Example 1:

Alan has been with Cigna for many years. He develops chest pains and is referred by his GP to a specialist. Medical investigations diagnose cardiovascular disease. Alan is placed on medication to control his symptoms.

Cigna’s response: Cigna will fund investigations leading to diagnosis of Alan’s condition. Treatment for the stabilisation of angina is covered along with surgical intervention for cardiovascular disease, angiography and bypass grafting. We won’t cover monitoring of cardiovascular disease once the condition is stable.

Two years later, Alan’s chest pain recurs more severely and his specialist recommends that he has a heart by-pass operation.

Cigna’s response: Surgical intervention including bypass grafting will be covered to Cigna limits, plus two post-op follow-up appointments. No further monitoring of this chronic condition would be covered, but Cigna would cover a further acute flare up.

Example 2:

Bob has been with Cigna for three years when he develops hip pain. His GP refers him to an osteopath who treats him every other day for two weeks and then recommends that he return once a month for additional treatment to prevent his symptoms from occurring again.

Cigna’s response: Cigna will fund a short course of osteopathic treatment to overcome the acute phase, and return Bob to his previous state of health. We won’t cover maintenance therapy to prevent a recurrence of Bob’s original chronic symptoms.

Example 3:

Deirdre has been with Cigna for two years when she develops symptoms that indicate she may have diabetes. Her GP refers her to an endocrinology specialist who organises a series of investigations to confirm the diagnosis. She then starts taking oral medication to control the diabetes. After several months of regular consultations and some adjustments made to her medication regime, the specialist confirms that Deirdre’s conditions is now well controlled and explains he would like to see her every four months to review the condition.

Cigna’s response: Cigna will fund the investigations leading to full diagnosis and the initial stabilisation of this condition. We won’t fund the ongoing review of this condition once it has been stabilised.

One year later, Deidre’s diabetes becomes unstable and her GP arranges for her to go into hospital for treatment.

Cigna’s response: Cigna would cover admission to hospital to achieve stabilisation of the diabetes. Once this is achieved no further monitoring of this chronic condition will be covered, however a further acute flare up would be covered.

Example 4:

Eve has been with Cigna for five years when she develops breathing difficulties. Her GP refers her to a specialist who arranges a number of tests. These reveal that Eve has asthma. Her specialist puts her on medication and recommends a follow-up consultation in three months, to see if Eve’s condition has improved. At that consultation Eve tells the specialist that her breathing has been much better, and it’s then suggested that she have check-ups every four months.

Cigna’s response: Cigna will fund the investigations leading to full diagnosis and the initial stabilisation of Eve’s condition. We won’t fund the ongoing review of this condition once it has been stabilised.

Eighteen months later, Eve has a bad asthma attack.

Cigna’s response: Cigna would cover investigations and treatment needed to stabilise Eve’s condition. Once stabilised, no further monitoring of this chronic condition would be covered, however, a further acute flare up would be covered.