MEDICAL PLANS CONTINUED Step Therapy In the Step Therapy program, certain high-cost medications need approval from Cigna before they’re covered by the plan. These medications are used to treat conditions including, but not limited to allergies, asthma/COPD, cardiovascular health, diabetes, heartburn/ulcer/stomach acid, high cholesterol, mental health, and overactive bladder/ bladder problems. Step Therapy medications have an “ST” listed next to them in the Notes column in the Cigna Prescription Drug List. Customers have to follow a series of steps before the higher-cost “Step Therapy” medication may be covered. They start by trying the most cost- effective appropriate medication(s) available that can be used to treat the same condition. Typically, these are generics or lower-cost preferred brands. Generic medications have the same strength and active ingredients as brand-name medications but often cost much less – in some cases, up to 80%–85% less. 3 Right after a customer fills a prescription for a Step Therapy medication (the higher-cost medication), we’ll send the customer and their doctor a letter that outlines the specific steps they need to take before their next refill to receive coverage. You can find more information in the “Documents and Forms” section of CignaforBrokers.com . Inpatient Admissions Prior authorization is required for all nonemergency inpatient admissions, and certain other admissions, to be eligible for benefits. Inpatient prior authorization reviews both the necessity of the admission and the need for continued stay in the hospital. Emergency admissions will be reviewed post-admission. Outpatient Procedures Certain outpatient procedures and services require review and prior authorization to be eligible for benefits. Outpatient prior authorization should only be requested for nonemergency procedures or services. Requests should be made at least four working days (Monday through Friday) before having the procedure performed or the service rendered. Prior authorization does not guarantee payment of benefits. Coverage is always subject to other requirements of the policy/service agreement limitations and exclusions, payment of premium, and eligibility at the time care and services are provided. However, if prior authorization was not performed, Cigna will use retrospective review to determine if a scheduled or emergency admission was medically necessary. In the event the services are determined to be medically necessary, benefits will be provided as described in the policy. If it is determined that a service was not medically necessary, the insured person is responsible for payment of the charges for those services. The programs below require prior authorization: This means if a customer wants to change plans during a Special Enrollment Period, they may need to select a new plan within the same plan category as their current plan or wait until the next Open Enrollment (if they want to change to a plan in a different category). Prior Authorization Cigna provides a comprehensive personal health solution medical management program that focuses on improving quality outcomes and maximizes value for its customers. Prior authorization can be obtained by the policyholder, a family member or the provider by calling the number on the back of the ID card. A customer may call the Member Services number on the back of the Cigna ID card or check myCigna.com , under “View Medical Benefit Details,” for more detailed information regarding services that require prior authorization. Failure to obtain prior authorization before an elective admission to a hospital or certain other facilities may result in a penalty or lack of coverage for services provided. 3. U .S. Food and Drug Administration (FDA). “Generic Drugs: Questions and Answers.” Last updated 03/16/21. www.fda.gov/drugs/questions-answers/generic-drugs- questions-answers .