CIGNA HealthCare's (CHC) current policy language excludes medical services incurred outside the United States and its designated territories, unless the charges are for expenses incurred outside the United States or Canada while traveling on business or pleasure. This language is intended to exclude from coverage claims incurred by individuals residing abroad or claims for individuals who travel abroad specifically to seek medical treatment (medical tourism). The intent is to cover only urgent and emergent services while temporarily traveling out of the country.
Emergency - The definition of an emergency is a situation in which a "prudent layperson" would believe such emergency care is required. Patients should get emergency care when they need it, at the sudden and unexpected onset of a serious injury or life-threatening illness.
Urgent Care - Urgent care covers non-emergency conditions or illnesses that require medical treatment for which patients should be treated by a physician (fever, ear infections, strep, etc.).
Note - Preventive services and elective care/surgeries outside the country are NOT covered under the Plan.
In summary, coverage exists for emergency/urgent care services only (and only if the services are coded as such – and are written in English). In general, the CIGNA-covered individual pays at the time of service and must submit the claim to CIGNA upon his/her return to the U.S.