Delivering Better Health Outcomes Through Integrated Clinical Support
At Cigna Healthcare, we’re focused on helping your customers access the right care, at the right time—wherever they are in the world. Our integrated clinical approach combines expert guidance, digital tools, and global provider access to deliver better outcomes and improved value for your customers.
A Smarter Approach to Care
Our clinical model is built to simplify healthcare journeys and ensure your customers receive appropriate, evidence-based treatment. Through personalised programmes and proactive support, we help improve outcomes, reduce unnecessary treatments, and support better decision-making.
Medical Necessity Review: doing the right thing for our customers
Medical necessity means ensuring the care provided is not only clinically appropriate but also in the best interest of the patient at a given time.
Not all care improves outcomes – our clinicians know the difference. Our team will carry out a Medical Necessity Review for prior approval and guarantee of payment, during treatment and during claims processing. These reviews lead to:
- Customers accessing the right care at the right time
- Improved care outcomes which protects your customers
- Clinical cost savings from doing the right thing
By making these decisions, grounded in medical evidence and clinical expertise, we can ensure cost savings for your customers.
- 14% of GIH customers who undergo claims review avoid unnecessary treatment, helping ensure care is both appropriate and effective.
- More than 400 GIH customers actively benefited from our clinical support.
- 1,270 GIH customers closed gaps in care through our evidence-based programs in 2025.
Supporting Members Every Step of the Way
Our core clinical programmes are designed to support customers across a wide range of needs:
- Case Management – Dedicated nurse case managers provide end-to-end support for complex cases, coordinating care and advocating for members.
- Chronic Condition Management – Personalised guidance for members living with conditions such as diabetes or cardiovascular disease, even if their condition has been excluded from their policy.
- Global Telehealth – Around-the-clock access to routine medical advice from qualified clinicians for convenient, non-emergency care.
- Second Medical Opinion (Decision Support) – Independent specialist insights to help members feel confident in their diagnosis and treatment plan.
Our programmes go beyond treatment to focus on prevention and long-term wellbeing, supporting earlier detection, improved medication adherence, and reduced reliance on emergency care.
Personalised Support for Every Life Stage
We recognise that healthcare needs change over time. That’s why our programmes are designed to support members through different life stages.
- Diabetes Prevention Program: Omada (US only) – We’ve partnered with Omada to provide your customers aged 18 and older who are ordinary residents in the US and at risk of Type 2 Diabetes, with support in preventing this.
- Family planning and hormonal health support (Carrot) – Helping your Platinum customers by providing expert guidance with family planning and hormonal support. This includes fertility and pregnancy advice, support through menopause, and beyond.
- Mental health and wellbeing support (Workplace Options/Life Management Assistance Programme) through our Health & Wellbeing module – 24/7 access to counselling, coaching, and practical life support.
Why This Matters for Brokers
For brokers, these clinical capabilities help demonstrate value beyond core policy benefits, strengthen customer confidence, and support retention by delivering real, ongoing value.
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