, Occupational Therapy and Speech Therapy)” in the
section of this Policy titled “Comprehensive Benefits: What the Policy Pays For.”
64. Foreign Country Provider charges except as specifically stated under “Foreign Country
Providers” in the section of this Policy titled “Comprehensive Benefits: What the Policy Pays
For.”
65. Routine foot care including the cutting or removal of corns or calluses; the trimming of nails,
routine hygienic care and any service rendered in the absence of localized Illness, a systemic
condition, Injury or symptoms involving the feet except as otherwise stated in this Policy.
66. Charges for which We are unable to determine Our liability because the Insured Person
failed, within 60 days, or as soon as reasonably possible to: (a) authorize Us to receive all the
medical records and information We requested; or (b) provide Us with information We requested
regarding the circumstances of the claim or other insurance coverage.
67. Charges for the services of a standby Physician.
68. Charges for animal to human organ transplants.
69. Claims received by Cigna Healthcare after 15 months from the date service was rendered,
except in the event of a legal incapacity.
70. Services obtained from a Dedicated Virtual Care Physician that are not Dedicated Virtual
Urgent Care or Dedicated Virtual Primary Care services.
71. Abortions, except in cases of rape, incest, lethal fetal anomaly, or when the pregnant person’s
life faces a serious health risk.