The Cigna Group, together with its subsidiaries, provides insurance and related products and services in the United States. The company operates as a global health company.
The company has two growth platforms: Evernorth Health Services and Cigna Healthcare.
Evernorth Health Services, through the company's Pharmacy Benefit Services and Specialty and Care Services operating segments, provides independent and coordinated health solutions and capabilities to enable the health care system to work...
The Cigna Group, together with its subsidiaries, provides insurance and related products and services in the United States. The company operates as a global health company.
The company has two growth platforms: Evernorth Health Services and Cigna Healthcare.
Evernorth Health Services, through the company's Pharmacy Benefit Services and Specialty and Care Services operating segments, provides independent and coordinated health solutions and capabilities to enable the health care system to work better and help people live richer, healthier lives. In addition to serving a wide variety of clients, Evernorth Health Services also enables the company to deepen existing relationships across its entire book of business. Cigna Healthcare is the health benefits segment of The Cigna Group and serves customers and clients for the company's U.S. Healthcare and International Health operating segments.
Together, Evernorth Health Services and Cigna Healthcare provide a strong and diverse foundation that allows the company to capitalize on growth opportunities by leading with its strengths – pharmacy and medical solutions – and then expanding those relationships by addressing additional client needs, as well as innovating and delivering new services and solutions. When considering the company's broad portfolio of businesses, it has strong foundational businesses that it expects to continue to grow. These businesses often serve as the key entry point for clients with either a pharmacy relationship, a medical relationship, or both. The company also has accelerated growth businesses, both scaled and emerging, which build upon its foundational relationships or provide exposure to adjacent high-growth areas.
Evernorth Health Services and Cigna Healthcare work together to enable cross-enterprise leverage by uniquely using the depth and breadth of the company's wide-ranging capabilities across the enterprise to efficiently move from ideation to solution creation to meet clients' evolving needs, while creating more value, expanding the company's reach, and driving growth.
Segments
The company operates through following segments, Evernorth Health Services and Cigna Healthcare.
Evernorth Health Services includes the company's Pharmacy Benefit Services and Specialty and Care Services operating segments, which provide independent and coordinated health solutions and capabilities to enable the health care system to work better and help people live richer, healthier lives.
Cigna Healthcare includes the U.S. Healthcare and International Health operating segments, which provide comprehensive medical plan services and coordinated solutions to clients and customers.
Other Operations comprises the remainder of the company's business operations, which includes certain continuing, run-off, and other non-strategic businesses.
Evernorth Health Services
Evernorth Health Services includes the company's Pharmacy Benefit Services and Specialty and Care Services operating segments, which provide independent and coordinated health solutions and capabilities to enable the health care system to work better and help people live richer, healthier lives. Within Evernorth Health Services, Pharmacy Benefit Services is a foundational growth business, and Specialty and Care Services is an accelerated growth business.
Evernorth Health Services offers a full suite of products and services that both enables the company's customers to combine its products and services to create a comprehensive benefit offering designed to manage prescription drugs and provide independent and coordinated health solutions and capabilities, and addresses the needs of a shared customer base across both operating segments of Evernorth Health Services. The company's ability to deliver this broad array of health care services on both a standalone or combined basis between its two operating segments enables it to drive incremental growth. Additionally, many Evernorth Health Services offerings are available within Cigna Healthcare solutions to drive cross-enterprise leverage.
Principal Products and Services
Pharmacy Benefit Services
Pharmacy Benefits: The company drives pharmacy care through a range of services. It adjudicates drug claims from retail network participants and provides retail pharmacy network administration, benefit design consultation, drug utilization review, drug formulary management, and other services.
Retail Pharmacy Network Administration: The company contracts with retail pharmacies to provide prescription drugs to customers of the pharmacy benefit plans its clients offer. It negotiates with pharmacies throughout the United States to discount drug prices and offer national and regional network options responsive to client preferences related to cost containment, convenience of access for customers, and network performance.
Benefits Design Consultation: The company consults with its clients on how best to structure and leverage the pharmacy benefit to meet plan objectives for affordable and sustainable access to the prescription medications customers need to stay healthy, as well as to ensure the safe and effective use of those medications.
Drug Utilization Review: When pharmacies submit claims for prescription drugs to the company, it reviews them in real time for health and safety.
Drug Formulary Management
Formularies are lists of drugs with designations that may be used to determine drug coverage and customer out-of-pocket costs, as well as to communicate plan preferences in competitive drug categories. The company's formulary management services support clients in establishing formularies that assist customers and physicians in choosing clinically appropriate, cost-effective drugs, and prioritize access, safety, and affordability.
The company administers specific formularies for its clients, including standard formularies developed by Express Scripts by Evernorth (‘Express Scripts’) and custom formularies in which it plays a more limited role. Many of the company's clients select standard formularies, governed by both internal and independent committees that make recommendations for formularies that first consider clinical results separate from price considerations.
One of the ways the company manages its drug formulary is through negotiating to secure additional affordability for the benefit of its clients based on the utilization of certain prescription drugs and supplies, which can be paid to it in the form of a rebate. With respect to its clients' rebate arrangements, most choose to receive the greater of a minimum rebate guarantee or a contractually agreed-upon percentage of rebates. In some rebate arrangements, Express Scripts takes on the risk of securing the rebate value necessary to meet the value guaranteed to its client. The actual amount of value secured by Express Scripts is dependent upon the result of its negotiations for rebates. In 2024, for clients covered under the company's pharmacy benefit contracts, Express Scripts shared over 95% of the drug formulary management rebates it received with its integrated clients, and more than two-thirds of clients received 100% of rebates.
Medical Drug Management: The company offers a comprehensive range of services with guaranteed savings for managing medically billed specialty drugs. Its solutions apply utilization management, site of care management, and claims prepayment review to help ensure patient safety and healthier outcomes, as well as to reduce wasteful spend.
Administration of Group Purchasing Organizations: The company participates in various group purchasing organizations that negotiate pricing for the purchase of pharmaceuticals or formulary rebates with pharmaceutical manufacturers on behalf of their participants.
Value-Based Programs: The company offers a variety of solutions aimed at helping clients reduce costs and enhance clinical outcomes. These programs include SafeGuardRx, Express Scripts Copay AssuranceSM, Express Scripts Patient Assurance, and Evernorth EncircleRxSM.
Evernorth Wholesale Marketplace: Evernorth Wholesale Marketplace offers a suite of flexible, private label pharmacy benefit manager solutions, including but not limited to a pharmacy rebate program, a retail network program, value-based solutions, a medical rebate program, and utilization management policies. These offerings are captured under either the company's drug formulary administrative service arrangements or its formulary processing arrangements.
Home Delivery Pharmacy: The company's Express Scripts Pharmacy by Evernorth (‘Express Scripts Pharmacy’) offers free standard shipping of medications nationwide, usually in a 90-day supply, directly to the customer's home and allows for automatic refills on eligible medications, and unrestricted telephone access to customer care advocates and specially trained pharmacists. The Home Delivery Pharmacy operations consist of 13 licensed pharmacies, including 4 fulfillment pharmacies. The company's fulfillment pharmacies are located in Arizona, Indiana, Missouri, and New Jersey.
Specialty and Care Services
Specialty Pharmacy: Specialty medications are primarily characterized as high-cost medications for the treatment of complex and rare diseases. These medications broadly include those with frequent dosing adjustments, intensive clinical monitoring, the need for customer training, specialized product administration requirements, or medications limited to certain specialty pharmacy networks by manufacturers. The front end of the company's pharmacy, anchored by Accredo by Evernorth (‘Accredo’), is organized into Therapeutic Resource Centers, where pharmacists focus their practice of pharmacy by condition. Accredo provides support for customers through its specially trained clinicians, network of in-home nursing services, nationwide footprint, drug reimbursement services, and highly tailored clinical care programs. The company's Specialty Pharmacy operations consist of 35 licensed pharmacies.
Specialty Distribution: CuraScript SD by Evernorth is a specialty distributor of pharmaceuticals and medical supplies (including injectable and infusible pharmaceuticals and medications to treat specialty and rare or orphan diseases) directly to health care providers, clinics, and hospitals in the United States for office or clinic administration. The company provides distribution services primarily to health care providers who treat customers with chronic diseases. This business operates three distribution centers and ships most products overnight within the United States. It is a contracted supplier with most major group purchasing organizations and leverages its distribution platform to operate as a third-party logistics provider for several pharmaceutical companies.
Care Services: The company offers clinical programs to help its clients, including third-party administrators, drive better whole-person health outcomes through its Care Delivery (MD Live by Evernorth (‘MD Live’) virtual care, in-home care, and physical primary care) and Care Management (EviCore by Evernorth (‘EviCore’), benefits management, behavioral health services, network services, and health coaching capabilities) offerings.
Clients and Customers
The company provides products and services in the Evernorth Health Services segment to clients and customers, as described below.
Clients: The company provides services to managed care organizations, health insurers, third-party administrators, employers, union-sponsored benefit plans, workers' compensation plans, government health programs, providers, clinics, hospitals, and others. It provides services to a majority of clients in its Cigna Healthcare segment.
Customers: Prescription drugs are dispensed to patients connected to the service offerings the company provides to clients. Prescription drugs are dispensed primarily through networks of retail pharmacies under nonexclusive contracts with the company and via home delivery pharmacies, including Express Scripts Pharmacy, and specialty pharmacies, including Accredo.
Evernorth Health Services has three clients that each drive significant revenues for the segment:
Express Scripts and Centene Corporation (‘Centene’) have a multi-year agreement, which began January 1, 2024, to manage pharmacy benefit services for Centene's customers, providing them with access to the extensive Express Scripts national network of retail pharmacies.
Express Scripts and Prime Therapeutics LLC (‘Prime’) have an agreement to deliver improved choice and affordability for Prime's clients and customers by enhancing retail pharmacy networks, providing access to Accredo and Express Scripts Pharmacy, and offering pharmaceutical manufacturer value.
The Department of Defense (‘DoD’) TRICARE is the military health care program available to active-duty service members, active-duty family members, National Guard and Reserve members and their family members, retirees and retiree family members, survivors, and certain former spouses.
Suppliers
The company maintains an inventory of brand-name and generic pharmaceuticals in its home delivery pharmacies, specialty pharmacies, and specialty distributor. Its specialty pharmacies and specialty distributor also carry biopharmaceutical products to meet the needs of its customers, including pharmaceuticals for the treatment of rare or chronic diseases. If a drug is not in the company's inventory, it can generally obtain it from a supplier within a reasonable amount of time.
The company purchases pharmaceuticals either directly from manufacturers or through authorized wholesalers. Evernorth Health Services uses one wholesaler for approximately half of its pharmaceutical purchases but holds contracts with other wholesalers if needs for an alternate source arise. Generic pharmaceuticals are generally purchased directly from manufacturers.
Cigna Healthcare
Cigna Healthcare includes the U.S. Healthcare and International Health operating segments, which provide comprehensive medical plan services and coordinated solutions to clients and customers. Excluding the businesses pending divestiture to Health Care Service Corporation (‘HCSC’), Cigna Healthcare is predominantly comprising foundational growth businesses.
The company offers administrative services only (‘ASO’) and insurance funding solutions to employers, groups, and individuals, along with other health care benefits and solutions to improve the quality of care, lower costs, and help customers achieve better health outcomes. Funding solutions, referring to the entity assuming financial risk, are described in the Premiums and Fees section below.
Principal Products and Services
U.S. Healthcare Medical Plans
Employer Medical Plans include health maintenance organizations (‘HMOs’), LocalPlus, Network, and Open Access Plus offered through the company's insurance companies and third-party administrators (‘TPAs’). These plans use cost-sharing incentives to encourage the use of ‘in-network’ rather than ‘out-of-network’ health care providers. Preferred Provider Organization (‘PPO’) plan offerings feature broader provider access than the other plans, do not require referrals, and typically have a higher cost-share for out-of-network services. Plans are offered nationwide, and the company's funding solutions include ASO (self-funded), insured guaranteed cost (‘GC’), and insured experience rated (‘ER’).
Consumer-Driven Products are paired with employer medical plans and offer customers a tax-advantaged way to pay for eligible health care expenses. Health savings accounts, health reimbursement accounts, and flexible spending accounts encourage customers to play an active role in managing their health and health care costs.
Individual and Family Plans (‘IFPs’) are Patient Protection and Affordable Care Act (‘ACA’) compliant exclusive provider organizations (‘EPOs’) or HMO plans marketed to individuals under age 65 without access to health care coverage through an employer or government program, such as Medicare or Medicaid. Customers receive comprehensive health care benefits and have access to a local network of health care providers who have been selected with cost and quality in mind. Plans are offered in 11 states with a GC funding solution.
Medicare Advantage Plans allow Medicare-eligible customers to receive health care benefits, including prescription drugs, through a managed care health plan. The company's plans include HMO and PPO plans with a GC funding solution marketed to individuals and qualified employer groups in 29 states and the District of Columbia.
Medicare Individual Stand-Alone Prescription Drug (‘Part D’) Plans provide a number of prescription drug plan options, as well as service and information support to Medicare-eligible individuals. The company's stand-alone plans offer the coverage of Medicare combined with the flexibility to select a product that provides enhanced benefits and a formulary that aligns with the individual's needs. Plans are offered nationwide with a GC funding solution.
Medicare Supplement Plans provide Medicare-eligible customers with federally standardized Medigap plans. Customers may select among the various Center for Medicare and Medicaid Services (‘CMS’) standardized plan designs to meet their unique needs and may visit any health care provider or facility that accepts Medicare throughout the United States without the need for a referral. Plans are offered in 48 states and the District of Columbia with a GC funding solution.
U.S. Healthcare Benefits and Solutions
Behavioral Health solutions consist of a broad national network of providers, including one of the largest virtual networks in the United States, specialty case and utilization management, a 24/7-accessible crisis intervention phone line, employee assistance programs, and work/life programs.
Consumer Health Engagement solutions include an array of health management, disease management and wellness programs to improve customers' health and well-being.
The company negotiates discounts with out-of-network providers, reviews provider bills, and recovers overpayments.
Dental solutions include HMO plans, PPO plans, EPO plans, traditional indemnity plans, and a discount program. Employers and other groups may purchase the company's products as standalone products or in conjunction with medical products. IFP standalone dental PPO plans are available in 49 states and sold to individuals under age 65 and retirees without access to dental coverage through an employer or a government program.
Pharmacy Management solutions and benefits may be combined with the company's medical and behavioral health offerings by leveraging the capabilities of Evernorth Health Services.
Stop-Loss insurance coverage is offered to self-funded clients whose group health plans are administered by Cigna Healthcare. Stop-loss insurance provides reimbursement for claims in excess of a predetermined amount for individuals, the entire group, or both.
International Health
Global Health Care offerings include medical, dental, pharmacy, vision, life, accidental death and dismemberment, and disability risks. The company provides products and services that meet the needs of multinational employers, intergovernmental and nongovernmental organizations, and globally mobile individuals, with a focus on keeping employees healthy and productive. Products and services are offered worldwide except as limited by applicable law and include ASO, GC, and ER funding solutions.
Local Health Care offerings include medical, dental, pharmacy, and vision, as well as life coverage. Customers include employers and individuals located in specific geographies (China, Singapore, Hong Kong, Spain, and India, along with various countries in the Middle East) where the products and services are purchased. Offerings include ASO, GC, and ER funding solutions.
Premiums and Fees
ASO: Plan sponsors (i.e., employers, unions, and other groups) create self-funded group health plans to fund all claims and may purchase stop-loss insurance to limit exposure. The company earns fees for providing access to its participating provider networks, claims administration services, and other benefits and solutions. ASO arrangements represent approximately 26% of segment revenues and 74% of Cigna Healthcare medical customers.
Insured
GC and ER. Individual and group insurance premium rates generally must be approved by the applicable state regulatory agency, and state or federal laws may restrict or limit the use of rating methods. Premium rates are established at the beginning of a policy period and may be based in whole or in part on prior experience, including estimates of future claims costs over the fixed contract period. With the exception of ER policies, the company generally cannot adjust premium rates to reflect actual claims experience until the next policy period, and the policyholder does not share in actual claim experience. The company retains any margin if costs are less than the premium charged (subject to minimum medical loss ratio (‘MLR’) rebate requirements) and bears the risk for costs in excess of the premium charged.
Medicare Advantage (held for sale). The company receives fixed monthly payments from CMS for each plan customer based on customer demographic data and actual customer health risk factors, and may earn additional revenue from CMS related to quality performance measures (Star Ratings). Premiums may be charged to customers when the plan premium exceeds the revenue determined by CMS.
The ACA subjects individual and small group policy rate increases above an identified threshold to review by the United States Department of Health and Human Services (‘HHS’), and the company's U.S. Healthcare medical plans are subject to minimum MLR requirements. The MLR represents the percentage of premiums used to pay claims and expenses for activities that improve the quality of care.
Market Segments
Cigna Healthcare medical customers comprise the following market segments:
National Accounts. Employers with 3,000 or more eligible employees.
Middle Market. Employers with 500 to 2,999 eligible employees, solutions for third-party payors, Taft-Hartley plans and other groups.
Select. Employers with 51 to 499 eligible employees.
Small. Employers with 2 to 50 eligible employees.
IFPs: Individual health insurance coverage both on and off the public exchanges and individual dental plans for customers across various distribution channels.
Medicare Advantage (held for sale): Includes individuals who are Medicare-eligible, as well as employer group-sponsored post-65 retirees.
International Health: Includes multinational employers and globally mobile individuals, and employers and individuals in specific countries outside of the United States.
Clients and Customers
The company provides clients and customers with access to a mix of medical and other health care benefits and solutions.
Clients: Employers, TPAs, union-sponsored benefit plans, government health programs and other groups.
Customers: Individuals who access the company’s offerings through an employer-sponsored plan, government-sponsored plan, individual plan or other insured group.
Primary Distribution Channels
Brokers and Consultants: Sales representatives distribute the company's products and solutions to a broad group of brokerage and consulting firms, as well as individuals.
Direct. Cigna Healthcare sales representatives distribute the company's products and solutions directly to employers, unions, and other groups or individuals. Various products may also be sold directly to insurance companies, HMOs, and TPAs.
Private Exchanges: The company partners with select private exchanges that provide employees of participating clients access to health insurance, targeting participation to those models that best align with its mission and value proposition.
Public Exchanges: Cigna Healthcare offers individual ACA-compliant policies through public health insurance exchanges in select geographies.
Provider Networks and Partnerships
Participating Provider Networks: The company provides its customers with a national network of participating health care providers, hospitals, and other facilities, pharmacies, and providers of health care services and supplies. Its U.S. network has approximately 1.8 million physicians, including specialists, and over 6,000 hospitals. The company has strategic alliances with several regional managed care organizations to gain access to their provider networks and discounts.
Network Strength and Stability: The company successfully maintains a broad provider network with high levels of provider retention to ensure its customers have access to high-quality care at affordable, competitive rates.
Provider Partnerships: The company partners with a variety of provider groups in value-based payment arrangements to continuously improve the quality of care for those it serves. With more than 200 arrangements with primary care groups, its flagship program is the Cigna Collaborative Accountable Care program, which rewards providers for improving quality outcomes and medical cost performance. The company has approximately 100 arrangements with specialist groups across six different disciplines. It also has contracts with more than 200 hospital systems, involving more than 800 hospitals, with reimbursements tied to quality metrics.
Site of Care Optimization: The company encourages the use of clinically appropriate settings through its clinical programs and partnership with EviCore. It offers flexibility while supporting the patient/provider relationship by providing access to virtual care services, including MD Live.
Other Operations
Other Operations comprises the remainder of the company's business operations, which includes certain continuing, run-off, and other non-strategic businesses. Other Operations also included the international life, accident, and supplemental benefits businesses, as well as the company's interest in a joint venture in Türkiye prior to the divestiture of these businesses in 2022.
Continuing Business
Corporate-Owned Life Insurance: The principal products of the corporate-owned life insurance (COLI) business are permanent insurance contracts sold to corporations to provide coverage on the lives of certain employees for financing employer-paid future benefit obligations. Permanent life insurance provides coverage that, when adequately funded, does not expire after a term of years.
Run-off Businesses
Settlement Annuity Business: The company's settlement annuity business is a closed, run-off block of single premium annuity contracts. These contracts are primarily liability settlements, with approximately 12% of the liabilities associated with guaranteed payments not contingent on survivorship. Non-guaranteed payments are contingent on the survival of one or more parties involved in the settlement.
Reinsurance: The company's reinsurance operations are an inactive business in run-off. In February 2013, it effectively exited the variable annuity reinsurance business by reinsuring 100% of its future exposures, net of retrocessional arrangements in place at that time, up to a specified limit. For additional information regarding this reinsurance transaction and the arrangements that secure its reinsurance recoverables.
Individual Life Insurance and Annuity and Retirement Benefits Businesses. The individual life insurance and annuity business and the retirement benefits business were sold through reinsurance agreements in 1998 and 2004, respectively.
Investment Management
The company's investment operations provide investment management and related services for its various businesses, including the insurance-related invested assets. The company manages its investment portfolios to reflect the underlying characteristics of related insurance and contractholder liabilities and capital requirements, as well as regulatory and tax considerations pertaining to those liabilities and state investment laws. Insurance and contract holder liabilities range from short-duration health care products to longer-term obligations associated with COLI products and the run-off settlement annuity business.
The Cigna Group Ventures: The Cigna Group Ventures, its strategic corporate venture fund that invests in promising startups and growth-stage companies making groundbreaking progress in three strategic areas: data and technology, digital health, and care delivery. Through these partnerships, the company collaborates, innovates, and develops new solutions to improve the health and vitality of those it serves.
Digital, Data and Technology
The Cigna Group investments in digital, data and technology are focused on cultivating robust digital-first capabilities to better engage with customers and stakeholders.
Innovation: Customer-centric, digital-first, virtual-led vision for health care remains at the forefront of its priorities. The advancement of its internal innovative capabilities and strategic partnerships continues to produce new and more effective ways to engage with its customers to help close gaps in care, optimize treatment, and improve outcomes.
At The Cigna Group, the company uses artificial intelligence (‘AI’) to support health care transformation by helping to enable the next generation of accessible, effective, affordable, and enhanced health care solutions. AI models can facilitate personalized solutions for individuals, inform earlier interventions, and simplify health care experiences.
The company has also established comprehensive governance processes for new capabilities, such as generative AI (‘Gen AI’). Its AI Center of Enablement (‘AI COE’) expands on EMG and brings together individuals from across its technology, privacy, data governance, security, legal, compliance, marketing, and other teams to evaluate and approve Gen AI use cases.
Data and Analytics: The company conducts timely, rigorous, and objective research and analysis that informs evidence-based medical and pharmacy benefit management decisions and evaluates the clinical, economic, and individual impact of enhanced benefit designs and programs, ultimately resulting in rich, integrated data that helps to provide differentiated outcomes. The combination of its predictive analytics, machine learning (‘ML’), and deep learning capabilities creates actionable intelligence that informs the decision-making of its health care professionals, improves operational efficiency, and enables greater innovation. The company's data-driven approach to behavioral health provides personalized and customized care across the entire continuum for the populations it serves.
Digital: The company's digital health focus has shown value across the enterprise by imagining the future of health care and creating engaging experiences that give customers the right information at the right time. It delivers resource-efficient products and features at scale and on time with a commitment to security, resiliency, and compliance. At its core, digital is a connected ecosystem that serves customers, clients, and providers and it paves the way for direct-to-consumer relationships and new growth opportunities. The company's digital strategy focuses on the drive from analog to digital, which complements the growth strategy of The Cigna Group, creates efficiency, and amplifies the value of existing offerings, as well as creates option value with industry-leading personalization and precision to drive better health and business outcomes. Cybersecurity protections continue to be a top priority across The Cigna Group's digital offerings to further strengthen its security posture and grow the trust of those it serves.
Technology Operations: The company's technology team supports the various information systems essential to its operations, including the health benefit claims processing systems and specialty and home delivery pharmacy systems. Uninterrupted point-of-sale electronic retail pharmacy claims processing is a significant operational requirement for its business. Its pharmacy technology platform allows it to safely, rapidly, and accurately adjudicate over two billion adjusted prescriptions annually. The technology helps retail pharmacies focus on patient care, and its real-time safety checks help avoid medication errors. The Cigna Group companies hold over 480 U.S. patents. The company uses these patents to protect its proprietary technological advances and to differentiate itself in the market.
Regulation
Many aspects of the company's business are directly regulated by federal and state laws and administrative agencies, such as HHS, CMS, the Internal Revenue Service ('IRS'), the U.S. Departments of Labor ('DOL') and Treasury, the Office of Personnel Management ('OPM'), the Federal Trade Commission ('FTC'), the SEC, the Office of the National Coordinator for Health Information Technology ('ONC'), state departments of insurance and state boards of pharmacy. The company's business practices may also be shaped by enforcement actions of federal agencies, such as the Department of Justice (‘DOJ’), state agencies, as well as judicial decisions.
The company's business operations and the books and records of its regulated businesses are routinely subject to regulatory examination and audit at regular intervals by state insurance and HMO regulatory agencies, state boards of pharmacy, CMS, DOL, and OPM to assess compliance with applicable laws and regulations. Its operations are also subject to nonroutine examinations, audits, and investigations by various state and federal regulatory agencies, generally as the result of a complaint. In addition, the company may be implicated in investigations of its clients whose group benefit plans it administers on their behalf. As a result, it routinely receives subpoenas and other demands or requests for information from various state insurance and HMO regulatory agencies, state attorneys general, the HHS Office of Inspector General (‘HHS-OIG’), the DOJ, the FTC, the DOL, and other state, federal, and international authorities.
The company’s business model is impacted by the Patient Protection and Affordable Care Act and may be impacted by additional, future changes to the ACA, including its relationships with current and future producers and health care providers, products, service providers and technologies.
Through its subsidiaries, the company offers individual and group Medicare Advantage, Medicare Prescription Drug, and Medicare Supplement products. It also provides Medicare Part D-related products and services to other Medicare Part D sponsors, Medicare Advantage Prescription Drug Plans, and employers and clients offering Medicare Part D benefits to Medicare Part D eligible beneficiaries, including those dually eligible for Medicare and Medicaid benefits (‘dual-eligible’). As part of its Medicare Advantage and Medicare Part D business, the company contracts with CMS to provide services to Medicare beneficiaries. It offers dual-eligible products and participates in state Medicaid programs directly or indirectly through its clients that are Medicaid managed care contractors. The company also performs certain Medicaid subrogation services and certain delegated services for clients, including utilization management, which are regulated by federal and state laws.
The company’s products and services are subject to health care fraud, waste and abuse laws, including the federal False Claims Act (‘False Claims Act’), state false claims acts, federal and state anti-kickback laws, and the federal Civil Monetary Penalties Law.
The company has a contract with the U.S. DoD that subjects it to applicable Federal Acquisition Regulations (‘FAR’) and the DoD FAR Supplement, which govern federal government contracts. Further, there are other federal and state laws applicable to its DoD arrangement and its arrangements with other clients that may be subject to government procurement regulations. In addition, certain of its clients participate as contracting carriers in the Federal Employees Health Benefits Program administered by the OPM, which includes various pharmacy benefit management standards.
The company’s domestic subsidiaries sell most of their products and services to sponsors of employee benefit plans that are governed by the Employee Retirement Income Security Act (ERISA).
The company is also subject to various other consumer protection laws that regulate its communications with customers, such as the FTC Act and the Telephone Consumer Protection Act. Certain of its businesses are also subject to the Payment Card Industry Data Security Standard (‘PCI DSS’), which is designed to protect credit card account data as mandated by payment card industry entities.
On the federal level, the company is subject to a number of sector-specific regulations related to the creation, collection, dissemination, receipt, maintenance, protection, use, transmission, disclosure, privacy, confidentiality, security, availability, integrity, processing, and disposal of protected health information (PHI) and other personally identifiable information (PII). The federal Health Insurance Portability and Accountability Act of 1996, as amended, and the regulations that implement such laws (collectively, HIPAA) impose requirements on covered entities and business associates (and the company is both) that address the privacy and security of PHI, regulate permissible uses and disclosures of PHI, and impose breach notification requirements.
The company is also subject to regulation by the Office of Foreign Assets Control of the U.S. Department of the Treasury, which administers and enforces economic and trade sanctions against targeted foreign jurisdictions and regimes based on U.S. foreign policy and national security goals. Certain of its products are subject to the Department of the Treasury anti-money laundering regulations under the Bank Secrecy Act. In addition, the company is subject to similar regulations in non-U.S. jurisdictions in which it operates.
The company engages in direct-to-consumer activities and is therefore subject to federal and state regulations applicable to electronic communications and other consumer protection laws and regulations, such as the Telephone Consumer Protection Act and the CAN-SPAM Act.
The company's operations in countries outside of the United States are subject to local regulations of the jurisdictions where it operates; in some cases, they are subject to regulations in the jurisdictions where customers reside; and in all cases, they are subject to the Foreign Corrupt Practices Act (FCPA).
Countries in which the company do business also have anti-corruption laws to which the company is subject, such as the UK Bribery Act of 2010.
In addition to the health care fraud and abuse laws and the privacy and security laws described above, the company's home delivery and specialty pharmacy operations are also subject to extensive federal and state laws and regulations that govern the labeling, packaging, repackaging, compounding, storing, holding, disposal, distribution, advertising, misbranding, adulteration, transfer, handling, and security of prescription drugs and the dispensing of prescription, over-the-counter, hazardous, and controlled substances, as well as laws enforced by the U.S. Drug Enforcement Administration, the FDA, state-controlled substance authorities, the FTC, and the United States Postal Service.
The company's products and its participation in government-sponsored health care programs are regulated by CMS, state Medicaid agencies, HHS-OIG, DOJ, and other federal and state agencies. It is also subject to risks associated with audits of its performance and audits to determine compliance with contracts and regulations.
History
The company was founded in 1792. The company was incorporated in 1981. The company was formerly known as Cigna Corporation and changed its name to The Cigna Group in February 2023.
