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01/01/2023 ASOOpen Access Plus HDHPQ - OAP SilverFacets - 16832465 - V 25 - 10/19/22 09:51 AM ET1 of 11©Cigna 2022BENEFIT SUMMARYAdministered by - Cigna Health and Life Insurance Co.For - Max Management, LLCOAP HDHPQ PlanOAP SilverEffective - 01/01/2023Selection of a Primary Care Provider - your plan may require or allow the designation of a primary care provider. You have the right to designate any primary care provider who participates in the network and who is available to accept you or your family members. If your plan requires designation of a primary care provider, Cigna may designate one for you until you make this designation. For information on how to select a primary care provider, and for a list of the participating primary care providers, visit www.mycigna.com or contact customer service at the phone number listed on the back of your ID card. For children, you may designate a pediatrician as the primary care provider.Direct Access to Obstetricians and Gynecologists - You do not need prior authorization from the plan or from any other person (including a primary care provider) in order to obtain access to obstetrical or gynecological care from a health care professional in our network who specializes in obstetrics or gynecology. The health care professional, however, may be required to comply with certain procedures, including obtaining prior authorization for certain services, following a pre-approved treatment plan, or procedures for making referrals. For a list of participating health care professionals who specialize in obstetrics or gynecology, visit www.mycigna.com or contact customer service at the phone number listed on the back of your ID card.Plan HighlightsIn-NetworkOut-of-NetworkLifetime MaximumUnlimitedUnlimitedPlan Year AccumulationYour Plan’s Deductibles, Out-of-Pockets and benefit level limits accumulate on a calendar year basis unless otherwise stated. In addition, all plan maximums and service-specific maximums (dollar and occurrence) cross-accumulate between In- and Out-of-Network unless otherwise noted.Plan CoinsurancePlan pays 90%Plan pays 70%Maximum Reimbursable ChargeNot Applicable110%Plan DeductibleIndividual - Employee Only: $2,800Individual - within a Family: $3,000Family Maximum: $5,600Individual - Employee Only: $5,400Individual - within a Family: $5,400Family Maximum: $10,800 Only the amount you pay for in-network covered expenses counts towards your in-network deductible. Only the amount you pay for out-of-network covered expenses counts towards your out-of-network deductible. Plan deductible always applies before any benefit copay/deductible or coinsurance. Plan deductible does not apply to in-network preventive services. Family members meet only their individual deductible and then their claims will be covered under the plan coinsurance; if the family deductible has been met prior to their individual deductible being met, their claims will be paid at the plan coinsurance. This plan includes a combined Medical/Pharmacy plan deductible.Note: Services where plan deductible applies are noted with a caret (^).

01/01/2023 ASOOpen Access Plus HDHPQ - OAP SilverFacets - 16832465 - V 25 - 10/19/22 09:51 AM ET2 of 11©Cigna 2022Plan HighlightsIn-NetworkOut-of-NetworkPlan Out-of-Pocket MaximumIndividual - Employee Only: $5,000Individual - within a Family: $5,000Family Maximum: $10,000Individual - Employee Only: $10,000Individual - within a Family: $10,000Family Maximum: $20,000 Only the amount you pay for in-network covered expenses counts toward your in-network out-of-pocket maximum. Only the amount you pay for out-of-network covered expenses counts toward your out-of-network out-of-pocket maximum. Plan deductible contributes towards your out-of-pocket maximum. All benefit copays/deductibles contribute towards your out-of-pocket maximum. Covered expenses that count towards your out-of-pocket maximum include customer paid coinsurance and charges for Mental Health and Substance Use Disorder. Out-of-network non-compliance penalties or charges in excess of Maximum Reimbursable Charge do not contribute towards the out-of-pocket maximum. After each eligible family member meets his or her individual out-of-pocket maximum, the plan will pay 100% of their covered expenses. Or, after the family out-of-pocket maximum has been met, the plan will pay 100% of each eligible family member's covered expenses. This plan includes a combined Medical/Pharmacy out-of-pocket maximum.BenefitIn-NetworkOut-of-NetworkNote: Services where plan deductible applies are noted with a caret (^). Plan deductible always applies before benefit copays/deductibles.Physician Services - Office VisitsPrimary Care Physician (PCP) Services/Office VisitPlan pays 90% ^Plan pays 70% ^Specialty Care Physician Services/Office VisitPlan pays 90% ^Plan pays 70% ^Surgery Performed in Physician's OfficeCovered same as Physician Services - Office VisitCovered same as Physician Services - Office VisitVirtual CareDedicated Virtual Providers - MDLIVEMDLIVE Urgent Virtual Care ServicesPlan pays 90% ^Not Covered Dedicated Virtual Providers may deliver services that are payable under other benefits (e.g., Preventive Care, Primary Care Physician, Behavioral; Dermatology/Specialty Care Physician). Lab services supporting a virtual visit must be obtained through dedicated labs. Includes charges for the delivery of medical and health-related services and consultations by dedicated virtual providers as medically appropriate through audio, video, and secure internet-based technologies.Virtual Physician Services - Office VisitsPrimary Care Physician (PCP) Services/Office VisitPlan pays 90% ^Plan pays 70% ^Specialty Care Physician Services/Office VisitPlan pays 90% ^Plan pays 70% ^ Physicians may deliver services virtually that are payable under other benefits (e.g., Preventive Care, Outpatient Therapy Services). Includes charges for the delivery of medical and health-related services and consultations as medically appropriate through audio, video, and secure internet-based technologies that are similar to office visit services provided in a face-to-face setting.Convenience Care ClinicConvenience Care ClinicPlan pays 90% ^Plan pays 70% ^

01/01/2023 ASOOpen Access Plus HDHPQ - OAP SilverFacets - 16832465 - V 25 - 10/19/22 09:51 AM ET3 of 11©Cigna 2022BenefitIn-NetworkOut-of-NetworkNote: Services where plan deductible applies are noted with a caret (^). Plan deductible always applies before benefit copays/deductibles.Preventive CarePreventive Care Office VisitPlan pays 100%Plan pays 70% ^Preventive ServicesPlan pays 100%Lab & X-ray: Plan pays 100%; All other services: Plan pays 70% ^ Includes preventive Mammograms, Papanicolaou (Pap), Prostate Specific Antigen (PSA) tests and colorectal screenings. Diagnostic-related services are covered at the same level of benefits as other x-ray and lab services, based on place of service.ImmunizationsPlan pays 100%Plan pays 70% ^InpatientInpatient Hospital Facility ServicesPlan pays 90% ^Plan pays 70% ^Note: Includes all Lab and Radiology services, including Advanced Radiological Imaging as well as Medical Specialty DrugsInpatient Hospital Physician's Visit/ConsultationPlan pays 90% ^Plan pays 70% ^Inpatient Professional ServicesPlan pays 90% ^Plan pays 70% ^ For services performed by Surgeons, Radiologists, Pathologists and AnesthesiologistsOutpatientOutpatient Facility ServicesPlan pays 90% ^Plan pays 70% ^Outpatient Professional ServicesPlan pays 90% ^Plan pays 70% ^ For services performed by Surgeons, Radiologists, Pathologists and AnesthesiologistsEmergency ServicesEmergency Room Includes ER Physician Charges, Lab and Radiology including Advanced Radiological Imaging (ARI)Plan pays 90% ^Urgent Care Facility Includes Physician Charges, Lab and RadiologyPlan pays 90% ^Plan pays 70% ^AmbulancePlan pays 90% ^Ambulance services used as non-emergency transportation (e.g., transportation from hospital back home) generally are not covered.Inpatient Services at Other Health Care FacilitiesSkilled Nursing Facility, Rehabilitation Hospital, Sub-Acute Facilities Annual Limit: 60 daysPlan pays 90% ^Plan pays 70% ^Laboratory ServicesPhysician’s Services/Office VisitCovered same as Physician Services - Office VisitCovered same as Physician Services - Office VisitIndependent LabPlan pays 90% ^Plan pays 70% ^Outpatient FacilityPlan pays 90% ^Plan pays 70% ^

01/01/2023 ASOOpen Access Plus HDHPQ - OAP SilverFacets - 16832465 - V 25 - 10/19/22 09:51 AM ET4 of 11©Cigna 2022BenefitIn-NetworkOut-of-NetworkNote: Services where plan deductible applies are noted with a caret (^). Plan deductible always applies before benefit copays/deductibles.Radiology ServicesPhysician’s Services/Office VisitCovered same as Physician Services - Office VisitCovered same as Physician Services - Office VisitOutpatient FacilityPlan pays 90% ^Plan pays 70% ^Advanced Radiological Imaging (ARI)Includes MRI, MRA, CAT Scan, PET Scan, etc.Outpatient FacilityPlan pays 90% ^Plan pays 70% ^Physician’s Services/Office VisitPlan pays 90% ^Plan pays 70% ^Outpatient Therapy ServicesOutpatient Physical TherapyPlan pays 90% ^Plan pays 70% ^Annual Limits: Physical Therapy – 30 visits Limits are not applicable to mental health conditions.Note: Therapy visits, provided as part of an approved Home Health Care plan, accumulate to the applicable Home Health Care maximum.Outpatient Speech Therapy, Hearing Therapy and Occupational TherapyPlan pays 90% ^Plan pays 70% ^Annual Limits: Speech, Hearing and Occupational Therapies – 30 visits Limits are not applicable to mental health conditions for Speech and Occupational Therapies.Note: Therapy visits, provided as part of an approved Home Health Care plan, accumulate to the applicable Home Health Care maximum.Chiropractic CarePlan pays 90% ^Plan pays 70% ^Annual Limit: Chiropractic Care – 25 visitsHospiceInpatient FacilitiesPlan pays 90% ^Plan pays 70% ^Outpatient ServicesPlan pays 90% ^Plan pays 70% ^Note: Includes Bereavement counseling provided as part of a hospice program.Medical Pharmaceutical DrugsCigna Pathwell Specialty℠ Medical PharmaceuticalsCigna Pathwell Specialty℠ Network:Plan pays 90% ^All other medical network providers:Not CoveredNot Covered

01/01/2023 ASOOpen Access Plus HDHPQ - OAP SilverFacets - 16832465 - V 25 - 10/19/22 09:51 AM ET5 of 11©Cigna 2022BenefitIn-NetworkOut-of-NetworkNote: Services where plan deductible applies are noted with a caret (^). Plan deductible always applies before benefit copays/deductibles.Other Medical PharmaceuticalsPlan pays 90% ^Not CoveredNote: This benefit only applies to the cost of Medical Pharmaceutical drugs administered. Related Facility, Office Visit or Professional charges are covered according to the plan design.Family PlanningWomen’s ServicesPlan pays 100%Coverage varies based on Place of ServiceIncludes contraceptive devices as ordered or prescribed by a physician and surgical sterilization services, such as tubal ligation (excludes reversals)Men’s ServicesCoverage varies based on Place of ServiceCoverage varies based on Place of ServiceIncludes surgical sterilization services, such as vasectomy (excludes reversals)AbortionAbortion ServicesCoverage varies based on Place of ServiceCoverage varies based on Place of ServiceNote: Elective and non-elective proceduresInfertilityInfertility TreatmentNote: Coverage will be provided for the treatment of an underlying medical condition up to the point an infertility condition is diagnosed. Services will be covered as any other illness.Outpatient Dialysis ServicesPhysician’s Services/Office VisitCovered same as Physician Services - Office VisitNot CoveredHome DialysisNote: Dialysis visits will not accumulate to Home Health Care maximumCovered same as plan's Home Health Care benefitNot CoveredOutpatient Facility ServicesCovered same as plan's Outpatient Facility Services benefitNot CoveredOutpatient Professional ServicesCovered same as plan’s Outpatient Professional Services benefitNot CoveredOther Health Care Facilities/ServicesHome Health CarePlan pays 90% ^Plan pays 70% ^ Annual Limit: 60 visits (The limit is not applicable to mental health and substance use disorder conditions.)Organ TransplantsCovered same as Inpatient benefitCovered same as Inpatient benefit Services paid at in-network level if performed at Cigna LifeSOURCE Transplant Network® Facilities. Travel Maximum - Cigna LifeSOURCE Transplant Network® Facility Only: After the plan deductible is met, $10,000 maximum per TransplantDurable Medical Equipment and External Prosthetic Appliances Annual Limit: UnlimitedPlan pays 90% ^Plan pays 70% ^

01/01/2023 ASOOpen Access Plus HDHPQ - OAP SilverFacets - 16832465 - V 25 - 10/19/22 09:51 AM ET6 of 11©Cigna 2022BenefitIn-NetworkOut-of-NetworkNote: Services where plan deductible applies are noted with a caret (^). Plan deductible always applies before benefit copays/deductibles.Breast Feeding Equipment and Supplies Limited to the rental of one breast pump per birth as ordered or prescribed by a physician Includes related suppliesPlan pays 100%Plan pays 70% ^Temporomandibular Joint Disorder (TMJ) Annual Limit: Unlimited for Surgical and Non-Surgical treatmentCoverage varies based on Place of ServiceCoverage varies based on Place of ServiceNote: Provided on a limited, case-by-case basis. Excludes appliances and orthodontic treatment.Note: Services where plan deductible applies are noted with a caret (^).Mental Health and Substance Use DisorderInpatient Mental HealthPlan pays 90% ^Plan pays 70% ^Outpatient Mental Health – Physician’s OfficePlan pays 90% ^Plan pays 70% ^Outpatient Mental Health – All Other ServicesPlan pays 90% ^Plan pays 70% ^Inpatient Substance Use DisorderPlan pays 90% ^Plan pays 70% ^Outpatient Substance Use Disorder – Physician’s OfficePlan pays 90% ^Plan pays 70% ^Outpatient Substance Use Disorder – All Other ServicesPlan pays 90% ^Plan pays 70% ^Annual Limits: Unlimited maximumNotes: Inpatient includes Acute Inpatient and Residential Treatment. Outpatient - Physician's Office - may include Individual, family and group therapy, psychotherapy, medication management, etc. Outpatient - All Other Services - may include Partial Hospitalization, Intensive Outpatient Services, Applied Behavior Analysis (ABA Therapy), etc.PharmacyIn-NetworkOut-of-NetworkCost Share and Supply

01/01/2023 ASOOpen Access Plus HDHPQ - OAP SilverFacets - 16832465 - V 25 - 10/19/22 09:51 AM ET7 of 11©Cigna 2022PharmacyIn-NetworkOut-of-NetworkMed Pharmacy Cost Share Retail – up to 90-day supply(except Specialty up to 30-day supply) Home Delivery – up to 90-day supply(except Specialty up to 30-day supply) If you receive a supply of 34 days or less at home delivery of a Specialty Prescription Drug, the Specialty home delivery cost share will be adjusted to reflect a Retail (per 30-day supply) cost share.Once the medical deductible is met then the customer is responsible for the cost shareRetail (per 30-day supply):Generic: You pay $10 ^Preferred Brand: You pay $30 ^Non-Preferred Brand: You pay $50 ^Retail and Home Delivery (per 90-day supply):Generic: You pay $30 ^Preferred Brand: You pay $90 ^Non-Preferred Brand: You pay $150 ^Once the medical deductible is met then the customer is responsible for the coinsuranceRetail:You pay 50% ^Your plan pays 50% ^Home Delivery:Not Covered Retail drugs for a 30 day supply may be obtained In-Network at a wide range of pharmacies across the nation although prescriptions for a 90 day supply (such as maintenance drugs) will be available at select network pharmacies. Cigna 90 Now Program: You can choose to fill your medications in a 30- or 90-day supply. If you choose to fill a 30-day prescription, it can be filled at any network retail pharmacy or network home delivery pharmacy. If you choose to fill a 90-day prescription, it must be filled at a 90-day network retail pharmacy or network home delivery pharmacy to be covered by the plan. Specialty medications are used to treat an underlying disease which is considered to be rare and chronic including, but not limited to, multiple sclerosis, hepatitis C or rheumatoid arthritis. Specialty Drugs may include high cost medications as well as medications that may require special handling and close supervision when being administered. You can elect brand or generic with no penalty (MAC C). Exclusive specialty home delivery: Specialty medications must be filled through home delivery; otherwise you pay the entire cost of the prescription upon your first fill. Some exceptions may apply. Your pharmacy benefits share an annual deductible and out-of-pocket maximum with the medical/behavioral benefits. The applicable cost share for covered drugs applies after the combined deductible has been met.Drugs CoveredPrescription Drug List:Your Cigna Performance Prescription Drug List includes a full range of drugs including all those required under applicable health care laws. To check which drugs are included in your plan, please log on to myCigna.com.Some highlights: Coverage includes Self Administered injectable drugs, but excludes infertility drugs. Contraceptive devices and drugs are covered with federally required products covered at 100%. Insulin, glucose test strips, lancets, insulin needles & syringes, insulin pens and cartridges are covered. Prescription smoking cessation drugs are covered.

01/01/2023 ASOOpen Access Plus HDHPQ - OAP SilverFacets - 16832465 - V 25 - 10/19/22 09:51 AM ET8 of 11©Cigna 2022Pharmacy Program InformationPharmacy Clinical Management: EssentialYour plan features drug management programs and edits to ensure safe prescribing, and access to medications proven to be the most reliable and cost effective for the medical condition, including: Prior authorization requirements Step Therapy on select classes of medications and drugs new to the market Quantity limits, including maximum daily dose edits, quantity over time edits, duration of therapy edits, and dose optimization edits Age edits, and refill-too-soon edits Plan exclusion edits Current users of Step Therapy medications will be allowed one 30-day fill during the first three months of coverage before Step Therapy program applies. Your plan includes Specialty Drug Management features, such as prior authorization and quantity limits, to ensure the safe prescribing and access to specialty medications. For customers with complex conditions taking a specialty medication, we will offer Accredo Therapeutic Resource Centers (TRCs) to provide specialty medication and condition counseling. For customers taking a specialty medication not dispensed by Accredo, Cigna experts will offer this important specialty medication and condition counseling.Patient Assurance ProgramYour plan includes the Patient Assurance Program, which waives the deductible and reduces the amount you owe for certain medications used to treat chronic conditions included in the program. Additionally: Any amount you pay for these medications count toward meeting both your deductible and out-of-pocket maximum. Any discount provided by a pharmaceutical manufacturer for these medications count toward meeting both your deductible and out-of-pocket maximum.Additional InformationCigna Diabetes Prevention Program in collaboration with OmadaCigna Diabetes Prevention Program in collaboration with Omada is a program to help you avoid the onset of diabetes, as well as health risks that might lead to heart disease or a stroke. The program is covered by your health plan at the preventive level, just like for your wellness visit. Program participants have access to a professional virtual health coach, an online support group, interactive lessons, and a smart-technology scale. The program will help you make small changes in your eating, activity, sleep, and stress to achieve healthy weight loss through a series of 16 weekly lessons and tools to help you maintain weight loss over time. You will also be offered the opportunity to join a gym for a low monthly fee and no enrollment fee.

01/01/2023 ASOOpen Access Plus HDHPQ - OAP SilverFacets - 16832465 - V 25 - 10/19/22 09:51 AM ET9 of 11©Cigna 2022Additional InformationMaximum Reimbursable ChargeThe allowable covered expense for non-network services is based on the lesser of the health care professional's normal charge for a similar service or a percentage of a fee schedule (110%) developed by Cigna that is based on a methodology similar to one used by Medicare to determine the allowable fee for the same or similar service in a geographic area. In some cases, the Medicare based fee schedule will not be used and the maximum reimbursable charge for covered services is based on the lesser of the health care professional's normal charge for a similar service or a percentile (80th) of charges made by health care professionals of such service or supply in the geographic area where it is received. If sufficient charge data is unavailable in the database for that geographic area to determine the Maximum Reimbursable Charge, then data in the database for similar services may be used. Out-of-network services are subject to a Calendar Year deductible and maximum reimbursable charge limitations.Out-of-Network Emergency Services Charges1. Emergency Services are covered at the In-Network cost-sharing level as required by applicable state or federal law if services are received from a non-participating (Out-of-Network) provider.2. The allowable amount used to determine the Plan's benefit payment for covered Emergency Services rendered in an Out-of-Network Hospital, or by an Out-of-Network provider in an In-Network Hospital, is the amount agreed to by the Out-of-Network provider and Cigna, or as required by applicable state or federal law.The member is responsible for applicable In-Network cost-sharing amounts (any deductible, copay or coinsurance). The member is not responsible for any charges that may be made in excess of the allowable amount. If the Out-of-Network provider bills you for an amount higher than the amount you owe as indicated on the Explanation of Benefits (EOB), contact Cigna Customer Service at the phone number on your ID card.Medicare CoordinationIn accordance with the Social Security Act of 1965, this plan will pay as the Secondary plan to Medicare Part A and B as follows:(a) a former Employee such as a retiree, a former Disabled Employee, a former Employee's Dependent, or an Employee's Domestic Partner who is also eligible for Medicare and whose insurance is continued for any reason as provided in this plan (including COBRA continuation);(b) an Employee, a former Employee, an Employee’s Dependent, or former Employee’s Dependent, who is eligible for Medicare due to End Stage Renal Disease after that person has been eligible for Medicare for 30 months.When a person is eligible for Medicare A and B as described above, this plan will pay as the Secondary Plan to Medicare Part A and B regardless if the person is actually enrolled in Medicare Part A and/or Part B and regardless if the person seeks care at a Medicare Provider or not for Medicare covered services.One GuideAvailable by phone or through myCigna mobile application. One Guide helps you navigate the health care system and make the most of your health benefits and programs.Out-of-Area Services Coverage for services rendered outside a network area ER and Ambulance paid the same as network services Preventive care services covered at 100% for Out-of-Area In-Network Deductible and Out-of-Pocket maximums applyFor all other services, plan pays 80%after the in-network deductible is metComplete Care ManagementPre-authorization is required on all inpatient admissions and selected outpatient procedures, diagnostic testing, and outpatient surgery. Network providers are contractually obligated to perform pre-authorization on behalf of their customers. For an out-of-network provider, the customer is responsible for following the pre-authorization procedures. If a customer does not follow requirements for obtaining pre-treatment authorization, a $250 penalty will be applied.

01/01/2023 ASOOpen Access Plus HDHPQ - OAP SilverFacets - 16832465 - V 25 - 10/19/22 09:51 AM ET10 of 11©Cigna 2022Additional InformationPre-Existing Condition Limitation (PCL) does not apply.DefinitionsCoinsurance - After you've reached your deductible, you and your plan share some of your medical costs. The portion of covered expenses you are responsible for is called Coinsurance.Copay - A flat fee you pay for certain covered services such as doctor's visits or prescriptions.Deductible - A flat dollar amount you must pay out of your own pocket before your plan begins to pay for covered services.Out-of-Pocket Maximum - Specific limits for the total amount you will pay out of your own pocket before your plan coinsurance percentage no longer applies. Once you meet these maximums, your plan then pays 100 percent of the "Maximum Reimbursable Charges" or negotiated fees for covered services.Place of Service - Your plan pays based on where you receive services. For example, for hospital stays, your coverage is paid at the inpatient level.Prescription Drug List - The list of prescription brand and generic drugs covered by your pharmacy plan.Professional Services - Services performed by Surgeons, Assistant Surgeons, Hospital Based Physicians, Radiologists, Pathologists and AnesthesiologistsTransition of Care - Provides in-network health coverage to new customers when the customer's doctor is not part of the Cigna network and there are approved clinical reasons why the customer should continue to see the same doctor.ExclusionsWhat's Not Covered (This Is Not All Inclusive; check your plan documents for a complete list) Services that aren't medically necessary Experimental or investigational treatments, except for routine patient care costs related to qualified clinical trials as described in your plan document Accidental injury that occurs while working for pay or profit Sickness for which benefits are paid or payable under any workers' compensation or similar law Services provided by government health plans Cosmetic surgery, unless it corrects deformities resulting from illness, breast reconstruction surgery after a mastectomy, or congenital defects of a newborn or adopted child or child placed for adoption Dental treatments and implants Custodial care Surgical procedures for the improvement of vision that can be corrected through the use of glasses or contact lenses Vision therapy or orthoptic treatment Hearing aids Reversal of sterilization procedures Nonprescription drugs or anti-obesity drugs Non-emergency services incurred outside the United States Bariatric surgery - except when medical necessity guidelines are met Infertility servicesThese are only the highlightsThis summary outlines the highlights of your plan. For a complete list of both covered and not covered services, including benefits required by your state, see your employer's insurance certificate, service agreement or summary plan description -- the official plan documents. If there are any differences between this summary and the plan documents, the information in the plan documents takes precedence.

01/01/2023 ASOOpen Access Plus HDHPQ - OAP SilverFacets - 16832465 - V 25 - 10/19/22 09:51 AM ET11 of 11©Cigna 2022All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company, Connecticut General Life Insurance Company, Evernorth Care Solutions, Inc., Evernorth Behavioral Health, Inc., Cigna Health Management, Inc., and HMO or service company subsidiaries of Cigna Health Corporation. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc.EHB State: VA

Cigna complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Cigna does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. Cigna: • Provides free aids and services to people with disabilities to communicate effectively with us, such as: – Qualified sign language interpreters – Written information in other formats (large print, audio, accessible electronic formats, other formats) • Provides free language services to people whose primary language is not English, such as: – Qualified interpreters – Information written in other languages If you need these services, contact customer service at the toll-free number shown on your ID card, and ask a Customer Service Associate for assistance. If you believe that Cigna has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance by sending an email to ACAGrievance@Cigna.com or by writing to the following address: Cigna Nondiscrimination Complaint Coordinator PO Box 188016 Chattanooga, TN 37422 If you need assistance filing a written grievance, please call the number on the back of your ID card or send an email to ACAGrievance@Cigna.com. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at: U.S. Department of Health and Human Services 200 Independence Avenue, SW Room 509F, HHH Building Washington, DC 20201 1.800.368.1019, 800.537.7697 (TDD) Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html. All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company, Connecticut General Life Insurance Company, Evernorth Care Solutions, Inc., Evernorth Behavioral Health, Inc., Cigna Health Management, Inc., and HMO or service company subsidiaries of Cigna Health Corporation and Cigna Dental Health, Inc. The Cigna name, logos, and other Cigna marks are owned by Cigna Intellectual Property, Inc. ATTENTION: If you speak languages other than English, language assistance services, free of charge are available to you. For current Cigna customers, call the number on the back of your ID card. Otherwise, call 1.800.244.6224 (TTY: Dial 711). ATENCIÓN: Si usted habla un idioma que no sea inglés, tiene a su disposición servicios gratuitos de asistencia lingüística. Si es un cliente actual de Cigna, llame al número que figura en el reverso de su tarjeta de identificación. Si no lo es, llame al 1.800.244.6224 (los usuarios de TTY deben llamar al 711). 896375b 05/21 © 2021 Cigna.Medical coverage DISCRIMINATION IS AGAINST THE LAW