The Cigna Group
The Cigna Group is an American multinational health services organization headquartered in Bloomfield, Connecticut, that provides health insurance, pharmacy benefits management, and related medical services to individuals, employers, and government programs primarily in the United States and internationally.[1][2] Formed in 1982 via the merger of the Insurance Company of North America, established in 1792 as the first marine insurer in the U.S., and Connecticut General Life Insurance Company, the company has evolved through acquisitions and divestitures to focus on integrated health solutions, including its Evernorth Health Services division for pharmacy and care delivery.[3][4] In 2024, The Cigna Group generated total revenues of $247.1 billion, reflecting a 27% increase from the prior year, driven by growth in its Medicare Advantage, employer health plans, and pharmacy benefits segments, while employing about 73,500 people worldwide.[5][6] The firm operates in over 30 countries, managing relationships with more than 2 million health care providers and serving around 178 million customer claims annually, positioning it as one of the largest players in the U.S. health insurance market.[2] Notable achievements include expanding Medicare offerings and integrating pharmacy services post the 2018 acquisition of Express Scripts, which enhanced its capabilities in specialty drug management and cost containment.[3] The company has encountered substantial controversies, particularly regarding billing practices and claim denials, including a 2023 settlement of $172 million with the U.S. Department of Justice to resolve allegations of submitting invalid diagnosis codes to artificially elevate Medicare Advantage risk adjustment payments, violating the False Claims Act.[7] Additional scrutiny involves claims of systematic use of algorithms to deny patient coverage and recent lawsuits over mismanagement of 401(k) plan forfeitures, highlighting tensions between cost-control measures and obligations to policyholders and regulators.[8]Company Profile
Overview and Mission
The Cigna Group is an American multinational managed health care and insurance company headquartered in Bloomfield, Connecticut. Formed in 1982 through the merger of the Insurance Company of North America (INA), established in 1792, and the Connecticut General Life Insurance Company, founded in 1865, the company has evolved into a major provider of health services.[3][9] In February 2023, it rebranded from Cigna Corporation to The Cigna Group to emphasize its structure as a holding company overseeing two primary divisions: Cigna Healthcare, which offers medical, dental, behavioral, and vision benefits primarily to employers, individuals, and government programs in the U.S., and Evernorth Health Services, which provides pharmacy benefits management, specialty pharmacy, and care delivery solutions.[10][11] The company operates globally, with a network exceeding 2 million relationships with health care providers, clinics, and facilities, serving more than 178 million customer relationships worldwide.[2] For the fiscal year ending December 31, 2024, The Cigna Group reported total revenues of $247.1 billion, reflecting significant growth driven by acquisitions such as Express Scripts in 2018 and ongoing expansion in health services.[12] It ranks among the largest U.S. corporations, placing 15th on the 2023 Fortune 500 list by revenue. The firm's operations emphasize integrated health solutions, including pharmacy benefit management and behavioral health support, amid broader industry trends toward value-based care and cost containment in response to rising medical expenses. The Cigna Group's stated mission is "to improve the health and vitality of those we serve," guided by core values that prioritize integrity, innovation, customer focus, and teamwork.[13] This mission informs its strategic focus on leveraging data analytics, digital tools, and partnerships to address complex health challenges, such as chronic disease management and access to affordable care, while navigating regulatory pressures and competitive dynamics in the U.S. health insurance market.[11] The company's approach underscores a commitment to measurable outcomes over expansive coverage mandates, aligning with empirical evidence that targeted interventions yield better long-term health results than undifferentiated insurance expansion.[2]Leadership and Governance
David M. Cordani has served as Chairman and Chief Executive Officer of The Cigna Group since September 2009, with his appointment as Chairman effective January 2022.[14] Prior to these roles, Cordani held executive positions at Cigna, including President and CEO of Health Care, contributing to the company's strategic expansion in health services.[15] At age 59, he also serves as a director since 2009.[16] In March 2025, The Cigna Group announced leadership restructuring to support growth, appointing Brian Evanko as President and Chief Operating Officer effective March 31, 2025, overseeing all business lines.[17] Evanko previously led Evernorth Health Services as President and CEO.[18] Ann Dennison serves as Executive Vice President and Chief Financial Officer, managing financial operations amid the company's focus on cost control and revenue growth.[19] Other key executives include Nicole S. Jones as Executive Vice President and General Counsel, and specialized leaders such as David J. Brailer, MD, PhD, in health policy roles.[20] The Board of Directors, which provides strategic oversight, includes Cordani as Chairman and independent members like Eric J. Foss, former CEO of PepsiCo.[16] On June 2, 2025, Michael J. Hennigan was appointed to the board, bringing expertise from his prior roles in financial services.[21] The board maintains an independent majority, with directors representing shareholder interests through periodic evaluations of size and composition.[22] Governance practices emphasize accountability via specialized committees, including the Audit Committee chaired by Kimberly A. Ross, responsible for financial reporting integrity, and the Corporate Governance Committee led by Donna F. Zarcone, which handles director nominations and board policies.[23] The board adheres to guidelines promoting ethical conduct, risk oversight, and shareholder engagement, with annual proxy disclosures affirming commitment to transparent practices.[24] These structures support enterprise-wide decision-making, including ESG oversight and compliance with regulatory standards in health insurance and services.[22]Historical Development
Pre-Merger Foundations
The Insurance Company of North America (INA), one of the foundational entities of The Cigna Group, was established in 1792 at Philadelphia's Independence Hall as the first marine insurance company in the United States. It issued its inaugural policies that year for the ship America, covering hull and cargo bound for Londonderry, Northern Ireland.[3] Incorporated in 1794, INA received authorization to underwrite marine, fire, and life insurance risks.[9] The company expanded westward early on, opening its first agency in Lexington, Kentucky, in 1807, and by 1876 operated through 1,300 agents nationwide.[9] INA contributed significantly to post-disaster reconstruction in major U.S. cities from 1871 to 1945 and advanced health insurance innovations amid growing public interest in the 1910s, with further momentum after World War II.[3] In 1967, it reorganized under INA Corporation as a holding company, and by 1978, ventured into health insurance via hospital management and health maintenance organizations (HMOs).[9] The Connecticut General Life Insurance Company (CG), the other key predecessor, was founded in 1865 through a special legislative act signed by the Governor of Connecticut, led by Guy R. Phelps.[3][9] Initially focused on life insurance, CG pioneered group coverage by introducing the first group life insurance policy in 1913 to 100 employees of the Hartford Courant.[9] It formalized its group operations in 1918, securing a major contract with 5,400 Gulf Oil employees that year.[9] Expanding beyond New England to more than 25 states by the late 19th century, CG diversified in 1962 by acquiring Aetna Insurance Company to bolster property and casualty lines.[9] By 1981, group life and health products accounted for 33% of its income, reflecting a strategic shift toward employee benefits.[9] In 1967, CG established Connecticut General Insurance Corporation as its holding company structure.[9] Both INA and CG built complementary strengths in property/casualty and group health/life insurance, setting the stage for their combination.[3]Formation and Early Expansion
The CIGNA Corporation was formed on March 31, 1982, through the merger of INA Corporation and Connecticut General Corporation, two established insurance entities seeking to consolidate their strengths in health, life, and related insurance operations.[9] INA, tracing its roots to the Insurance Company of North America founded in 1792 as the first marine insurer in the United States, brought expertise in property-casualty and international coverage, while Connecticut General, established in 1865 by special act of the Connecticut Governor, specialized in life and group health insurance.[25] [3] The merger created a diversified financial services firm with combined assets exceeding $20 billion and positioned it as a leader in employee benefits and health care coverage, amid a consolidating industry landscape.[9] Following the merger, CIGNA established its headquarters in Philadelphia in 1983, integrating operations from both predecessors to streamline administration and leverage complementary portfolios.[9] Early expansion efforts focused on bolstering international presence and health services; in December 1983, the company agreed in principle to acquire the American Foreign Insurance Association (AFIA), an international underwriting group, which was completed in 1984 and merged into CIGNA International to enhance global property and specialty risk coverage.[26] [9] Additionally, INA's pre-merger 1980 purchase of Ross-Loos Medical Group—the nation's oldest health maintenance organization (HMO), founded in 1929—was integrated into CIGNA's health operations, supporting expansion into managed care models amid rising demand for cost-controlled health plans.[3] By 1987, CIGNA reorganized its property-casualty lines by renaming the acquired Aetna Insurance subsidiary as CIGNA Property and Casualty Insurance Company, reflecting efforts to unify branding and operations while navigating challenges like underwriting losses in non-health segments that totaled $423 million in the first three quarters of 1982 alone.[27] [9] These steps laid the groundwork for a shift toward health-focused growth, with the company prioritizing group health and benefits to capitalize on demographic trends and regulatory changes favoring employer-sponsored coverage.[9]Modern Growth and Rebranding
The merger with Express Scripts, completed on December 20, 2018, for approximately $67 billion, represented a cornerstone of Cigna's modern expansion strategy, integrating its medical, dental, and vision insurance operations with one of the largest pharmacy benefit managers (PBMs) in the United States.[28] This combination expanded Cigna's addressable market by adding Express Scripts' network of over 1.4 million pharmacies and its management of pharmaceutical benefits for more than 100 million members, enabling synergies in cost containment, data analytics, and service integration that the company projected would drive annual cost savings exceeding $1 billion.[29] Post-merger, Cigna's first-quarter 2019 revenue tripled to $30.4 billion compared to the prior year, reflecting the immediate scale from incorporating Express Scripts' $25 billion quarterly revenue stream, while its integrated medical benefits segment grew 12.8% to $9.2 billion.[30] Subsequent years saw sustained revenue expansion, fueled by organic growth in employer-sponsored plans, Medicare Advantage enrollment, and PBM services amid rising healthcare utilization. Cigna's annual revenue climbed from $153.6 billion in 2019 to over $247 billion in 2024, with trailing twelve-month revenue reaching $262 billion as of June 30, 2025, marking a 20.23% year-over-year increase driven by Evernorth's pharmacy services, which accounted for a growing share of total revenues.[12] In the second quarter of 2025 alone, total revenues rose 11% to $67.2 billion, supported by 7% growth in Evernorth adjusted revenues to $47.5 billion, though offset somewhat by medical cost pressures in the Cigna Healthcare segment.[31] Strategic investments, such as Evernorth's $3.5 billion infusion into a former Walgreens specialty pharmacy network in September 2025, further bolstered capabilities in high-cost drug management, enhancing competitive positioning in a market where PBMs handle over 80% of U.S. prescriptions.[32] Rebranding efforts aligned with this diversification, beginning with the September 2020 launch of Evernorth as the umbrella for Cigna's health services portfolio, encompassing Express Scripts, Accredo specialty pharmacy, and eviCore utilization management to unify non-insurance operations under a distinct identity.[33] This was followed by a comprehensive corporate rebrand in February 2023 to The Cigna Group, establishing Cigna Healthcare for insurance products and Evernorth Health Services for pharmacy, behavioral health, and care delivery, better reflecting the company's evolution from a traditional insurer to a diversified health services provider serving 178 million customer relationships globally.[34] The rebranding, which employed 70,000 people across 30 countries, aimed to clarify brand architecture amid portfolio expansion while maintaining consumer trust in core offerings, as articulated by leadership emphasizing continuity in mission despite structural changes.[35] These initiatives coincided with a focus on operational efficiencies, though empirical analyses of similar consolidations have noted potential premium elevations in segments like Medicare Part D due to reduced competition, underscoring trade-offs in scale-driven growth.[36]Business Operations
Cigna Healthcare Division
Cigna Healthcare operates as the health benefits division of The Cigna Group, encompassing U.S. commercial employer plans, U.S. government programs, and international health coverage. Established through a 2023 rebranding to delineate it from the Evernorth Health Services division, it focuses on delivering medical, pharmacy, behavioral health, dental, vision, supplemental, and savings account solutions to promote wellness across diverse populations.[37][38] In the U.S. employer segment, Cigna Healthcare provides comprehensive plans including medical coverage, pharmacy benefits, behavioral health and wellness programs, vision and dental insurance, supplemental health options, and flexible spending arrangements such as health reimbursement accounts (HRAs), health savings accounts (HSAs), and flexible spending accounts (FSAs). The U.S. government business includes Medicare Advantage plans offered through subsidiaries like HealthSpring, alongside individual and family plans with integrated medical, vision, dental, and pharmacy components. Internationally, it supports expatriates, employers, intergovernmental organizations (IGOs), and nongovernmental organizations (NGOs) with tailored health plans available in over 200 countries and jurisdictions.[38][1][39] As of 2024, Cigna Healthcare serves approximately 19.1 million medical customers, reflecting its scale in managed care delivery. Dental plans attract over 17 million participants, supported by networks emphasizing lower deductibles and broad provider access. Vision coverage leverages one of the largest specialty networks for routine and medical eye care. These operations prioritize integrated benefits design to address employer, individual, and global client needs, with pharmacy integration handled in coordination with Evernorth but administered under Healthcare's umbrella for plan members.[40][41][38]Evernorth Health Services Division
Evernorth Health Services constitutes one of The Cigna Group's two primary operating segments, alongside Cigna Healthcare, focusing on pharmacy benefits management, specialty pharmacy, utilization management, behavioral health, and integrated care delivery solutions.[42] Rebranded in September 2020 to unify Cigna's existing health services portfolio, it integrates capabilities from acquisitions such as Express Scripts, acquired in 2018 for $67 billion, to provide scalable solutions aimed at reducing costs and improving health outcomes for employers, health plans, and government programs.[43][44] The division operates through a network of subsidiaries and brands, emphasizing data-driven interventions to address complex healthcare challenges like medication adherence and chronic disease management.[45] Core offerings include Express Scripts, which manages pharmacy benefits for over 100 million members and handles mail-order and retail prescriptions to optimize drug utilization and pricing.[43] Accredo provides specialty pharmacy services for high-cost, complex therapies, such as those for oncology and rare diseases, delivering home-based infusions and patient support programs.[43] eviCore specializes in evidence-based utilization management for medical, behavioral, and pharmacy services, reviewing prior authorizations to ensure clinical necessity while controlling expenditures.[43] Additional components encompass MDLIVE for virtual care consultations and Evernorth Care Group, a network of primary care clinics rebranded from Cigna Medical Group in 2022, offering integrated services like dermatology, family medicine, and onsite behavioral health in select markets.[46][47] The division extends into behavioral health through measurement-based care programs, which track patient progress via standardized assessments to adjust treatments dynamically and enhance provider efficiency.[48] Care enablement tools, such as CareNav+, facilitate personalized benefits navigation for employees, integrating family planning, fertility, and postpartum support to simplify access and lower overall costs.[49] Partnerships with hospitals and health systems further enable efficiencies in fragmented care ecosystems, including EncircleRX for closed-door pharmacies tailored to institutional needs.[50] These services collectively serve diverse clients, from large employers to government entities, by leveraging proprietary data analytics for predictive modeling and intervention strategies.[44] Financially, Evernorth has driven significant growth for The Cigna Group, with segment revenues reaching $57.8 billion in the second quarter of 2025, a 17% increase year-over-year, fueled by expanded pharmacy volumes and specialty services.[51] For the full year 2024, Evernorth contributed to the company's total revenues of $247.1 billion, up 27% from 2023, underscoring its role in diversifying beyond traditional insurance through high-margin services.[5] Adjusted income from operations in the segment reflected robust margins, supported by operational scale and cost containment measures amid rising drug prices.[52]International Presence
The International Health operating segment of The Cigna Group delivers medical coverage, coordinated behavioral health, dental, vision, and other ancillary services to expatriates, globally mobile individuals, employers, and international governmental organizations (IGOs) and nongovernmental organizations (NGOs). This segment focuses on tailored plans for personal, family, retirement, student, and group needs, supported by a network exceeding 1.5 million hospitals and healthcare professionals across more than 200 markets and territories.[53][54] Operations emphasize 24/7 multilingual assistance in over 50 languages, enabling access to care without geographic restrictions in many plans.[54] Key operational hubs include offices in Belgium, China (Shanghai), [Hong Kong](/page/Hong Kong), India, Malaysia, Kenya, Lebanon, and Scotland (Greenock), facilitating localized support in Asia-Pacific, Europe, Africa, and the [Middle East](/page/Middle East). In Africa, the company maintains a dedicated unit with over 60 years of experience serving international organizations, providing 24/7 regional support and tailored group benefits. Expansion into Asia dates back to the late 1980s, with Cigna International marking 20 years of operations in Korea and [Hong Kong](/page/Hong Kong) by 2009. The segment serves customers in over 30 countries, prioritizing expatriate and multinational employee needs through products like Cigna Global Health Options, launched in March 2011 to target individual markets for globally mobile persons.[55][56][3][57]Financial Performance
Revenue and Earnings Trends
The Cigna Group's total revenues grew steadily from $153.6 billion in 2019 to $195.3 billion in 2023, reflecting expansion in its pharmacy benefits management through Evernorth and health insurance segments, before surging to $247.1 billion in 2024, a 27% increase attributed to strong performance in both Cigna Healthcare and Evernorth divisions.[12][5] This 2024 acceleration followed organic growth and operational efficiencies, with adjusted revenues also rising 27% year-over-year.[5] Shareholders' net income exhibited greater volatility over the same period, peaking at $8.5 billion in 2020 amid favorable market conditions and one-time gains, before declining to $3.4 billion in 2024 due to higher medical costs, regulatory pressures, and adjustments in the healthcare segment.[58][5] The 2023 net income of $5.2 billion represented a 23% drop from 2022's $6.7 billion, influenced by increased utilization in medical benefits and integration costs from prior expansions.[59][60]| Year | Revenue ($B) | Year-over-Year Change (%) | Net Income ($B) | Year-over-Year Change (%) |
|---|---|---|---|---|
| 2019 | 153.6 | - | 5.1 | - |
| 2020 | 160.4 | +4.5 | 8.5 | +66.7 |
| 2021 | 174.1 | +8.5 | 5.4 | -36.5 |
| 2022 | 180.5 | +3.7 | 6.7 | +24.1 |
| 2023 | 195.3 | +8.2 | 5.2 | -22.4 |
| 2024 | 247.1 | +26.6 | 3.4 | -34.6 |
Market Share and Competitive Standing
The Cigna Group ranks as the fourth-largest health insurer in the United States by market share in the employer-sponsored insurance segment, holding approximately 11% as of December 2024. This positions it behind UnitedHealth Group at 15%, Elevance Health at 12%, and CVS Health (including Aetna) at 12%, with the top five insurers collectively controlling over 50% of the market and contributing to heightened concentration concerns.[61] Market share metrics, derived from enrollment and premiums data, underscore Cigna's focus on commercial group plans, where it maintains a strong foothold among large employers, though it ceded ground in Medicare Advantage by divesting that business to Health Care Service Corporation in March 2024 for $3.7 billion to prioritize higher-margin segments.[61]| Insurer | Approximate U.S. Employer-Sponsored Market Share (2024) |
|---|---|
| UnitedHealth Group | 15% |
| Elevance Health | 12% |
| CVS Health (Aetna) | 12% |
| The Cigna Group | 11% |
| Health Care Service Corp. | 7% |