01/01/2026 ASO Open Access Plus - OAP Traditional Plan Proclaim - 37302332 - V 33 - 10/20/25 05:18 PM ET 13 of 18 ©Cigna 2025 Additional Information Medicare Coordination In accordance with the Social Security Act of 1965, this plan will pay Secondary 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 Spouse and/or Dependent Child(ren), including a former Employee’s Domestic Partner, or a COBRA continuant (whose insurance is continued for any reason), and who is also eligible for Medicare due to age or disability; (b) an Employee's Domestic Partner who is also eligible for Medicare due to age; (c) an Employee, a former Employee, an Employee’s or former Employee’s Dependent Spouse and/or Dependent Child(ren), an Employee's Dependent, including a Domestic Partner, 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. Multiple Surgical Reduction Multiple surgeries performed during one operating session result in payment reduction of 50% to the surgery of lesser charge. The most expensive procedure is paid as any other surgery. One Guide Available 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. Premium Personal Health Team The Premium Personal Health Team is a designated and integrated service delivery approach using a one health advocate model. Core functions include:  Case Management - Short term and complex  Inpatient Advocacy  Pre Admission Outreach  Post Discharge Outreach  24 hour Health Information Line Outreach Care Facility - N/A Pre-Certification - Continued Stay Review - Preferred Care Management Inpatient - required for all inpatient admissions In-Network: Coordinated by your physician Out-of-Network: Customer is responsible for contacting Cigna Healthcare. Subject to penalty/reduction or denial for non-compliance.  $750 penalty applied to hospital inpatient charges for failure to contact Cigna Healthcare to precertify admission.  Benefits are denied for any admission reviewed by Cigna Healthcare and not certified.  Benefits are denied for any additional days not certified by Cigna Healthcare. Pre-Certification - Preferred Care Management Outpatient Prior Authorization - required for selected outpatient procedures and diagnostic testing In-Network: Coordinated by your physician Out-of-Network: Customer is responsible for contacting Cigna Healthcare. Subject to penalty/reduction or denial for non-compliance.  $750 penalty applied to outpatient procedures/diagnostic testing charges for failure to contact Cigna Healthcare and to precertify admission.  Benefits are denied for any outpatient procedures/diagnostic testing reviewed by Cigna Healthcare and not certified. Pre-Existing Condition Limitation (PCL) does not apply.