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The purpose of this communication is the solicitation
of insurance. Contact will be made by an insurance
agent or insurance company.

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Applicant 1

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MI

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Date of Birth *

Age

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Do you agree to receive marketing content electronically and authorize electronic correspondence for policy delivery? *

Yes

You have the option for a written communication to be provided or made available in paper or another nonelectronic form, if you so choose. You also have the right to withdraw your consent to electronic delivery of materials related to your policy. In order to withdraw consent, you must send a written request to the PO Box address at the top of the application.

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Apt/Suite/Other

City *

State *

Zip Code *

Is your mailing address the same as your residential address? *

Yes

No

Mailing Address (If different from above)

Apt/Suite/Other

City *

State *

Zip Code *

Total Premium
$0.00/month

Apply online
or call:

1-877-895-4619
Apply online
or contact
your agent
Monday - Friday

Questions? Call us!

Questions?

1-877-895-4619

1-877-895-4619
Contact your
agent
Monday - Friday

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*Insured by Cigna Insurance Company.

VIEW STATE DISCLOSURES, EXCLUSIONS & LIMITATIONS

VIEW STATE DISCLOSURES, EXCLUSIONS & LIMITATIONS

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INDDENGN1120 941251 11/20 ©2020 Cigna This application is not proof of coverage.

Notice for persons eligible for Medicare because of disability:

In the following states, all Medicare Supplement plans are available to persons eligible for Medicare because of disability: California, Colorado, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Kansas, Kentucky, Louisiana, Maine, Minnesota, Mississippi, Missouri, Montana, New Hampshire, Oregon, Pennsylvania, South Dakota, Tennessee, Vermont and Wisconsin.

In the following states, all Medicare Supplement plans are available to persons eligible for Medicare because of disability: California, Delaware, Idaho, Maine, Minnesota, Missouri, Montana, New Hampshire and Vermont.

In the following states, all Medicare Supplement plans are available to persons eligible for Medicare because of disability:

In the following states, all Medicare Supplement plans are available to persons eligible for Medicare because of disability: Hawaii.

In the following states, all Medicare Supplement plans are available to persons eligible for Medicare because of disability: Florida, Georgia, Illinois, Kansas, Kentucky, Louisiana, Mississippi, South Dakota, Tennessee and Wisconsin.

In the following states, all Medicare Supplement insurance plans are available to persons eligible for Medicare because of disability: Colorado and Pennsylvania.

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Ⓒ 2024 Cigna. All rights reserved.

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Website not approved for use in: Oregon

AN OUTLINE OF COVERAGE IS AVAILABLE UPON REQUEST AT ANY TIME.

We'll provide an outline of coverage to all persons at the time the application is presented.

Our company and agents/producers are not connected with or endorsed by the U.S. Government or the federal Medicare program. This is a solicitation for insurance. An insurance agent/producer may contact you. Premium and benefits vary by plan selected. Plan availability varies by state. These policies contain exclusions, limitations and terms under which the policies may be continued in force or discontinued. For costs and complete details of coverage, contact the company.

The following Medicare Supplement Plans are available to persons eligible for Medicare due to disability: Plan A in Arkansas, Connecticut, Indiana, Maryland, Oklahoma, Rhode Island, Texas & Virginia; Plans A, F and G in North Carolina; and Plans C and D in New Jersey for individuals aged 50-64.

All Cigna Healthcare products and services are provided exclusively by or through operating subsidiaries of The Cigna Group. Medicare Supplement policies are underwritten by American Retirement Life Insurance Company, Cigna Health and Life Insurance Company (Bloomfield, CT), Cigna Insurance Company, Cigna National Health Insurance Company and Loyal American Life Insurance Company. In Kansas, insured by Cigna National Health Insurance Company, Cigna Health and Life Insurance Company and Loyal American Life Insurance Company. American Retirement Life Insurance Company is not available to residents of Kansas and Kentucky. In Maryland, North Carolina, Ohio and Utah, insured by Cigna National Health Insurance Company domiciled in Ohio. In Idaho and New Mexico, insured by Cigna Health and Life Insurance Company. In Pennsylvania, insured by Cigna Insurance Company. Each insurer has sole responsibility for its own products. The Cigna Healthcare name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc.

American Retirement Life Insurance Company, Cigna Insurance Company, Cigna National Health Insurance Company and Loyal American Life Insurance Company do not issue policies in New Mexico.

Idaho Medicare Supplement Policy Forms: Plan A: CHLIC-MS-CR-A.v2-ID; Plan F: CHLIC-MS-CR-F.v2-ID; Plan High Deductible F (HDF): CHLIC-MS-CR-HDF.v2-ID; Plan G: CHLIC-MS-CR-G.v2-ID and Plan N: CHLIC-MS-CR-N.v2-ID

Tennessee Medicare Supplement Policy Forms: Plan A: CNHIC-MS-AA-A-TN; Plan F: CNHIC-MS-AA-F-TN; Plan G: CNHIC-MS-AA-G-TN; Plan N: CNHIC-MS-AA-N-TN.

Kansas Disclosures, Exclusions and Limitations

Medicare Supplement Policy Forms: Plan A: CNHIC-MS-AA-A-KS, CNHIC-MS-AO-A-KS; Plan F: CNHIC-MS-AA-F-KS, CNHIC-MS-AO-F-KS; Plan G: CNHIC-MS-AA-G-KS, CNHIC-MS-AO-G-KS; Plan N: CNHIC-MS-AA-N-KS, CNHIC-MS-AO-N-KS

Exclusions and Limitations:

The benefits of this policy will not duplicate any benefits paid by Medicare. The combined benefits of this policy and the benefits paid by Medicare may not exceed one-hundred percent (100%) of the Medicare Eligible Expenses incurred. This policy will not pay benefits for the following:

(1) the Medicare Part B Deductible;

(2) any expense which You are not legally obligated to pay; or services for which no charge is normally made in the absence of insurance;

(3) any services that are not medically necessary as determined by Medicare;

(4) any portion of any expense for which payment is made by Medicare or other government programs (except Medicaid); or for which payment would have been made by Medicare if You were enrolled in Parts A and B of Medicare;

(5) any type of expense not a Medicare Eligible Expense except as provided previously in this policy;

(6) any deductible, Coinsurance or Co-payment not covered by Medicare, unless such coverage is listed as a benefit in this policy; or

(7) Preexisting Conditions: We will not pay for any expenses incurred for care or treatment of a Preexisting Condition for the first six (6) months from the effective date of coverage. This exclusion does not apply if You applied for and were issued this policy under guaranteed issue status; if on the date of application for this policy You had at least six (6) months of prior Creditable Coverage; or, if this policy is replacing another Medicare Supplement policy and a six (6) month waiting period has already been satisfied. Evidence of prior coverage or replacement must have been disclosed on the application for this policy. If You had less than six (6) months prior Creditable Coverage, the Preexisting Conditions limitation will be reduced by the aggregate amount of Creditable Coverage. If this policy is replacing another Medicare Supplement policy, credit will be given for any portion of the waiting period that has been satisfied.

Website not approved for use in: Oregon

AN OUTLINE OF COVERAGE IS AVAILABLE UPON REQUEST AT ANY TIME.

We'll provide an outline of coverage to all persons at the time the application is presented.

AN OUTLINE OF COVERAGE IS AVAILABLE UPON REQUEST AT ANY TIME.

We'll provide an outline of coverage to all persons at the time the application is presented.

Our company and agents/producers are not connected with or endorsed by the U.S. Government or the federal Medicare program. This is a solicitation for insurance. An insurance agent/producer may contact you. Premium and benefits vary by plan selected. Plan availability varies by state. These policies contain exclusions, limitations and terms under which the policies may be continued in force or discontinued. For costs and complete details of coverage, contact the company.

The following Medicare Supplement Plans are available to persons eligible for Medicare due to disability: Plan A in Arkansas, Connecticut, Indiana, Maryland, Oklahoma, Texas & Virginia; Plans A, F and G in North Carolina; and Plans C and D in New Jersey for individuals aged 50-64.

All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation. Medicare Supplement policies are underwritten by American Retirement Life Insurance Company, Cigna Health and Life Insurance Company, Cigna National Health Insurance Company, Cigna Insurance Company and Loyal American life Insurance Company. Each insurer has sole responsibility for its own products. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc.

THESE POLICIES PAY LIMITED BENEFITS ONLY. THEY DO NOT CONSTITUTE COMPREHESIVE HEALTH INSURANCE COVERAGE AND ARE NOT INTENDED TO COVER ALL MEDICAL EXPENSES. THIS COVERAGE DOES NOT SATISFY THE "MINIMIUM ESSENTIAL COVERAGE" OR INDIVIDUAL MANDATE REQUIREMENTS OF THE AFFORDABLE CARE ACT (ACA). THIS COVERAGE IS NOT MEDICAID OR MEDICARE SUPPLEMENT INSURANCE. THE LUMP SUM CANCER AND CANCER TREATMENT POLICIES ARE CANCER ONLY POLICIES.

THE LUMP SUM CANCER POLICY IS A CANCER ONLY POLICY. THE LUMP SUM CANCER AND LUMP SUM HEART ATTACK AND STROKE POLICIES PAY LIMITED BENEFITS ONLY. THEY DO NOT CONSTITUTE COMPREHENSIVE HEALTH INSURANCE COVERAGE AND ARE NOT INTENDED TO COVER ALL MEDICAL EXPENSES. THIS COVERAGE DOES NOT SATISFY THE "MINIMIUM ESSENTIAL COVERAGE" OR INDIVIDUAL MANDATE REQUIREMENTS OF THE AFFORDABLE CARE ACT (ACA). THIS COVERAGE IS NOT MEDICAID OR MEDICARE SUPPLEMENT INSURANCE.

This website is designed as a marketing aid and is not to be construed as a contract for insurance. It provides a brief description of the important features of the policy. Full terms and conditions of coverage are defined by and governed by an issued policy. Please refer to the policy for the full terms and conditions of coverage.

This is a solicitation for insurance and an insurance agent may contact you. Product availability varies by state. All insurance policies may contain exclusions, limitations, reduction of benefits, and terms under which the policy may be continued in force or discontinued. For cost and complete details of coverage, contact your insurance agent or the company. Cancer Treatment, Lump Sum Cancer, Lump Sum Heart Attack and Stroke and Individual Whole Life Insurance Policies are insured by Loyal American Life Insurance Company.

The Dental, Vision and Hearing policy is not available in MA, NM, NY, NC, OR, RI, VA or WA.

The Cancer Treatment policy is not available in ID, MA, MN, NH, NJ, NY or UT.

The Lump Sum Cancer policy is not available in ID, NY or VA.

The Lump Sum Heart Attack and Stroke policy is not available in ID, MA, NY, or VA.

The Hospital Indemnity policy is not available in CA, CT, ID, NH, or NY.

The Whole Life policy is not available in FL or NY.

All Cigna Healthcare products and services are provided exclusively by or through operating subsidiaries of The Cigna Group, including Loyal American Life Insurance Company. The Cigna Healthcare name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc.

This page is not intended for residents of Idaho, New Mexico and Oregon.

Privacy Policy || Legal Disclaimers || Policy Disclosures, Exclusions & Limitations || Language Assistance || Nondiscrimination Notice ||

Insured by Cigna Health and Life Insurance Company. Product availability may vary by location and plan type and is subject to change. All dental insurance policies and dental benefit plans contain exclusions and limitations. For costs and details of coverage, review your plan documents or contact a Cigna Healthcare representative. All Cigna Healthcare products and services are provided exclusively by or through operating subsidiaries of The Cigna Group, including Cigna Health and Life Insurance Company and Cigna Dental Health, Inc. In Texas, the Dental plan is known as Cigna Dental Choice, and this plan uses the national Cigna DPPO Advantage network. In New Mexico, the policy form numbers for stand-alone dental plans are INDDENPOLNM0322.1500 and INDDENPOLNM0322.1000. For Oregon residents, this page is advertising dental insurance products and form codes are INDDVPOL (OR) 1021.1000, INDDVHPOL (OR), 1021.2000, INDDVHPOL (OR), 1021.3500. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc.

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Your Progress

Applicant Information

Applicant 1

First Name *

MI

Last Name *

Gender *

Date of Birth *

Age

Email Address *

Phone *

Resident Street Address (no PO Box) *

Apt/Suite/Other

City *

State *

Zip Code *

Is your mailing address the same as your residential address? *

Mailing Address (If different from above)

Apt/Suite/Other

City *

State *

Zip Code *

1-877-895-4619

Monday - Friday

1-877-895-4619

1-877-895-4619

Monday - Friday

*Insured by Cigna Insurance Company.

VIEW STATE DISCLOSURES, EXCLUSIONS & LIMITATIONS

VIEW STATE DISCLOSURES, EXCLUSIONS & LIMITATIONS

INDDENGN1120 941251 11/20 ©2020 Cigna This application is not proof of coverage.