Cigna, one of the largest medical insurance companies in the world, published a document on coverage policy for clinical genome and exome sequencing.

The policy can be accessed from here.

Briefly, the policy contains three separate sections on genetic counseling, whole exome sequencing and whole genome sequencing, respectively. Note that Cigna does NOT cover genome sequencing for any indication because it is considered experimental, investigational, and unproven.

For whole exome sequencing, Cigna covers the insurance only if ALL of the following criteria are met:

1. Individual has been evaluated by a board-certified medical geneticist or other board certified specialist physician specialist with specific expertise in the conditions and relevant genes for which testing is being considered
2. WES results will directly impact clinical decision-making and clinical outcome for the individual being tested
3. a genetic etiology is the most likely explanation for the phenotype as demonstrated by EITHER of the following:
   • multiple abnormalities affecting unrelated organ systems
   • TWO of the following criteria are met:
     • abnormality affecting a single organ system
     • significant intellectual disability, symptoms of a complex neurodevelopmental disorder (e.g. self-injurious behavior, reverse sleep-wake cycles), or severe neuropsychiatric condition (e.g. schizophrenia, bipolar disorder, Tourette syndrome)
     • family history strongly implicating a genetic etiology
     • period of unexplained developmental regression (unrelated to autism or epilepsy)
4. no other causative circumstances (e.g. environmental exposures, injury, infection) can explain symptoms
5. clinical presentation does not fit a well-described syndrome for which single-gene or targeted panel testing is available
6. the differential diagnosis list and/or phenotype warrant testing of multiple genes and ONE of the following:
   • WES is more practical than the separate single gene tests or panels that would be recommended based on the differential diagnosis
   • WES results may preclude the need for multiple and/or invasive procedures, follow-up, or screening that would be recommended in the absence of testing