Cigna has some universal individual health insurance exclusions and limitations that apply nationwide. Here is a partial list of them, and keep in mind they vary slightly from state, although Cigna only offers individual in about 10 states.

  • Conditions which are pre-existing as defined in the Definitions section. The Definitions section is included in your Cigna health policy.
  • Any amounts in excess of maximum amounts of Covered Expenses stated in this Policy. Most policies don’t have maximums anymore due to the health reform law, except on particular services in rare instances.
  • Services not specifically listed in this Policy as Covered Services.
  • Services or supplies that are not Medically Necessary. This is a universal exclusion and usually refers to vanity or cosmetic procedures.
  • Services or supplies that CIGNA considers to be for Experimental Procedures or Investigative Procedures. If this should come up and you have a rare condition, you can contest this through an independent arbitrator.
  • Services received before the Effective Date of coverage.
  • Services received after coverage ends.
  • Services for which You have no legal obligation to pay or for which no charge would be made if You did not have health plan or insurance coverage.
  • Any condition for which benefits are paid, recovered or can be recovered, either by adjudication, settlement or otherwise, under any workers’ compensation, employer’s liability law or occupational disease law, even if the Insured Person does not claim those benefits.
  • Conditions  caused  by:  (a)  an  act  of  war;  (b)  the  inadvertent  release  of  nuclear  energy  when government funds are available for treatment of Illness or Injury arising from such release of nuclear energy; (c) an Insured Person participating in the military service of any country; (d) an Insured Person participating in an insurrection, rebellion, or riot.
  • Any services provided by a local, state or federal government agency, except (a) when payment under this Policy is expressly required by federal or state law.
  • If the Insured Person is eligible for Medicare part A or B CIGNA will provide claim payment according to this Policy minus any amount paid by Medicare, not to exceed the amount CIGNA would have paid if it were the sole insurance carrier.
  • Any services for which payment may be obtained from any local, state or federal government agency (except  Medicaid).  Veterans  Administration  Hospitals  and  Military  Treatment  Facilities  will  be considered for payment according to current legislation.
  • Professional services received or supplies purchased from the Insured Person, a person who lives in the Insured Person’s home or who is related to the Insured Person by blood, marriage or adoption.
  • Custodial Care.
  • Inpatient or outpatient services of a private duty nurse.
  • Inpatient room and board charges in connection with a Hospital stay primarily for environmental change or physical therapy; Custodial Care or rest cures; services provided by a rest home, a home for the aged, a nursing home or any similar facility service.
  • Assistance in activities of daily living, including but not limited to: bathing, eating, dressing, or other Custodial Care, self-care activities or homemaker services, and services primarily for rest, domiciliary or convalescent care.
  • Inpatient room and board charges in connection with a Hospital stay primarily for diagnostic tests which could have been performed safely on an outpatient basis.
  • Treatment of Mental, Emotional or Functional Nervous Disorders or psychological testing except as specifically provided in this Policy.  However, medical conditions that are caused by behavior of the Insured Person and that may be associated with these mental conditions are not subject to these limitations.
  • Smoking cessation programs.
  • Treatment of substance abuse.
  • Dental services, dentures, bridges, crowns, caps or other Dental Prostheses, extraction of teeth or treatment to the teeth or gums, except as specifically provided in this Policy.
  • Orthodontic Services, braces and other orthodontic appliances including orthodontic services for Temporomandibular Joint Dysfunction.
  • Dental  Implants:  Dental  materials  implanted  into  or  on  bone  or  soft  tissue  or  any  associated procedure as part of the implantation or removal of dental implants.
  • Hearing aids.
  • Routine  hearing  tests  except  as  provided  under  Well  Baby and Well  Child  Care and Newborn Hearing Benefits.
  • Optometric services, eye exercises including orthoptics, eyeglasses, contact lenses, routine eye exams, and routine eye refractions, except as specifically stated in this Policy.
  • An eye surgery solely for the purpose of correcting refractive defects of the eye, such as near- sightedness (myopia), astigmatism and/or farsightedness (presbyopia).
  • Outpatient speech therapy, expect as specifically provided in this Policy.
  • Cosmetic surgery or other services for beautification, to improve or alter appearance or self esteem or   to   treat   psychological   or   psychosocial   complaints   regarding   one’s   appearance   including macromastia or gynecomastia surgeries; surgical treatment of varicose veins; abdominoplasty/panniculectomy;  rhinoplasty; and blepharoplasty.  This exclusion does not apply to Reconstructive  Surgery to restore a bodily function or to correct a deformity caused by Injury or congenital defect of a Newborn child, or for Medically Necessary Reconstructive Surgery performed to restore symmetry incident to a mastectomy.
  • Aids or devices that assist with nonverbal communication, including but not limited to communication boards,  prerecorded  speech  devices,  laptop  computers,  desktop  computers,  Personal  Digital Assistants (PDAs), Braille typewriters, visual alert systems for the deaf and memory books.
  • Non-medical  counseling  or  ancillary  services,  including  but  not  limited  to:  education,  training, vocational rehabilitation, behavioral training, biofeedback, neurofeedback,  hypnosis, sleep therapy, employment  counseling,  back  school,  return  to work  services,  work  hardening  programs,  driving safety, and services, training, educational therapy or other non-medical ancillary services for learning disabilities and developmental delays.
  • Services for redundant skin surgery, removal of skin tags, acupressure, craniosacral/cranial therapy, dance therapy, movement therapy, applied kinesiology, rolfing, pryotherapy and extracorporeal shock wave  lithotripsy  (ESWL)  for  musculoskeletal  and  orthopedic  conditions,  regardless  of  clinical indications.
  • Procedures or treatments to change characteristics of the body to those of the opposite sex. This includes any medical, surgical or psychiatric treatment or study related to sex change.
  • Treatment  of  sexual  dysfunction  impotence  and/or  inadequacy  except  if  this  is  a  result  of  an Accidental Injury, organic cause, trauma, infection, or congenital disease or anomalies.
  • All services related to the evaluation or treatment of fertility and/or Infertility, including, but not limited to, all tests, consultations, examinations, medications, invasive, medical, laboratory or surgical procedures including sterilization reversals and In vitro fertilization, except as specifically stated in  this Plan.
  • All non-prescription Drugs, devices and/or supplies that are available over the counter or without a prescription,
  • Cryopreservation of sperm or eggs.
  • Orthopedic shoes (except when joined to braces) or shoe inserts, including orthotics.
  • Services primarily for weight reduction or treatment of obesity including morbid obesity, or any care which involves weight reduction as a main method for treatment. This includes any morbid obesity surgery, even if the Insured Person has other health conditions that might be 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.
  • Routine physical exams or tests that do not directly treat an actual Illness, Injury or condition, including those required by employment or government authority, including physical exams required for or by an employer, or for school, or sports physicals, except as otherwise specifically stated in this Plan.
  • Charges by a provider for telephone or email consultations.
  • Items  which  are  furnished  primarily  for  personal  comfort  or  convenience  (air  purifiers,  air conditioners, humidifiers, exercise equipment, treadmills, spas, elevators and supplies for hygiene or beautification, including wigs etc.).
  • Educational services except for Diabetes Self-Management Training Program, and as specifically provided or arranged by CIGNA.
  • Nutritional counseling or food supplements, except as stated in this Policy.
  • Durable medical equipment not specifically listed as Covered Services in the Covered Services section of this Policy. Excluded durable medical equipment includes, but is not limited to: orthopedic shoes or shoe inserts; air purifiers, air conditioners, humidifiers; exercise equipment, treadmills; spas; elevators; supplies for comfort, hygiene or beautification; disposable sheaths and supplies; correction appliances or support appliances and supplies such as stockings.
  • Physical,  and/or  Occupational  Therapy/Medicine  except  when  provided  during  an  inpatient Hospital confinement or as specifically provided under the benefits for Physical and/or Occupational Therapy/Medicine.
  • Self-administered Injectable Drugs, except as stated in the Prescription Drug Benefits section of this Policy.
  • Syringes, except as stated in the Policy.
  • All Foreign Country Provider charges are excluded under this Policy except as specifically stated under Treatment received from Foreign Country Providers in the Benefits section of this Policy.
  • Growth Hormone Treatment except when such treatment is medically proven to be effective for the treatment of documented growth retardation due to deficiency of growth hormones, growth retardation secondary  to  chronic  renal  failure  before  or  during  dialysis,  or  for  patients  with  AIDS  wasting syndrome.   Services must also be clinically proven to be effective for such use and such treatment must be likely to result in a significant improvement of the Insured Person’s condition.
  • Routine foot care including the pairing and removing of corns and calluses or trimming of nails. However, services associated with foot care for diabetes and peripheral vascular disease are covered when Medically Necessary.
  • 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.
  • Charges for the services of a standby Physician.
  • Charges for animal to human organ transplants.
  • Charges for Normal Pregnancy or Maternity Care, including normal delivery, elective abortions or elective/non-emergency cesarean sections except as specifically stated under ‘Complications of Pregnancy’ in the ‘Comprehensive Benefits’ section of this Policy.
  • Claims received by CIGNA after 15 months from the date service was rendered, except in the event of a legal incapacity.