BETTER HEALTH WERE IN IT TOGETHER Working together

BETTER HEALTH. WE’RE IN IT TOGETHER. Working together to provide affordable, accessible, quality health care May 18, 2017 Janet Mead Eric Demers

Better health. We’re in it together. • • Introductions Better health. We’re in it together. Delivery system and network solutions Keeping you updated You, your patients, and Cigna Electronic services Claim submissions and payments Q&A AGENDA Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna 2

commitment your pledge, our Health care professional Cigna A pledge to provide patient care with the utmost respect, sympathy, and a commitment to total health A commitment to helping people improve their health, well-being and sense of security Patient care Respect and compassion Total health Health Well-being Sense of security our shared goal: patient health and wellness Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna 3

Better health. We’re in it together. DELIVERY SYSTEMS AND NETWORK SOLUTIONS Driving higher quality, lower cost, and a better experience Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna 4

A new, easy way to view sample Cigna ID cards The Quick Guide to Cigna ID cards interactive digital tool • View sample ID cards for certain plan types • Choose the image that matches the patient’s ID card • See both the front and the back of the card • Choose “About This Plan” to read more about the plan To access the Quick Guide to Cigna ID Cards digital tool, go to Cigna. com > Health Care Professionals > ID Card Details or go to Cignafor. HCP. com > View Sample ID Cards Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna 5

our strategic alliances network coverage for multisite clients Tufts Health Plan (Care. Link. SM) in Massachusetts, and Rhode Island Health Alliance Plan (HAP) in southeast Michigan Health. Partners in Minnesota, western Wisconsin, and North Dakota MVP/Preferred Care in upstate New York Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna 6

Cigna global health benefits Cigna Global Health Benefits® provides coverage for: • Expatriate employees and dependents living outside the United States when they return to the United States for care • Foreign nationals and dependents working in the United States • American employees living outside the country, working for defense contractors with dependents living in the United States Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna 7

COVENANT HEALTH PLANS Administered by Qual. Care, Inc. (dba QANI Administrators), A Cigna Company

Claims, eligibility, BENEFITS, and Precertifications Navi. Net With Navi. Net® you can: Conduct transactions electronically with Qual. Care using a variety of online features: ○ Eligibility and benefit determination ○ Claim status inquiry ○ Precertification requests* Access secure, up-to-date patient information, and save your office time, money, and resources. Register at https: //Navinet. navimedix. com If you are new to Navi. Net, click here to create an account: https: //navinet. secure. force. com/ Use Navi. Net to check eligibility, benefits, and claims, and to request precertifications for your patients with Covenant Health coverage. https: //navinet. navimedix. com * Tier 2 providers will also need to use evi. Core and Care. Centrix for precertification of certain services. Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna 9

Covenant Health plans Offered as part of an arrangement with Cigna Three plans: About the plans Health Maintenance Organization (HMO) The plans will be administered by Qual. Care, Inc. * How providers conduct business for their patients with this coverage will be different than how they conduct business for their other patients with Cigna coverage. Preferred Provider Organization (PPO) High Deductible Health Plan (HDHP) The information in this presentation will describe how to work with Qual. Care to administer the Covenant Health plans. *Doing business as QANI Administrators Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna 10

Qual. Care, Inc. (dba QANI Administrators), A Cigna Company At a glance About Wholly-owned subsidiary of QANI, A Cigna Company, focused on providing health plan services and solutions Mission To provide best-in-class solutions and services that comprehensively balance the needs of customers, providers, and health plans Products Administrative services only (ASO) Third-party administration (TPA) Network access (PPO, HMO, and workers’ compensation) Services Plans Claims administration Care management Population health management Wellness Flexible spending account administration Health Care Exchange (HIX) support services PPO network based HMO network based Risk administration COBRA* administration Dependent audit administration Out-of-network fee negotiation Pharmacy benefit manager (PBM) and other benefit integration POS network based High deductible * Consolidated Omnibus Budget Reconciliation Act Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2015 Cigna 11

Claims, eligibility, BENEFITS, and Precertifications (CONT. ) Navi. Net: Qual. Care, A Cigna Company Step 2 Click “My Health Plans” and select Qual. Care, A Cigna Company Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2015 Cigna 12

Claims, eligibility, BENEFITS, and Precertifications (CONT. ) Where to send claims Submit your claims to: Mail: Qual. Care, Inc. (dba QANI Administrators) PO Box 459 Piscataway, NJ 08855 -0459 Payer ID: 22312 Change Healthcare (formerly Emdeon®) Please refer to your patient’s ID card for precertification requirements and other details. Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna 13

Better health. We’re in it together. LOCALPLUS Providing local, quality, cost-effective care Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna 14

Local. Plus providing local, quality, cost-effective care WHY Access to affordable care without sacrificing quality WHAT A smaller, local network HOW In-network referrals help to keep costs (and administrative time) down Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna Your patient 15

Local. Plus: how it’s built Physician model A select group of physicians, and any contracted facilities referred by those physicians, who participate in the Cigna Open Access Plus (OAP) network that is aligned to that market’s Local. Plus® plan Hospital and physician model A select group of hospitals, and associated physicians and facilities, that participate in the Cigna OAP network that is aligned to that market’s Local. Plus plan Cigna OAP hospitals Considerations: Cigna Care designation Cigna Collaborative Care Cost efficiency Episode treatment group Referral patterns Network adequacy Local market insight Cost efficiency Selected physician groups in local market Selected hospitals in local market PLUS ALL Cigna OAP contracted hospitals in local market Physicians and facilities associated with the selected hospitals Local. Plus Network Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna Local. Plus Network 16

Payer Solutions: third-party administrators Cigna contracts with third-party administrators (TPAs), selected insurers, and claim administrators (referred to collectively as “payers”) to share the administration of self -funded Administrative Services Only (ASO) plans. We also contract with several insurance companies that issue individual and group insurance policies. For these relationships, we: – provide access to our network – perform medical management and utilization reviews – re-price claims according to our contracted rates and claims logic – provide clinical appeals management – provide contract dispute resolution TPAs and insurance companies: • maintain eligibility • administer benefits • pay claims for these shared accounts on their own systems Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna 17

Payer Solutions: points of interaction Claim flow: • Claims should be submitted to Cigna (payer ID 62308 or to the claims mailing address on the patient’s ID card • Cigna prices the claims based on the network contracted rates • The priced claim is then forwarded to the payer for payment based on the patient’s eligibility and benefits • The payers then remit payment following contractually agreed upon turnaround requirements Clinical and contract-related appeals: • Appeals of clinical denials should be sent to Cigna using the contact information supplied in the denial letter(s) • Appeals of application of contract rates should go to the address on the patient’s ID card Contact the payer* for: • • • Eligibility Benefits Precertification Claims status Non-pricing appeals * The contact phone number is located on the patient’s ID card Contact Cigna* for: • • • Reimbursement issues Pricing appeals General contract questions * The contact phone number for Cigna is 1. 888. 663. 8081 Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna 18

specialty everyday value for pharmacy services Working with you to support your patients taking specialty medications health care professionals • Reduced administrative burden through proactive prescription refills, renewals, and prior-authorization support • Easy access to obtain and submit prescription requests with online and faxable order forms, pharmacists who are available 24/7, and e. Prescribe technology • One-stop shopping to fill and dispense specialty and non-specialty medications together • Medicare Part D and Part B prescription claim processing • Specialty drug choice and infusion site collaboration • High access to limited distribution drugs • Unique fee schedule discounts for specialty drugs Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna 19

specialty everyday value for your pharmacy services patients, Working with you to support your patients taking specialty medications our customers We provide added support by helping your patients better understand their condition, medications, side effects, and the importance of adherence. This includes: • Injection training in your office or your patient’s home • Reliable service and convenient delivery directly to your patient’s home • Refill reminders to help keep patients adherent Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna 20

Better health. We’re in it together. CIGNA CARE DESIGNATION Recognizing quality, cost-efficient care among health care professionals Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna 21

Cigna Care designated physicians are rated in both quality and cost efficiency Online quality recognition and cost-efficiency displays Quality recognition displays • National Committee for Quality Assurance (NCQA) recognition for: − Diabetes − Heart/Stroke − Physician Practice Connections − Patient-Centered Medical Home − Patient-Centered Specialty Practice • American Board of Medical Specialties • Evidence Based Medicine Standards Cost-efficiency symbols Physicians who earn the 2017 Cigna Care designation will be identified in our online directory by a unique symbol. Results in top category for cost efficiency Results in middle category for cost efficiency Results in low category for cost efficiency Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna 22

Reviewed specialties 18 specialties • • • Allergy and immunology Cardiothoracic surgery Dermatology Ear, nose, and throat Endocrinology Gastroenterology General surgery Hematology and oncology 3 primary care physician types • • • Nephrology Neurosurgery Ob-gyn Ophthalmology Orthopedics and surgery Pulmonology Rheumatology Urology • Family practice • Internal medicine • Pediatrics The 21 specialty types reviewed account for more than 90% of primary and specialty care, and 85% of total medical and pharmaceutical spending based on claims data. Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2017 Cigna 23

Resources Cigna for Health Care Professionals website (Cignaforhcp. com) § Cigna Care designation & Physician Quality and Cost-Efficiency Displays Methodologies § Cigna Centers of Excellence Methodology § Network News articles Directory displays Cigna. com and my. Cigna. com § Cigna Care designation § Quality symbols my. Cigna. com only § Cost-efficiency stars Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2015 Cigna 24

Better health. We’re in it together. NATIONAL ANCILLARY PROGRAMS Lowering costs without sacrificing quality Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna 25

National Ancillary Programs* providing your patients with quality and cost-effective care Accessible Service National ancillary providers* Chiropractic American Specialty Health® Durable medical equipment, home health care, infusion therapy Care. Centrix High-technology radiology and diagnostic cardiology evi. Core healthcare Laboratory • Laboratory Corporation of America® • Quest Diagnostics, Inc. Musculoskeletal and pain management evi. Core healthcare Physical and occupational therapy American Specialty Health® Quality focused Cost efficient Patient oriented 20% decrease in unnecessary radiology procedures 1 45%– 80% savings with national labs over other lab services 2 Up to $50, 000 per case savings using in-network outpatient dialysis facilty 3 45%– 50% savings on total chiropractic costs 4 *List is not all-inclusive of all Cigna national ancillary providers. Ancillary health care professionals do not manage services in all states and markets. 1. Cigna internal analysis of full year 2013 book of business. Results may vary 2. Savings estimate is based on an internal Cigna national study of 2013 lab utilization data, costs and discounts. Savings will vary. 3. evi. Core healthcare, (formally Care. Core | Med. Solutions Management), internal analysis of full year 2013 book of business. Individual client savings/results may vary. 4. Cigna internal analysis of full year 2013 book of business chiropractic costs for managed business. Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna 26

collaborating with evi. Core healthcare to manage precertification for Cigna’s Integrated Oncology Management Program Benefits to submitting your request online: • Real-time access to patient authorization and eligibility information • Self-service web portal is available 24/7 • Added "Pause/Start" features a 48 -hour window that allows you to return to a case you've started but not yet completed • Upload electronic PDF/Word files with additional clinical documents when case is sent for review Modify cases online by changing substitutable CPT® Codes • Duplication feature allows you to duplicate information into a new case using the same patient, provider, procedure, and program/health plan. Information about orientation sessions can be found on our dedicated program website at https: //www. evicore. com/Cigna/Pages/Medical. Oncology. aspx. Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna 27

national ancillary providers with a local presence Some Cigna employer groups use separate ancillary providers for specialty services such as vision, chiropractic care, and mental health or substance abuse. Before referring your patient, verify their coverage and the ancillary provider network by using one of the methods listed below. For patients with Cigna ID cards For patients with GWH-Cigna or “G” ID cards • Visit the Cigna for Health Care Professionals website (Cignafor. HCP. com) • Call 1. 800. 88 Cigna (882. 4462) • Call 1. 866. 494. 2111 • Access through your electronic clearinghouse or vendor Check the back of the patient’s ID card or Cignafor. HCP. com for coverage and precertification requirements. The website will have the most up-to-date information. Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna 28

Better health. We’re in it together. ELECTRONIC SERVICES Tools to make your life easier Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna 29

Information. Delivered. Cigna for Health Care Professionals website (Cignafor. HCP. com) • Patient Information and Transactions – Eligibility and benefits – Patient out-of-pocket cost estimation (medical, behavioral) – Precertification submission and inquiry (medical) – Claims status inquiry – Electronic funds transfer enrollment and management – Remittance reports • Resources – e. Courses – Cigna formularies/drug list – ID cards – Clinical reimbursement and payment policies – Forms – Reference guides Trading Partners/EDI Vendors HIPAA 5010 transactions – Eligibility and benefits inquiry and response (270/271) – Health service review/precertification (278) – Electronic claim submission (837) – Claim acknowledgement (277 CA) – Claims status inquiry and response (276/277) – Electronic remittance advice (835) – Patient out of pocket cost estimation (Availity only) – Electronic funds transfer enrollment and management (CAQH only) Transaction availability varies by partner/vendor. For more information, visit Cigna. com/EDIvendors. Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna 30

Better health. We’re in it together. KEEPING YOU UPDATED The latest information on policy and coverage updates Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna 31

Opioid Quality Improvement Pledge An initiative to help: • Reduce potentially hazardous opioid prescribing, and • Improve the coordination and quality of care for patients who are taking opioids Updated Cigna Reference Guides The updated guides effective January 1, 2017 can be accessed by registered users of the Cigna for Health Care Professionals website (Cignafor. HCP. com > Resources > Reference Guides). Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna 32

Telehealth services Online and on-demand health care delivery services The delivery of health-related services and information through: • Telecommunication technologies, including telephones and smartphones • Personal computers for secure virtual consultations between a patient and a health care professional • Provides access to online video or telephone consultations with board-certified internal medicine, family practice and pediatric physicians. • Available 24 hours a day, seven days a week (including holidays), by telephone or video from virtually anywhere Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna 33

Better health. We’re in it together. YOU, YOUR PATIENTS, AND CIGNA Support, advocacy, and resources Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna 34

resources for you • Quarterly Network News • Use material in meeting packet • Go to the Cigna for Health Care Professionals website (Cignafor. HCP. com) Email: Network. News. Editor@Cigna. com to be added to the distribution Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna 35

Demographic changes Please notify us in writing 90 days before changing your office or billing address, telephone number, Taxpayer Identification Number (TIN), National Provider Identifier (NPI), or specialty. You can submit your demographic changes by email, fax, mail, or online. Refer to the chart below to identify the contact information for your state. * How you can submit changes Email: Intake_PDM@Cigna. com Fax: 1. 877. 358. 4301 Mail: Cigna Provider Data Management Two College Park Drive Hooksett, NH 03106 Online: Cigna for Health Care Professionals (Cignafor. HCP. com > Resources > Forms) * Third-party vendor states are Idaho, Iowa, Montana, Nebraska, New Mexico, North Dakota and South Dakota. For these states, submit your changes directly to the third-party vendor. Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna 36

Onboarding process steps • Application intake • Application review the process is designed from start to finish in * 45 days • Credentialing verification • Credentialing Committee review • Post-determination activities • In some states mid-level providers are included, depending on state requirements and Cigna’s recruitment policies *Turnaround time may increase during peak periods. Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna 37

resources for your patients with Cigna coverage • 1. 800. Cigna 24 • Health advocacy • Cigna. com/healthwellness • Supportive programs • Health and wellness apps Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna 38

24 -Hour Health Information Line™ Here for your patients any hour of the day, any day of the week Specialists are available 24 hours a day, seven days a week to help your patients: Understand make informed decisions about symptom-based health issues. Choose the right care in the right setting at the right time: • Emergency department • Urgent care center • Doctors appointment • Home treatment options • 9 -1 -1 Helping patients reach our Health Information Line is easy. Just tell them to call 1. 800. Cigna 24 or the toll-free number on their ID card. Access a variety of online tools to help them become more engaged in their own health care. Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna 39

Shaping healthier behavior through technology YOUR HEALTH HAS MET ITS APP ® Cigna mobile apps are free and available for i. OSTM and Android. TM devices. Customers can access their personal health information from their device, anytime, anywhere. Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna 40

Q&A Thank you! Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna 41

Offered by: Connecticut General Life Insurance Company or Cigna Health and Life Insurance Company. “Cigna” and the “Tree of Life” logo are registered service marks of Cigna Intellectual Property, Inc. , licensed for use by Cigna Corporation and its operating subsidiaries. All products and services are provided by or through such operating subsidiaries and not by Cigna Corporation. Such operating subsidiaries include Cigna Health and Life Insurance Company, Connecticut General Life Insurance Company, Cigna Behavioral Health, Inc. , and HMO or service company subsidiaries of Cigna Health Corporation and Cigna Dental Health, Inc. All models are used for illustrative purposes only. THN- 2016 -461 © 2016 Cigna. Some content provided under license. 42