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    CIGNA 2019 ANNUAL REPORT The Power of We.


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    THIS YEAR We invested in growth. We capitalized on innovation. We committed to the future. 02 Shareholder Letter 13 Cigna Foundation 14 Cigna Connects 17 Milestones, Awards & Recognitions 20 Cigna in Perspective 24 Corporate & Board of Directors TA B L E O F C O N T E N T S 1


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    A message from our President and CEO, David Cordani DRIVEN BY THE POWER OF WE I often talk about the importance of partnerships to and with the communities where we live and work. The deliver the best results for all of our stakeholders, which Power of We magnifies and unleashes the impact we is why one of Cigna’s key strategic imperatives is to be can have on society and for those we serve, makes our the undisputed partner of choice for health care. solutions available to more people, and fuels our ability As one recent example of Cigna’s emphasis on to continue investing and delivering outstanding results partnering, as well as our commitment to our customers, for our shareholders. clients and communities, I often share the details of a partnership we formed with the city of San Diego this C U S T O M E R S AT T H E C E N T E R O F A L L W E D O past year to address the unique health needs of the city’s first responders. Above all, the Power of We drives Cigna to continue First responders – notably firefighters, police, putting our customers at the center of all we do, each emergency medical teams and 911 dispatchers – are on the and every day. front lines serving their neighbors and communities at their One of the first things Cigna and Express Scripts did moments of greatest need. Given the unique pressures after coming together was to update our mission, which they face, it’s unsurprising that 85% of them have reported is to improve the health, well-being and peace of mind symptoms related to behavioral health issues.1 of those we serve. Through our partnership in San Diego, we’re giving We embody this mission through a global workforce them access to behavioral wellness treatment and other which embraces its collective role as champions for our resources that help them better cope with traumatic customers – providing the right services and solutions, at and high-stress situations while on the job. the right time, to contribute to the diverse health needs This initiative, and so many others like it, reflects of our customers in a highly personalized way. the values and attributes Cigna’s colleagues around the This means customers like Bryan Ott, who developed world aspire to every day, including empathy, partnership diabetes at age 30 – and didn’t even realize it until Cigna- and an unwavering belief in what’s possible. provided data identified his elevated A1C level, and At Cigna, we call this the “Power of We.” Through the associated risk for other diseases. Bryan attributed a mix Power of We, Cigna’s colleagues are bound by a shared of medical intervention and health coaching to putting mission, values and strategy. It reminds and inspires us him back on track, remarking that “I’m adding time onto on a daily basis that we are far more powerful when we my life instead of subtracting it from my life.” work together, in close partnership with each other, as It also includes customers like Kerry Petryck, who well as with our customers, patients and clients; with lost 44 pounds through her participation in a well-being health care professionals; with government agencies; program conceived by Cigna and her employer, our 2 SHAREHOLDER LETTER


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    The Power of We magnifies the impact we can have on society and fuels our ability to continue delivering outstanding results for our shareholders. client American Eagle Outfitters. Kerry remarks that she in pharmacy cost savings.4 Today, everyone we serve doesn’t know if “I’d be the healthy person I am now” now has access to these pharmacy services, including without the benefit of this program. our industry-leading Accredo specialty pharmacy. These are only a couple of the millions of individual Our specialist pharmacists have deep expertise in healthy lives we help shape every day. 21 disease states5 – bringing tailored, personalized care to Our commitment extends to our innovative online millions of people. And in 2019 alone, 550 Accredo nurses6 tools and digital apps to help make the health care system traveled more than nine million miles to reach patients easier to navigate, and is why Cigna offers a customer throughout the United States.7 support line that makes a live operator available to all We’ve also added Express Scripts’ home delivery of our customers, 24 hours a day, seven days a week, pharmacy to our Cigna network, which ensures our clients’ every day of the year.2 employees get the clinical support they need – when and That’s the Power of We – more than 70,000 how they want it. colleagues2 who focus on how we can help our customers Further, our combination has accelerated our ability live better lives. to bring an array of innovative health care solutions to the marketplace. A handful of our 2019 highlights T R A N S F O R M I N G H E A LT H C A R E included our: By leveraging the resources of our combined company, › Patient Assurance Program, capping the 30-day we’re positioned with leading capabilities to drive transform- out-of-pocket cost of insulin at $25; ational change in health care and to deliver whole person › Embarc Benefit ProtectionSM Program, which will health – meaning treating each person holistically, both put life-saving gene therapy in reach of those mind and body. who need it; Our market-leading medical and behavioral › Digital Health Formulary, the industry’s first, to capabilities take a research-based approach to improve help customers and clients make better decisions connectivity and deliver whole person solutions for from 300,000 digital health tools; and, better physical and mental health outcomes. A three-year › Health Connect 360, our innovative tool that study, released last year, of more than 210,000 customers, generates deep personalized insights at the found that Cigna’s health engagement incentive programs clinical level and enables better health outcomes. improve health outcomes and lower total medical costs an average of 10%.3 Our improved pharmacy capabilities through Express Scripts play a pivotal role in our ability to deliver excellent service and clinical support. In 2019, Express Scripts saved its clients and customers more than $50 billion SHAREHOLDER LETTER 3


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    B U I L D I N G P A R T N E R S H I P S T O D R I V E I N N O VAT I O N We continued to embrace partnering as a key point of Another example of the premium Cigna places on differentiation and a growth driver for Cigna in 2019, partnerships is our long history of innovative, value- and will continue to do so in 2020 and beyond. based arrangements with health care professionals For example, beginning in April 2020, we are making in our U.S. Commercial and Government businesses. pharmacy care more affordable by enhancing pharmacy Across our top 40 markets in the United States and all networks and pharmaceutical manufacturer value for of our Medicare business, more than 65% of Cigna’s Prime Therapeutics’ 28 million members who are covered medical payments are now in value-based arrangements.8 by 23 health plans, plus employer and government Importantly, 92% of the health care providers in our programs such as Medicare and Medicaid. programs are delivering a differentiated level of quality Other recent examples are our partnerships of care and 90% believe that Cigna is the industry leader with, and investments in, emerging companies such as in this area.9 Oscar Health. With Oscar, we can do more to give small This provides meaningful opportunity for our businesses access to affordable, fully insured health plans Medicare Advantage business, whose growth is anchor- that broaden choice and prioritize whole person health. ed in the geographies where we have deep health Cigna will focus on four geographies with Oscar in 2020, care provider partnerships. We already capitalized and will test, learn and look to expand over time. on this growth opportunity in 2019 by accelerating Outside of the United States, Cigna also announced our geographic expansion in Medicare Advantage and the formation of a new partnership with Australia-listed bringing new solutions to market – all of which has nib Group, to create a health care data science venture. contributed to our high Medicare Advantage customer This joint venture will analyze and interpret underlying NPS levels, averaging approximately 70 across our individual disease risks, and provide guidance on markets. We are excited about our opportunities for how risks can be best prevented, mitigated, managed future customer growth in this business, which is or treated. projected to be 10% to 15% on an annualized basis over the next five years.10 4 SHAREHOLDER LETTER


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    The Lab is our state-of-the-art research facility where diverse experts collaborate on cutting-edge solutions. SHAREHOLDER LETTER 5


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    A D VA N C I N G O U R S O C I A L R E S P O N S I B I L I T Y P L AT F O R M The Power of We extends to our emphasis on fostering This is all a part of Cigna’s commitment to advocate for diversity and inclusion in our organization, as well as the next generation. We believe that all Americans need healthy and vibrant communities where we live and work. and deserve a sustainable (and therefore affordable) We’re especially proud of our efforts to ensure a health care system that helps bring them health and workplace that respects the diversity and inclusion of vitality. We believe that the essential elements of this our colleagues’ cultures, beliefs and values. Cigna is system require: committed to respecting and protecting the rights of every employee. In recognition of our endeavors to › Employers, individuals and the government to remain celebrate our colleagues’ differences and contributions, highly engaged and motivated to drive and adopt Cigna achieved “Best of the Best” workplace awards solutions that advance the transformation of our in 2019 from Professional Woman’s Magazine, Hispanic health care system, and contribute to its financing; Network Magazine and Black EOE Journal, as well › Partnership between the private sector (to drive as recognition from Diversity, Inc. as a top company innovation, personalized solutions and coordination for LGBT employees and people with disabilities. of individual care across the health care ecosystem) And, reflecting our commitment to veterans, we were and government (to provide funding and a reliable once again named a Military Times “Best for Veterans” safety net for our most vulnerable and underserved employer for 2019. populations, and set standards that encourage and In 2019, Cigna invested even more in the communities enable competition, innovation and choice); and, where we live and work. Through a five-year, $25 million › The power of what Cigna refers to as micro global initiative called Healthier Kids For Our Future, we communities. began fighting childhood hunger and food insecurity to help today’s children grow into tomorrow’s healthy A micro community can range in size from a tight- adults. And, we extended our efforts by addressing the knit group of two, three or more people coming together emerging challenge of mental illness among children. for a finite period of time, to a larger community-based Cigna’s research shows that loneliness, in addition to program intent on creating positive health care out- stress and depression, takes a toll on people of all ages, comes for a broader population. The key elements of but is having a particularly profound impact on our micro communities are a shared goal, and the support young people. surrounding individuals to help them reach that goal. One of the most effective, and certainly the most scaled, micro communities is the employer community. Approximately 180 million people obtain health coverage through their employers.11 Within this system, people have access to plans that have flexibility, choice, engagement tools, and relevancy with health care professionals and – as a result – the United States has a healthier and more productive workforce. 6 SHAREHOLDER LETTER


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    We believe all Americans need and deserve a sustainable health care system that helps bring them health and vitality. SECTION NAME 7


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    Partnerships underscore a critical point: The most effective solutions are not simply national in scope – they're highly localized. Another micro community that’s special to everyone As a global health service company, our partnership with at Cigna is our partnership with the fearless and proud Achilles helps champion our brand, supports our mission, athletes from Achilles International. Achilles is dedicated and expresses our gratitude to the heroes who served, to helping wounded veterans and people with disabilities and continue to serve, in the United States military – compete in long-distance races. At the heart of our including the more than 2,500 veterans we employ partnership with Achilles is a shared committment to at Cigna.12 helping people be their healthiest, be their best, and Micro communities can also help those in achieve their most important personal goals. disadvantaged neighborhoods overcome the social In 2019: determinants of health. That’s why partnerships between corporate or private foundations, hospitals, schools, › The Cigna Foundation sponsored 50 athletes houses of worship, neighborhoods and more underscore from Achilles International to participate in a critical point: The most effective solutions are not simply the 2019 Marine Corps Marathon, with Cigna national in scope – they’re highly localized. employees serving as guides to help them cross One such example is Cigna’s work with Chicago’s the finish line. highly at-risk Bronzeville community to address trauma › Cigna was also privileged to play a part in among victims of violence. The Cigna Foundation helping Achilles raise $1.7 million at its annual awarded a $450,000 grant to the Bright Star Community fundraising event. Outreach program to address this critical issue, and Cigna › At the latest Walt Disney World® Marathon participated in the community’s 4th Ward Festival last Weekend, Cigna sponsored 31 athletes, and year to screen residents for four key numbers – blood nearly 25 Team Cigna members helped to guide sugar, blood pressure, cholesterol and Body Mass Index – those athletes in a variety of races. which collectively can indicate the majority of chronic, › And, we’re especially proud to now be the treatable illnesses such as diabetes and heart disease. official sponsor of the Achilles Freedom Team Whether it’s an employer with 1,000 employees or an of Wounded Veterans. organization supporting hundreds of disabled athletes, micro communities are powerful tools to encourage individuals to be their best and healthiest selves. SHAREHOLDER LETTER 9


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    BUILDING ON OUR TRACK RECORD OF Cigna’s 2019 performance gives us considerable O U T S TA N D I N G R E S U LT S momentum to drive attractive growth in 2020 and beyond. We remain well positioned to achieve our All of this led to a landmark 2019 for our company. We 2021 EPS target of $20–$21. extended our decade-long track record of delivering outstanding financial performance. And, our first full year A N T I C I PAT I N G W H AT ’ S N E X T as a combined company with Express Scripts greatly accelerated our ability to expand choice, and address Going forward, we are confident that our collective drive our customers’ whole person health needs – both mind to do even more will keep us successful. and body – in a way that is affordable, predictable In 2020, Cigna will remain focused on bringing and simple. forward the best market-driven health care solutions By delivering on and advancing our key priorities as we deliver increased value for our stakeholders, and throughout the year, Cigna delivered outstanding financial affordable, predictable and simple health care for our performance in 2019 for the benefit of our shareholders. customers and clients. This included: We’ll build on our momentum to drive attractive growth in the near term, as evidenced by our 2020 out- › Adjusted revenue of $140 billion; look and 2021 EPS target. We’ll also drive growth in the › Earnings of $6.5 billion after tax; long term, including 6% to 8% revenue growth and 10% › Adjusted income from operations per share to 13% EPS growth on an average annual basis, delivered growth of 20%, to $17.05; and, through a capital-light framework, with exceptional cash › Outstanding operating cash flow that more flows that enhance our strategic and financial flexibility. than doubled, to $9.5 billion.13 And we’ll continue to leverage the Power of We, with a firm belief that maximizing the positive impact As a result, we exceeded our guidance that we we make for our customers, patients, clients, health had already raised each quarter for revenue, earnings care professional partners, communities and employees and earnings per share, as well as for cash flow from positions us to best deliver for the shareholders who operations – with exceptional execution across our four invest in us. core business platforms of Health Services, Commercial, Thank you for your continued belief and investment Government and International Markets. in Cigna, so we can continue to improve the health, well- Several factors contributed to Cigna’s robust 2019 being and peace of mind for our 170 million customer results. In Health Services, we delivered market-leading relationships around the world. customer and client retention, including 97% retention for the 2020 selling season.14 We achieved continued strong organic growth in prescriptions, and saved our customers and clients $50 billion on annual prescription costs.15 In our Commercial business, we again delivered industry-leading medical cost trend, and we grew our commercial medical customers for the 10th consecutive David M. Cordani year – led by another year of double-digit growth in the PRESIDENT AND CHIEF EXECUTIVE OFFICER Select segment.16 And, in our Government Business, The Centers for Medicare and Medicaid Services’ most recent Star ratings position us to have 87% of our Medicare Advantage customers in 4-Star or higher plans for 2021 – a reinforcement of our strong customer satisfaction and high levels of clinical quality.16 SHAREHOLDER LETTER 11


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    Through Healthier Kids For Our Future, we’ve committed $25 million to combat childhood hunger. 12 C I G N A F O U N D AT I O N


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    C I G N A F O U N D AT I O N We’re committed to creating brighter futures in our communities. In 2019, we continued to advance our Healthier Kids For which delivers free groceries for a small shipping cost Our FutureSM initiative. Healthier Kids For Our Future is to the doorsteps of hard-working, struggling families our five-year, $25 million commitment to improve the across America. In collaboration with FCE, our grant health and well-being of children worldwide to tackle the funding will help create zero hunger by 2030 by providing challenges affecting their health today so that they can access to safe, nutritious and sufficient food year-round grow into healthy adults tomorrow. We are a company for families with children in grades K through eight in focused on preventive care, and regular access to 14 selected locations in the United States. nutritious and sufficient food is the starting point for a As we look toward our future work with Healthier healthier, more productive life. As such, we began our Kids For Our Future, we will be addressing other pressing Healthier Kids initiative by targeting childhood hunger health challenges, including the mental health of our youth. and food insecurity. Beyond Healthier Kids For Our Future, the Cigna The Cigna Foundation awarded Healthier Kids Foundation continues its ongoing commitment to grants to more than 40 organizations in 2019. As part addressing health equity. Our World of Difference grants of this effort, we collaborated with some of our grant support nonprofit organizations whose work helps partners to develop shared targets supporting United underserved groups overcome barriers to health and Nations Sustainable Development Goal 2: Zero hunger improves access to essential health services. From and Goal 3: Good health and well-being. An example health navigation programs supporting veterans in is the landmark $1 million Cigna Foundation grant to urban New York to Native Americans in rural Montana, Feeding Children Everywhere (FCE). With this funding, we continue to make a world of difference for FCE will be able to fully launch their Full Cart program communities everywhere. C I G N A F O U N D AT I O N 13


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    CIGNA CONNECTS Our commitment to corporate responsibility. Cigna Connects, our approach to corporate responsibility, O U R T H R E E S T R AT E G I C F O C U S A R E A S supports Cigna’s mission to help improve the health, well-being and peace of mind for the people we serve Our Cigna Connects corporate responsibility platform is by making powerful connections that positively impact focused on three key focus areas: Health and Well-being, the health of people, communities and the environment. Environment, and Inclusive and Responsible Business. Through Cigna Connects we aim to serve as a catalyst Within each focus area, we aim to apply our global of action and a convener of stakeholders who, together, health service expertise, resources and innovative thinking can make a difference around critical health topics. We to help solve complex challenges globally and within recognize social and environmental sustainability issues key markets. not only as problems to be solved, but as opportunities As we move through 2020, with the inclusion to create meaningful improvements for our stakeholders of Express Scripts and continued focus on future and for society. By applying our expertise and innovative opportunities for advancing the work of Cigna Connects, thinking to social issues, we can fully realize the potential we’ll be setting new targets and objectives to guide our of understanding how interconnectedness creates value. efforts. You can learn more about these key focus areas and our aligned initiatives in our annual Cigna Connects Corporate Responsibility Report which communicates our progress toward our environmental, social and governance objectives. 14 CIGNA CONNECTS


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    H E A LT H A N D W E L L - B E I N G ENVIRONMENT INCLUSIVE AND RESPONSIBLE BUSINESS CIGNA CONNECTS 15


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    M I L E S T O N E S , AWA R D S & R E C O G N I T I O N S We’re making a meaningful impact on the world around us. In November, Express Scripts opened its newly updated an inclusive environment which values all aspects of and expanded Lab – a reimagined, technologically diversity. In 2019, noteworthy organizations continued advanced research and solution center where a diverse to recognize Cigna for its commitment to diversity team of experts work to create a better health care and inclusion. experience for the people we serve. In 2019, our clinical solutions, born in the Lab, saved plans $49.5 billion.17 › Cigna scored 100% on the Disability Equality In 2019, Cigna was named to the Dow Jones Index and was designated as a Best Place Sustainability World and North America Indices for the to Work for Disability Inclusion for the fifth third year in a row with the leading score for the health consecutive year. care providers and services industry sector. The Dow Jones › Cigna was recognized by Victory Media as Sustainability Indices are among the most important a Military Friendly® Employer and Military global indicators of sustainability leadership. Friendly® Spouse Employer. Cigna was also named to Corporate Responsibility › The Human Rights Campaign Foundation Magazine’s 100 Best Corporate Citizen’s List for the fifth (HRC) identified Cigna as one of the "Best consecutive year. This ranking recognizes outstanding Places to Work for LGBTQ Equality." Cigna environmental, social and governance transparency also scored 100 on the HRC's Corporate and performance among the 1,000 largest U.S. Equality Index (CEI). public companies. › Cigna received multiple “Best of the Best” In addition, Cigna ranked second on the new list of recognitions: U.S. Veterans Magazine, Black Top 100 U.S. Companies Supporting Health Communities EOE Journal, Hispanic Network Magazine, and Families compiled by JUST Capital with support Professional Woman’s Magazine, DIVERSEability from the Robert Wood Johnson Foundation. Cigna took Magazine; and, the top spot among health care industry companies › Express Scripts was identified by Diversity Inc. that made the list. as a Top 50 Company for Diversity. In our efforts to better understand our workforce and customers, we take an active, strategic approach to Also in 2019, the National Business Group on Health appreciate our individual and collective experience (NBGH) awarded Cigna with an Innovation in Advancing and different ways of thinking. At Cigna, we strive for Health Equity Award. This national award recognized Cigna for its ongoing commitment to advancing health equity through innovative initiatives and effective practices that impact the environments in which individuals live, learn, work and play. M I L E S T O N E S , AWA R D S & R E C O G N I T I O N S 17


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    CIGNA IN PERSPECTIVE We’re moving forward to set the standards of health. 18 CIGNA IN PERSPECTIVE


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    Cigna in Perspective Cigna’s combination with Express Scripts in December Medicare offerings for seniors and individual insurance 2018 created an enterprise uniquely capable of delivering offerings both on and off the public health insurance affordability, predictability and simplicity of health care exchanges. We differentiate ourselves by providing to those we serve. Cigna offers a differentiated set of innovative, personalized and affordable health care benefit pharmacy, medical, behavioral, dental, disability, life and solutions based on the unique needs of the individuals accident insurance and related products and services. and clients we serve. We present the financial results of our businesses in the following segments: Health Services, Integrated has operations in over I N T E R N AT I O N A L M A R K E T S Medical, International Markets, and Group Disability and 30 countries and jurisdictions, providing a full range of Other. Detailed descriptions of product offerings can be comprehensive medical and supplemental health, life found on page four of our Annual Report on Form 10-K. and accident benefits to individuals and employers. Summarized below is a brief description of each business, Products and services include comprehensive health along with high-level financial information. coverage, hospitalization, dental, critical illness, personal accident, term life and variable universal life. consists of pharmacy benefit H E A LT H S E R V I C E S management, supply chain administration and G R O U P D I S A B I L I T Y A N D O T H E R consists of our management, clinical solutions to drive better health Group Disability and Life operating segment, along outcomes at a lower cost, value programs to assist with Corporate-owned Life Insurance and certain run- customers with chronic conditions and certain medical off businesses. In December 2019, Cigna entered into a management services. We focus our solutions to align definitive agreement to sell the Group Disability and Life with our clients’ challenges across care, cost and service. business to New York Life Insurance Company for $6.3 As a result, we believe we deliver better outcomes, higher billion. The sale is expected to close in the third quarter customer satisfaction and a more affordable prescription of 2020 subject to applicable regulatory approvals and drug benefit. other customary closing conditions. Until the transaction is closed, we will continue to operate our business as offers a mix of core health I N T E G R AT E D M E D I C A L usual and serve our customers. insurance products and services to employers, other groups and individuals, along with specialty products and services designed to improve the quality of care, lower cost and help customers achieve better health outcomes. This business consists of a Commercial operating segment which includes our employer-sponsored medical coverage and a Government operating segment which includes 20 CIGNA IN PERSPECTIVE


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    H E A LT H S E R V I C E S $96.4B Adjusted Revenues 18 45% Network 5% Other 50% Home Delivery and Specialty I N T E G R AT E D M E D I C A L $36.5B Adjusted Revenues 18 33% Government 67% Commercial I N T E R N AT I O N A L M A R K E T S $5.6B Adjusted Revenues 18 37% Korea 14% Other 4% Hong Kong 17% North America 8% Middle East 5% Taiwan 15% Europe GROUP DISABILITY AND OTHER $5.2B Adjusted Revenues 18 53% Disability 33% Life 14% Other CIGNA IN PERSPECTIVE 21


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    C O R P O R AT E & B O A R D O F D I R E C T O R S We believe that different points of view lead to stronger results. 22 C O R P O R AT E & B O A R D O F D I R E C T O R S


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    2019 Corporate & Board of Directors BOARD OF DIRECTORS John M. Partridge Former President Isaiah Harris, Jr. Visa Inc., a consumer credit company Independent Chairman of the Board Former President and Chief Executive Officer William L. Roper, MD, MPH AT&T Advertising and Publishing – East, Interim President a communications services company The University of North Carolina System David M. Cordani Eric C. Wiseman President and Chief Executive Officer Former Executive Chairman, Cigna Corporation President and Chief Executive Officer VF Corporation, an apparel and William J. DeLaney footwear company Former Chief Executive Officer Sysco Corporation, a food marketing and Donna F. Zarcone distribution company President and Chief Executive Officer The Economic Club of Chicago, a civic Eric J. Foss and business leadership organization Former Chairman, President and Chief Executive Officer EXECUTIVE COMMITTEE ARAMARK Corporation, a provider of food services, facilities management and uniform services Isaiah Harris, Jr., Chair David M. Cordani Elder Granger, MD, MG, USA (Retired) Roman Martinez IV Chief Executive Officer John M. Partridge The 5Ps LLC, a healthcare, education, and William L. Roper, MD, MPH leadership consulting firm Eric C. Wiseman Donna F. Zarcone Roman Martinez IV Private Investor AUDIT COMMITTEE Kathleen M. Mazzarella Roman Martinez IV, Chair Chairman, President and Chief Executive Officer William J. DeLaney Graybar Electric Company, Inc., a distributor of John M. Partridge electrical, communications and data networking products and provider of related supply chain COMPLIANCE COMMITTEE management and logistics services William L. Roper, MD, MPH, Chair Mark B. McClellan, MD, PhD Eric J. Foss Director, Duke-Robert J. Margolis, MD Elder Granger, MD, MG, USA Center for Health Policy Donna F. Zarcone 24 C O R P O R AT E & B O A R D O F D I R E C T O R S


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    C O R P O R AT E G O V E R N A N C E C O M M I T T E E Steven B. Miller, MD Executive Vice President Donna F. Zarcone, Chair and Chief Clinical Officer William J. DeLaney Eric J. Foss John M. Murabito Elder Granger, MD, MG, USA Executive Vice President, Mark B. McClellan, MD, PhD Human Resources and Services FINANCE COMMITTEE Eric Palmer Executive Vice President John M. Partridge, Chair and Chief Financial Officer Roman Martinez IV Kathleen M. Mazzarella Jason D. Sadler William L. Roper, MD, MPH President, International Markets Eric C. Wiseman Michael Triplett PEOPLE RESOURCES COMMITTEE President, U.S. Markets Eric C. Wiseman, Chair Timothy C. Wentworth Kathleen M. Mazzarella President, Health Services Mark B. McClellan, MD, PhD OTHER OFFICERS EXECUTIVE OFFICERS Julia Brncic David M. Cordani Senior Vice President, President and Chief Executive Officer Chief Counsel and Corporate Secretary Mark L. Boxer Timothy D. Buckley Executive Vice President Vice President and Treasurer and Chief Information Officer Mary T. Agoglia Hoeltzel Brian Evanko Senior Vice President, President, Tax and Chief Accounting Officer Government Business Nicole S. Jones Executive Vice President and General Counsel Matt Manders President, Strategy and Solutions C O R P O R AT E & B O A R D O F D I R E C T O R S 25


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    2020 ANNUAL MEETING SHAREHOLDER ACCOUNT ACCESS Wednesday, April 22 at 8:00 am You can access your Cigna shareholder account Windsor Marriott Hotel, online through the Computershare website: Ballroom IV www.computershare.com/investor, or by calling 28 Day Hill Road 800.760.8864. Windsor, CT 06095 DIRECT DEPOSIT OF DIVIDENDS Proxies and proxy statements have been made available to shareholders of record as of February Direct deposit of dividends provides a prompt, efficient 24, 2020. On December 31, 2019, there were 35,727 way to have your dividends electronically deposited into common shareholders of record. your checking or savings account. It avoids the possibility of lost or delayed dividend checks. The deposit is made F I N A N C I A L I N F O R M AT I O N electronically on the payment date. For more information and an enrollment authorization Cigna’s Form 10-K is available online at Cigna.com. For form, contact Computershare at 800.760.8864, or a copy of Cigna’s quarterly earnings’ news releases, outside the United States, U.S. territories and Canada go to Cigna.com/about-us and open Newsroom. at 201.680.6578. You can access your account online through the Computershare website: OFFICES www.computershare.com/investor. 900 Cottage Grove Road STOCK LISTING Bloomfield, CT 06002 860.226.6000 Cigna’s common shares are listed on the New York Stock Exchange. The ticker symbol is CI. One Express Way St. Louis, MO 63121 TRANSFER AGENCY 314.996.0900 By regular mail: Two Liberty Place Computershare 1601 Chestnut Street PO Box 505000 Philadelphia, PA 19192-1550 Louisville, KY 40233-5000 215.761.1000 By overnight delivery: DIRECT STOCK PURCHASE PLAN Computershare 462 South 4th Street Shareholders can automatically reinvest their annual Suite 1600 dividends and make optional cash purchases of common Louisville, KY 40202 shares. For information on these services, please contact: Toll-free: 800.760.8864 Computershare Outside United States, U.S. territories and Canada: PO Box 505000 201.680.6578 Louisville, KY 40233-5000 TDD: 800.952.9245 Toll-free: 800.760.8864 Website: www.computershare.com/investor Outside the United States, U.S. territories and Canada: 201.680.6578 CIGNA ONLINE TDD: 800.952.9245 To access online information about Cigna, our products Website: www.computershare.com/investor and services, visit Cigna.com. 26 C O R P O R AT E & B O A R D O F D I R E C T O R S


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    UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 FORM 10-K (Mark One)  ANNUAL REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934 For the fiscal year ended December 31, 2019 OR  TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934 For the transition period from ______________ to ______________ Commission file number 001-38769 Cigna Corporation (Exact name of registrant as specified in its charter) Delaware 82-4991898 (State or other jurisdiction of incorporation or organization) (I.R.S. Employer Identification No.) 900 Cottage Grove Road, Bloomfield, Connecticut 06002 (Address of principal executive offices) (Zip Code) (860) 226-6000 Registrant’s telephone number, including area code Securities registered pursuant to Section 12(b) of the Act: Title of each class Trading Symbol(s) Name of each exchange on which registered Common Stock, Par Value $0.01 CI New York Stock Exchange, Inc. Securities registered pursuant to Section 12(g) of the Act: NONE Indicate by check mark Yes No • if the registrant is a well-known seasoned issuer, as defined in Rule 405 of the Securities Act.   • if the registrant is not required to file reports pursuant to Section 13 or Section 15(d) of the Act   • whether the registrant (1) has filed all reports required to be filed by Section 13 or 15(d) of the Securities Exchange   Act of 1934 during the preceding 12 months (or for such shorter period that the registrant was required to file such reports), and (2) has been subject to such filing requirements for the past 90 days • whether the registrant has submitted electronically every Interactive Data File required to be submitted pursuant to   Rule 405 of Regulation S-T during the preceding 12 months (or for such shorter period that the registrant was required to submit such files) • whether the registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer, a smaller reporting company or an emerging growth company. See definitions of “large accelerated filer,” “accelerated filer,” “smaller reporting company” and “emerging growth company” in Rule 12b-2 of the Exchange Act. Large accelerated filer  Accelerated filer  Non-accelerated filer  Smaller reporting company  Emerging growth company  • If an emerging growth company, indicate by check mark if the registrant has elected not to use the extended  transition period for complying with any new or revised financial accounting standards provided pursuant to Section 13(a) of the Exchange Act. • whether the registrant is a shell company (as defined in Rule 12b-2 of the Act).   The aggregate market value of the voting stock held by non-affiliates of the registrant as of June 28, 2019 was approximately $59.4 billion. As of January 31, 2020, 372,043,094 shares of the registrant’s Common Stock were outstanding. DOCUMENTS INCORPORATED BY REFERENCE Part III of this Form 10-K incorporates by reference information from the registrant’s definitive proxy statement related to the 2020 annual meeting of shareholders.


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    TABLE OF CONTENTS FREQUENTLY REQUESTED 10-K INFORMATION Page Risk Factors ....................................................................................................................... 31 Executive Overview ........................................................................................................... 52 Industry Developments and Other Matters ........................................................................ 56 Liquidity and Capital Resources ........................................................................................ 58 Critical Accounting Estimates............................................................................................ 63 Segment Information.......................................................................................................... 143 Revenues by Product Type ................................................................................................ 145 Page Cautionary Statement PART I Item 1. Business . Overview ........................................................................................................................ 1 . Health Services ............................................................................................................... 3 . Integrated Medical .......................................................................................................... 8 . International Markets...................................................................................................... 13 . Group Disability and Other ............................................................................................ 16 . Investment Management................................................................................................. 20 . Miscellaneous ................................................................................................................. 20 . Regulation....................................................................................................................... 20 Item 1A. Risk Factors .......................................................................................................................... 31 Item 1B. Unresolved Staff Comments ................................................................................................. 46 Item 2. Properties ............................................................................................................................... 46 Item 3. Legal Proceedings ................................................................................................................. 46 Item 4. Mine Safety Disclosures ........................................................................................................ 46 Information about our Executive Officers................................................................................................... 47 PART II Item 5. Market for Registrant’s Common Equity, Related Stockholder Matters and Issuer Purchases of Equity Securities .............................................................................................. 48 Item 6. Selected Financial Data ............................................................................................................ 50 Item 7. Management’s Discussion and Analysis of Financial Condition and Results of Operations (“MD&A”) ........................................................................................................ 51 Item 7A. Quantitative and Qualitative Disclosures about Market Risk ................................................... 76 Item 8. Financial Statements and Supplementary Data ........................................................................ 77 Item 9. Changes in and Disagreements with Accountants on Accounting and Financial Disclosure ............................................................................................................................. 148 Item 9A. Controls and Procedures........................................................................................................... 148 Item 9B. Other Information ..................................................................................................................... 148 PART III Item 10. Directors, Executive Officers and Corporate Governance. ...................................................... 149 A. Directors of the Registrant................................................................................................. 149 B. Executive Officers of the Registrant ................................................................................. 149 C. Code of Ethics and Other Corporate Governance Disclosures .......................................... 149 D. Delinquent Section 16(a) Reports...................................................................................... 149 Item 11. Executive Compensation .......................................................................................................... 149 Item 12. Security Ownership of Certain Beneficial Owners and Management and Related Stockholder Matters .................................................................................................... 150 Item 13. Certain Relationships and Related Transactions, and Director Independence ......................... 150 Item 14. Principal Accountant Fees and Services................................................................................... 150 PART IV Item 15. Exhibits and Financial Statement Schedules ............................................................................ 151


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    Item 16. Form 10-K Summary ............................................................................................................... 162 Signatures....................................................................................................................................................... 163 Index to Financial Statement Schedules......................................................................................................... FS-1 Exhibits .......................................................................................................................................................... E-1


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    CAUTIONARY NOTE REGARDING FORWARD-LOOKING STATEMENTS This Annual Report on Form 10-K contains forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. Forward-looking statements are based on Cigna’s current expectations and projections about future trends, events and uncertainties. These statements are not historical facts. Forward-looking statements may include, among others, statements concerning future financial or operating performance, including our ability to deliver affordable, personalized and innovative solutions for our customers and clients; future growth, business strategy, strategic or operational initiatives, including our organizational efficiency plan; economic, regulatory or competitive environments, particularly with respect to the pace and extent of change in these areas; financing or capital deployment plans and amounts available for future deployment; our prospects for growth in the coming years; strategic transactions, including the merger (“Merger”) with Express Scripts Holding Company and the sale of our Group Disability and Life business; and other statements regarding Cigna’s future beliefs, expectations, plans, intentions, financial condition or performance. You may identify forward-looking statements by the use of words such as “believe,” “expect,” “plan,” “intend,” “anticipate,” “estimate,” “predict,” “potential,” “may,” “should,” “will” or other words or expressions of similar meaning, although not all forward-looking statements contain such terms. Forward-looking statements are subject to risks and uncertainties, both known and unknown, that could cause actual results to differ materially from those expressed or implied in forward-looking statements. Such risks and uncertainties include, but are not limited to: our ability to achieve our financial, strategic and operational plans or initiatives; our ability to predict and manage medical and pharmacy costs and price effectively; our ability to adapt to changes or trends in an evolving and rapidly changing industry; our ability to effectively differentiate our products and services from those of our competitors and maintain or increase market share; our ability to develop and maintain good relationships with physicians, hospitals, other health care providers, producers, consultants and pharmaceutical manufacturers; changes in the pharmacy provider marketplace or pharmacy networks; changes in drug pricing; the impact of modifications to our operations and processes; our ability to identify potential strategic acquisitions or transactions and realize the expected benefits (including anticipated synergies) of such transactions in full or within the anticipated time frame, including with respect to the Merger and sale of our Group Disability and Life business, as well as our ability to integrate or separate operations, resources and systems; the substantial level of government regulation over our business and the potential effects of new laws or regulations or changes in existing laws or regulations; the outcome of litigation, regulatory audits, investigations, actions or guaranty fund assessments; uncertainties surrounding participation in government-sponsored programs such as Medicare; the effectiveness and security of our information technology and other business systems and those of our key suppliers or other third parties; the impact of our debt service obligations on the availability of funds for other business purposes; unfavorable industry, economic or political conditions, including foreign currency movements; acts of civil unrest, war, terrorism, natural disasters or pandemics; reinsurance credit risk; as well as more specific risks and uncertainties discussed in Part I, Item 1A – Risk Factors and Part II, Item 7 – Management’s Discussion and Analysis of Financial Condition and Results of Operations of this Form 10-K and as described from time to time in our future reports filed with the Securities and Exchange Commission (the “SEC”). You should not place undue reliance on forward-looking statements, which speak only as of the date they are made, are not guarantees of future performance or results, and are subject to risks, uncertainties and assumptions that are difficult to predict or quantify. Cigna undertakes no obligation to update or revise any forward-looking statement, whether as a result of new information, future events or otherwise, except as may be required by law.


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    PART I Item 1. BUSINESS OVERVIEW Cigna Corporation, together with its subsidiaries (either individually or collectively referred to as “Cigna,” the “Company,” “we,” “our” or “us”) is a global health service organization. Our Mission To improve the health, well-being and peace of mind of those we serve Our Strategy Go Deeper: To expand and deepen our customer, client and partner relationships and create depth in targeted sub-segments and geographies Go Local: To ensure our solution suite and services meet customer, client and partner needs at a local market level Go Beyond: To innovate and further differentiate our businesses, the experiences we deliver and our overall social impact How We Win Address Whole Person Health Be the Undisputed Affordable Greater Partner of Choice Predictable Customer Simple Value Accelerate Innovation Cigna is an enterprise uniquely capable of delivering affordability, predictability and simplicity of health care to those we serve. We have broad and deep capabilities that accelerate our strategy to achieve our mission of improving the health, well-being and peace of mind of those we serve. Cigna’s employees are champions for the people we serve and over the past decade, our focus has shifted to helping people thrive by offering solutions to prevent and better manage health challenges. When sickness or disability do occur, we support our customers’ ability to have broad choices in how they best access high quality, affordable care. We see three primary ways to help individuals maintain, improve or recover their physical or mental health: 1) behavioral and lifestyle changes – with over 1,000 health coaches helping individuals set and meet health goals; 2) pharmaceutical interventions – with our leading pharmacy services improving health and driving affordability; and 3) medical and surgical interventions – with a clear and proven strategy around partnerships and value-based care programs, powered by applied informatics and aligned incentives. We maximize use of evidence- based care, while delivering best-in-class quality of care for our customers with acute and chronic conditions through enhanced real- time data across an expanded platform with industry-leading solutions to support care decisions. We offer a differentiated set of pharmacy, medical, behavioral, dental, disability, life and accident insurance and related products and services. Our capabilities include: 1) a broad portfolio of specialty services, some of which can be offered on a stand-alone basis; 2) integrated behavioral, medical and pharmacy management services; 3) leading specialty pharmacy expertise; and 4) advanced analytics that help us engage more meaningfully with individuals, plan sponsors we serve and our provider partners. These capabilities enhance Cigna’s ability to drive improved cost affordability, quality of care and predictability. We put medicine within reach for patients and help providers improve access to prescription drugs by making them more affordable. We improve patient outcomes and better manage the cost of the pharmacy benefit by: • Identifying products and offering innovative solutions that improve patient outcomes and control costs • Evaluating medicines for efficacy, value and price to assist clients in selecting a cost-effective formulary 1


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    • Offering home delivery and specialty services that save money for clients and customers while providing better and specialized clinical care • Leveraging purchasing volume to deliver discounts drive risk-sharing and value-based care across the pharmaceutical supply chain • Promoting the use of generics and lowest cost, clinically effective brands of medications We work with key stakeholders across the health care system to improve health outcomes and patient satisfaction, increase efficiency in drug distribution and manage costs of the pharmacy benefit. In 2019, we launched three major initiatives: 1) the Patient AssuranceSM program that offers diabetic customers a low, fixed monthly out-of-pocket cost for insulin; 2) the Embarc Benefit ProtectionSM program that improves care, access and affordability for potentially life-changing medicines that are extremely costly and 3) our Digital Health Formulary that helps clients and customers get the most value from innovative digital health products. Plan sponsors and participants can achieve the best health and financial outcomes when they use our comprehensive set of solutions to manage drug spend. We present the financial results of our businesses in the following segments: Health Services includes pharmacy benefits management, specialty pharmacy services, clinical solutions, home delivery and health management services. Integrated Medical offers a variety of health care solutions to employers and individuals. • The Commercial operating segment serves employers (also referred to as “clients”) and their employees (also referred to as “customers”) and other groups. This segment provides deeply integrated medical and specialty offerings including medical, pharmacy, behavioral health, dental, vision, health advocacy programs and other products and services to insured and self- insured clients. • The Government operating segment offers Medicare Advantage, Medicare Supplement, and Medicare Part D plans (including the acquired Express Scripts’ Medicare Part D business) for seniors, Medicaid plans and individual health insurance coverage both on and off the public exchanges. International Markets includes supplemental health, life and accident insurance products and health care coverage in our international markets as well as health care benefits to globally mobile employees of multinational organizations. Group Disability and Other contains the remainder of our business operations, consisting of the following: • Group Disability and Life provides group long-term and short-term disability, group life, accident, voluntary and specialty insurance products and related services. • Corporate-Owned Life Insurance (“COLI”) offers permanent insurance contracts sold to corporations to provide coverage on the lives of certain employees for financing employer-paid future benefit obligations. • Run-off businesses: • Reinsurance: predominantly comprised of guaranteed minimum death benefit (“GMDB”) and guaranteed minimum income benefit (“GMIB”) business effectively exited through reinsurance with Berkshire Hathaway Life Insurance Company of Nebraska (“Berkshire”) in 2013. • Settlement Annuity business in run-off. • Individual Life Insurance and Annuity and Retirement Benefits Businesses: comprised of deferred gains from the sales of these businesses. Other Information The financial information included in this Form 10-K for the fiscal year ended December 31, 2019 is in conformity with accounting principles generally accepted in the United States of America (“GAAP”) unless otherwise indicated. In the segment discussions that follow, we use the terms “adjusted revenues” and “pre-tax adjusted income from operations” to describe segment results. See the introduction to the Management Discussion and Analysis section of this Form 10-K for definitions of those terms. Industry rankings and percentages set forth herein are for the year ended December 31, 2019 unless otherwise indicated. In addition, statements set forth in this document concerning our rank or position in an industry or particular line of business have been developed internally based on publicly available information unless otherwise noted. 2


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    Cigna Holding Company (formerly Cigna Corporation) was incorporated in Delaware in 1981. Halfmoon Parent, Inc. was incorporated in Delaware in March 2018. Halfmoon Parent, Inc. was renamed Cigna Corporation concurrent with the consummation of the combination with Express Scripts on December 20, 2018. You can access our website at http://www.cigna.com to learn more about our company. We make annual, quarterly and current reports and proxy statements and amendments to those reports available, free of charge through our website (http://www.cigna.com, under the “Investors—Quarterly Reports and SEC Filings” captions) as soon as reasonably practicable after we electronically file these materials with, or furnish them to, the Securities and Exchange Commission (the “SEC”). We also use our website as a means of disclosing material information and for complying with our disclosure obligations under the SEC’s Regulation FD (Fair Disclosure). Important information, including news releases, analyst presentations and financial information regarding Cigna is routinely posted on and accessible at http://www.cigna.com. Accordingly, investors should monitor the Investor Relations portion of our website, in addition to following our press releases, SEC filings and public conference calls and webcasts. The information contained on, or that may be accessed through, our website is neither incorporated by reference into nor a part of this report. See also “Code of Ethics and Other Corporate Governance Disclosures” in Part III, Item 10 of this Form 10-K for additional information regarding the availability of our Codes of Ethics on our website. HEALTH SERVICES This segment consists of pharmacy benefit management, home delivery and specialty pharmacy and certain health management services. In 2019, Health Services reported adjusted revenues of $96.4 billion and pre-tax adjusted income from operations of $5.1 billion. HOW WE WIN • Creating innovative solutions that improve patient outcomes and control costs • Evaluating medicines for efficacy, value and price to assist clients in selecting a cost-effective formulary • Offering home delivery and specialty services that save money for clients and customers, while providing better and specialized clinical care • Leveraging purchasing volume to deliver discounts and drive risk-sharing and value-based care across the pharmaceutical supply chain • Promoting the use of generics and lowest-cost, clinically effective brands of medications 3


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    The following chart depicts a high-level summary of our principal products and services in this segment with definitions on subsequent pages. Principal Products & Brands/ Key Relationships Primary Competitors Services Subsidiaries Accredo®, Therapeutic Independent Pharmacy Benefit Resource Centers®, Express Managers (“PBMs”), Managed Care Pharmacy Dispensing Clients, Customers, Providers Scripts Pharmacy SM, Cigna PBMs, Retail Pharmacies, Specialty Home Delivery Pharmacy Pharmacies Independent PBMs, Managed Care Supply Chain Express Scripts, Smart90®, PBMs, Third Party Benefit Administration and SmartShareRx®, Ascent Clients, Customers Administrators, Group Purchasing Management Health Services, Econdisc Organizations Health Connect 360SM, Advanced Utilization Independent PBMs, Managed Care Clinical Solutions Management, Express Scripts Clients, Customers PBMs, Third-Party Benefit Digital Health Formulary, Administrators Fraud, Waste & Abuse SafeGuardRx®, Express Value-Based Scripts Patient Independent PBMs, Managed Care Clients, Customers Programs AssuranceSM,Embarc Benefit PBMs Protection SM Health Care Providers, Clinics, Provider Services CuraScript SD® Specialty Drug Distributors Hospitals Health Plans, Third-Party Benefits Health Benefit Health Plans, Commercial and Administrators, Clinical Solutions eviCore Management Services Government Payors and Health Care Data Analytics Companies Principal Products & Services Pharmacy Benefit Management Services: Our services drive high-quality, cost-effective care through prescription drug utilization and cost management. We support our clients’ plan design selections to deliver balanced affordability, choice, simplicity and convenience. We focus our solutions to align with our clients’ needs across care, cost and service. As a result, we believe we deliver better outcomes, higher customer satisfaction and a more affordable prescription drug benefit. The home delivery pharmacy operations of our Health Services segment consist of eight order processing pharmacies, eight patient contact centers and four high- volume automated home delivery dispensing pharmacies located throughout the United States. Health Services’ home delivery dispensing pharmacies are located in Arizona, Indiana, Missouri and New Jersey. Health Services also has seven specialty home delivery pharmacies and 38 specialty branch pharmacies. • Pharmacy Dispensing: o Home Delivery Pharmacy Services: In addition to the order processing that occurs at our home delivery pharmacies, we operate several non-dispensing prescription processing facilities and customer contact centers. Our pharmacies provide greater safety and accuracy than retail pharmacies, convenient access to maintenance medications and better management of our clients’ drug costs through operating efficiencies. We are directly involved with the prescriber and customer through our home delivery pharmacies and our research shows that we achieve a higher level of generic substitutions, therapeutic interventions and better adherence than is achieved through retail pharmacy networks. o Specialty Pharmacy Services: Specialty medications are used primarily for the treatment of complex diseases. These medications are broadly characterized to include those with frequent dosing adjustments, intensive clinical monitoring, the need for customer training, specialized product administration requirements or medications limited to certain specialty pharmacy networks by manufacturers. Through a combination of assets and capabilities, we provide an enhanced level of predictable care and therapy management for customers taking specialty medications and increased visibility and improved outcomes for payors, as well as custom programs for biopharmaceutical manufacturers. Accredo Health Group (“Accredo”) is focused on dispensing injectable, infused, oral or inhaled drugs that require a higher level of clinical service and support than traditional pharmacies typically offer. Accredo supports successful outcomes for 4


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    customers and reduces waste for clients through specialty trained clinicians, a nationwide footprint, and a network of in- home nursing services, reimbursement and customer assistance programs and biopharmaceutical services. o Drug Claim Adjudication: We process drug claims for home delivery, specialty, or retail networks by integrating retail network pharmacy administration, benefit design consultation, drug utilization review, drug formulary management and pharmacy fulfillment services. We administer payments to retail networks and bill benefits costs to our clients through our end-to-end adjudication services. o Drug Utilization Review program: When pharmacies submit claims for prescription drugs to us, we review them electronically in real time for health and safety. We then alert the dispensing pharmacy of any detected issues. Clients may also choose to enroll in programs that result in communications about potential therapy concerns being sent to prescribers after the initial claim submission. • Supply Chain Administration and Management: o Retail Network Pharmacy Administration: We contract with retail pharmacies to provide prescription drugs to customers of the pharmacy benefit plans we manage. In the United States, Puerto Rico and the Virgin Islands, we negotiate with pharmacies to discount drug prices provided to customers and manage national and regional networks responsive to client preferences related to cost containment, convenience of access for customers and network performance. We also manage networks of pharmacies customized for or under direct contract with specific clients and have contracted with pharmacy provider networks to comply with the Center for Medicare and Medicaid Services (“CMS”) access requirements for the federal Medicare Part D prescription drug program (“Medicare Part D”). All retail pharmacies in our network communicate with us online and in real-time to process prescription drug claims. When a plan customer presents their identification card at a network pharmacy, the pharmacy sends specific customer, prescriber and prescription information in an industry-standard format through our systems, which process the claim and respond to the pharmacy with relevant information to process the prescription. o Benefits Design Consultation: We consult with our clients on how best to structure and leverage the pharmacy benefit to meet plan objectives for affordable access to the prescription medications people need to stay healthy, and ensure the safe and effective use of those medications. o Drug Formulary Management: Formularies are lists of drugs with designations that may be used to determine drug coverage, customer out-of-pocket costs and communicate plan preferences in competitive drug categories. Our formulary management services support clients in establishing formularies that assist customers and physicians in choosing clinically-appropriate, cost-effective drugs and prioritize access, safety and affordability. We administer specific formularies on behalf of our clients, including standard formularies developed and offered by Express Scripts and custom formularies in which we play a more limited role. Most of our clients select standard formularies, governed by our National Pharmacy & Therapeutics Committee comprised of a panel of independent physicians and pharmacists in active clinical practice representing a variety of specialties and practice settings, typically with major academic affiliations. In making formulary recommendations, this committee considers only the drug’s safety and efficacy and not the cost of the drug, including any negotiated manufacturer discount or rebate arrangement. This process is designed to ensure the clinical recommendation is not affected by our financial arrangements. We fully comply with this committee’s clinical recommendations regarding drugs that must be included or excluded from the formulary based on their assessment of safety and efficacy. o Administration of Group Purchasing Organizations: Express Scripts operates various group purchasing organizations that negotiate pricing for the purchase of pharmaceuticals, fees and formulary rebates with pharmaceutical manufacturers on behalf of their participants. They also provide various administrative services to their participants including management and reporting. • Clinical Solutions: We offer innovative clinical programs to help our clients drive better health outcomes at a lower cost by identifying and addressing potentially unsafe or wasteful prescribing, dispensing and use of prescription drugs and communicating with, or supporting communications with, physicians, pharmacies and customers. o Our Health Connect 360 SM offering is a transformational, outcomes based clinical management program that bridges pharmacy, medical, lab and patient engagement data to develop insights and deliver personalized health care interventions. Clinical outcomes and quality metrics are tailored to client needs and guaranteed. o Through the Express Scripts Digital Health FormularySM offering, we evaluate digital health solutions available on the market, providing a list to clients of solutions that provide clinical effectiveness, data security, user-friendly experience and financial value. o Advanced Utilization Management programs are the number-one tool for decreasing client spend on pharmacy. These include prior authorization, drug quantity management, step therapy and preferred specialty management. o Enhanced Fraud, Waste & Abuse is an investigative service program that helps plan sponsors identify potential problem customers and prescribers with unusual or excessive utilization patterns. The program is designed to help identify outliers and situations of abnormal use or prescribing patterns by analyzing types of prescriptions, refill patterns and pharmacy utilization. 5


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    Other solutions include RationalMed®, ScreenRx®, ExpressAlliance®, Advanced Opioid Management®, and OnePASM offerings, as well as Medication Therapy and Medical Benefit Drug Management. • Value-Based Programs: o SafeGuardRx®: We offer a solution platform aimed at therapy classes that pose significant budgetary threats and clinical challenges to patients. Our solutions are designed to keep our clients ahead of the cost curve while providing customers the personalized care and access they need. These solutions are offered throughout our pharmacy benefit management services and include, but are not limited to care for: cardiovascular, diabetes, hepatitis, inflammatory conditions, migraine, multiple sclerosis, oncology, pulmonary, and rare conditions. Innovative programs, such as our SafeGuardRx program, combine utilization management controls with formulary management, the specialized care model of our Therapeutic Resource Center® program and comprehensive guarantees, and help us to change the market in key categories. Through our Therapeutic Resource Center® offering, we provide caring for customers with the most complex and costly chronic conditions including cardiovascular disease, diabetes, cancer, HIV, asthma, depression and other rare and specialty conditions. These services optimize the safe and appropriate dispensing of therapeutic agents, minimize waste and improve clinical and financial outcomes. Through these services, specialist pharmacists provide the expert, personalized care that customers increasingly demand. Notably, our programs covering oncology and inflammatory conditions have introduced a value-based contracting approach with payments now tied to a product’s effectiveness. o Patient Assurance ProgramSM: This program addresses the need for greater affordability and access to insulin by providing a fixed out-of-pocket cost to customers in non-government funded benefit plans. o Embarc Benefit ProtectionSM: This program combines health benefit management, health services and specialty pharmacy capabilities to make emerging gene therapy treatments more affordable for the payor, the employer and the patient. • Provider Services: CuraScript SD is a specialty distributor of pharmaceuticals and medical supplies (including injectable and infusible pharmaceuticals and medications to treat specialty and rare or orphan diseases) directly to health care providers, clinics and hospitals in the United States for office or clinic administration. Through this business, we provide distribution services primarily to office and clinic-based physicians who treat customers with chronic diseases and regularly order costly specialty pharmaceuticals. This business provides competitive pricing on pharmaceuticals and medical supplies, operates three distribution centers and ships most products overnight within the United States; it also provides distribution capabilities to Puerto Rico and Guam. It is a contracted supplier with most major group purchasing organizations and leverages our distribution platform to operate as a third-party logistics provider for several pharmaceutical companies. • Health Benefit Management Services: eviCore is a leading provider of integrated health benefit management solutions that focus on driving adherence to evidence-based guidelines, improving the quality of patient outcomes and reducing the cost of care for our clients. eviCore manages: diagnostic imaging, comprehensive musculoskeletal disorders, sleep disorders, post- acute care, genetic lab, specialty pharmacy and medical oncology. eviCore contracts with health plans and other commercial and government payors to promote the appropriate use of health care services by the customers they serve. In certain instances, this occurs through capitated risk arrangements, when we assume the financial obligation for the cost of health care services provided to eligible customers covered by eviCore health care management programs. Customers • Clients: We provide services to managed care organizations, health insurers, third-party administrators, employers, union- sponsored benefit plans, workers’ compensation plans, government health programs, providers, clinics, hospitals and others. • Patients: Prescription drugs are dispensed to patients connected to the service offerings we provide to clients. Prescription drugs are dispensed primarily through networks of retail pharmacies under non-exclusive contracts with us and through our home delivery and specialty drug fulfillment pharmacies. The Department of Defense’s TRICARE® Pharmacy Program is the military health care program serving active-duty service customers, National Guard and Reserve customers and retirees, as well as their dependents. Under this contract, we provide online claims adjudication, home delivery services, specialty pharmacy clinical services, claims processing and contact center support and other services critical to managing pharmacy trend. In 2019, revenues from this contract were significant to the segment. On January 30, 2019, Anthem, Inc. (“Anthem”) exercised its right to early termination of its pharmacy benefit management services agreement, effective March 1, 2019. As of December 31, 2019, the transition of customers is substantially complete. For further discussion of our Anthem relationship, see the “Executive Summary – Key Transactions and Business Developments” section of our MD&A located in Part II, Item 7 of the Form 10-K. In 2019, Anthem revenues were significant to the segment. In December 2019, Express Scripts and Prime Therapeutics LLC (“Prime”) announced a three-year agreement designed to deliver care for Prime’s clients and their patients by enhancing pharmacy networks and pharmaceutical manufacturer value. 6


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    Competition The health care industry has undergone periods of substantial consolidation and may continue to consolidate in the future. We believe the primary competitive factors in the industry include the ability to: negotiate with retail pharmacies to ensure our retail pharmacy networks meet the needs of our clients and customers; provide home delivery and specialty pharmacy services; negotiate discounts and rebates on prescription drugs with drug manufacturers; navigate the complexities of government-reimbursed business including Medicare, Medicaid and the public exchanges; manage cost and quality of specialty drugs; use the information we obtain about drug utilization patterns and consumer behavior to reduce costs for our clients and customers and the level of service we provide. • Managed Care PBMs: CVS Caremark (owned by CVS Health Corporation), Envision Rx (owned by Rite Aid Corporation), Humana, IngenioRx (owned by Anthem), Optum (owned by UnitedHealth Group Inc.) and Prime Therapeutics (owned by a collection of Blue Cross / Blue Shield Plans) compete with us on a variety of products and in various regions throughout the United States. • Independent PBMs: MedImpact and Navitus Health Solutions compete with us on a variety of products and in various regions throughout the United States. • Retail Pharmacies: CVS Caremark, Walgreens Boots Alliance, Inc. and WalMart, Inc. • Third-Party Benefits Administrators: Third parties that specialize in claim adjudication and benefit administration, such as Argus, are direct competitors. With the emergence of alternative benefit models through Private Exchanges, the competitive landscape also includes brokers, health plans and consultants. Some of these competitors may deploy greater financial, marketing and technological resources than we do and new market entrants, including strategic alliances aimed at modifying the current health care delivery models or entering the prescription drug sector from another sector of the health care industry, may increase competition as barriers to entry are relatively low. • Clinical Solutions and Health Care Data Analytics Companies: OptumRx (owned by UnitedHealth Group Inc.), Anthem, Magellan Health, HealthHelp, Cotiviti, and Inovalon are among the companies that compete with us in this market. Operations • Sales and Account Management: Our sales and account management teams market and sell pharmacy benefit management solutions and are supported by client service representatives, clinical pharmacy managers and benefit analysis consultants. These teams work with clients to develop innovative strategies that put medicine within reach of customers while helping health benefit providers improve access to and affordability of prescription drugs. • Supply Chain: Our supply chain contracting and strategy teams negotiate and manage pharmacy network contracts, pharmaceutical and wholesaler purchasing contracts and manufacturer rebate contracts. As our clients continue to experience increased cost trends, our supply chain teams develop innovative solutions such as our SafeGuardRx program and narrow networks to combat these cost increases. In addition, our Formulary Consulting team, consisting of pharmacists and financial analysts, provides services to our clients to support formulary decisions, benefit design consultation and utilization management programs. • Clinical Support: Our staff of highly trained health care professionals provides clinical support for our pharmacy benefit management and health benefit management services, including more specialized care for customers with select chronic and complex conditions. We operate condition-specific Therapeutic Resource Center facilities staffed with specialist pharmacists, nurses and other clinicians who provide personal and specialized customer care. Our clinical solutions staff of pharmacists and physicians provides clinical development and operational support for our pharmacy benefit management services. These health care providers conduct a wide range of activities including identifying emerging medication-related safety issues and alerting physicians, clients, and customers (as appropriate); providing drug information services; managing formulary; and developing utilization management, safety (drug utilization review) and other clinical interventions. Suppliers We maintain an inventory of brand-name and generic pharmaceuticals in our home delivery and specialty pharmacies. Our specialty pharmacies also carry biopharmaceutical products to meet the needs of our customers, including pharmaceuticals for the treatment of rare or chronic diseases; if a drug is not in our inventory, we can generally obtain it from a supplier within one business day. We purchase pharmaceuticals either directly from manufacturers or through authorized wholesalers. Health Services uses one wholesaler more than others in the industry, but holds contracts with other wholesalers if needs for an alternate source arise. Generic pharmaceuticals are generally purchased directly from manufacturers. 7


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    Industry Developments See the “Industry Developments” section of the MD&A in this Form 10-K for discussion of key industry developments impacting this segment. Intellectual Property Rights Our Company’s Health Services-related trademark and service marks include, but are not limited to, the following: EXPRESS SCRIPTS®, MEDCO®, ACCREDO®, CURASCRIPTSD®, EVICORE HEALTHCARE®, FREEDOM FERTILITY PHARMACY®, RATIONALMED®, SCREENRX®, EXPRESSALLIANCE®, THERAPEUTIC RESOURCE CENTER®, ADVANCED OPIOID MANAGEMENT®, SAFEGUARDRX®, CARDIOVASCULAR CARE VALUESM, HEPATITIS CURE VALUESM, MARKET EVENTS PROTECTIONSM, ONCOLOGY CARE VALUESM, DIABETES CARE VALUESM, INFLAMMATORY CONDITIONS CARE VALUESM, INFLATION PROTECTIONSM, PULMONARY CARE VALUESM, MULTIPLE SCLEROSIS CARE VALUESM, HEALTH CONNECT 360SM, EMBARC BENEFIT PROTECTIONSM, EXPRESS SCRIPTS PATIENT ASSURANCESM and INSIDE RX®. We, or our affiliated companies, own trademark registrations for these and other company marks. Other names and marks referenced herein are the property of their respective owners. We also hold a portfolio of patents and pending patent applications. We are not substantially dependent on any single patent or group of related patents. INTEGRATED MEDICAL Integrated Medical consists of a Commercial operating segment that includes our employer-sponsored medical coverage and a Government operating segment that includes Medicare offerings for seniors and individual insurance offerings both on and off the public health insurance exchanges. In 2019, Integrated Medical reported adjusted revenues of $36.5 billion and pre-tax adjusted income from operations of $3.8 billion. HOW WE WIN • Broad and deep portfolio of solutions across Commercial and Government operating segments • Commitment to highest-quality health outcomes and customer experiences • Collaborative physician engagement models emphasizing value over volume of services • Integrated benefit solutions that deliver value for our customers, clients and partners • Technology and data analytics powering actionable insights and affordable, predictable solutions • Talented and caring people embracing change and putting customers at the center of all we do We differentiate ourselves by providing innovative, personalized, and affordable health care benefit solutions based on the unique needs of the individuals and clients we serve. We increase value through our integrated approach and use of technology and data analytics to enhance patient engagement and health care outcomes, underscoring our strategic focus on delivering an industry-leading customer experience. We continue to strengthen our collaborative relationships with providers as we accelerate our transition to a value-based reimbursement system. We offer a mix of core health insurance products and services to employers, other groups and individuals along with specialty products and services designed to improve the quality of care, lower cost and help customers achieve better health outcomes. Many of these products are available on a standalone basis, but we believe they create additional value when integrated with a Cigna- administered health plan. Our products are available through several distribution channels including brokers, direct sales and public and private exchanges. Our three funding solutions (i.e., insured – experience-rated (“ER”), insured – guaranteed cost (“GC”), and administrative services only (“ASO”) arrangements) enable us to customize the amount of risk taken by, and lower costs for, our customers and clients. 8


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    The following chart depicts a high-level summary of our principal products and services in this segment, with definitions on subsequent pages. Principal Primary Major Funding Market Primary Products & Geography Distribution Brand(s) Solution(s) Segment(s) Competitors Services Channel(s) Commercial Medical National Insurers, Local Healthplans, Cigna Managed Care Nationwide Third-Party HealthCare Administrators (“TPAs”) Preferred Provider Brokers, Private National Insurers, Cigna Nationwide GC, ER, ASO Commercial Organization Exchanges, Direct TPAs (“PPO”) National Insurers, Local Health Consumer- Cigna Nationwide Maintenance Driven Organizations (“HMOs”) Government Medical Local Healthplans, Individual and Public and Private Cigna Connect 9 states(1) GC Individual Start-ups, National Family Plans Exchanges Insurers 16 states(2) & Medicare National Insurers, Cigna District of GC Government Direct, Brokers Advantage Local Healthplans Columbia Medicare Stand Cigna, Express Scripts Nationwide GC Government Direct, Brokers National Insurers –Alone PDPs 48 states(3) & Medicare Brokers, Direct, Cigna District of GC Government National Insurers Supplement Private Exchanges Columbia Specialty Products and Services National Insurers, Stop-Loss Cigna Nationwide GC Commercial Brokers, Direct Specialty Companies Cost- National Insurers, Cigna Nationwide GC, ER, ASO Commercial Direct Containment Specialty Companies Consumer Commercial, National Insurers, Health Cigna Nationwide GC, ER, ASO Brokers, Direct Government Specialty Companies Engagement Pharmacy Commercial, Cigna Nationwide GC, ER, ASO Brokers, Direct National PBMs Management Government Cigna Behavioral National Insurers, Behavioral Nationwide GC, ER, ASO Commercial Brokers, Direct Health Specialty Companies Health Cigna Dental GC, ER, ASO Commercial, Dental Insurers, Dental Nationwide Brokers, Direct HealthCare Government National Insurers (1) AZ, CO, FL, IL, MO, NC, TN, TX, VA (2) AL, AZ, AR, DE, FL, GA, IL, KS, MD, MS, MO, NC, PA, SC, TN, TX (3) All states except MA and NY 9


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    Principal Products & Services Commercial Medical • Managed Care Plans are offered through our insurance companies, HMOs and TPA companies. HMO, LocalPlus®, Network Open Access and Open Access Plus plans use meaningful cost-sharing incentives to encourage the use of “in- network” versus “out-of-network” health care providers. The national provider network for Managed Care Plans is somewhat smaller than the national network used with the PPO plan product line. • PPO Plans feature a network with broader provider access than the Managed Care Plans. • Consumer-Driven Products are typically paired with a high-deductible medical plan and offer customers a tax-advantaged way to pay for eligible health care expenses. These products, consisting of health savings accounts, health reimbursement accounts and flexible spending accounts, encourage customers to play an active role in managing their health and health care costs. Government Medical • Individual and Family Plans feature an insurance policy coupled with a network of health care providers in a geographic area who have been selected with cost and quality in mind. • Medicare Advantage Plans allow Medicare-eligible beneficiaries to receive health care benefits, including prescription drugs, through a managed care health plan such as our coordinated care plans. Our Medicare Advantage Plans are primarily HMO plans marketed to individuals. A significant portion of our Medicare Advantage customers receive medical care from our value-based models that focus on developing highly engaged physician networks, aligning payment incentives to improved health outcomes and using timely and transparent data sharing. • Medicare Stand-Alone Prescription Drug Products provide a number of prescription drug plan options, as well as service and information support, to Medicare and Medicaid eligible customers. Our stand-alone plans offer the savings of Medicare combined with the flexibility to provide enhanced benefits and a drug list tailored to an individual’s specific needs. Eligible beneficiaries benefit from broad network access and value-added services intended to promote wellness and affordability for our eligible beneficiaries. • Medicare Supplement Plans provide Medicare-eligible beneficiaries with federally standardized Medigap-style plans. Beneficiaries may select among the various plans with specific plan options to meet their unique needs and may visit, without the need for a referral, any health care provider or facility that accepts Medicare throughout the United States. Specialty Products and Services • Stop-Loss insurance coverage is offered to self-insured clients whose group health plans are administered by Cigna. Stop- loss insurance provides reimbursement for claims in excess of a predetermined amount for individuals, the entire group, or both. • Cost-Containment Programs are designed to contain the cost of covered health care services and supplies. These programs reduce out-of-network utilization and costs, protect customers from balance billing and educate customers regarding the availability of lower cost in-network services. In addition, under these programs we negotiate discounts with out-of-network providers, review provider bills and recover overpayments. We charge fees for providing or arranging for these services. These programs may be administered by third-party vendors that have contracted with Cigna. • Consumer Health Engagement services are offered to customers covered under plans administered by Cigna or by third-party administrators. These services consist of an array of health management, disease management and wellness services. Our Medical Management programs include case, specialty and utilization management and a Health Information line. Our Health Advocacy program services include early intervention in the treatment of chronic conditions and an array of health and wellness coaching. Additionally, we administer incentives programs designed to encourage customers to engage in health improvement activities. • Pharmacy Management services and benefits can be combined with our medical offerings. The comprehensive suite of pharmacy management services available to clients and customers includes benefits management, specialty pharmacy services, clinical solutions, home delivery and certain health management services. • Behavioral Health services consist of behavioral health care case management, employee assistance programs (“EAP”) and work/life programs. We focus on integrating our programs and services with medical, pharmacy and disability programs to facilitate customized, holistic care. 10


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    • Dental solutions include dental health maintenance organization plans, dental preferred provider organization plans, exclusive dental provider organization plans, traditional dental indemnity plans and a dental discount program. Employers and other groups can purchase our products on either an insured or self-insured basis as standalone products or in conjunction with medical products. Additionally, individual customers can purchase insured dental preferred provider organization plans as standalone products or in conjunction with individual medical policies. Funding Solutions • ASO. Plan sponsors (i.e., employers, unions and other groups) self-fund all claims, but may purchase stop-loss insurance to limit exposure. We collect fees from plan sponsors for providing access to our participating provider network and for other services and programs including: claims administration; behavioral health services; disease management; utilization management; cost containment; dental and pharmacy benefit management. Approximately 85% of our commercial medical customers are in ASO arrangements. • Experience-rated Insurance. Premium rates are established at the beginning of a policy period and are typically based on prior claim experience of the policyholder. When claims and expenses are less than the premium charged (an “experience surplus” or “margin”), the policyholder may be credited for a portion of this experience surplus or margin. If claims and expenses exceed the premium charged (an “experience deficit”), we bear these costs. In certain cases, experience deficits incurred while the policy is in effect are accumulated and may be recovered through future policy year experience surpluses or margins. Approximately 6% of commercial medical customers are in experience-rated arrangements. • Guaranteed Cost Insurance. Premium rates are established at the beginning of a policy period and, depending on group size, may be based in whole or in part on prior experience of the policyholder or on a pool of similar policyholders. We generally cannot subsequently adjust premiums to reflect actual claim experience until the next annual renewal. The policyholder does not participate, or share in, actual claim experience. We keep any experience surplus or margin if costs are less than the premium charged (subject to minimum medical loss ratio rebate requirements discussed below) and bear the risk for actual costs in excess of the premium charged. Approximately 9% of commercial medical customers are in guaranteed cost arrangements. In most states, individual and group insurance premium rates must be approved by the applicable state regulatory agency (typically department of insurance) and state or federal laws may restrict or limit the use of rating methods. Premium rates for groups and individuals are subject to state review to determine whether they are adequate, not excessive and not unfairly discriminatory. In addition, the Patient Protection and Affordable Care Act (“ACA”) subjects individual and small group policy rate increases above an identified threshold to review by the United States Department of Health and Human Services (“HHS”) and requires payment of premium refunds on individual and group medical insurance products if minimum medical loss ratio (“MLR”) requirements are not met. The MLR represents the percentage of premiums used to pay medical claims and expenses for activities that improve the quality of care. In our individual business, premiums may also be adjusted as a result of the government risk adjustment program that accounts for the relative health status of our customers. See the “Business - Regulation” section of this Form 10-K for additional information about commercial MLR requirements and risk mitigation programs of the ACA. Market Segments • Commercial comprises employers from the following market segments: o National. Multistate employers with 5,000 or more U.S.-based, full-time employees. We offer primarily ASO funding solutions in this market segment. o Middle Market. Employers generally with 500 to 4,999 U.S.-based, full-time employees. This segment also includes single-site employers with more than 5,000 employees and Taft-Hartley plans and other groups. We offer ASO, experience-rated and guaranteed cost insured funding solutions in this market segment. o Select. Employers generally with 51-499 eligible employees. We usually offer ASO with stop-loss insurance coverage and guaranteed cost insured funding solutions in this market segment. o Small Group Employers generally with 2-50 eligible employees. Pending regulatory approvals, we expect to launch a small group offering in select markets in 2020 with a strategic partner. • Individual. Consistent with the regulations for Individual ACA compliant plans, we offer only guaranteed cost plans in this market segment. • Government includes individuals who are Medicare-eligible beneficiaries, as well as employer group sponsored pre- and post-65 retirees. We also have dual-eligible customers who receive both Medicare and Medicaid benefits. We receive revenue from the Centers for Medicare and Medicaid Services (“CMS”) based on customer demographic data and health risk factors. In 2019, revenues from CMS were significant to the segment. 11


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    Primary Distribution Channels • Brokers. Sales representatives distribute our products and services to a broad group of insurance brokers and consultants across the United States. • Direct. Cigna sales representatives distribute our products and services directly to employers, unions and other groups or individuals across the United States. Various products may also be sold directly to insurance companies, HMOs and third- party administrators. This may take the form of in-person contact, telephone or group selling venues. • Private Exchanges. We partner with select companies that have created private exchanges where individuals and organizations can acquire health insurance. We actively evaluate private exchange participation opportunities as they emerge in the market and target our participation to those models that best align with our mission and value proposition. • Public Exchanges. Public health insurance exchanges for ACA compliant plans on which Cigna may offer individual policies. Competition The primary competitive factors affecting our business are quality and cost effectiveness of service and provider networks; effectiveness of medical care management; products that meet the needs of employers and their employees; total cost management; technology; and effectiveness of marketing and sales. Financial strength, as indicated by ratings issued by nationally recognized rating agencies, is also a competitive factor. Our health advocacy capabilities, holistic approach to consumer engagement, breadth of product offerings, clinical care and health management capabilities and array of product funding options are competitive advantages. We believe our focus on improving the health, well-being and peace of mind of those we serve, and how we deliver better affordability, predictability and simplicity in health care will allow us to further differentiate ourselves. • National Insurers. United HealthGroup Inc., Aetna Inc. (owned by CVS Health Corporation), Anthem, Humana and Blue Cross Blue Shield plans compete with us in a variety of products and regions throughout the United States. • Local Healthplans. Blue Cross Blue Shield plans, local affiliates of major insurance companies and hospitals and regional stand-alone managed care and specialty companies compete with us in the states in which we offer managed care products. Additionally, plan sponsors may contract directly with providers. • TPAs. Third-party administrators compete with us for ASO business. • Start-ups. Emerging participants including alternative health service models, consortiums and other health plans seeking to disrupt, often through competitive technology. • Dental Insurers. Various companies offering primarily dental insurance compete with us on these products. • Specialty Companies. Specialty insurance or service companies that offer niche products and services compete with us. Partnering to Deliver on the Promise of More Affordable, Predictable, Simple Health Care Cigna’s Connected Care strategy engages customers in their health, collaborates with providers to help them improve their performance, and connects customers and providers through aligned health goals, incentives and actionable information to enable better decisions and outcomes. Our delivery strategy is designed to ensure our customers have access to the right care and in the preferred and appropriate setting at the right time. Fueled by advanced insights and predictive analytics, Cigna is committed to developing innovative solutions that span the health care delivery system and can be applied to different types of providers. Currently we have numerous collaborative arrangements with our participating health care providers that reach 3.9 million customers and are actively developing new arrangements to support our Connected Care strategy. • Accountable Care Program. We have 257 collaborative care arrangements with primary care groups built on the patient-centered medical home and accountable care organization (“ACO”) models. Our arrangements span more than 34 states and reach over 3 million customers. We are committed to increasing the number of groups over the next several years, as well as deepening existing relationships, with a goal of reaching over 270 programs by the end of 2020. • Hospital Quality Program. We have contracts with over 500 hospitals with reimbursements tied to quality metrics. We expect to grow this number to over 600 hospitals by the end of 2020. • Specialist Programs. We have 290 arrangements with specialist groups in value-based reimbursement arrangements. Our goal is to reach approximately 380 arrangements by the end of 2020. Programs include nationwide arrangements with several types of specialist groups including orthopedics, obstetrics and gynecology, cardiology, gastroenterology, oncology, nephrology and neurology. Arrangements include care coordination and episodes of care reimbursements for meeting cost and quality goals. • Independent Practice Associations. We have value-based physician engagement models in our Medicare Advantage business that allow physician groups to share financial outcomes with us. This clinical model also includes outreach to new and at-risk patients to ensure they are accessing their primary care physician. 12


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    • Participating Provider Network. We provide our customers with an extensive network of participating health care providers, hospitals and other facilities, pharmacies and providers of health care services and supplies. In most instances, we contract with them directly; however, in some instances, we contract with third parties for access to their provider networks and care management services. In addition, we have entered into strategic alliances with several regional managed care organizations (e.g., Tufts Health Plan, HealthPartners, Inc., Health Alliance Plan and MVP Health Plan) to gain access to their provider networks and discounts. INTERNATIONAL MARKETS Cigna’s International Markets segment has operations in over 30 countries or jurisdictions providing a full range of comprehensive medical and supplemental health, life, and accident benefits to individuals and employers. Products and services include comprehensive health coverage, hospitalization, dental, critical illness, personal accident, term life, and variable universal life. In 2019, International Markets reported adjusted revenues of $5.6 billion and pre-tax adjusted income from operations of $762 million. HOW WE WIN • Offering a broad range of health and protection-related solutions to meet the needs of the growing middle class and globally mobile • Leveraging deep consumer insights to drive product and service innovation • Maintaining leading innovative, direct-to-consumer distribution capabilities • Providing access to quality, affordable care through one of the largest global provider networks • Implementing locally-licensed and compliant solutions managed by strong, locally-developed talent Demand for our products and services is driven by the growing global middle class, aging populations, increasing prevalence of chronic conditions and rising global health care costs. Our focus on product and service innovation means we continue to deliver solutions that meet the evolving needs of individual and group customers. Our products, distribution channels and funding sources range by customer and geography. 13


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    International Markets is well positioned to address the growing demand for access to quality, affordable care and supplemental health and life protection that fill gaps in public and private care. We distinguish ourselves through differentiated direct-to-consumer distribution, customer insights, product innovation, a leading provider network and compliant solutions. We identify and pursue attractive market opportunities to bring health and protection solutions and tailor those solutions to the market and customer needs. Over the past several years, we have extended our product offerings and geographic reach. The chart below provides a high-level summary of our principal products and services in this segment with definitions on subsequent pages. Primary Principal Products Major Funding Primary Geography Key Relationships Distribution & Services Brand(s) Solution(s) Competitors Channel(s) Multinational Cigna Global Companies, Inter- Health Worldwide governmental and Brokers, Global insurers Global Health Benefits (except as limited Non-governmental ER, GC, ASO Agents, Direct- Care by applicable Organizations to-Consumer Cigna Global law) IPMI Globally mobile individuals Cigna United Kingdom, Employer Groups Brokers, Global insurers and Local Health Spain, Hong ManipalCigna ER, GC, ASO Agents, Direct- local non-U.S. Care Kong, India, Individuals to-Consumer insurers China, Singapore CignaCMB Cigna LINA Korea Affinity, Supplemental Bancassurance, Global insurers and Asia Pacific, Health, Life, & CignaCMB GC Individuals Brokers, local non-U.S. India, Turkey Accident Agents, Direct- insurers ManipalCigna to-Consumer CignaFinans Principal Products & Services Global Health Care products and services include insurance and administrative services for medical, dental, pharmacy, vision and life, accidental death and dismemberment and disability risks. We are leading providers of products and services that meet the needs of multinational employers, intergovernmental and nongovernmental organizations and globally mobile individuals with a focus on keeping employees healthy and productive. The employer benefits products and services are offered through guaranteed cost, experience-rated and administrative services only funding solutions, while individuals purchase guaranteed cost coverage. For definitions of funding solutions, see “Funding Solutions” in the “Integrated Medical” description of business section of this Form 10-K. Local Health Care products and services include medical, dental, pharmacy and vision as well as life coverage. The customers of local health care businesses are employers and individuals located in specific countries where the products and services are purchased. These employer services can similarly be funded through a range of options; individuals purchase on a guaranteed cost basis. Supplemental Health, Life and Accident Insurance products and services generally provide simple, affordable coverage of risks for the health and financial security of individuals. Supplemental health products provide stated benefit payments for certain specified health risks and include personal accident, accidental death, critical illness, hospitalization, travel, dental, dementia, cancer and other dread disease coverages. We also offer customers term and variable universal life insurance and certain savings products in select markets. 14


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    Competition We anticipate that the competitive environment will intensify as insurance and financial services providers more aggressively pursue expansion opportunities across geographies, particularly Asia. We believe competitive factors will include speed-to-market, customer insights, branding, product, distribution and service innovation, underwriting and pricing, efficient management of marketing and operating processes, commission levels paid to distribution partners, the quality of compliance functions, claims, network coverage and medical cost management, and talent acquisition and retention. Additionally, in most overseas markets, perception of commitment to the market and financial strength will likely be an important competitive factor. Pricing and Reinsurance Premium rates and fees for our global and local health care products reflect assumptions about future claims, expenses, customer demographics, investment returns and profit margins. For products using networks of contracted health care providers and facilities, premiums reflect assumptions about the impact of these contracts and utilization management on future claims. Most contracts permit rate changes at least annually. The profitability of health care products is dependent upon the accuracy of projections for health care inflation (unit cost, location of delivery of care, currency of incurral and utilization), customer demographics, the adequacy of fees charged for administration and effective medical cost management. Premium rates for our supplemental benefits products are based on assumptions about mortality, morbidity, customer acquisition and retention, customer demographics, expenses and capital requirements, as well as interest rates. Variable universal life insurance products fees consist of mortality, administrative, asset management and surrender charges assessed against the contractholder’s fund balance. Mortality charges on variable universal life may be adjusted prospectively to reflect expected mortality experience. Most contracts permit premium rate changes at least annually. A global approach to underwriting risk management allows each local business to underwrite and accept risk within specified limits. Retentions are centrally managed through cost-effective use of external reinsurance to limit our liability on per life, per risk and per event (catastrophe) bases. Industry Developments and Other Items Affecting International Markets South Korea represents our single largest geographic market for International Markets. For information on this concentration of risk for the International Markets segment's business in South Korea, see "Other Items Affecting Results of International Markets" in the International Markets section of the MD&A of this Form 10-K. Pressure on social health care systems, a rapidly aging population and increased wealth and education in developing insurance markets are leading to higher demand for health insurance and financial security products. In the supplemental health, life and accident business, direct marketing channels continue to grow and attract new competitors with industry consolidation among financial institutions and other affinity partners. Data privacy regulation has tightened in all markets in the wake of high-profile data privacy incidents, impacting affinity partner and customer attitudes toward direct marketing of insurance and other financial services. It has also placed an added emphasis on the importance of operational compliance. 15


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    GROUP DISABILITY AND OTHER As explained further in the introduction to this Form 10-K, Group Disability and Other consists of our Group Disability and Life operating segment, along with COLI and certain run-off businesses reported together in Other Operations. In 2019, Group Disability and Other reported adjusted revenues of $5.2 billion and pre-tax adjusted income from operations of $501 million. In December 2019, Cigna entered into a definitive agreement to sell the Group Disability and Life business to New York Life Insurance Company for $6.3 billion. The sale is expected to close in the third quarter of 2020 subject to applicable regulatory approvals and other customary closing conditions. Until the transaction is finalized, we continue to operate our business as usual and serve our customers. HOW WE WIN • Disability absence management model that reduces overall costs to employers • Integration of disability products with medical and specialty offerings, promoting health and wellness and optimizing employee productivity • Complementary portfolio of group disability, life and accident offerings • Disciplined underwriting, pricing and investment strategies supporting profitable long-term growth Group Disability and Life Our Group Disability and Life operating segment includes our commercial long- and short-term disability products and our term life group insurance products. We also offer personal accident insurance and voluntary products and services. These products and services are distributed through brokers and direct sales and are available in guaranteed cost, experience-rated and ASO arrangements. The following chart depicts a high-level summary of our Principal Products and Services in this segment with definitions on subsequent pages. Primary Principal Products Premium Market Primary Payor Funding Solution(s) Distribution & Services Rates Segment(s) Competitors Channel(s) Group Disability Long-term Employer, Preset, National Insurers, ER, GC, ASO Commercial Brokers, Direct Disability Employee guaranteed Regional Insurers Short-term Employer, Preset, National Insurers, ER, GC, ASO Commercial Brokers, Direct Disability Employee guaranteed Regional Insurers Group Life Employer, Preset, National Insurers, Term Life ER, GC Commercial Brokers, Direct Employee guaranteed Regional Insurers Group Accident and Voluntary Personal Accident Employer, Preset, National Insurers, ER, GC Commercial Brokers, Direct Insurance Employee guaranteed Regional Insurers Voluntary Preset, National Insurers, Products and Employee GC Commercial Brokers, Direct guaranteed Regional Insurers Services Principal Products & Services Group Disability • Group Long-term and Short-term Disability insurance products generally provide a fixed level of income to replace a portion of wages lost due to disability. As part of our group disability insurance products, we also assist employees in returning to work and employers with resources to manage the cost of employee disability • Leave Administration solutions help customers effectively manage workforce absence and provide coverage for paid leave. 16


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    Group Life Insurance • Group Term Life insurance may be employer-paid basic life insurance, employee-paid supplemental life insurance or a combination thereof. Group Accident and Voluntary • Personal Accident Insurance coverage consists primarily of accidental death and dismemberment and travel accident insurance to employers. • Voluntary Products and Services include plans that provide employers with administrative solutions designed to provide a complete and simple way to manage their benefits program. These voluntary offerings include accidental injury insurance, critical illness coverage and hospital care coverage, and provide additional dollar payouts to employees for unexpected accidents, hospitalization or more serious illnesses. Pricing Premiums charged for disability and term life insurance products are usually established in advance of the policy period and are generally guaranteed for one to three years, but selectively guaranteed for up to five years. Policies are generally subject to termination by the policyholder or by the insurance company annually. Premium rates reflect assumptions about future claims, expenses, credit risk, investment returns and profit margins. These assumptions may be based in whole or in part on prior experience of the account or on a pool of accounts, depending on the group size and the statistical credibility of the experience that varies by product. Market Segments • Commercial. Commercial market segments are as follows: o National. Multistate employers with 5,000 or more U.S.-based, full-time employees. o Middle Market. Employers generally with 250 to 4,999 U.S.-based, full-time employees. o Select. Employers generally with up to 249 eligible employees. Primary Distribution Channels • Insurance Broker and Consultants. Sales representatives distribute our products and services to a broad group of insurance brokers and consultants across the United States. • Direct. Sales representatives distribute our products and services directly to employers, unions and other groups or individuals across the United States. This may take the form of in-person contact, telephone or group selling venues. Competition The principal competitive factors that affect the Group Disability and Life segment are underwriting and pricing, the quality and effectiveness of claims management, relative operating efficiency, investment and risk management, distribution methodologies and producer relations, the breadth and variety of products and services offered, the quality of customer service and, more importantly, the state of the tools and technology available for customers, clients, consultants and producers. For certain products with longer-term liabilities, such as group long-term disability insurance, the financial strength of the insurer, as indicated by ratings issued by nationally recognized rating agencies, is also a competitive factor. • National Insurers. Unum, The Hartford, Prudential Financial, Lincoln Financial Group and MetLife compete with us on a variety of products and regions throughout the United States. Industry Developments Employers have expressed a growing interest in employee wellness, absence management and productivity and recognize a strong link between employee health productivity and profitability. 17


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    The group insurance market remains highly competitive as the rising cost of medical coverage has forced companies to re-evaluate their overall employee benefit spending, resulting in lower volumes of group disability and life insurance business and more competitive pricing. Over the past few years, there has been heightened review by state regulators of the claims handling practices within the disability and life insurance industry. This has resulted in an increase in coordinated, multistate examinations that target specific market practices in addition to regularly recurring examinations of an insurer’s overall operations conducted by an individual state’s regulators. We have been subject to such an examination over the past several years. The lower level of interest rates in the United States over the last several years has constrained earnings growth in this segment due to lower yields on our fixed-income investments and higher benefit expenses resulting from the discounting of future claim payments at lower interest rates. Other Operations Other Operations includes the following: Corporate-owned Life Insurance The principal products of the COLI business are permanent insurance contracts sold to corporations to provide coverage on the lives of certain employees for financing employer-paid future benefit obligations. Permanent life insurance provides coverage that, when adequately funded, does not expire after a term of years. The contracts are primarily non-participating universal life policies. Fees for universal life insurance products consist primarily of mortality and administrative charges assessed against the policyholder’s fund balance. Interest credited and mortality charges for universal life and mortality charges on variable universal life may be adjusted prospectively to reflect expected interest and mortality experience. To reduce our exposure to large individual and catastrophe losses, we purchase reinsurance from unaffiliated reinsurers. Run-off Settlement Annuity Business Our settlement annuity business is a closed, run-off block of single premium annuity contracts. These contracts are primarily liability settlements with approximately 20% of the liabilities associated with guaranteed payments not contingent on survivorship. Non- guaranteed payments are contingent on the survival of one or more parties involved in the settlement. Run-off Reinsurance Our reinsurance operations are an inactive business in run-off. In February 2013, we effectively exited the guaranteed minimum death benefit (“GMDB”) and guaranteed minimum income benefit (“GMIB”) business by reinsuring 100% of our future exposures, net of retrocessional arrangements in place at that time, up to a specified limit. For additional information regarding this reinsurance transaction and the arrangements that secure our reinsurance recoverables, see Note 10 to the Consolidated Financial Statements. Individual Life Insurance and Annuity and Retirement Benefits Businesses This business includes deferred gains recognized from the 1998 sale of the individual life insurance and annuity business and the 2004 sale of the retirement benefits business. For more information regarding the arrangements that secure our reinsurance recoverables for the retirement benefits business, see Note 10 to the Consolidated Financial Statements. TECHNOLOGY Cigna Technology Services supports our business strategy by focusing first and foremost on strong foundational technology services, delivery of a business-aligned technology project portfolio and focused strategic innovation that creates technology solutions to differentiate us in the market. Our innovation continues to focus on three strategic areas: insights and analytics; digital health and care delivery and management. Our technology strategy drives improved customer experience, increases engagement and advances population health with data driven insights and using advanced analytics and predictive intelligence to provide key areas of competitive advantage. Innovation is core to the way we do business and will be a critical factor to our success in the highly dynamic health care industry. Our business strategy is based upon providing customers with differentiated, easy-to-use, seamless and secure products and solutions that use insights from advanced analytics to exceed their expectations. 18


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    Our technology team, powered by approximately 7,000 employees and several thousand external resources contracted with our partners, supports the various information systems essential to our operations including the health benefit claims processing systems and specialty and home delivery pharmacy systems. Uninterrupted point-of-sale electronic retail pharmacy claims processing is a significant operational requirement for our business. We believe we have substantial capacity for growth in our United States claims processing facilities. Our pharmacy technology platform allows us to safely, rapidly and accurately adjudicate over one billion adjusted prescriptions annually. Our technology helps retail pharmacies focus on patient care and our real-time safety checks help avoid hundreds of thousands of medication errors annually. We anticipate needs and meet customers where they are, from predicting and preventing chronic diseases, to using data to reduce payment and claims fraud, optimizing whole person health and leveraging the data from wearable devices and the Internet of Things to optimize population health status. Innovation is at the center of what differentiates Cigna. Cigna innovations improve patient outcomes while eliminating waste in the health care system. The Cigna companies hold more than 190 United States patents. We use these patents to protect our proprietary technological advances and to differentiate ourselves in the market. We continue to bring new technology-enabled products and services to the market, including biometric stress prediction and focused insights in spaces such as women’s health and opioid addiction. Our digital health focus has shown value across the enterprise by creating engaging experiences that give customers the right information at the right time. This includes an enhanced MyCigna.com experience with new features, including refill and payment options, without leaving the mobile application. Cybersecurity protections, such as multi-factor authentication, have been launched across Cigna’s digital offerings providing better peace of mind and a stronger sense of security. During 2019, significant technology integration, including with the acquired Express Scripts platform, delivered cost synergies, drove differentiated innovation and facilitated the transition to Express Scripts capabilities in areas such as supply chain, specialty pharmacy and retail networks. In the future, we expect continued integration and value realization with focus on customer-facing system integration and opportunities for enhanced value in specialty, claims and retail. With the combined strengths and capabilities of Cigna and Express Scripts, we see greater opportunities to create novel, highly-tailored customer insights as we mine data and use sophisticated advanced analytics and predictive intelligence to build better models that help us find solutions to complex questions and improve health care outcomes. ANALYTICS Cigna’s investments in data and analytics enable affordability, simplicity, predictability and growth across all of our business platforms. We create value for our customers and stakeholders by enabling better insights and actionable intelligence, developing new solutions and digitally-enabled value propositions and creating innovative data and analytics driven services. We leverage advanced analytics and predictive intelligence to design more affordable benefit plans and services, serve our customers and clients, and improve care costs and health outcomes. Our teams conduct timely, rigorous and objective research and analysis that informs evidence-based medical and pharmacy benefit management and evaluates the clinical, economic and individual impact of enhanced benefit designs and programs. Our commitment to innovation generates new and more effective ways to close care gaps, optimize treatment and improve outcomes. Our data and analytics talent empowers these capabilities through deep expertise in data management, business analysis, intelligence and data science, with ongoing investments in talent development, analytic and big data technologies, as well as innovative third party partnerships while ensuring controls are in place to protect sensitive client and customer information. 19

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