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Microsoft word - bw hras-hraf basic plan 2013 oap hra core plan employee v1 10-01-12.doc

EMPLOYEE SUMMARY OF BENEFITS
Connecticut General Life Insurance Co.

This is a summary of benefits for your CIGNA Choice Fund/Open Access Plus with HRA
plan. All deductibles and plan out-of-pocket maximums cross –accumulate between in-
and out-of--network unless otherwise noted. Plan maximums and service-specific
maximums (dollar and occurrence) cross-accumulate between in- and out-of-network
unless otherwise noted. CIGNA Pharmacy plan deductibles, out-of-pocket maximums,
copays and annual maximums do not integrate with the employee medical program.
Health Reimbursement Account (HRA) Basic Plan
Your plan includes a health reimbursement account that you can use to pay
for eligible out-of-pocket expenses.
Employer Contribution (Pro-rated monthly for new
In-Network Member Gap (Difference between In- Out-of-Network Member Gap (Difference between Employee Contribution Toward the Basic HRA Plan Premium Equivalent
Employee Contribution: Net of all available
CIGNA HealthCare Benefit Summary
BorgWarner Inc.
HRA with Open Access Plus Coins-HRAS/HRAF
Basic Plan
Effective 1/1/2013
Account # 3207248
BENEFIT HIGHLIGHTS
IN-NETWORK
OUT-OF-NETWORK
PPACA Status
Lifetime Maximum
Coordination of Benefits Administration
Coinsurance Levels
BENEFIT HIGHLIGHTS
IN-NETWORK
OUT-OF-NETWORK
Maximum Reimbursable Charge
determined based on the lesser of the provider's normal charge for a similar service or supply; or
A percentage of a fee schedule developed by CIGNA that is based upon a methodology similar to a methodology
utilized by Medicare to determine the allowable fee for the
same or similar service within the geographic market.
Note: In some cases, a Medicare based fee schedule will
not be used and the Maximum Reimbursable charge for
covered services is determined based on the lesser of:
the provider’s normal charge for a similar service or supply; or the charges made by 20% of the providers of such service or supply in the geographic area where it is received as compiled in a database selected by CIGNA.
Note: The provider may bill the member the difference
between the provider’s normal charge and the Maximum
Reimbursable Charge as determined by the benefit plan, in
addition to applicable deductibles, copayments and
coinsurance.
Deductible Accumulators
Contract Year Deductible
Collective Deductible: The individual deductible applies if Individual: $1,500
only the Employee is enrolled. The family deductible applies if two or more individuals are enrolled. All family members contribute towards the family deductible. A single family member or combination of family members can meet the full family deductible amount. If only the Employee is enrolled, claims are payable less any coinsurance amount after the individual deductible has been met. If two or more individuals are enrolled, claims are payable less any coinsurance amount once the family deductible has been met. This plan does not include a combined Medical/Rx deductible. Out-of-Pocket Maximum Accumulators
Out-of-Pocket Maximum
BENEFIT HIGHLIGHTS
IN-NETWORK
OUT-OF-NETWORK
Collective OOP: The individual out-of-pocket maximum
applies if only the Employee is enrolled. The family out-of- pocket maximum applies if two or more individuals are enrolled. All family members contribute to towards the family OOP. A single family member or combination of family members can meet the full family out-of-pocket The out-of-pocket maximums are The out-of-pocket maximums are offset by the Employer’s HRA If only the Employee is enrolled, claims are payable at 100% once the individual out-of-pocket maximum has been met. If two or more individuals are enrolled, claims are payable at 100% once the family out-of-pocket maximum has been met. This plan does not include a combined Medical/Rx out-of-pocket maximum. Automated Annual Reinstatement
Physician's Services

Primary Care Physician's Office visit Specialty Care Physician's Office Visit Consultant and Referral Physician's Services Note: OB-GYN providers will be considered either as
a PCP or Specialist, depending on how the provider
contracts with CIGNA (i.e. as a PCP or as a
Specialist).
Surgery Performed In the Physician's Office Second Opinion Consultations (services will be Allergy Testing/ Treatment/Injections Allergy Serum (dispensed by the physician in the Preventive Care
Routine Preventive Care (Well-Baby, Well-Child and Preventive Care Maximum: $Unlimited Including, but not limited to: Physician’s office visit, immunizations, routine screenings, mammogram, pap smear and PSA. Inpatient Hospital - Facility Services

Semi Private Room and Board

BENEFIT HIGHLIGHTS
IN-NETWORK
OUT-OF-NETWORK
Outpatient Facility Services
Operating Room, Recovery Room, Procedures Room, Treatment Room and Observation Room Inpatient Hospital Physician’s Visits/Consultations
Inpatient Hospital Professional Services
Surgeon, Radiologist, Pathologist, Anesthesiologist Multiple Surgical Reduction
Multiple surgeries performed during one operating session result in payment reduction of 50% of charges to the surgery of lesser charge. The most expensive procedure is paid as any other surgery. Outpatient Professional Services
Surgeon, Radiologist, Pathologist, Anesthesiologist Emergency and Urgent Care Services
after plan deductible if only x-ray and/or lab services (radiology, pathology and ER physician) Urgent Care Facility or Outpatient Facility Inpatient Services at Other Health Care Facilities
Includes Skilled Nursing Facility, Rehabilitation Hospital and Sub-Acute Facilities 60 days combined maximum per contract year Laboratory and Radiology Services
(includes pre-admission testing)
Emergency Room/Urgent Care Facility (billed by the facility as part of the ER/UC visit) Independent X-ray and/or Lab Facility Independent X-ray and/or Lab Facility in conjunction 20% after plan deductible Advanced Radiological Imaging
(i.e. MRI’s, MRAs CAT Scans, PET Scans, etc.)
BENEFIT HIGHLIGHTS
IN-NETWORK
OUT-OF-NETWORK
Emergency Room/Urgent Care Facility (billed by the facility as part of the ER visit)  Scans are subject to the applicable place of service Outpatient Short-Term Rehabilitative Therapy and
Cardiac Rehabilitation
Maximum per contract year : Unlimited days Note: Therapy days, provided as
part of an approved Home
provided by each Participating provider. Autism Spectrum Disorder
Includes: Screening tests to confirm ASD diagnosis Psychotherapy Physical Therapy Speech Therapy Occupational Therapy 60 days maximum per contract year for physical, speech and occupational therapies combined Chiropractic Care Services (includes Chiropractors)
12 days per contract year maximum Home Health Care
120 days maximum per contract year (includes outpatient private duty nursing when approved as medically necessary) Note: The maximum number of hours per day is
limited to 16 hours. Multiple visits can occur in one
day; with a visit defined as a period of 2 hours or less
(e.g. maximum of 8 visits per day).
Hospice
BENEFIT HIGHLIGHTS
IN-NETWORK
OUT-OF-NETWORK
Bereavement Counseling
Services provided as part of Hospice Care Services provided by Mental Health Professional Maternity Care Services
Initial Visit to Confirm Pregnancy Note: OB-GYN providers will be considered either as after plan deductible if only x-
a PCP or Specialist, depending on how the provider
contracts with CIGNA (i.e. as a PCP or as a All Subsequent Prenatal Visits, Postnatal Visits, and Physician’s Delivery Charges (i.e. global maternity fee) Office Visits in addition to the global maternity fee when performed by an OB or Specialist. after plan deductible if only x-ray and/or lab services performed and billed. Delivery – Facility (Inpatient Hospital, Birthing Abortion
Includes non-elective procedures-only Family Planning – Men’s Services
Includes surgical services such as vasectomy (excludes BENEFIT HIGHLIGHTS
IN-NETWORK
OUT-OF-NETWORK
20% after plan deductible; 20% 40% after plan deductibleafter plan deductible if only x- ray and/or lab services performed and billed. Family Planning – Women’s Services
Includes surgical services such as tubal ligation Contraceptive devices as ordered or prescribed by a Infertility Treatment (Option 1)
Coverage will be provided for the following services: Testing and treatment services performed in connection with an underlying medical condition. Testing performed specifically to determine the Treatment and/or procedures performed specifically to restore fertility (e.g. procedures to correct an infertility condition). Services not covered include: In-vitro, Artificial Insemination, GIFT, ZIFT, etc. Office Visit (Lab and Radiology Test, Counseling) after plan deductible if only x-ray and/or lab services performed and billed Organ Transplant
Includes all medically appropriate, non-experimental transplants Organ Transplant Lifetime Maximum Lifesource center , otherwise 20% after plan deductible BENEFIT HIGHLIGHTS
IN-NETWORK
OUT-OF-NETWORK
Lifesource center; otherwise 20% after plan deductible Travel Services Maximum- only available for Durable Medical Equipment
Breast Feeding Equipment and Supplies
 Limited to the rental of one breast pump per birth as External Prosthetic Appliances
Podiatry
Non-routine Foot Disorders (when medically necessary) May include bursitis, heel spur, sprain/strain of the foot, bunion, hammer toe, plantar fasciitis, neuroma, ingrown toenail, infections , warts Routine Foot Disorders
Dental Care
Limited to charges made for a continuous course of dental treatment started within six months of an injury to sound, natural teeth. after plan deductible if only x-ray and/or lab services performed and billed TMJ - Surgical
Provided on a limited, case by case basis. Always exclude appliances and orthodontic treatment. Subject to medical necessity. BENEFIT HIGHLIGHTS
IN-NETWORK
OUT-OF-NETWORK
after plan deductible if only x-ray and/or lab services performed and billed Oral Surgery for removal of impacted teeth
Obesity/Bariatric Surgery Rider
Note: Coverage is provided subject to medical necessity
and clinical guidelines.

The following are specifically excluded with this buy-up:

Medical and surgical services to alter appearances or physical changes that are the result of any surgery performed for the management of obesity or clinically severe (morbid) obesity. Weight loss programs or treatments, whether prescribed or recommended by a physician or under medical supervision. Lifetime Maximum – Surgeon Professional services- after plan deductible if only x-ray and/or lab services performed and billed Prescription Safety Glasses – Coverage limited to
prescription single, bi-focal and tri-focal safety glass lens, a $100 maximum frames, and side guards. (Codes S0504, S0506, S0508 and S0516) Maximum: Replacement once every 2 years (unless there is damage or a change in the lens prescription). Note: All other vision-related coverage is carved out to
CIGNA VISIONCARE

BENEFIT HIGHLIGHTS
IN-NETWORK
OUT-OF-NETWORK
Prescription Drugs
3-Tier; Up to a 30 day supply or 100 doses Mandatory Generic, Incentive Prescription Drug List, Includes: Oral Contraceptives and Contraceptive Prior Authorization for Emphysema, Acne, Hypertension Non-Preferred Brand; $8 then and Weight Management medications Step Therapy for ACEI/ARBs* (Hypertension class), PPI, and Statins* (Cholesterol class). * Includes NOTE:1/09 For Cardiac Global Step Therapy – Grandfathering existing users, some of whom may be from ESI. Pharmacy Deductible
Pharmacy Out of Pocket Maximum
Pharmacy Annual Maximum
Tel-Drug Mail Order Drug Program
Mandatory Generic, Incentive Prescription Drug List Includes: Oral Contraceptives and Contraceptive Prior Authorization for Emphysema, Acne, Hypertension maximum copay per 90-day and Weight Management medications Step Therapy for ACEI/ARBs (Hypertension class), PPI, Cardiac and Statins (Cholesterol class) NOTE:1/09 For Cardiac Global Step Therapy – Grandfathering existing users, some of whom may be Specialty Pharmacy

Prior authorization required on specialty medications and quantity
limits may apply.
TheraCare® Program
Specialty RX – Self Administered Injectables
Up to a 30-day supply per fill through Tel-drug coinsurance up to a $50 maximum copay per 30-day Initial fill at retail pharmacy, then must use mail order supply
Non-Preferred Brand: 50% coinsurance up to a $100 maximum copay per 30- day supply BENEFIT HIGHLIGHTS
IN-NETWORK
OUT-OF-NETWORK
Dispensing methodology:
Whether the member or the doctor requests brand when a (Dispense AsWrittenAs Written Does Not Apply) paying the brand copay plus the difference between the cost of the brand and the generic amount. The following are included in the pharmacy plan:  Insulin syringes and needles, diabetic test strips and  Pre-natal vitamins and certain prescription vitamins, such as, Folic Acid Preparations (i.e., Folic Acid), Vitamin D Preparations (i.e., Calderol, D.H.T., Hytakerol, Rocaltrol, Vitamin D), and Vitamin K Preparations (i.e., Mephyton),  Certain self-injectable drugs subject to quantity limitations: Ana-Kit, Arixtra, D.H.E. 45, Epipen, Epipen Jr., Fragmin, Glucagon, Heparin, Imitrex, Innohep and Lovenox.  Certain self-injectable drugs not subject to quantity limitations: Insulin and Cyanocobalamin. necessary (covered to maintain pregnancy only) Includes Chantix, Zyban, Wellbutrin & NRTs Diabetic Supplies ie: all syringes (including non-insulin syringes), needles, insulin injectable devices, swabs, blood monitors (eg: glucometers) and kits, urine test BENEFIT HIGHLIGHTS
IN-NETWORK
OUT-OF-NETWORK
Prescription Vitamins
 The prescription vitamins option includes non- injectable drug products only in the following drug classes.  Common examples of each of these drug classes are provided below, given the number of drugs included in drug classes: Iron Replacements (i.e., Anemagen FA, Chromagen FA, Niferex 150/Forte, Hemocyte/Plus, Vitafol) Multivitamin Preparations (i.e., Berocca Plus, Therobec Plus) Pediatric Fluoride Drops (i.e., Fluoritab, Luride, Sodium Fluoride) Pediatric Vitamin Preparations (i.e., PolyViFlor, PolyViFlor with iron, TriViFlor, Vi-Daylin [/F, /F ADC and /F with Iron]) Vitamin A Preparations (i.e., Aquasol A) Vitamin B Preparations (i.e., Folgard, Nephrovite) Lifestyle Drugs
Coverage for lifestyle drugs under the pharmacy plan is currently limited to sexual dysfunction drugs (Caverject and Edex). All drugs covered under this benefit will require prior authorization to determine medical necessity and will have quantity limitations. Additional Comments
chamber, spacers, and nebulizers and spacers Mental Health and Substance Abuse
Mental Health
Mental Health Outpatient Includes Individual, Group and Intensive Outpatient Physician’s Office and Outpatient Facility Substance Abuse (Alcohol & Drug)
Substance Abuse Outpatient Includes Individual and Intensive Outpatient Physician’s Office and Outpatient Facility BENEFIT HIGHLIGHTS
IN-NETWORK
OUT-OF-NETWORK
MH/SA Service Specific Administration
Partial Hospitalization, Residential Treatment and Intensive Outpatient Programs: The following administration will apply: Partial Hospitalization and Residential Treatment: Covered
as inpatient Mental Health and/or Substance Abuse
Intensive Outpatient Program (IOP): Covered as outpatient
Mental Health and/or Substance Abuse. Coverage only if
approved through CHS (CIGNA Health Solutions) Case
Management.
MH/SA Utilization Review & Case Management
CHS provides utilization review and case management for In-network and Out-of-network Inpatient Management Services. Pre-existing Condition Limitation (PCL)
Pre-Admission Certification - Continued Stay Review
Personal Health Solutions+

*CIGNA's PAC/CSR is not necessary for Medicare
Primary individuals (applicable in cases such as end-state
renal disease)

Inpatient Pre-Admission Certification - Continued Stay
Mandatory: Employee is
Review (required for all inpatient admissions) Healthcare. Penalties for non-compliance: inpatient charges for failure to contact CIGNA HealthCare to precertify admission. . admission reviewed by CIGNA Healthcare and not certified. additional days not certified by CIGNA Healthcare. Outpatient Prior Authorization (required for selected
Mandatory: Employee is
outpatient procedures and diagnostic testing) Healthcare. Penalties for non-compliance: procedures/diagnostic testing charges for failure to contact Cigna Healthcare and to precertify admission. outpatient procedures/diagnostic testing admission reviewed by CIGNA Healthcare and not certified. Case Management
Coordinated by CIGNA HealthCare. This is a service designated to provide assistance to a patient who is at risk of developing medical complexities or for whom a health incident has precipitated a need for rehabilitation or additional health care support. The program strives to attain a balance between quality and cost-effective care while maximizing the patient’s quality of life. BENEFIT HIGHLIGHTS
IN-NETWORK
OUT-OF-NETWORK
IPHT-A (Integrated Personal Health Team)
 The CIGNA Integrated Personal Health Team provides total health management with easy access to one team of health professionals/advocates including individuals trained as nurses, coaches, dieticians, clinicians, counselors, and more – who will listen, understand a person’s needs and help find solutions.  Individuals can partner with a health advocate one-on- one to understand health assessment results; achieve better work/life balance; find local counselors, doctors or other health professionals; get support for mental Program Name: Cigna Personal Health Team health, substance abuse and crises; know what to expect if time in the hospital is required; get unbiased advise on options in order to make an informed decision with their health professional; and understand the importance of preventive screenings. Telephone coaching, online self-service tools, and print materials support this fully integrated approach to improving and maintaining health. Lifestyle Management
Tobacco Cessation/Quit Today
Healthy Steps to Weight Loss
Strength and Resilience

Choice Fund Incentive Points
Medical Benefit Exclusions (by way of example but not limited to):

Your plan provides coverage for medically necessary services. Your plan does not provide coverage for the following except as
required by law:
Care for health conditions that are required by state or local law to be treated in a public facility. Care required by state or federal law to be supplied by a public school system or school district. Care for military service disabilities treatable through governmental services if you are legally entitled to such treatment and facilities are reasonably available. Treatment of an illness or injury which is due to war, declared or undeclared. Charges for which you are not obligated to pay or for which you are not billed or would not have been billed except that you were covered under this Agreement. Assistance in the activities of daily living, including but not limited to eating, bathing, dressing or other Custodial Services or self-care activities, homemaker services and services primarily for rest, domiciliary or convalescent care. Any services and supplies for or in connection with experimental, investigational or unproven services. 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 Healthplan Medical Director to be: Not demonstrated, through existing peer-reviewed, evidence-based scientific literature to be safe and effective for treating or diagnosing the condition or illness for which its use is proposed; or Not approved by the U.S. Food and Drug Administration (FDA) or other appropriate regulatory agency to be lawfully marketed for the proposed use; or The subject of review or approval by an Institutional Review Board for the proposed use. Cosmetic Surgery and Therapies. Cosmetic surgery or therapy is defined as surgery or therapy performed to improve or alter appearance or self-esteem or to treat psychological symptomatology or psychosocial complaints related to one’s appearance. The following services are excluded from coverage regardless of clinical indications: Macromastia or Gynecomastia Surgeries; Abdominoplasty; Panniculectomy; Rhinoplasty; Blepharoplasty; Redundant skin surgery; Removal of skin tags; Acupressure; Craniosacral/cranial therapy; Dance therapy, movement therapy; Applied kinesiology; Rolfing; Prolotherapy; and Extracorporeal shock wave lithotripsy (ESWL) for musculoskeletal and orthopedic conditions. 10. Non-surgical treatment of TMJ disorder. 11. Dental treatment of the teeth, gums or structures directly supporting the teeth, including dental x-rays, examinations, repairs, orthodontics, periodontics, surgery of impacted teeth, casts, splints and services for dental malocclusion, for any condition. However, charges made for services or supplies provided for or in connection with an accidental injury to sound natural teeth are covered provided a continuous course of dental treatment is started within 6 months of the accident. Sound natural teeth are defined as natural teeth that are free of active clinical decay, have at least 20% bony support and are functional in the arch. 12. Medical and surgical services intended primarily for the treatment or control of obesity. However, treatment of clinically severe obesity, as defined by the body mass index (BMI) classifications of the National Heart, Lung, and Blood Institute (NHLBI) guideline is covered only at approved centers if the services are demonstrated, through existing peer-reviewed, evidence-based, scientific literature and scientifically based guidelines, to be safe and effective for treatment of the condition. Clinically severe obesity is defined by the NHLBI as a BMI of 40 or greater without comorbidities, or 35-39 with comorbidities. The following are specifically excluded: medical and surgical services to alter appearances or physical changes that are the result of any surgery performed for the management of obesity or clinically severe (morbid) obesity; and weight loss programs or treatments, whether prescribed or recommended by a Physician or under medical supervision. 13. Unless otherwise covered as a basic benefit, reports, evaluations, physical examinations, or hospitalization not required for health reasons, including but not limited to employment, insurance or government licenses, and court ordered, forensic, or custodial evaluations. 14. Court ordered treatment or hospitalization, unless such treatment is being sought by a Participating Physician or 15. Injectable infertility drugs, surgical or medical treatment programs for infertility, including in vitro fertilization, Artificial Insemination, gamete intrafallopian transfer (GIFT), zygote intrafallopian transfer (ZIFT), variations of these procedures, and any costs associated with the collection, washing, preparation or storage of sperm for artificial insemination (including donor fees). Cryopreservation of donor sperm and eggs are also excluded from coverage. 16. Reversal of male and female voluntary sterilization procedures. 17. Transsexual surgery, including medical or psychological counseling and hormonal therapy in preparation for, or 18. Any services or supplies, for the treatment of male or female sexual dysfunction such as, but not limited to, treatment of erectile dysfunction (including penile implants), anorgasmia, and premature ejaculation. 19. Medical and hospital care and costs for the infant child of a Dependent, unless this infant child is otherwise eligible 20. Non-medical counseling or ancillary services, including, but not limited to Custodial Services, education, training, vocational rehabilitation, behavioral training, biofeedback, neurofeedback, sleep therapy, employment counseling, back school, return-to-work services, work hardening programs, driving safety, and services, training, educational therapy or other non-medical ancillary services for learning disabilities, developmental delays, autism or mental retardation. 21. Therapy or treatment intended primarily to improve or maintain general physical condition or for the purpose of enhancing job, school, athletic or recreational performance, including, but not limited to routine, long-term or maintenance care which is provided after the resolution of the acute medical problem and when significant therapeutic improvement is not expected. 22. Consumable medical supplies other than ostomy supplies and urinary catheters. Excluded supplies include, but are not limited to bandages and other disposable medical supplies, skin preparations and test strips, except as otherwise covered. 23. Private hospital rooms and/or private duty nursing except as otherwise covered. 24. Personal or comfort items such as personal care kits provided on admission to a hospital, television, telephone, newborn infant photographs, complimentary meals, birth announcements, and other articles which are not for the specific treatment of illness or injury. 25. Artificial aids, including but not limited to corrective orthopedic shoes, arch supports, elastic stockings, garter belts, 26. Hearing aids, including, but not limited to semi-implantable hearing devices, audiant bone conductors and Bone Anchored Hearing Aids (BAHAs). A hearing aid is any device that amplifies sound. 27. Aids or devices that assist with non-verbal communications, including, but not limited to communication boards, pre- recorded speech devices, laptop computers, desktop computers, Personal Digital Assistants (PDAs), Braille typewriters, visual alert systems for the deaf and memory books. 28. Eyeglass lenses and frames and contact lenses (except for the first pair of contact lenses for treatment of keratoconus or 29. Routine refraction, eye exercises and surgical treatment for the correction of a refractive error, including radial 30. Treatment by acupuncture except when it is a part of tobacco cessation treatment. 31. Hypnosis except when it is a part of tobacco cessation treatment. 32. All non-injectable prescription drugs, injectable prescription drugs that do not require physician supervision and are typically considered self-administered drugs, non-prescription drugs, and investigational and experimental drugs, except as otherwise covered. 33. Routine foot care, including the paring and removing of corns and calluses or trimming of nails. However, services associated with foot care for diabetes and peripheral vascular disease are covered when Medically Necessary. 34. Membership costs or fees associated with health clubs, weight loss programs. 35. Genetic screening or pre-implantation genetic screening. General population-based genetic screening is a testing method performed in the absence of any symptoms or any significant, proven risk factors for genetically-linked inheritable disease. 37. Fees associated with the collection or donation of blood or blood products, except for autologous donation in anticipation of scheduled services where in the Healthplan Medical Director’s opinion the likelihood of excess blood loss is such that transfusion is an expected adjunct to surgery. 38. Blood administration for the purpose of general improvement in physical condition. 39. Cost of biologicals that are immunizations or medications for the purpose of travel, or to protect against occupational 40. Cosmetics, dietary supplements and health and beauty aids. 41. All nutritional supplements and formulae are excluded, except for infant formula needed for the treatment of inborn 42. Services for or in connection with an injury or illness arising out of, or in the course of, any employment for wage or 43. Telephone, e-mail & Internet consultations and telemedicine. This Benefit Summary highlights some of the benefits available under your plan. A complete description regarding the terms of coverage, exclusions and limitations, including legislated benefits, will be provided in your Group Service Agreement or Certificate. Benefits are insured and/or administered by Connecticut General Life Insurance Company. “CIGNA HealthCare” refers to various operating subsidiaries of CIGNA Corporation. Products and services are provided by these subsidiaries and not by CIGNA Corporation. These subsidiaries include Connecticut General Life Insurance Company, CIGNA Vision Care, Inc., Tel-Drug, Inc. and its affiliates, CIGNA Behavioral Health, Inc., Intracorp, and HMO or service company subsidiaries of CIGNA Health Corporation and CIGNA Dental Health, Inc. "CIGNA Tel-Drug" refers to Tel-Drug, Inc. and Tel-Drug of Pennsylvania, L.L.C., which are also operating subsidiaries of CIGNA Corporation.

Source: http://www.borgwarner.com/Benefits/SiteAssets/Pages/Medical/Basic%20Plan%20-%20Benefit%20Summary.pdf

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