Pages 1--55 from CIGNA HealthCare of California, Inc.

CIGNA HealthCare of California, Inc.
http:// www. cigna. com/ healthcare

RI 73-402
2001
Federal Employees Health Benefits Program

HealthCare
For changes
in benefits
see page7.

This Plan has commendable accreditation
from the NCQA. See the 2001 Guide for
more information on NCQA.

Enrollment codes for this Plan:

9T1 Self Only
9T2 Self and Family

SPECIAL NOTICE: Monterey County has been dropped from our Service Area.
See page 7 for instructions on how to select a new health plan.

Authorized for distribution by the: 1
1 Page 2 3
2001 CIGNA HealthCare of California, Inc. 1 Table of Contents
Table of Contents
Introduction ................................................................................................................................................................. 3
Plain Language .............................................................................................................................................................. 3
Section 1. Facts about this HMO plan ...................................................................................................................... 4
How we pay providers ............................................................................................................................. 4
Who provides my healthcare? .................................................................................................................. 5
Patients' Bill of Rights ............................................................................................................................. 5
Service Area ............................................................................................................................................. 5
Section 2. How we change for 2001 ......................................................................................................................... 7
Program-wide changes ............................................................................................................................. 7
Changes to this Plan ................................................................................................................................. 7
Section 3. How you get care ..................................................................................................................................... 8
Identification cards ................................................................................................................................... 8
Where you get covered care ..................................................................................................................... 8
° Plan providers .................................................................................................................................... 8
° Plan facilities ...................................................................................................................................... 8
What you must do to get covered care ..................................................................................................... 8
° Primary care ....................................................................................................................................... 9
° Specialty care ..................................................................................................................................... 9
° Hospital care ...................................................................................................................................... 9
Circumstances beyond our control......................................................................................................... 10
Services requiring our prior approval .................................................................................................... 10
Section 4. Your costs for covered services ............................................................................................................. 11
° Copayments .................................................................................................................................... 11
° Deductible ....................................................................................................................................... 11
° Coinsurance .................................................................................................................................... 11

Your out-of-pocket maximum for copayments ...................................................................................... 11
Section 5. Benefits .................................................................................................................................................. 12
Overview ................................................................................................................................................ 12
(a) Medical services and supplies provided by physicians and other health care professionals .......... 13
(b) Surgical and anesthesia services provided by physicians and other health care professionals ...... 20
(c) Services provided by a hospital or other facility, and ambulance services .................................... 23
(d) Emergency services/ accidents ........................................................................................................ 26
(e) Mental health and substance abuse benefits ................................................................................... 28
(f) Prescription drug benefits ............................................................................................................... 30
(g) Special features ............................................................................................................................... 32
(h) Dental benefits ................................................................................................................................ 33
(i) Non-FEHB benefits available to Plan members ............................................................................. 34 2
2 Page 3 4
2001 CIGNA HealthCare of California, Inc. 2 Table of Contents
Section 6. General exclusions Ð things we don't cover .......................................................................................... 35
Section 7. Filing a claim for covered services ........................................................................................................ 36
Section 8. The disputed claims process .................................................................................................................. 37
Section 9. Coordinating benefits with other coverage ............................................................................................ 39
When you haveÉ
° Other health coverage ..................................................................................................................... 39
° Original Medicare ........................................................................................................................... 39
° Medicare managed care plan .......................................................................................................... 41

TRICARE/ Workers' Compensation/ Medicaid ...................................................................................... 41
Other Government agencies ................................................................................................................... 42
When others are responsible for injuries ............................................................................................... 42
Section 10. Definitions of terms we use in this brochure ......................................................................................... 43
Section 11. FEHB facts ............................................................................................................................................. 45
Coverage information ............................................................................................................................ 45
° No pre-existing condition limitation ............................................................................................... 45
° Where you get information about enrolling in the FEHB Program ................................................ 45
° Types of coverage available for you and your family .................................................................... 45
° When benefits and premiums start ................................................................................................. 45
° Your medical and claims records are confidential .......................................................................... 46
° When you retire .............................................................................................................................. 46

When you lose benefits .......................................................................................................................... 46
° When FEHB coverage ends ........................................................................................................... 46
° Spouse equity coverage .................................................................................................................. 46
° Temporary Continuation of Coverage (TCC) ................................................................................. 46
° Converting to individual coverage .................................................................................................. 47
° Getting a Certificate of Group Health Plan Coverage .................................................................... 47

Inspector General Advisory ................................................................................................................... 47
Department of Defense/ FEHB Demonstration Project ............................................................................................... 48
Index ............................................................................................................................................................... 50
Summary of benefits .................................................................................................................................................... 52
Rates ................................................................................................................................................. Back cover 3
3 Page 4 5
2001 CIGNA HealthCare of California, Inc. 3 Introduction/ Plain Language
Introduction
CIGNA HealthCare of California, Inc.
400 North Brand Boulevard
Glendale, California 91203

This brochure describes the benefits of CIGNA HealthCare of California, Inc. under our contract (CS 2841) with the
Office of Personnel Management (OPM), as authorized by the Federal Employees Health Benefits law. This brochure is
the official statement of benefits. No oral statement can modify or otherwise affect the benefits, limitations, and exclu-sions
of this brochure.

If you are enrolled in this plan, you are entitled to the benefits described in this brochure. If you are enrolled for Self and
Family coverage, each eligible family member is also entitled to these benefits. You do not have a right to benefits that
were available before January 1, 2001, unless those benefits are also shown in this brochure.

OPM negotiates benefits and rates with each plan annually. Benefit changes are effective January 1, 2001, and are
summarized on page 7. Rates are shown at the end of this brochure.

Plain Language
The President and Vice President are making the Government's communication more responsive, accessible, and under-standable
to the public by requiring agencies to use plain language. In response, a team of health plan representatives
and OPM staff worked cooperatively to make this brochure clearer. Except for necessary technical terms, we use common
words. "You" means the enrollee or family member; "we" means CIGNA HealthCare of California, Inc.

The plain language team reorganized the brochure and the way we describe our benefits. When you compare this Plan
with other FEHB plans, you will find that the brochures have the same format and similar information to make compari-sons
easier.

If you have comments or suggestions about how to improve this brochure, let us know. Visit OPM's "Rate Us" feedback
area at www. opm. gov/ insure or e-mail us at fehbwebcomments@ opm. gov or write to OPM at Insurance Planning and
Evaluation Division, P. O. Box 436, Washington, DC 20044-0436. 4
4 Page 5 6
2001 CIGNA HealthCare of California, Inc. 4 Section 1
Section 1. Facts about this HMO plan
This Plan is a health maintenance organization (HMO). We require you to see specific physicians, hospitals, and other
providers that contract with us. These Plan providers coordinate your health care services.

HMOs emphasize preventive care such as routine office visits, physical exams, well-baby care, and immunizations, in
addition to treatment for illness and injury. Our providers follow generally accepted medical practice when prescribing
any course of treatment.

When you receive services from Plan providers, you will not have to submit claim forms or pay bills. You only pay the
copayments, coinsurance, and deductibles described in this brochure. When you receive emergency services from non-Plan
providers, you may have to submit claim forms.

You should join an HMO because you prefer the plan's benefits, not because a particular provider is available.
You cannot change plans because a provider leaves our Plan. We cannot guarantee that any one physician,
hospital, or other provider will be available and/ or remain under contract with us.

How we pay providers
We contract with individual physicians, medical groups, and hospitals to provide the benefits in this brochure. These Plan
providers accept a negotiated payment from us, and you will only be responsible for your copayments or coinsurance. We
compensate our participating providers in ways that are intended to emphasize preventive care, promote quality of care,
and assure the most appropriate use of medical services. You can discuss with your provider how he is compensated by
us. The methods we use to compensate participating providers are:

Discounted fee for service Ð payment for service is based on an agreed upon discounted amount for the services provided.
Capitation Ð Physicians, provider groups and physician/ hospital organizations are paid a fixed amount at regular intervals
for each Member assigned to the physician, provider group or physician/ hospital organization, whether or not services are
provided. This payment covers the physician and/ or, where applicable, hospital or other services covered under the
benefit plan. Medical groups and physician/ hospital organizations may in turn compensate providers using a variety of
methods.

Capitation offers health care providers a predictable income, encourages Physicians to keep people well through preven-tive
care, eliminates the financial incentive to provide services that will not benefit the patient, and reduces paperwork.

Providers paid on a "capitated" basis may participate with us in a risk sharing arrangement. They agree upon a target
amount for the cost of certain health care services, and they share all or some of the amount by which actual costs are
over target. Provider services are monitored for appropriate utilization, accessibility, quality and Member satisfaction.

We may also work with third parties who administer payments to Participating Providers. Under these arrangements, we
pay the third party a fixed monthly amount for these services. Providers are compensated by the third party for services
provided to Healthplan participants from the fixed amount. The compensation varies based on overall utilization.

Salary Ð Physicians and other providers who are employed to work in our medical facilities are paid a salary. The
compensation is based on a dollar amount, decided in advance each year, that is guaranteed regardless of the services
provided. Physicians are eligible for any annual bonus based on quality of care, quality of service and appropriate use of
Medical Services.

Bonuses and Incentives Ð Eligible Physicians may receive additional payments based on their performance. To determine
who qualifies, we evaluate Physician performance using criteria that may include quality of care, quality of service,
accountability and appropriate use of Medical Services. 5
5 Page 6 7
2001 CIGNA HealthCare of California, Inc. 5 Section 1
Per Diem Ð A specific amount is paid to a hospital per day for all health care received. The payment may vary by type of
service and length of stay.

Case Rate Ð A specific amount is paid for all the care received in the hospital for each standard service category as
specified in our contract with the provider (e. g., for a normal maternity delivery).

Who provides my health care?
We contract with a group of doctors and hospitals to provide your health care. You will select a primary care physician
who supervises your total health care needs. You may see a Plan gynecologist for annual routine examination without a
referral.

Patients' Bill of Rights
OPM requires that all FEHB Plans comply with the Patients' Bill of Rights, recommended by the President's Advisory
Commission on Consumer Protection and Quality in the Health Care Industry. You may get information about us, our
networks, providers, and facilities. OPM's FEHB website (www. opm. gov/ insure) lists the specific types of information
that we must make available to you. Some of the required information is listed below.

° CIGNA HealthCare of California is in compliance with all State and Federal licensing and certification requirements
and has received its certification by the National Committee on Quality Assurance (NCQA) in 1999.

° CIGNA HealthCare of California is a Health Services Corporation licensed in the State of California since 1978.

If you want more information about us, call 1-800-832-3211, or write to CIGNA HealthCare of California, Inc.,
400 North Brand Boulevard, Glendale, California 91203. You may also visit our website at www. cigna. com/ healthcare.

Service Area
To enroll with us, you must live in our service area. This is where our providers practice.

Northern California Area
Service area: Alameda, Butte, Contra Costa, El Dorado, Fresno, Glenn, King, Marin, Placer, Sacramento, San Francisco,
San Joaquin, San Mateo, Santa Clara, Santa Cruz, Solano, Sonoma, Stanislaus, Tulare, and Yolo counties. Merced county
is only partially covered, the zip codes lists below describe the areas that are covered in these counties:

Merced: 95315, 95324
Southern California Area
Service area: Los Angeles, Orange, San Luis Obispo, Santa Barbara, and Ventura counties. Kern, Riverside and
San Barnardino counties are only partially covered, the zip code lists below describe the areas that are covered in these
counties:

Kern: 93203, 93205, 93206, 98215, 93216, 93217, 93220, 93222, 93224, 93225, 93226, 93238, 93240,
93241, 93243, 93249, 93250, 93251, 93252, 93255, 93263, 93268, 93276, 93280, 93283, 93285,
93287, 93300, 93301, 93302, 93303, 93304, 93305, 93306, 93307, 93308, 93309, 93311, 93312,
93313, 93380-9, 93390, 93399, 93501-5, 93516, 93518, 93519, 93523, 93524, 93527, 93528,
93531, 93554, 93555, 93556, 93560, 93561, 93570, 93581, 93582, 93596

Riverside: 91718-20, 91752, 91760, 92220, 92223, 92230, 92282, 92320, 92379, 92500-9, 92513-23,
92530-2, 92551-7, 92562-4, 92567, 92570-2, 92589-93, 92595, 92599

San Bernardino: 91701, 91708-10, 91729-30, 91737, 91739, 91743, 91758, 91760-4, 91784-6, 91798, 92301,
92307-9, 92311-3, 92316, 92317, 92324, 92329, 92334-7, 92340, 92342, 92345-6, 92350, 92354,
92356-9, 92368-9, 92372-7, 92392-4, 92397, 92399, 92400-16, 92418, 92420, 92423-4, 92427

San Diego Area
Service area: San Diego county 6
6 Page 7 8
2001 CIGNA HealthCare of California, Inc. 6 Section 1
Ordinarily, you must get your care from providers who contract with us. If you receive care outside our service area, we
will pay only for emergency care. We will not pay for any other health care services.

If you or a covered family member move outside of our service area, you can enroll in another plan. If your dependents
live out of the area (for example, if your child goes to college in another state), you should consider enrolling in a fee-for-service
plan or an HMO that has agreements with affiliates in other areas. If you or a family member move, you do not
have to wait until Open Season to change plans. Contact your employing or retirement office. 7
7 Page 8 9
2001 CIGNA HealthCare of California, Inc. 7 Section 2
Section 2. How we change for 2001
Program-wide changes
° The plain language team reorganized the brochure and the way we describe our benefits. We hope this will make it
easier for you to compare plans.

° This year, the Federal Employees Health Benefits Program is implementing network mental health and substance
abuse parity. This means that your coverage for mental health, substance abuse, medical, surgical, and hospital
services from providers in our plan network will be the same with regard to deductibles, coinsurance, copays, and
day and visit limitations when you follow a treatment plan that we approve. Previously, we placed higher patient cost
sharing and shorter day or visit limitations on mental health and substance abuse services than we did on services to
treat physical illness, injury, or disease.

° Many healthcare organizations have turned their attention this past year to improving healthcare quality and patient
safety. OPM asked all FEHB plans to join them in this effort. You can find specific information on our patient safety
activities by calling our Customer Service Department at 1-800-832-3211, or checking our website www. cigna. com/
healthcare. You can find out more about patient safety on the OPM website, www. opm. gov/ insure. To improve your
healthcare, take these five steps:

°° Speak up if you have questions or concerns.
°° Keep a list of all the medicines you take.
°° Make sure you get the results of any test or procedure.
°° Talk with your doctor and health care team about your options if you need hospital care.
°° Make sure you understand what will happen if you need surgery.
° We clarified the language to show that anyone who needs a mastectomy may choose to have the procedure performed on
an inpatient basis and remain in the hospital up to 48 hours after the procedure. Previously, the language referenced
only women.

Changes to this Plan
° Your share of the non-Postal premium will increase by 7.7% for Self Only or 7.7% for Self and Family.

° The vision exam copay has been increased to $10 from $5.
° Self Only out-of-pocket maximum is now $1,500 per calendar year instead of $1,000. Self and Family out-of-pocket
maximum remains at $3,000 per calendar year.

SPECIAL NOTICE:
Monterey County has been dropped from the plan's service area. Members living in
Monterey County are strongly advised to select a new health plan during open season. If
you do not select a new plan, you will be required to use Plan providers in our remaining
service area.

Active members (employees) should contact their personnel office for information on
how to select a new plan. Retirees should follow instructions in the open season package
mailed to you or call the Office of Personnel Management Retirement Information Office
at 1-888-767-6738. 8
8 Page 9 10
2001 CIGNA HealthCare of California, Inc. 8 Section 3
Identification cards
Where you get covered care
° Plan providers

° Plan facilities
What you must do to get covered care

Section 3. How you get care
We will send you an identification (ID) card when you enroll. You should
carry your ID card with you at all times. You must show it whenever you
receive services from a Plan provider, or fill a prescription at a Plan pharmacy.
Until you receive your ID card, use your copy of the Health Benefits
Election Form, SF-2809, your health benefits enrollment confirmation (for
annuitants), or your Employee Express confirmation letter.

If you do not receive your ID card within 30 days after the effective date of
your enrollment, or if you need replacement cards, call us at 1-800-832-3211.

You get care from "Plan providers" and "Plan facilities." You will only pay
copayments, deductibles, and/ or coinsurance, and you will not have to file
claims unless you receive emergency services from a provider who does not
have a contract with us.

Plan providers are physicians and other health care professionals in our
service area that we contract with to provide covered services to our members.
We credential Plan providers according to national standards.

We list Plan providers in the provider directory, which we update periodically.
The list is also on our website.

Plan facilities are hospitals and other facilities in our service area that we
contract with to provide covered services to our members. We list these in
the provider directory, which we update periodically. The list is also on our
website.

It depends on the type of care you need. First, you and each family member
must choose a primary care physician. This decision is important since your
primary care physician provides or arranges for most of your health care.
When you enroll, you choose a Primary Care Physician (PCP). Each family
member also chooses a PCP. Your PCP is your personal doctor and serves as
your health care manager. If you do not select a PCP, we will assign one for
you. If your PCP leaves our network, you will be able to choose a new PCP.
You may voluntarily change your PCP for other reasons but not more than
once in any calendar month. We reserve the right to determine the number
of times during a year that you will be allowed to change your PCP. If you
select a new PCP before the fifteenth day of the month, the designation will
be effective on the first day of the month following your selection. If you
select a new PCP on or after the fifteenth day of the month, the designation
will be effective on the first day of the month following the next full month.
For example, if you notify us on June 10, the change will be effect on July 1.
If you notify us on June 15, the change will be effective on August 1.

Some Primary Care Physicians belong to provider organizations which usually
refer you to a network of Specialty Care Physicians and Hospitals that are in
the provider organization. Your choice of Primary Care Physician may affect
the Hospital( s) and Specialty Care Physicians to which you may be referred.
Therefore, you may not have access to every specialist or Participating
Provider in your Service Area. Before you select a PCP, you should check to
see if that PCP is associated with the specialist or facility you prefer to use. 9
9 Page 10 11
2001 CIGNA HealthCare of California, Inc. 9 Section 3
Your primary care physician can be a general practitioner, family practitioner,
internist or pediatrician. Your primary care physician will provide most of
your health care, or give you a referral to see a specialist.

If you want to change primary care physicians or if your primary care
physician leaves the Plan, call us. We will help you select a new one.

Your primary care physician will refer you to a specialist for needed care.
However, you may see an OB/ GYN for well-woman care or go to a hospital
for emergency care without a referral.

Here are other things you should know about specialty care:
° If you need to see a specialist frequently because of a chronic, complex,
or serious medical condition, your primary care physician will work with
the Plan to develop a treatment plan that allows you to see your specialist
for a certain number of visits without additional referrals. Your primary
care physician will use our criteria when creating your treatment plan
(the physician may have to get an authorization or approval beforehand).

° If you are seeing a specialist when you enroll in our Plan, talk to your
primary care physician. Your primary care physician will decide what
treatment you need. If he or she decides to refer you to a specialist, ask
if you can see your current specialist. If your current specialist does not
participate with us, you must receive treatment from a specialist who
does. Generally, we will not pay for you to see a specialist who does not
participate with our Plan.

° If you are seeing a specialist and your specialist leaves the Plan, call your
primary care physician, who will arrange for you to see another specialist.
You may receive services from your current specialist until we can make
arrangements for you to see someone else.

° If you have a chronic or disabling condition and lose access to your
specialist because we:

°° terminate our contract with your specialist for other than cause; or
°° drop out of the Federal Employees Health Benefits (FEHB) Program
and you enroll in another FEHB Plan; or

°° reduce our service area and you enroll in another FEHB Plan,
you may be able to continue seeing your specialist for up to 90 days after
you receive notice of the change. Contact us or, if we drop out of the
Program, contact your new plan.

If you are in the second or third trimester of pregnancy and you lose access
to your specialist based on the above circumstances, you can continue to see
your specialist until the end of your postpartum care, even if it is beyond the
90 days.

Your Plan primary care physician or specialist will make necessary hospital
arrangements and supervise your care. This includes admission to a skilled
nursing or other type of facility.

If you are in the hospital when your enrollment in our Plan begins, call our
customer service department immediately at 1-800-832-3211. If you are
new to the FEHB Program, we will arrange for you to receive care.

° Primary care
° Specialty care

° Hospital care 10
10 Page 11 12
2001 CIGNA HealthCare of California, Inc. 10 Section 3
If you changed from another FEHB plan to us, your former plan will pay for
the hospital stay until:

° You are discharged, not merely moved to an alternative care center; or
° The day your benefits from your former plan run out; or
° The 92nd day after you become a member of this Plan, whichever
happens first.

These provisions apply only to the benefits of the hospitalized person.

Under certain extraordinary circumstances, such as natural disasters, we may
have to delay your services or we may be unable to provide them. In that case,
we will make all reasonable efforts to provide you with the necessary care.

Your primary care physician has authority to refer you for most services.
For certain services, however, your physician must obtain approval from us.
Before giving approval, we consider if the service is covered, medically
necessary, and follows generally accepted medical practice.

A referral or Prior Authorization must be obtained prior to receiving services
performed by any health care provider EXCEPT:

For services provided by
° Your Primary Care Physician;
° OB/ GYN Services; and
° Emergency Services or Urgently Needed Care.

A Referral must be obtained directly from your Primary Care Physician.
Your Primary Care Physician must provide a referral if you receive services
and benefits such as Specialty Care Physician services. If you receive
services which require a referral without a referral from your Primary
Care Physician, you will be obligated to pay for the unauthorized Services.
We will not pay for such unauthorized Services.

Certain benefits and services require Prior Authorization from us. Prior
Authorization must always be obtained through your Plan Provider. If Prior
Authorization is required from us, your Primary Care Physician or Specialty
Care Physician will make arrangements with our Medical Director. Prior
Authorization is required for the following types of benefits and services
such as: Inpatient and Outpatient Hospital Services, Rehabilitative Therapy,
Skilled Nursing Facility Services, Home Health Services, Second Surgical
Opinions, Services provided by a Non-Plan Provider, Durable Medical
Equipment and Prosthetic Devices.

If your coverage is terminated prior to the date of service, the service will
not be covered, regardless of any Prior Authorization given by us or your
Primary or Specialty Care Physician.

Circumstances beyond our control
Services requiring our prior approval 11
11 Page 12 13
2001 CIGNA HealthCare of California, Inc. 11 Section 4
Section 4. Your costs for covered services
You must share the cost of some services. You are responsible for:

A copayment is a fixed amount of money you pay to the provider when you
receive services.

Example: When you see your primary care physician you pay a
copayment of $10 per office visit.

A deductible is a fixed expense you must incur for certain covered services
and supplies before we start paying benefits for them. We do not have a
deductible.

NOTE: If you change plans during open season, you do not have to start a
new deductible under your old plan between January 1 and the effective date
of your new plan. If you change plans at another time during the year, you
must begin a new deductible under your new plan.

Coinsurance is the percentage of our negotiated fee that you must pay for
your care.

Example: In our Plan, you pay 50% of our allowance for
infertility services.

After your copayments total $1,500 per person or $3,000 per family enroll-ment
in any calendar year, you do not have to pay any more for covered
services. However, copayments for the following services do not count
toward your out-of-pocket maximum, and you must continue to pay
copayments for these services:

° prescription drugs
° dental services
° mental health/ substance abuse
° external prosthetic appliances

Be sure to keep accurate records of your copayments since you are
responsible for informing us when you reach the maximum.

° Copayments
° Deductible

° Coinsurance
Your out-of-pocket maximum for copayments 12
12 Page 13 14
2001 CIGNA HealthCare of California, Inc. 12 Section 5
Section 5. Benefits Ð OVERVIEW (See page 7 for how our benefits changed this year and page 52 for a benefits summary.)
NOTE: This benefits section is divided into subsections. Also read the General Exclusions in Section 6; they apply to
the benefits in the following subsections. Please read the important things you should keep in mind at the beginning
of each subsection. To obtain claims forms, claims filing advice, or more information about our benefits, contact us at
1-800-832-3211 or at our website at www. cigna. com/ healthcare.

° Medical emergency
(d) Emergency services/ accidents ......................................................................................................................... 26-27

° Inpatient hospital
° Outpatient hospital or ambulatory surgical center

(c) Services provided by a hospital or other facility, and ambulance services ..................................................... 23-25

° Surgical procedures
° Reconstructive surgery

(b) Surgical and anesthesia services provided by physicians and other health care professionals ....................... 20-22

° Diagnostic and treatment services
° Lab, X-ray, and other diagnostic tests
° Preventive care, adult
° Preventive care, children
° Maternity care
° Family planning
° Infertility services
° Allergy care
° Treatment therapies
° Rehabilitative therapies

(a) Medical services and supplies provided by physicians and other health care professionals .......................... 13-19
° Hearing services (testing, treatment, and supplies)

° Vision services (testing, treatment, and supplies)
° Foot care
° Orthopedic and prosthetic devices
° Durable medical equipment (DME)
° Home health services
° Alternative treatments
° Educational classes and programs

° Oral and maxillofacial surgery
° Organ/ tissue transplants
° Anesthesia

° Extended care benefits/ skilled nursing care facility benefits
° Hospice care
° Ambulance

(e) Mental health and substance abuse benefits .................................................................................................... 28-29
(f) Prescription drug benefits ................................................................................................................................ 30-31
(g) Special features .................................................................................................................................................... 32
° Flexible benefits
° 24 hour nurse line
° Services for deaf and hearing impaired
° High risk pregnancies
° Centers of Excellence for transplants/ heart surgery/ etc.
° Travel benefit/ services overseas

(h) Dental benefits ...................................................................................................................................................... 33

(i) Non-FEHB benefits available to Plan members .................................................................................................. 34
Summary of benefits ............................................................................................................................................ 52

° Ambulance 13
13 Page 14 15
2001 CIGNA HealthCare of California, Inc. 13 Section 5( a)
Diagnostic and treatment services
Professional services of physicians $10 per office visit
° In physician's office
° In an urgent care center
° During a hospital stay
° In a skilled nursing facility
° Initial examination of a newborn child covered under a family enrollment

° Office medical consultations
° Second surgical opinion

Lab, X-ray and other diagnostic tests
Tests, such as: Nothing
° Blood tests
° Urinalysis
° Pap tests
° Pathology
° X-rays
° Mammograms
° CAT Scans/ MRI
° Ultrasound
° Electrocardiogram and EEG

Note: You pay nothing for Lab, X-rays and other diagnostic tests, however a provider or facility copayment may apply. Refer to the

provider/ facility charges identified in this Section 5.

Benefit Description You pay
I
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P
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I
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Section 5 (a). Medical services and supplies provided by physicians and other health care professionals
Here are some important things to keep in mind about these benefits:
° Please remember that all benefits are subject to the definitions, limitations, and
exclusions in this brochure and are payable only when we determine they are
medically necessary.

° Plan physicians must provide or arrange your care.
° We have no calendar year deductible.
° Be sure to read Section 4, Your costs for covered services for valuable informa-tion
about how cost sharing works. Also read Section 9 about coordinating
benefits with other coverage, including with Medicare. 14
14 Page 15 16
2001 CIGNA HealthCare of California, Inc. 14 Section 5( a)
Preventive care, adult You pay
Routine screenings, such as: Nothing
° Blood lead level Ð One annually
° Total Blood Cholesterol Ð once every three years, ages 19 through 64

° Colorectal Cancer Screening, including
°° Fecal occult blood test
°° Sigmoidoscopy, screening Ð every five years starting at age 50 Nothing

Prostate Specific Antigen (PSA test) Ð one annually for men age 40 Nothing and older

Routine pap test Nothing
Note: The office visit is covered if pap test is received on the same day; see Diagnostic and treatment services, above.

Routine mammogram Ðcovered for women age 35 and older, Nothing as follows:
° From age 35 through 39, one during this five year period
° From age 40 through 64, one every calendar year
° At age 65 and older, one every two consecutive calendar years

Note: You pay nothing for routine screenings, however a provider or facility copayment may apply. Refer to the provider/ facility

charges identified in this Section 5.

Not covered: Physical exams required for obtaining or continuing All charges. employment or insurance, attending schools or camp, or travel.

Routine Immunizations, limited to: Nothing
° Tetanus-diphtheria (Td) booster Ð once every 10 years, ages 19 and over (except as provided for under Childhood immunizations)

° Influenza/ Pneumococcal vaccines, annually, age 65 and over

Preventive care, children
° Childhood immunizations and injections recommended by the Nothing American Academy of Pediatrics

Note: You pay nothing for childhood immunizations, however a provider or facility copayment may apply. Refer to the provider/
facility charges identified in this Section 5.

° Examinations, such as: $10 per office visit
°° Eye exams through age 17 to determine the need for vision correction

°° Ear exams through age 17 to determine the need for hearing correction
°° Examinations done on the day of immunizations (through age 22)
° Well-child care charges for routine examinations, immunizations and care (through age 22)
° Early intervention services (through age 2)
Note: You pay nothing for childhood immunizations, however a provider or facility copayment may apply. Refer to the provider/

facility charges identified in this Section 5. 15
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2001 CIGNA HealthCare of California, Inc. 15 Section 5( a)
Maternity care You pay
Complete maternity (obstetrical) care, such as:
° Prenatal care
° Delivery
° Postnatal care

Note: Here are some things to keep in mind:
° You do not need to obtain prior authorization for your normal delivery; see page 10 for other circumstances, such as extended

stays for you or your baby.
° You may remain in the hospital up to 48 hours after a regular delivery and 96 hours after a cesarean delivery. We will extend

your inpatient stay if medically necessary.
° We cover routine nursery care of the newborn child during the covered portion of the mother's maternity stay. We will cover other care of an

infant who requires non-routine treatment only if we cover the infant under a Self and Family enrollment.

° We pay hospitalization and surgeon services (delivery) the same as for illness and injury. See Hospital benefits (Section 5c) and Surgery
benefits (Section 5b).

Not covered: Routine sonograms to determine fetal age, size or sex . All charges.

Family planning
° Voluntary sterilization Nothing
Note: You pay nothing for Voluntary sterilization, however a provider or facility copayment may apply. Refer to the provider/ facility charges

identified in this Section 5.

° Surgically implanted contraceptives $10 per office visit
° Injectable contraceptive drugs
° Intrauterine devices (IUDs)

Not covered: reversal of voluntary surgical sterilization, genetic All charges. counseling.

Infertility services
Diagnosis of infertility $20 per office visit
Treatment of infertility, such as: 50% per treatment/ surgical
° Artificial insemination: procedure
°° intravaginal insemination (IVI)
°° intracervical insemination (ICI)
°° intrauterine insemination (IUI)
° Fertility drugs

Note: We cover injectable fertility drugs under medical benefits and oral fertility drugs under the prescription drug benefit.

Not covered: All charges.
° Assisted reproductive technology (ART) procedures, such as:
°° in vitro fertilization
°° embryo transfer and GIFT
° Services and supplies related to excluded ART procedures
° Cost of donor sperm

$10 for the first office visit to confirm pregnancy; no copay
for all pre-/ post-delivery visits thereafter. 16
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2001 CIGNA HealthCare of California, Inc. 16 Section 5( a)
Allergy care You pay
Testing and treatment $10 per office visit
Allergy injection

Allergy serum Nothing
Not covered: All charges.
° Self-administered allergy injections

Treatment therapies
° Chemotherapy and radiation therapy
Note: High dose chemotherapy in association with autologous bone marrow transplants are limited to those transplants listed under

Organ/ Tissue Transplants on page 22.
° Respiratory and inhalation therapy
° Dialysis Ð Hemodialysis and peritoneal dialysis
° Intravenous (IV)/ Infusion Therapy Ð Home IV and antibiotic therapy
° Growth hormone therapy (GHT)

Note: We will only cover GHT when your PCP has received our prior authorization Ð Prior approval must be received before you begin

treatment; otherwise, we will only cover GHT services from the date your PCP receives prior authorization. If prior authorization is not
received or if we determine GHT is not medically necessary, we will not cover the GHT or related services and supplies. GHT is covered
under the prescription drug benefit. See Services requiring our prior approval in Section 3.

Rehabilitative therapies
Physical therapy, occupational therapy and speech therapy $10 per office visit
° Services covered for two consecutive months per condition if significant improvement can be expected within the two months.

° Services of each of the following are covered:
°° qualified physical therapists;
°° speech therapists;
°° occupational therapists; and
°° chiropractors.

Note: We only cover therapy to restore bodily function or speech when there has been a total or partial loss of bodily function or

functional speech due to illness or injury.

Not covered: All charges.
° long-term rehabilitative therapy
° exercise programs
° cardiac and pulmonary rehabilitation programs 17
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2001 CIGNA HealthCare of California, Inc. 17 Section 5( a)
Hearing services (testing, treatment, and supplies) You pay
° Hearing testing for children through age 17 (see Preventive care, $10 per office visit children)

Not covered: All charges.
° All other hearing testing
° Hearing aids, testing and examinations for them

Vision services (testing, treatment, and supplies)
One eye refraction per year to provide a written lens prescription $10 per office visit for eyeglasses.

One pair of eyeglasses or contact lenses for treatment of keratoconus or $10 per office visit post-cataract surgery

Eye exam to determine the need for vision correction for children $10 per office visit through age 17 (see preventive care)
Not covered: All charges.
° Eyeglasses or contact lenses and examinations for them
° Eye exercises and orthoptics
° Radial keratotomy and other refractive surgery

Foot care
Routine foot care when you are under active treatment for medical $10 per office visit conditions such as diabetes; fungal infection of the nail beds, circulatory
impairment; immunocomprimised patients.
See orthopedic and prosthetic devices for information on podiatric shoe inserts.

Not covered: All charges.
° Cutting, trimming or removal of corns, calluses, or the free edge of toenails, and similar routine treatment of conditions of the foot,

except as stated above
° Treatment of weak, strained or flat feet or bunions or spurs; and of any instability, imbalance or subluxation of the foot (unless the

treatment is by open cutting surgery)

Orthopedic and prosthetic devices
° Artificial limbs and eyes; hands or hooks. First $200 per calendar year and all charges after the annual
maximum Plan payment of $1,000 for all devices.

° Externally worn breast prostheses and surgical bras, including Nothing necessary replacements, following a mastectomy.
° Internal prosthetic devices, such as artificial joints, pacemakers, cochlear implants, and surgically implanted breast implant following
mastectomy. Note: See 5( b) for coverage of the surgery to insert the device.

Orthopedic and prosthetic devices continued on next page. 18
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2001 CIGNA HealthCare of California, Inc. 18 Section 5( a)
Orthopedic and prosthetic devices (Continued) You pay
Not covered: All charges.
° orthopedic and corrective shoes
° arch supports
° foot orthotics and braces
° heel pads and heel cups
° lumbosacral supports
° corsets, trusses, elastic stockings, support hose, and other supportive devices

° prosthetic replacements due to wear and tear, loss, theft or destruction.
° Corrective orthopedic appliances for non-dental treatment of temporomandibular joint (TMJ) pain dysfunction syndrome

° Biomechanical devices
° Penile prosthetics

Durable medical equipment (DME)
Initial rental or purchase, at our option, including repair and adjustment, Nothing of durable medical equipment prescribed by your Plan physician and
received from a vendor approved by the Plan, such as:
° Oxygen tents;
° Dialysis equipment;
° Hospital beds;
° Wheelchairs (limited to the lowest cost alternative to satisfy medical necessity);

° Crutches;
° Walkers;
° blood glucose monitors and blood glucose monitors for the legally blind;

° insulin pumps and infusion devices;
° respirators; and
° oxygen tents.

Note: Your PCP will prescribe and arrange for a participating health care provider to rent or sell you the durable medical equipment.

We will not cover equipment received from a non-participating health care provider unless your PCP has received our prior authorization.

Not covered: All charges.
° Hygienic or self-help items or equipment, or item or equipment that are primarily for comfort or convenience, such as bathtub chairs,

safety grab bars, stair gliders or elevators, over-the-bed tables, saunas or exercise equipment;

° Environmental control equipment, such as air purifiers, humidifiers, and electrostatic machines;
° Institutional equipment such as air fluidized beds and diathermy machines;
° Consumable medical supplies including, but not limited to, bandages and other disposable supplies, skin preparations, test strips, ostomy
supplies, surgical leggings, elastic stockings and wigs. 19
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2001 CIGNA HealthCare of California, Inc. 19 Section 5( a)
Home health services You pay
° Home health care ordered by a Plan physician and provided by a Nothing registered nurse (R. N.), licensed practical nurse (L. P. N.), licensed
vocational nurse (L. V. N.), or home health aide.
° Services include oxygen therapy, intravenous therapy and medications.

Not covered: All charges.
° nursing care requested by, or for the convenience of, the patient or the patient's family;

° nursing care primarily for hygiene, feeding, exercising, moving the patient, homemaking, companionship or giving oral medication;
° services primarily for rest, domiciliary or convalescent care.

Alternative treatments
No benefit All charges.

Educational classes and programs
No benefit All charges. 20
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2001 CIGNA HealthCare of California, Inc. 20 Section 5( b)
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Section 5 (b). Surgical and anesthesia services provided by physicians and other health care professionals
Here are some important things to keep in mind about these benefits:
° Please remember that all benefits are subject to the definitions, limitations, and
exclusions in this brochure and are payable only when we determine they are
medically necessary.

° Plan physicians must provide or arrange your care.
° We have no calendar year deductible.
° Be sure to read Section 4, Your costs for covered services for valuable information
about how cost sharing works. Also read Section 9 about coordinating benefits
with other coverage, including with Medicare.

° The amounts listed below are for the charges billed by a physician or other health
care professional for your surgical care. Look in Section 5( c) for charges associated
with the facility (i. e. hospital, surgical center, etc.).

° YOUR PLAN PROVIDER MUST GET PRIOR AUTHORIZATION OF SOME
SURGICAL PROCEDURES. Please refer to the prior authorization information
shown in Section 3 to be sure which services require prior authorization and
identify which surgeries require prior authorization.

Benefit Description You pay
Surgical procedures
° Treatment of fractures, including casting Nothing
° Normal pre-and post-operative care by the surgeon
° Correction of amblyopia and strabismus
° Endoscopy procedure
° Biopsy procedure
° Removal of tumors and cysts
° Correction of congenital anomalies (see reconstructive surgery)
° Surgical treatment of morbid obesity Ð a condition in which an individual weighs 200% of his or her normal weight according to

the 1983 Metropolitan Life Insurance Company height-weight chart with a history of morbid obesity for at least 5 years and has
complied with more conservative methods of weight loss
° Insertion of internal prosthetic devices. See 5( a) Ð Orthopedic braces and prosthetic devices for device coverage information

° Voluntary sterilization Nothing
° Norplant (a surgically implanted contraceptive) and intrauterine devices (IUDs) Note: Devices are covered under 5( a)

° Treatment of burns
Note: Generally, we pay for internal prostheses (devices) according to where the procedure is done. For example, we pay Hospital

benefits for a pacemaker and Surgery benefits for insertion of the pacemaker.

Surgical procedures continued on next page.

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2001 CIGNA HealthCare of California, Inc. 21 Section 5( b)
Surgical procedures (Continued) You pay
Not covered: All charges.
° Reversal of voluntary sterilization
° Routine treatment of conditions of the foot; see Foot care.
° Cosmetic therapy or surgery primarily for the purpose of altering appearance.

Reconstructive surgery
° Surgery to correct a functional defect Nothing
° Surgery to correct a condition caused by injury or illness if:
°° the condition produced a major effect on the member's appearance and

°° the condition can reasonably be expected to be corrected by such surgery.
° Surgery to correct a condition that existed at or from birth and is a significant deviation from the common form or norm. Examples of
congenital anomalies are: protruding ear deformities; cleft lip; cleft palate; birth marks; webbed fingers; and webbed toes.

° All stages of breast reconstruction surgery following a mastectomy, such as:
°° surgery to produce a symmetrical appearance on the other breast;
°° treatment of any physical complications, such as lymphedemas;
°° breast prostheses and surgical bras and replacements (see Prosthetic devices).

Note: If you need a mastectomy, you may choose to have the procedure performed on an inpatient basis and remain in the hospital up to 48 hours
after the procedure.

Not covered: All charges.
° Cosmetic surgery Ð any surgical procedure (or any portion of a procedure) performed primarily to improve physical appearance

through change in bodily form, except repair of accidental injury
° Surgeries related to sex transformation

Oral and maxillofacial surgery
Oral surgical procedures, with the prior approval of Plan Medical Nothing Director, such as:
° Reduction of fractures of the jaws or facial bones;
° Surgical correction of cleft lip, cleft palate or severe functional malocclusion;

° Removal of stones from salivary ducts;
° Excision of leukoplakia or malignancies;
° Excision of cysts and incision of abscesses when done as independent procedures; and

° Other surgical procedures that do not involve the teeth or their supporting structures.

Not covered: All charges.
° Oral implants and transplants

° Procedures that involve the teeth or their supporting structures (such as the periodontal membrane, gingiva, and alveolar bone)

° Other surgical procedures which have not received prior approval from the Plan Medical Director. 22
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2001 CIGNA HealthCare of California, Inc. 22 Section 5( b)
Organ/ tissue transplants You pay
Limited to: Nothing
° Cornea
° Heart
° Heart/ lung
° Kidney
° Pancreas
° Liver
° Lung
° Allogeneic (donor) bone marrow transplants
° Autologous bone marrow transplants (autologous stem cell and peripheral stem cell support) for the following conditions: acute

lymphocytic or non-lymphocytic leukemia; advanced Hodgkin's lymphoma; advanced non-Hodgkin's lymphoma; advanced
neuroblastoma; breast cancer; multiple myeloma; epithelial ovarian cancer; and testicular, mediastinal, retroperitoneal and
ovarian germ cell tumors
° National Transplant Program (NTP) please see Section 5( g), Special Features

Limited Benefits Ð Treatment for breast cancer, multiple myeloma, and epithelial ovarian cancer may be provided in an NCI-or
NIH-approved clinical trial at a Plan-designated center of excellence and if approved by the Plan's Medical Director in accordance with the
Plan's protocols.
Note: We cover related medical and hospital expenses of the donor when we cover the recipient.

Not covered: All charges.
° Donor screening tests and donor search expenses, except those performed for the actual donor

° Implants of artificial organs
° Transplants not listed as covered

Anesthesia
Professional services provided in Ð Nothing
° Hospital (inpatient)

Professional services provided in Ð Nothing
° Hospital outpatient department
° Skilled nursing facility
° Ambulatory surgical center
° Office 23
23 Page 24 25
2001 CIGNA HealthCare of California, Inc. 23 Section 5( c)
Inpatient hospital
Room and board, such as: Nothing
° ward, semiprivate, or intensive care accommodations;
° general nursing care; and
° meals and special diets.

NOTE: If you want a private room when it is not medically necessary, you pay the additional charge above the semiprivate room rate.

Other hospital services and supplies, such as: Nothing
° Operating, recovery, maternity, and other treatment rooms
° Prescribed drugs and medicines
° Diagnostic laboratory tests and X-rays
° Administration of blood, blood products and other biologicals
° Blood or blood plasma
° Dressings, splints, casts, and sterile tray services
° Medical supplies and equipment, including oxygen
° Anesthetics and anesthesia services

Not covered: All charges.
° Custodial care
° Non-covered facilities, such as nursing homes, skilled nursing facilities, schools

° Personal comfort items, such as telephone, television, barber services, guest meals and beds
° Private nursing care

Section 5 (c). Services provided by a hospital or other facility, and ambulance services
Here are some important things to remember about these benefits:
° Please remember that all benefits are subject to the definitions, limitations, and
exclusions in this brochure and are payable only when we determine they are
medically necessary.

° Plan physicians must provide or arrange your care and you must be hospitalized
in a Plan facility.

° We have no calendar year deductible.
° Be sure to read Section 4, Your costs for covered services for valuable information
about how cost sharing works. Also read Section 9 about coordinating benefits
with other coverage, including with Medicare.

° The amounts listed below are for the charges billed by the facility (i. e., hospital
or surgical center) or ambulance service for your surgery or care. Any costs
associated with the professional charge (i. e., physicians, etc.) are covered in
Section 5( a) or (b).

° Your Primary Care Physician must obtain our Prior Authorization for Hospital
Stays, except for emergencies.

Benefit Description You pay

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2001 CIGNA HealthCare of California, Inc. 24 Section 5( c)
Outpatient hospital or ambulatory surgical center You pay
° Operating, recovery, and other treatment rooms Nothing
° Prescribed drugs and medicines
° Diagnostic laboratory tests, X-rays, and pathology services
° Administration of blood, blood products and other biologicals
° Blood and blood plasma
° Pre-surgical testing
° Dressings, casts, and sterile tray services
° Medical supplies, including oxygen
° Anesthetics and anesthesia services

NOTE: We cover hospital services and supplies related to dental procedures when necessitated by a non-dental physical impairment.

We do not cover the dental procedures.

Not covered: blood and blood derivatives not replaced by the member All charges.

Extended care benefits/ skilled nursing care facility benefits
Benefits will be provided for up to 60 days per calendar year when Nothing full-time skilled nursing care is necessary and confinement in a skilled
nursing facility is medically appropriate as determined by a Plan doctor and approved by the Plan. Covered services include:

° Skilled and general nursing services
° Physicians visits
° Physiotherapy
° X-rays
° Administration of drugs, medications and fluids

Not covered: All charges.
° personal comfort items, such as television and telephone

° custodial care, rest cures, domiciliary or convalescent care 25
25 Page 26 27
2001 CIGNA HealthCare of California, Inc. 25 Section 5( c)
Hospice care You pay
Supportive and palliative care for a terminally ill member is covered. Nothing Services are provided under the direction of a Plan doctor who certifies
that the patient is in the terminal stages of illness, with a life expectancy of approximately six (6) months or less.

Hospice care services include:
° Inpatient care

° outpatient care
° physician services
° psychologist, social worker or family counselor services for individual or family counseling

Not covered: All charges.
° Independent nursing
° homemaker services, including services and supplies that are primarily to aid you or your dependent in daily living

° services of a person who is a member of your family who normally resides in your house
° services or supplies not listed in the Hospice Care Program
° services for curative or life-prolonging procedures
° services for respite care
° nutritional supplements, non-prescription drugs or substances, medical supplies, vitamins or minerals

° bereavement counseling

Ambulance
° Local professional ambulance service when medically appropriate Nothing 26
26 Page 27 28
2001 CIGNA HealthCare of California, Inc. 26 Section 5( d)
Section 5 (d). Emergency services/ accidents
Here are some important things to keep in mind about these benefits:
° Please remember that all benefits are subject to the definitions, limitations, and
exclusions in this brochure.

° We have no calendar year deductible.
° Be sure to read Section 4, Your costs for covered services for valuable informa-tion
about how cost sharing works. Also read Section 9 about coordinating
benefits with other coverage, including with Medicare.

What is a medical emergency?
A medical emergency is the sudden and unexpected onset of a condition or an injury that you believe endangers
your life or could result in serious injury or disability, and requires immediate medical or surgical care. Some
problems are emergencies because, if not treated promptly, they might become more serious; examples include
deep cuts and broken bones. Others are emergencies because they are potentially life-threatening, such as heart
attacks, strokes, poisonings, gunshot wounds, or sudden inability to breathe. There are many other acute conditions
that we may determine are medical emergencies Ð what they all have in common is the need for quick action.

What to do in case of emergency:
Emergencies inside or outside our service area: In the event of an emergency, get help immediately. Go to the
nearest emergency room, the nearest hospital or call or ask someone to call 911 or your local emergency service,
police or fire department for help. You do not need a Referral from your PCP for Emergency Services, but you do
need to call your PCP as soon as possible for further assistance and advice on follow-up care. If you require
specialty care or a hospital admission, your PCP will coordinate it and handle the necessary authorizations for care
or hospitalization. Participating Providers are on call twenty-four (24) hours a day, seven (7) days a week, to assit
you when you need Emergency Services.

If you receive Emergency Services outside the Service Area, you must notify us as soon as reasonably possible. We
may arrange to have you transferred to a Participating Provider for continuing or follow-up care if it is determined
to be medically safe to do so.

Emergency Services are defined as the medical, psychiatric, surgical, hospital and related health care services and
testing, including ambulance service, which are required to treat a bodily injury or a serious illness which could
reasonably be expected by a prudent layperson to result in serious medical complications, or in the case of a
pregnant woman, serious jeopardy to the health of the woman or her unborn child, loss of life or permanent
impairment to bidily functions in the absence of immediate medical attention. Examples of emergency situations
include, but are not limited to, uncontrolled bleeding, seizures or loss of consciousness, shortness of breath, chest
pains or severe squeezing sensations in the chest, suspected overdoes of medication or poisoning, sudden paralysis
or slurred speech, burns, cuts, and broken bones, or services required by a Member to determine if a psychiatric
Emergency Medical Condition exists, and the care and treatment necessary to relieve or eliminate the psychiatric
Emergency Medical Condition within the capability of the facility.

Continuing or follow-up treatment, whether In or Out of the Service Area, is not covered unless it is provided or
arranged for by your PCP or upon Prior Authorization of the Plan Medical Director.

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2001 CIGNA HealthCare of California, Inc. 27 Section 5( d)
Benefit Description You pay
Emergency within our service area
° Emergency care at a Plan doctor's office $10 per office visit
° Emergency care at a Plan urgent care center $50 per office visit
° Emergency care as an outpatient or inpatient at a hospital, $50 per office visit. including doctors' services

Note: Urgent care center copay and emergency hospital care copay waived if admitted to hospital

Not covered: Elective care or non-emergency care All charges
Emergency outside our service area
° Emergency care at a doctor's office $10 per office visit
° Emergency care at an urgent care center $50 per office visit
° Emergency care as an outpatient or inpatient at a hospital, $50 per office visit. including doctors' services

Note: Urgent care center copay and emergency hospital care copay waived if admitted to hospital

Not covered: All charges.
° Elective care or non-emergency care
° Emergency care provided outside the service area if the need for care could have been foreseen before leaving the service area

Ambulance
Professional ambulance service when medically appropriate. Nothing
See 5( c) for non-emergency service. 28
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2001 CIGNA HealthCare of California, Inc. 28 Section 5( e)
Mental health and substance abuse benefits
All diagnostic and treatment services recommended by a Plan Your cost sharing provider and contained in a treatment plan that we approve. The responsibilities are no
treatment plan may include services, drugs, and supplies described greater than for other elsewhere in this brochure. illness or conditions.

Note: Plan benefits are payable only when we determine the care is clinically appropriate to treat your condition and only when you
receive the care as part of a treatment plan that we approve.

° Professional services, including individual or group therapy by $10 per office visit providers such as psychiatrists, psychologists, or clinical social
workers
° Medication management

° Diagnostic tests Nothing
° Inpatient Services provided by a hospital or other facility Nothing
° Outpatient Services in approved alternative care settings such Nothing, however a provider as partial hospitalization, residential treatment, facility based copayment may apply.

intensive outpatient treatment

Not covered: Services we have not approved. All charges.
Note: OPM will base its review of disputes about treatment plans on the treatment plan's clinical appropriateness. OPM will generally

not order us to pay or provide one clinically appropriate treatment plan in favor of another.

Mental health and substance abuse benefits continued on next page.

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Section 5 (e). Mental health and substance abuse benefits
Parity
Beginning in 2001, all FEHB plans' mental health and substance abuse benefits will
achieve "parity" with other benefits. This means that we will provide mental health
and substance abuse benefits differently than in the past.

When you get our approval for services and follow a treatment plan we approve,
cost-sharing and limitations for Plan mental health and substance abuse benefits will
be no greater than for similar benefits for other illnesses and conditions.

Here are some important things to keep in mind about these benefits:
° All benefits are subject to the definitions, limitations, and exclusions in this
brochure.

° We have no calendar year deductible.
° Be sure to read Section 4, Your costs for covered services for valuable information
about how cost sharing works. Also read Section 9 about coordinating benefits
with other coverage, including with Medicare.

° YOU MUST GET PREAUTHORIZATION OF THESE SERVICES. See the
Instructions after the benefits description below.

Benefit Description You pay 29
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2001 CIGNA HealthCare of California, Inc. 29 Section 5( e)
Mental health and substance abuse benefits (Continued)
To be eligible to receive these benefits you must follow your treatment plan
and all the following authorization processes:

Mental Health and Substance Abuse Services are provided by CIGNA
Behavioral Health, Inc. You do not need a referral to receive these services.
However, to obtain these services, you must call CIGNA Behavioral Health
directly, their phone number can be found on your ID Card, to get more
information or speak with someone about a specific problem. A representa-tive
is available to assist you twenty-four (24) hours a day, seven (7) days a
week. The representative will provide you with a choice of providers in your
area and will authorize an appropriate number of visits.

If a mental health or substance abuse professional provider is treating you
under our plan as of January 1, 2001, you will be eligible for continued
coverage with your provider for up to 90 days under the following condition:

° If your mental health or substance abuse professional provider with
whom you are currently in treatment leaves the plan at our request for
other than cause.

If this condition applies to you, we will allow you reasonable time to transfer
your care to a Plan mental health or substance abuse professional provider.
During the transitional period, you may continue to see your treating
provider and will not pay any more out-of-pocket than you did in the year
2000 for services. This transitional period will begin with our notice to you
of the change in coverage and will end 90 days after you receive our notice.
If we write to you before October 1, 2000, the 90-day period ends before
January 1 and this transitional benefit does not apply.

We may limit your benefits if you do not follow your treatment plan.

Preauthorization
Special transitional benefit

Limitation 30
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2001 CIGNA HealthCare of California, Inc. 30 Section 5( f)
Section 5 (f). Prescription drug benefits
Here are some important things to keep in mind about these benefits:
° We cover prescribed drugs and medications, as described in the chart beginning
on the next page.

° All benefits are subject to the definitions, limitations and exclusions in this
brochure and are payable only when we determine they are medically necessary.

° We have no calendar year deductible.
° Be sure to read Section 4, Your costs for covered services for valuable information
about how cost sharing works. Also read Section 9 about coordinating benefits
with other coverage, including with Medicare.

There are important features you should be aware of. These include:
° Who can write your prescription. A plan physician or licensed dentist must write the prescription .
° Where you can obtain them. You may fill the prescription at a plan retail pharmacy, or by plan mail-order
pharmacy. You must fill the prescription at a plan retail pharmacy. You may fill your maintenance medications
by mail through a plan mail-order pharmacy.

° We use a formulary. A formulary is a listing of approved drug products. The drugs and medications included
have been approved in accordance with parameters established by Healthplan. This list is subject to periodic
review and is amended as required. Only those medications included on the formulary are covered.

These are the dispensing limitations. Ð
° Your copayment for generic retail prescription drugs is $5. Your copayment for name brand retail prescription
drugs is $10. Each prescription order or refill is limited to a consecutive thirty (30) day supply at a retail
participating pharmacy, unless limited by the drug manufacturer's packaging.

° Maintenance medications prescribed by Plan doctors may also be obtained through our mail order program.
Your copayment for generic mail order prescription drugs is $10. Your copayment for name brand mail order
prescription drugs is $20. Each prescription order or refill is limited to a consecutive ninety (90) day supply at
a mail order participating pharmacy, unless limited by the manufacturer's packaging.

Each prescription order or refill is further limited to:
° Those drugs and medicines that appear on the formulary
° "generic" drugs unless a generic alternative does not exist or substitution is not permitted by state law.
Coverage for prescription drugs are subject to a Copayment. In no event will the Copayment exceed the cost of the drug.

In the event you insist on:
(i) a more expensive name brand drug where a generic drug would otherwise have been dispensed, you are financially responsible for the amount by which the cost of the name brand drug exceeds the generic drug,

plus the name brand copayment; or
(ii) a non-formulary drug, you will be financially responsible for the full cost of the non-Formulary drug.

° When you have to file a claim. Please refer to Section 7 "Filing a claim for covered services".
Prescription drug benefits begin on the next page.

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2001 CIGNA HealthCare of California, Inc. 31 Section 5( f)
Benefit Description You pay
Covered medications and supplies
We cover the following medications and supplies prescribed by a Plan physician and obtained from a Plan pharmacy or through our
mail order program:
° Drugs and medicines that by Federal law of the United States require a physician's prescription for their purchase, except as excluded below

° Insulin
° Disposable needles and syringes for the administration of covered medications

° Drugs for sexual dysfunction (contact Plan for dose limits)
° Oral and injectable contraceptive drugs and contraceptive devices (such as diaphragms)

° Intravenous fluids and medications for home use.
° Implanted time-release medications such as Norplant. You pay a one-time copay of $10 per prescription. Norplant, and some

injectable drugs are covered under Medical and Surgical Benefits.
° For other implanted time-release medications, you pay $5 for generic and $10 for name brand. There is no charge when the

device is implanted during a covered hospitalization.
° Nutritional supplements (formulas) as medically necessary for the therapeutic treatment of phenylketonuria (PKU), branched-chain

ketonuria, galactosemia and homocystinuria as administered under the direction of a Primary Care Physician

° Diabetic supplies such as test strips
° Oral agent for controlling blood sugar

Here are some things to keep in mind about our prescription drug program:

° A generic equivalent will be dispensed if it is available, unless your physician specifically requires a name brand. If you receive a name
brand drug when a Federally-approved generic drug is available, and your physician has not specified Dispense as Written for the name
brand drug, you have to pay the difference in cost between the name brand drug and the generic.

Not covered: All charges.
° Drugs and supplies for cosmetic purposes
° Vitamins (except for prenatal vitamins), and fluoride products, nutrients and food supplements even if a physician prescribes or

administers them
° Non-prescription medicines
° Over the counter drugs
° Drugs obtained from a non-Plan pharmacy except for out-of-area emergencies

° Medical supplies such as dressings and antiseptics
° Drugs to enhance athletic performance
° Smoking cessation drugs and medications, including nicotine patches
° Diet pills or appetite suppressants (except when used in the treatment of morbid obesity)

° Replacement of drugs due to loss or theft
° Prescriptions more than one year from the original date of issue
° Injectable fertility drugs (see Infertility benefit under Medical and Surgical Benefits for limited coverage)

Retail Pharmacy
$5 per generic drug.
$10 per name brand drug.
Mail Order
$10 per generic drug.
$20 per name brand drug.
Note: If there is no generic equivalent available, you will

still have to pay the brand name copay. 32
32 Page 33 34
2001 CIGNA HealthCare of California, Inc. 32 Section 5( g)
Section 5 (g). Special Features
Feature Description

Under the flexible benefits option, we determine the most effective way to
provide services.

° We may identify medically appropriate alternatives to traditional care and
coordinate other benefits as a less costly alternative benefit.

° Alternative benefits are subject to our ongoing review.
° By approving an alternative benefit, we cannot guarantee you will get it
in the future.

° The decision to offer an alternative benefit is solely ours, and we may
withdraw it at any time and resume regular contract benefits.

° Our decision to offer or withdraw alternative benefits is not subject to
OPM review under the disputed claims process.

For any of your health concerns, 24 hours a day, 7 days a week, you may call
1-800-832-3211 and talk with a registered nurse who will discuss treatment
options and answer your health questions.

Deaf/ Hearing impaired individuals may access the member services
department by calling their state relay line.

Healthy Babies is a program that provides guidance and support to women
from pre-pregnancy through post-partum care. This program is designed to
promote better maternity care, reduce the number of premature births and
educate expectant parents.

CIGNA HealthCare members have access to the CIGNA Lifesource Organ
Transplant Network ® which is an organization of participating hospitals
which provides organ transplant services. As part of the rigorous
credentialing program, each hospital's transplant program is evaluated for
patient outcome, as well as waiting period, housing arrangements, "patient
friendly" environment and the availability of transportation, before it is
included in the CIGNA Lifesource Organ Transplant Network ®.

We cover you for emergency services anywhere in the world.

Flexible benefits option
24 hour nurse line
Services for deaf and hearing impaired

Centers of Excellence for transplants/ heart
surgery/ etc.

Travel benefit/ services overseas

High risk pregnancies 33
33 Page 34 35
2001 CIGNA HealthCare of California, Inc. 33 Section 5( h)
Section 5 (h). Dental Benefits
Here are some important things to keep in mind about these benefits:
° Please remember that all benefits are subject to the definitions, limitations, and
exclusions in this brochure and are payable only when we determine they are
medically necessary.

° Plan dentists must provide or arrange your care.
° We have no calendar year deductible.
° We cover hospitalization for dental procedures only when prior authorized by the
Plan Medical Director and a non-dental physical impairment exists which makes
hospitalization necessary to safeguard the health of the patient; we do not cover
the dental procedure unless it is described below.

° We cover anesthesia for dental procedures only when (a) age 7 years and under;
(b) developmentally disabled, regardless of age; or (c) health compromised and
general anesthesia is Medically Necessary, regardless of age; AND prior autho-rized
by the Plan Medical Director and a non-dental physical impairment exists
which makes hospitalization necessary to safeguard the health of the patient;
we do not cover the dental procedure unless it is described below.

° Be sure to read Section 4, Your costs for covered services for valuable information
about how cost sharing works. Also read Section 9 about coordinating benefits
with other coverage, including with Medicare.

Accidental injury benefit You pay
We cover restorative services and supplies necessary to promptly repair $10 per office visit. (but not replace) sound natural teeth. The need for these services must
result from an accidental injury.

Dental benefits
We have no other dental benefits.

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2001 CIGNA HealthCare of California, Inc. 34 Section 5( i)
Section 5 (i). Non-FEHB benefits available to Plan members
The benefits on this page are not part of the FEHB contract or premium, and you cannot file an FEHB disputed claim
about them. Fees you pay for these services do not count toward FEHB deductibles or out-of-pocket maximums.

Guest Privileges
If you or a covered family member temporarily moves outside of the service area for at least 90 days, you may be eligible
for the Plan's "guest privileges" program. The "guest privileges" program allows participants to enroll as "guests" in
another CIGNA HealthCare site. This program is only available when you or your covered family member is temporarily
relocating to an approved CIGNA guest site. Guest privileges is an ideal way to arrange for benefits in situations such as:
a temporary job transfer/ work assignments; college child attending school away from home, etc. You should be aware that
your FEHBP benefits will NOT follow you to the guest site. You will be covered by the CIGNA HealthCare "guest
privileges" program plan of benefits. Contact member services at 1-800-832-3211 for more information.

CIGNA Dental Care
Health coverage for your mouth is available for FEHB program members at a very affordable cost. It is not necessary to
have CIGNA Medical Care to purchase CIGNA Dental Care for yourself and your family.

° No deductibles
° No annual maximums
° No claim forms
° No charge for preventive services (oral exams, x-rays, routine cleanings, fluoride treatments)
° Low copayments required for other treatments (see Dental Fee Overview)
° Orthodontic coverage for both children and adults for treatment started after the effective date of your plan

For questions about enrollment, call Wright & Co. at 1-800-51DENTAL. For questions about the CIGNA Dental Care
plan, call member services at 1-800-367-1037.

Members Choice allows you to select a different dental office for each covered member. To enroll in CIGNA Dental
Care, choose any network general dentist for yourself and each of your covered dependents from the CIGNA Dental Care
Network Directory, or access the dental office locator by calling 1-800-367-1037. 35
35 Page 36 37
2001 CIGNA HealthCare of California, Inc. 35 Section 6
Section 6. General exclusions Ñ things we don't cover
The exclusions in this section apply to all benefits. Although we may list a specific service as a benefit, we will not
cover it unless your Plan doctor determines it is medically necessary to prevent, diagnose, or treat your illness,
disease, injury, or condition and we agree, as discussed under Services Requiring Our Prior Approval on page 10.

We do not cover the following:
° Care by non-Plan providers except for authorized referrals or emergencies (see Emergency Benefits);
° Services, drugs, or supplies you receive while you are not enrolled in this Plan;
° Services, drugs, or supplies that are not medically necessary;
° Services, drugs, or supplies not required according to accepted standards of medical, dental, or psychiatric practice;
° Experimental or investigational procedures, treatments, drugs or devices;
° Services, drugs, or supplies related to abortions, except when the life of the mother would be endangered if the fetus
were carried to term or when the pregnancy is the result of an act of rape or incest;

° Services, drugs, or supplies related to sex transformations; or
° Services, drugs, or supplies you receive from a provider or facility barred from the FEHB Program. 36
36 Page 37 38
2001 CIGNA HealthCare of California, Inc. 36 Section 7
Section 7. Filing a claim for covered services
When you see Plan physicians, receive services at Plan hospitals and facilities, or obtain your prescription drugs at Plan
pharmacies, you will not have to file claims. Just present your identification card and pay your copayment.

You will only need to file a claim when you receive emergency services from non-plan providers. Sometimes these
providers bill us directly. Check with the provider. If you need to file the claim, here is the process:

In most cases, providers and facilities file claims for you. Physicians must
file on the form HCFA-1500, Health Insurance Claim Form. Facilities will
file on the UB-92 form. For claims questions and assistance, call us at
1-800-832-3211.

When you must file a claim Ð such as for out-of-area care Ð submit it on the
HCFA-1500 or a claim form that includes the information shown below.
Bills and receipts should be itemized and show:

° Covered member's name and ID number;
° Name and address physician or facility that provided the service or supply;
° Dates you received the services or supplies;
° Diagnosis;
° Type of each service or supply;
° The charge for each service or supply;
° A copy of the explanation of benefits, payments, or denial from any
primary payer Ð such as the Medicare Summary Notice (MSN); and

° Receipts, if you paid for your services.

Submit your claims to: Please refer to your ID card for the address to
mail any claims.

Send us all of the documents for your claim as soon as possible. You must
submit the claim by December 31 of the year after the year you received the
service, unless timely filing was prevented by administrative operations of
Government or legal incapacity, provided the claim was submitted as soon
as reasonably possible.

Please reply promptly when we ask for additional information. We may
delay processing or deny your claim if you do not respond.

Medical, hospital and drug benefits
Deadline for filing your claim
When we need more information 37
37 Page 38 39
2001 CIGNA HealthCare of California, Inc. 37 Section 8
Section 8. The disputed claims process
Follow this Federal Employees Health Benefits Program disputed claims process if you disagree with our decision on
your claim or request for services, drugs, or supplies Ð including a request for preauthorization:

Ask us in writing to reconsider our initial decision. Write to us at: CIGNA HealthCare of California, Inc.,
400 North Brand Boulevard, Glendale, California 91203. You must:

(a) Write to us within 6 months from the date of our decision; and

(b) Send your request to us at: CIGNA HealthCare of California, Inc., 400 North Brand Boulevard, Glendale,
California 91203; and

(c) Include a statement about why you believe our initial decision was wrong, based on specific benefit
provisions in this brochure; and

(d) Include copies of documents that support your claim, such as physicians' letters, operative reports, bills,
medical records, and explanation of benefits (EOB) forms.

We have 30 days from the date we receive your request to:
(a) Pay the claim (or, if applicable, arrange for the health care provider to give you the care); or

(b) Write to you and maintain our denial Ð go to step 4; or
(c) Ask you or your provider for more information. If we ask your provider, we will send you a copy of our
request Ð go to step 3.

You or your provider must send the information so that we receive it within 60 days of our request. We will then
decide within 30 more days.

If we do not receive the information within 60 days, we will decide within 30 days of the date the information
was due. We will base our decision on the information we already have.

We will write to you with our decision.

If you do not agree with our decision, you may ask OPM to review it.
You must write to OPM within:
° 90 days after the date of our letter upholding our initial decision; or

° 120 days after you first wrote to us Ð if we did not answer that request in some way within 30 days; or
° 120 days after we asked for additional information.

Write to OPM at: Office of Personnel Management, Office of Insurance Programs, Contracts Division III,
P. O. Box 436, Washington, D. C. 20044-0436.

Send OPM the following information:
° A statement about why you believe our decision was wrong, based on specific benefit provisions in this
brochure;

° Copies of documents that support your claim, such as physicians' letters, operative reports, bills, medical
records, and explanation of benefits (EOB) forms;

° Copies of all letters you sent to us about the claim;
° Copies of all letters we sent to you about the claim; and
° Your daytime phone number and the best time to call.

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2001 CIGNA HealthCare of California, Inc. 38 Section 8
The disputed claims process (continued)
Note: If you want OPM to review different claims, you must clearly identify which documents apply to
which claim.

Note: You are the only person who has a right to file a disputed claim with OPM. Parties acting as your
representative, such as medical providers, must provide a copy of your specific written consent with the review
request.

Note: The above deadlines may be extended if you show that you were unable to meet the deadline because of
reasons beyond your control.

OPM will review your disputed claim request and will use the information it collects from you and us to decide
whether our decision is correct. OPM will send you a final decision within 60 days. There are no other adminis-trative
appeals.

If you do not agree with OPM's decision, your only recourse is to sue. If you decide to sue, you must file the suit
against OPM in Federal court by December 31 of the third year after the year in which you received the disputed
services, drugs, or supplies. This is the only deadline that may not be extended.

OPM may disclose the information it collects during the review process to support their disputed claim decision.
This information will become part of the court record.

You may not sue until you have completed the disputed claims process. Further, Federal law governs your
lawsuit, benefits, and payment of benefits. The Federal court will base its review on the record that was before
OPM when OPM decided to uphold or overturn our decision. You may recover only the amount of benefits in
dispute.

NOTE: If you have a serious or life threatening condition (one that may cause permanent loss of bodily functions or
death if not treated as soon as possible), and

(a) We haven't responded yet to your initial request for care or preauthorization/ prior approval, then call us at
1-800-832-3211 and we will expedite our review; or

(b) We denied your initial request for care or preauthorization/ prior approval, then:
°° If we expedite our review and maintain our denial, we will inform OPM so that they can give your claim expedited
treatment too, or

°° You can call OPM's Health Benefits Contracts Division III at 202-606-0737 between 8 a. m. and 5 p. m. eastern time.

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39 Page 40 41
2001 CIGNA HealthCare of California, Inc. 39 Section 9
Section 9. Coordinating benefits with other coverage
You must tell us if you are covered or a family member is covered under
another group health plan or have automobile insurance that pays health care
expenses without regard to fault. This is called "double coverage."

When you have double coverage, one plan normally pays its benefits in full
as the primary payer and the other plan pays a reduced benefit as the
secondary payer. We, like other insurers, determine which coverage is
primary according to the National Association of Insurance Commissioners'
guidelines.

When we are the primary payer, we will pay the benefits described in this
brochure.

When we are the secondary payer, we will determine our allowance. After
the primary plan pays, we will pay what is left of our allowance, up to our
regular benefit. We will not pay more than our allowance.

Medicare is a Health Insurance Program for:
°° People 65 years of age and older.
°° Some people with disabilities, under 65 years of age.
°° People with End-Stage Renal Disease (permanent kidney failure
requiring dialysis or a transplant).

Medicare has two parts:
°° Part A (Hospital Insurance). Most people do not have to pay for Part A.
°° Part B (Medical Insurance). Most people pay monthly for Part B.

If you are eligible for Medicare, you may have choices in how you get your
health care. Medicare + Choice is the term used to describe the various health
plan choices available to Medicare beneficiaries. The information in the
next few pages shows how we coordinate benefits with Medicare, depending
on the type of Medicare managed care plan you have.

The Original Medicare Plan is available everywhere in the United States.
It is the way most people get their Medicare Part A and Part B benefits. You
may go to any doctor, specialist, or hospital that accepts Medicare. Medicare
pays its share and you pay your share. Some things are not covered under
Original Medicare, like prescription drugs.

When you are enrolled in this Plan and Original Medicare, you still need to
follow the rules in this brochure for us to cover your care. Your care must
continue to be authorized by your Plan PCP, or recertified as required.

We will not waive any of our copayments or coinsurance.

(Primary payer chart begins on next page.)

When you have other health coverage
° What is Medicare?

° The Original Medicare Plan 40
40 Page 41 42
2001 CIGNA HealthCare of California, Inc. 40 Section 9
Primary Payer Chart
A. When either you Ð or your covered spouse Ð are age 65 or over and É Then the primary payer is...
Original Medicare This Plan

1) Are eligible for Medicare based on disability, and
................................................................................. 4 a) Are an annuitant, or

b) Are an active employee ............................................................................ 4

1) Are an active employee with the Federal government (including when you
or a family member are eligible for Medicare solely because of a disability), 4

2) Are an annuitant, 4
3) Are a reemployed annuitant with the Federal government whenÉ
................................................ 4 a) The position is excluded from FEHB, or

b) The position is not excluded from FEHB ............................................... 4
Ask your employing office which of these applies to you.

4) Are a Federal judge who retired under title 28, U. S. C., or a Tax Court judge
who retired under Section 7447 of title 26, U. S. C. (or if your covered spouse 4
is this type of judge),

5) Are enrolled in Part B only, regardless of your employment status, 4 4
(for Part B (for other
services) services)

6) Are a former Federal employee receiving Workers' Compensation and 4
the Office of Workers' Compensation Programs has determined that (except for claims
you are unable to return to duty, related to Workers'
Compensation.)

The following chart illustrates whether Original Medicare or this Plan should be the primary payer for you according to
your employment status and other factors determined by Medicare. It is critical that you tell us if you or a covered family
member has Medicare coverage so we can administer these requirements correctly.

1) Are within the first 30 months of eligibility to receive Part A benefits 4
solely because of ESRD,

2) Have completed the 30-month ESRD coordination period and are 4
still eligible for Medicare due to ESRD,

3) Become eligible for Medicare due to ESRD after Medicare became 4
primary for you under another provision,

B. When you Ð or a covered family member Ð have Medicare
based on end stage renal disease (ESRD) andÉ

C. When you or a covered family member have FEHB andÉ 41
41 Page 42 43
2001 CIGNA HealthCare of California, Inc. 41 Section 9
° Claims process Ð You probably will never have to file a claim form when
you have both our Plan and Medicare. Please note, if your Plan physician
does not participate in Medicare, you will have to file a claim with
Medicare.

° When we are the primary payer, we process the claim first.
° When Original Medicare is the primary payer, Medicare processes your
claim first. In most cases, your claims will be coordinated automatically
and we will pay the balance of covered charges. You will not need to do
anything. To find out if you need to do something about filing your claims,
call us at 1-800-832-3211, or write to CIGNA HealthCare of California,
Inc., 400 North Brand Boulevard, Glendale, California 91203. You may
also visit our website at www. cigna. com/ healthcare. In this case we do
not waive any out-of-pocket costs.

If you are eligible for Medicare, you may choose to enroll in and get your
Medicare benefits from a Medicare managed care plan. These are health
care choices (like HMOs) in some areas of the country. In most Medicare
managed care plans, you can only go to doctors, specialists, or hospitals that
are part of the plan. Medicare managed care plans cover all Medicare Part A
and B benefits. Some cover extras, like prescription drugs. To learn more
about enrolling in a Medicare managed care plan, contact Medicare at
1-800-MEDICARE (1-800-633-4227) or at www. medicare. gov. If you enroll
in a Medicare managed care plan, the following options are available to you:

This Plan and another Plan's Medicare managed care plan: You may
enroll in another plan's Medicare managed care plan and also remain enrolled
in our FEHB plan. We will still provide benefits when your Medicare
managed care plan is primary, even out of the managed care plan's network
and/ or service area (if you use our Plan providers), but we will not waive any
of our copayments, coinsurance, or deductibles.

Suspended FEHB coverage and a Medicare managed care plan: If you
are an annuitant or former spouse, you can suspend your FEHB coverage to
enroll in a Medicare managed care plan, eliminating your FEHB premium.
(OPM does not contribute to your Medicare managed care plan premium.)
For information on suspending your FEHB enrollment, contact your retire-ment
office. If you later want to re-enroll in the FEHB Program, generally
you may do so only at the next open season unless you involuntarily lose
coverage or move out of the Medicare + Choice service area.

Note: If you choose not to enroll in Medicare Part B, you can still be covered
under the FEHB Program. We cannot require you to enroll in Medicare.

TRICARE is the health care program for eligible dependents of military
persons and retirees of the military. TRICARE includes the CHAMPUS
program. If both TRICARE and this Plan cover you, we pay first. See your
TRICARE Health Benefits Advisor if you have questions about TRICARE
coverage.

° Medicare managed care plan
° Enrollment in Medicare Part B
TRICARE 42
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2001 CIGNA HealthCare of California, Inc. 42 Section 9
We do not cover services that:
° you need because of a workplace-related disease or injury that the Office
of Workers' Compensation Programs (OWCP) or a similar Federal or
State agency determines they must provide; or

° OWCP or a similar agency pays for through a third party injury settlement
or other similar proceeding that is based on a claim you filed under
OWCP or similar laws.

Once OWCP or similar agency pays its maximum benefits for your treatment,
we will cover your benefits. You must use our providers.

When you have this Plan and Medicaid, we pay first.
We do not cover services and supplies when a local, State, or Federal
Government agency directly or indirectly pays for them.

When you receive money to compensate you for medical or hospital care for
injuries or illness caused by another person, you must reimburse us for any
expenses we paid. However, we will cover the cost of treatment that exceeds
the amount you received in the settlement.

If you do not seek damages you must agree to let us try. This is called
subrogation. If you need more information, contact us for our subrogation
procedures.

Medicaid
When other Government agencies are responsible

for your care

When others are responsible for injuries

Workers' Compensation 43
43 Page 44 45
2001 CIGNA HealthCare of California, Inc. 43 Section 10
Section 10. Definitions of terms we use in this brochure
January 1 through December 31 of the same year. For new enrollees, the
calendar year begins on the effective date of their enrollment and ends on
December 31 of the same year.

A copayment is a fixed amount of money you pay when you receive covered
services. See page 11.

Coinsurance is the percentage of our allowance that you must pay for your
care. See page 11.

Care we provide benefits for, as described in this brochure.
A deductible is a fixed amount of covered expenses you must incur for
certain covered services and supplies before we start paying benefits for
those services. See page 11.

Experimental, investigational and unproven services are medical, surgical,
diagnostic, psychiatric, substance abuse or other health care technologies,
supplies, treatments, procedures, drug therapies or devices that are determined
by the Independent Review Process for Experimental and Investigational
Therapies (see "Section III. Agreement Provisions") and the Healthplan
Medical Director to be:

° not approved by the U. S. Food and Drug Administration (FDA) to be
lawfully marketed for the proposed use and not recognized for the
treatment of the particular indication in one of the standard reference
compendia (The United States Pharmacopoeia Drug Information, The
American Medical Association Drug Evaluations; or the American
Hospital Formulary Service Drug Information) or in medical and scien-tific
evidence. Medical and scientific evidence means:

a. peer-reviewed literature, biomedical compendia, and other medical
literature that meet the criterial of the National Institute of Health's
National Library of Medicine for indexing in Index Medicus,
Excerpta Medicus (EMBASE), and MEDLARS database Health
Services Technology Assessment Research (HSTAR);

b. medical journals recognized by the Secretary of Health and Human
Services;

c. the following standard reference compendia: The American Hospital
Formulary Service-Drug Information, the American Medical
Assocation Drug Evaluation, the American Dental Association
Accepted Dental Therapeutics, and the United States Pharmacopoeia-Drug
Information;

d. findings, studies, or research conducted by or under the auspices of
federal government agencies and nationally recognized federal
research institutes; and

e. peer-reviewed abstracts accepted for presentation at major medical
association meetings.

° the subject of review or approval by an Institutional Review Board for the
proposed use;

° the subject of an ongoing clinical trial that meets the definition of a phase
I, II or III Clinical Trial as set forth in the FDA regulations, regardless of
whether the trial is subject to FDA oversight ; or

° not demonstrated, through existing peer-reviewed literature to be safe and
effective for treating or diagnosing the condition or illness for which its
use is proposed.

Calendar year
Copayment
Coinsurance
Covered services
Deductible

Experimental or investigational services 44
44 Page 45 46
2001 CIGNA HealthCare of California, Inc. 44 Section 10
Medically necessary covered Services and Supplies are those Services and
Supplies that are determined by our Medical Director to be:

° No more than required to meet your basic health needs; and
° consistent with the diagnosis of the condition for which they are
required; and

° consistent in type, frequency and duration of treatment with scientifically
based guidelines as determined by medical research; and

° required for purposes other than the comfort and convenience of the
patient or his Physician; and

° rendered in the least intensive setting that is appropriate for the delivery
of health care; and

° of demonstrated medical value.

Us and we refer to CIGNA HealthCare of California, Inc.

You refers to the enrollee and each covered family member.

Medical necessity
Us/ We
You 45
45 Page 46 47
2001 CIGNA HealthCare of California, Inc. 45 Section 11
Section 11. FEHB facts
We will not refuse to cover the treatment of a condition that you had before
you enrolled in this Plan solely because you had the condition before you
enrolled.

See www. opm. gov/ insure. Also, your employing or retirement office can
answer your questions, and give you a Guide to Federal Employees Health
Benefits Plans, brochures for other plans, and other materials you need to
make an informed decision about:

° When you may change your enrollment;
° How you can cover your family members;
° What happens when you transfer to another Federal agency, go on leave
without pay, enter military service, or retire;

° When your enrollment ends; and
° When the next open season for enrollment begins.

We don't determine who is eligible for coverage and, in most cases, cannot
change your enrollment status without information from your employing or
retirement office.

Self Only coverage is for you alone. Self and Family coverage is for you,
your spouse, and your unmarried dependent children under age 22, including
any foster children or stepchildren your employing or retirement office
authorizes coverage for. Under certain circumstances, you may also con-tinue
coverage for a disabled child 22 years of age or older who is incapable
of self-support.

If you have a Self Only enrollment, you may change to a Self and Family
enrollment if you marry, give birth, or add a child to your family. You may
change your enrollment 31 days before to 60 days after that event. The Self
and Family enrollment begins on the first day of the pay period in which the
child is born or becomes an eligible family member. When you change to
Self and Family because you marry, the change is effective on the first day of
the pay period that begins after your employing office receives your enroll-ment
form; benefits will not be available to your spouse until you marry.

Your employing or retirement office will not notify you when a family
member is no longer eligible to receive health benefits, nor will we. Please
tell us immediately when you add or remove family members from your
coverage for any reason, including divorce, or when your child under age 22
marries or turns 22.

If you or one of your family members is enrolled in one FEHB plan, that
person may not be enrolled in or covered as a family member by another
FEHB plan.

The benefits in this brochure are effective on January 1. If you are new to
this Plan, your coverage and premiums begin on the first day of your first
pay period that starts on or after January 1. Annuitants' premiums begin on
January 1.

No pre-existing condition limitation
Where you can get information about
enrolling in the FEHB Program

Types of coverage available for you and your family

When benefits and premiums start 46
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2001 CIGNA HealthCare of California, Inc. 46 Section 11
We will keep your medical and claims information confidential. Only the
following will have access to it:

° OPM, this Plan, and subcontractors when they administer this contract;
° This Plan, and appropriate third parties, such as other insurance plans and
the Office of Workers' Compensation Programs (OWCP), when coordi-nating
benefit payments and subrogating claims;

° Law enforcement officials when investigating and/ or prosecuting alleged
civil or criminal actions;

° OPM and the General Accounting Office when conducting audits;
° Individuals involved in bona fide medical research or education that does
not disclose your identity; or

° OPM, when reviewing a disputed claim or defending litigation about a
claim.

When you retire, you can usually stay in the FEHB Program. Generally, you
must have been enrolled in the FEHB Program for the last five years of your
Federal service. If you do not meet this requirement, you may be eligible for
other forms of coverage, such as Temporary Continuation of Coverage
(TCC).

You will receive an additional 31 days of coverage, for no additional
premium, when:

°° Your enrollment ends, unless you cancel your enrollment; or
°° You are a family member no longer eligible for coverage.

You may be eligible for spouse equity coverage or Temporary Continuation
of Coverage.

If you are divorced from a Federal employee or annuitant, you may not
continue to get benefits under your former spouse's enrollment. But, you
may be eligible for your own FEHB coverage under the spouse equity law.
If you are recently divorced or are anticipating a divorce, contact your ex-spouse's
employing or retirement office to get RI 70-5, the Guide to Federal
Employees Health Benefits Plans for Temporary Continuation of Coverage
and Former Spouse Enrollees, or other information about your coverage
choices.

If you leave Federal service, or if you lose coverage because you no longer
qualify as a family member, you may be eligible for Temporary Continuation
of Coverage (TCC). For example, you can receive TCC if you are not able
to continue your FEHB enrollment after you retire.

You may not elect TCC if you are fired from your Federal job due to gross
misconduct.

Get the RI 79-27, which describes TCC, and the RI 70-5, the Guide to
Federal Employees Health Benefits Plans for Temporary Continuation of
Coverage and Former Spouse Enrollees, from your employing or retirement
office or from www. opm. gov/ insure.

Your medical and claims records are confidential
When you retire
When you lose benefits
° When FEHB coverage ends

° Spouse equity coverage

° TCC 47
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2001 CIGNA HealthCare of California, Inc. 47 Sec