Cigna and Emeritus (Ameritas) have announced a new reciprocal shared network agreement effective November 1, 2025. While many shared network agreements follow similar patterns, this agreement is more complex due to how Emeritus handles direct contracts and overrides.
This page explains how the Cigna–Emeritus agreement works, which scenarios require action, and where practices face increased risk of unintended reimbursement downgrades.
What the Cigna–Emeritus Agreement Does
This agreement allows:
Emeritus to be paid under Cigna fee schedules, and
Cigna to be paid under Emeritus fee schedules,
depending on which direct contracts a practice holds.
The agreement is reciprocal, but the way each carrier applies overrides is not symmetrical, making careful review essential.
Practices With Direct Contracts With Both Cigna and Emeritus
If a practice has direct contracts with both Cigna and Emeritus, additional analysis is required.
Cigna direct contracts do override shared network agreements
Emeritus direct contracts do not always override shared network agreements
If the practice’s Cigna fee schedule is lower than its Emeritus fee schedule, Emeritus may choose to pay under the lower Cigna fees unless an opt-out is submitted.
This is a key distinction from many other shared network agreements.
Direct Contract With Cigna Only
If the practice has a direct contract with Cigna and is out of network with Emeritus:
If the practice does not mind Emeritus being picked up under Cigna fees
No action is required.
If the practice does not want Emeritus picked up under Cigna fees
The practice must opt out with Cigna before the effective date.
Opting out prevents Emeritus from paying under Cigna’s fee schedule and does not change the existing Cigna contract.
Direct Contract With Emeritus Only
If the practice has a direct contract with Emeritus and is out of network with Cigna:
If the practice does not mind Cigna being picked up under Emeritus fees
No action is required.
If the practice does not want Cigna picked up under Emeritus fees
The practice must opt out with Emeritus.
Emeritus allows opt-outs on an agreement-by-agreement basis.
Practices Receiving One or Both Carriers Through Shared Network Agreements
If a practice is receiving Cigna and/or Emeritus through third-party shared network agreements:
No action is required if neither carrier is held directly
This agreement only applies when a direct contract exists with Cigna or Emeritus
Direct Contract Plus Existing Shared Network Path
If the practice has:
A direct contract with Cigna, and
Emeritus through another shared network agreement
The practice should compare:
Current Emeritus fees under the existing shared network
Cigna fee schedule
If Cigna fees are lower, Emeritus may drop the higher-paying path and pay under the lower Cigna fees unless the practice opts out with Cigna.
The reverse applies if the practice has:
A direct contract with Emeritus, and
Cigna through another shared network agreement
In that case, if Emeritus fees are lower than the current Cigna shared-network fees, opting out with Emeritus is recommended.
Important Opt-Out Rules
Cigna opt-outs are all-or-nothing
Opting out removes the practice from all Cigna shared network agreements (including Sun Life, Humana, and Emeritus)
Emeritus allows selective opt-outs
Practices can opt out of specific agreements without affecting others
These differences should be carefully considered before submitting opt-out requests.
How to Opt Out
Cigna Opt-Out
Request must include practice name, Tax ID, NPI, and a statement requesting opt-out of the Cigna–Emeritus shared network agreement
Emeritus Opt-Out
Practices may also use Emeritus-provided opt-out forms when available
Follow-up confirmation is strongly recommended for both carriers.
Key Considerations
There is no guarantee of pickup under shared network agreements
Failure to opt out may result in reimbursement downgrades
Emeritus’s override rules increase risk compared to many other agreements
Summary
The Cigna–Emeritus shared network agreement introduces elevated complexity due to differences in how each carrier applies direct contract overrides. Practices with direct contracts should carefully compare fee schedules and submit opt-outs when necessary to prevent unintended participation or reimbursement reductions.
