Cigna Segmentation Criteria

There are multiple criteria that play a role in determining whether we ae prepared to insure a particular risk, what we are prepared to insure it against, and what the premium will be. These criteria serve as Acceptance Criteria (AC), Special Terms (SP) and Pricing. Based on these segmentation criteria, we try to find a balance between the premium you pay and the loss we anticipate. The segmentation criteria are objective criteria that can influence the probability or extent of loss.

Please find below an explanation of the segmentation criteria we apply.

UW Type

Certain UW types have specific acceptance criteria (MHD & CPME) and are not open to everyone. MHD has a higher base price.

Coverage Selection

This isn’t a driver for overall acceptance/declines but we may take modular attachments into account when deciding to apply an individual exclusion/loading.  Overall product selection generally doesn’t impact the UW decision.

Age

Affects the level of medical risk presented.

Country of Residence

Medical costs can vary depending on country in which treatment is received. Some countries are restricted due to sanctions.

Nationality

Medical costs can vary depending on country in which treatment is received and people get treatment while visiting their home country. Some nationalities are restricted due to sanctions.

BMI

Body mass index at the extreme ends of the scale are indicators of increased medical risk.

Smoking status

Smoking increases medical risk factors.  We don’t load smokers at the outset, nor do we apply exclusions specifically for this. We do factor this is as a consideration when other conditions are present or the person has a high BMI.

Occupation

We may apply an exclusion or offer loading when someone has a dangerous occupation.

Hobbies/Avocations/Hazardous pursuits

We may apply an exclusion or offer loading when someone engages in an activity where there is an increased risk of injury.

Medical History

Medical history including ongoing conditions or undiagnosed symptoms is an indicator of the level of risk.