Cigna (CI) 10-Q 2 May 19 2019 Q1 Quarterly report Financial data

Document and Entity Information

Document and Entity Information - $ / shares	3 Months Ended
	Mar. 31, 2019	Apr. 15, 2019	Dec. 31, 2018
Document Document And Entity Information [Abstract]
Document Type	10-Q
Document Fiscal Period Focus	Q1
Document Fiscal Year Focus	2019
Document Period End Date	Mar. 31, 2019
Current Fiscal Year End Date	--12-31
Registrant Name	CIGNA Corporation
Central Index Key	0001739940
Common stock, par value per share	$ 0.01		$ 0.01
Trading Symbol	CI
Current Reporting Status	Yes
Filer Category	Large Accelerated Filer
Smaller reporting company	false
Emerging growth company	false
Common Stock outstanding		379,457,650
Amendment Flag	false

Consolidated Statements of Inco

Consolidated Statements of Income - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Revenues
Premiums	$ 9,971	$ 8,999
Net investment income	346	329
Total revenues	37,946	11,413
Benefits and Expenses
Medical costs and other benefit expenses	7,620	6,772
Pharmacy and other service costs	24,050	561
Selling, general and administrative expenses	3,303	2,745
Amortization of other acquired intangible assets	743	27
Total benefits and expenses	35,716	10,105
Income from operations	2,230	1,308
Interest expense and other	(452)	(57)
Net realized investment gains (losses)	10	(33)
Income (loss) before income taxes	1,788	1,218
Total income taxes	416	301
Net Income	1,372	917
Less: net income (loss) attributable to noncontrolling interests	4	2
Shareholders' net income	$ 1,368	$ 915
Shareholders' net income per share:
Basic	$ 3.61	$ 3.78
Diluted	$ 3.56	$ 3.72
Fees and other revenues [Member]
Revenues
Pharmacy revenues, fees and other revenues	$ 2,450	$ 1,368
Pharmacy revenues [Member]
Revenues
Pharmacy revenues, fees and other revenues	$ 25,179	$ 717

Consolidated Statements of Shar

Consolidated Statements of Shareholders' Comprehensive Income - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Statement Of Comprehensive Income
Shareholders' net income	$ 1,368	$ 915
Shareholders' other comprehensive income (loss), net of tax:
Net unrealized appreciation (depreciation), securities and derivatives	442	(284)
Net translation (losses) gains on foreign currencies	(24)	45
Postretirement benefits liability adjustment	11	13
Shareholders' other comprehensive income (loss), net of tax	429	(226)
Shareholders' comprehensive income (loss)	$ 1,797	$ 689

Consolidated Statements of Tota

Consolidated Statements of Total Comprehensive Income - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Statement Of Comprehensive Income
Shareholders' comprehensive income (loss)	$ 1,797	$ 689
Comprehensive income (loss) attributable to noncontrolling interests:
Net income (loss) attributable to redeemable noncontrolling interests	3	2
Net income (loss) attributable to other noncontrolling interests	1	0
Other comprehensive income (loss) attributable to redeemable noncontrolling interests	(2)	(2)
Total comprehensive income (loss) attributable to noncontrolling interests	2	0
Total comprehensive income	$ 1,799	$ 689

Consolidated Balance Sheets

Consolidated Balance Sheets - USD ($) $ in Millions		Mar. 31, 2019	Dec. 31, 2018
Assets
Cash and cash equivalents		$ 4,976	$ 3,855
Investments		1,662	2,045
Accounts receivable, net		10,941	10,473
Inventories		2,382	2,821
Other current assets		1,175	1,236
Total current assets		21,136	20,430
Long-term investments		27,257	26,929
Reinsurance recoverables		5,385	5,507
Deferred policy acquisition costs		2,817	2,821
Property and equipment		4,523	4,562
Goodwill		44,537	44,505
Other intangible assets		38,338	39,003
Other assets		2,276	1,630
Separate account assets		8,079	7,839
TOTAL ASSETS		154,348	153,226
Liabilities:
Current insurance and contractholder liabilities		7,060	6,801
Pharmacy and service costs payable		11,145	10,702
Accounts payable		4,488	4,366
Accrued expenses and other liabilities		7,361	7,071
Short-term debt		2,915	2,955
Total current liabilities		32,969	31,895
Non-current insurance and contractholder liabilities		20,043	19,974
Deferred tax liabilities, net		9,403	9,453
Other non-current liabilities		3,832	3,470
Long-term debt		37,571	39,523
Separate account liabilities		8,079	7,839
TOTAL LIABILITIES		111,897	112,154
Redeemable noncontrolling interests		38	37
Shareholders' Equity
Common stock	[1]	4	4
Additional paid-in capital		27,855	27,751
Accumulated other comprehensive income (loss)		(1,282)	(1,711)
Retained earnings		16,426	15,088
Less: treasury stock, at cost		(595)	(104)
TOTAL SHAREHOLDERS' EQUITY		42,408	41,028
Other noncontrolling interests		5	7
Total equity		42,413	41,035
Total liabilities and shareholders' equity		$ 154,348	$ 153,226
Shareholders' Equity Per Share		$ 111.52	$ 107.71
[1]	Par value per share, $0.01; shares issued, 384 million as of March 31, 2019 and 381 million as of December 31, 2018; authorized shares; 600 million.

Consolidated Balance Sheets (Pa

Consolidated Balance Sheets (Parentheticals) - $ / shares shares in Millions	Mar. 31, 2019	Dec. 31, 2018
Consolidated Balance Sheets
Common stock, par value per share	$ 0.01	$ 0.01
Common stock shares issued	384	381
Common stock shares authorized	600	600

Consolidated Statements of Chan

Consolidated Statements of Changes in Total Equity - USD ($) $ in Millions	Total	Shareholders' Equity [Member]	Common Stock [Member]	Additional Paid In Capital [Member]	Accumulated Other Comprehensive Income [Member]	Retained Earnings [Member]	Treasury Stock [Member]	Other noncontrolling interests [Member]
Total Equity, beginning of period at Dec. 31, 2017	$ 13,711	$ 13,711	$ 74	$ 2,940	$ (1,082)	$ 15,800	$ (4,021)	$ 0
Increase (Decrease) In Stockholders Equity [Roll Forward]
Reclassification adjustment related to U.S. tax reform legislation	0				(229)	229
Effect of issuing stock for employee benefit plans	22	22		23		(69)	68
Other comprehensive income (loss)	(226)	(226)			(226)
Net income (loss)	915	915				915
Common dividends declared (per share: $0.04)	(10)	(10)				(10)
Repurchase of common stock	(275)	(275)					(275)
Other transactions impacting noncontrolling interest	0	0
Total Equity, end of period at Mar. 31, 2018	14,195	14,195	74	2,963	(1,547)	16,933	(4,228)	0
Beginning Balance at Dec. 31, 2017	49
Redeemable Noncontrolling Interests
Other comprehensive income (loss)	(2)
Net income (loss)	2
Ending Balance at Mar. 31, 2018	49
Total Equity, beginning of period at Dec. 31, 2018	41,035	41,028	4	27,751	(1,711)	15,088	(104)	7
Increase (Decrease) In Stockholders Equity [Roll Forward]
Effect of issuing stock for employee benefit plans	75	75		104			(29)
Other comprehensive income (loss)	429	429			429
Net income (loss)	1,369	1,368				1,368		1
Common dividends declared (per share: $0.04)	(15)	(15)				(15)
Repurchase of common stock	(462)	(462)					(462)
Other transactions impacting noncontrolling interest	(3)	0						(3)
Total Equity, end of period at Mar. 31, 2019	42,413	$ 42,408	4	27,855	$ (1,282)	$ 16,426	$ (595)	$ 5
Beginning Balance at Dec. 31, 2018	37
Redeemable Noncontrolling Interests
Other comprehensive income (loss)	(2)
Net income (loss)	3
Other transactions impacting noncontrolling interest	0
Ending Balance at Mar. 31, 2019	$ 38
Increase (Decrease) In Stockholders Equity [Roll Forward]
Cumulative effect of new accounting guidance			$ 0	$ 0

Consolidated Statements of Cash

Consolidated Statements of Cash Flows - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Cash Flows from Operating Activities
Net Income	$ 1,372	$ 917
Adjustments to reconcile net income to net cash provided by (used in) operating activities:
Depreciation and amortization	897	140
Realized investment (gains) losses	(10)	33
Deferred income taxes (benefits)	(162)	9
Net changes in assets and liabilities, net of non-operating effects:
Accounts receivable	(396)	(53)
Inventories	440	94
Deferred policy acquisition costs	(51)	(76)
Reinsurance recoverables and other assets	124	51
Insurance liabilities	360	849
Pharmacy and service costs payable	444	(124)
Accounts payable, accrued expenses and other liabilities	91	193
Other, net	83	(8)
Net cash provided by (used in) operating activities	3,192	2,025
Proceeds from investments sold:
Fixed maturities and equity securities	1,471	499
Investment maturities and repayments:
Fixed maturities and equity securities	319	297
Commercial mortgage loans	89	28
Other sales, maturities and repayments (primarily short-term and other long-term investments)	367	112
Investments purchased or originated:
Fixed maturities and equity securities	(1,088)	(2,259)
Commercial mortgage loans	(95)	(68)
Other (primarily short-term and other long-term investments)	(388)	(206)
Property and equipment purchases	(194)	(103)
Acquisitions, net of cash acquired	(6)	0
Net cash provided by (used in) investing activities	475	(1,700)
Cash Flows from Financing Activities
Deposits and interest credited to contractholder deposit funds	247	292
Withdrawals and benefit payments from contractholder deposit funds	(251)	(306)
Net change in short-term debt	(1,048)	(3)
Repayment of long-term debt	(1,000)	(131)
Repurchase of common stock	(462)	(310)
Issuance of common stock	53	20
Other, net	(73)	(92)
Net cash provided by (used in) financing activities	(2,534)	(530)
Effect of foreign currency rate changes on cash and cash equivalents	(12)	4
Net increase / (decrease) in cash and cash equivalents	1,121	(201)
Cash and cash equivalents, January 1,	3,855	2,972
Cash and cash equivalents, March 31,	4,976	2,771
Supplemental Disclosure of Cash Information:
Income taxes paid, net of refunds	29	31
Interest paid	$ 377	$ 46

Description of Business

Description of Business	3 Months Ended
	Mar. 31, 2019
Description Of Business [Abstract]
Description of Business	Note 1 – Description of Business 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 dedicated to a mission of helping those we serve improve their health, well-being and peace of mind. Our evolved strategy in support of our mission is Go Deeper, Go Local, Go Beyond using a differentiated set of pharmacy , medical, dental, disability, life and accident insurance an d related products and services offered by our subsidiaries . The majority of these products are offered through employers and other groups such as governmental and non-governmental organizations, unions and associations. Cigna also offers commercial heal th and dental insurance, Medicare and Medicaid products and health, life and accident insurance coverages to individuals in the United States and selected international markets. In addition to these ongoing operations, Cigna also has certain run-off opera tions. As described more fully in Note 4 , o n December 20, 2018, Cigna completed the acquisition of Express Scripts Holding Company (“Express Scripts”). As a result, our segments have changed as described below, effective in the fourth quarter of 2018. Prior year f inancial data presented in this Form 10-Q has been re stated to reflect this new segment presentation . Health Services includes pharmacy benefits management, pharmacy home delivery and certain medical management services. This segment includes Express Scripts’ business from the date of acquisition with the exception of Express Scripts’ Medicare Part D business that is reported in the Government operating segment. Integrated Medical offers a variety of medical solutions to employers and individ uals. 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, dental, behavioral health and 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 to Medi care-eligible beneficiaries as well as Medicaid plans. This operating segment also offers health insurance coverage to individual customers both on and off public exchanges. This segment includes the acquired Express Scripts’ Medicare Part D business. I nternational 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. The remainder of our business operations are reported in Group Disability and Other, 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 servic es. Corporate-Owned Life Insurance (“COLI”) offers permanent insurance contracts sold to corporations to provide coverage on the lives of certain employees for the purpose of 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 20 13. Settlement Annuity business in run-off. Individual Life Insurance and Annuity and Retirement Benefits Businesses: deferred gains from the sales of these businesses. Certain international run-off businesses Corporate reflects amounts not allocated to operating segments, including interest expense , net investment income on investments not supporting segment and other operations, interest on uncertain tax positions, certain litigation matters, expense associated with our fr ozen pension plans, severance, certain enterprise-wide projects and intersegment eliminations for products and services sold between segments .

Summary of Significant Accounti

Summary of Significant Accounting Policies	3 Months Ended
	Mar. 31, 2019
Accounting Policies [Abstract]
Significant Accounting Policies [Text Block]	Note 2 – Summary of Significant Accounting Policies Basis of Presentation The Consolidated Financial Statements include the accounts of Cigna Corporation and its consolidated subsidiaries. Intercompany transactions and accounts have been eliminated in consolidation. These Consolidated Financial Statements were prepared in conformity with accounting principles generally accepted in the United States of America (“GAAP”). The Company adopted Article 5 of Regulation S-X issued by the Securit ies and Exchange Commission (“SEC”) effective December 31, 2018 in conjunction with the acquisition of Express Scripts. As a result, the Company now presents current assets and liabilities on its balance sheet. The Company reclassified realized investmen t gains (losses) from revenue and now reports them below income from operations with interest expense in our Consolidated Statements of I ncome, in conformity with Article 5 . Prior year s’ information was reclassified to conform to this new presentation. A mounts recorded in the Consolidated F inancial S tatements necessarily reflect management’s estimates and assumptions about medical costs, investment and receivable valuation s , interest rates and other factors. Significant estimates are discussed throughout these Notes; however, actual results could differ from those estimates. The impact of a change in estimate is generally included in earnings in the period of adjustment. These interim Consolidated Financial Statements are unaudited but include all adju stments (including normal recurring adjustments) necessary, in the opinion of management, for a fair statement of financial position and results of operations for the periods reported. The interim Consolidated Financial Statements and Notes should be read in conjunction with the Consolidated Financial Statements and Notes included in the 2018 Annual Report on Form 10-K (“2018 Form 10-K”). The preparation of interim Consolidated Financial Statements necessarily relies heavily on estimates. This and certai n other factors, including the seasonal nature of portions of the health care and related benefits business, as well as competitive and other market conditions, call for caution in estimating full-year results based on interim results of operations. Recen t Accounting Pronouncements The 2018 Form 10-K includes discussion of significant recent accounting pronouncements that either have impacted or may impact our financial statements in the future. The following information provides updates on recently adop ted or recently issued accounting pronouncements that have occurred since the Company filed its 2018 Form 10-K. Recent ly Adopted Accounting Guidance The Company adopted Accounting Standards Update (“ASU”) 2016-02, Leases¸ as of January 1, 2019 (the adoption date) on a modified retrospective basis for leases in effect as of and after the adoption date. This new guidance requires balance sheet recognition of assets and liabilities arising from leases, as well as additional disclosures regarding the amount, timing and uncertainty of cash flows from leases. The Company implemented a new lease system and corresponding internal controls to administer our leases and facilitate compliance with this new standard. The Company elec ted the practical expedient package, allowing the Company to carry forward the assessment of 1) whether our contracts contain or are leases, 2) lease classification and 3) whether previously capitalized costs continue to qualify as initial direct costs. U pon adoption, the Company recognized new right-of-use assets and lease liabilities related to our operating leases, because finance (capital) leases were already reflected on the Company’s Consolidated Balance Sheets. The impact of adoption on the Company ’s net assets and retained earnings was not material, nor was there a material impact on our Consolidated Statements of Income or Cash Flows. See Note 14 for additional disclosures about the Company’s leases. Accounting Guidance Not Yet Adopted Accounting Standard and Effective Date Requirements and Expected Effects of New Guidance Not Yet Adopted Measurement of Credit Losses on Financial Instruments (ASU 2016-13) Required as of January 1, 2020 Requires: • A new approach using expected credit losses to estimate and recognize credit losses for certain financial instruments (such as mortgage loans, reinsurance recoverables and other receivables) when such instruments are first originated or acquired. • Changes in the criteria for impairment of available-for-sale debt securities • Adoption using a modified retrospective approach with a cumulative-effect adjustment recorded in retained earnings Expected effects: • The Company is continuing to evaluate this new standard and its expected effects on our financial statements and disclosures. We will adopt the standard as of January 1, 2020. • An additional allowance for future expected credit losses for certain financial instruments will be required at adoption.

Accounts Receivable, Net

Accounts Receivable, Net	3 Months Ended
	Mar. 31, 2019
Receivables [Abstract]
Accounts Receivable, Net	Note 3 - Accounts Receivable, Net The following amounts we re included within accounts receivable, net of our allowance for doubtful accounts, customer credit allowances and contractual allowances that, in the aggregate, were $456 million as of March 31, 2019 and $217 million as of December 31, 2018 (In millions) March 31, 2019 December 31, 2018 Insurance customer receivables $ 2,261 $ 1,888 Noninsurance customer receivables 4,635 4,988 Pharmaceutical manufacturers receivable (1) 3,682 3,321 Other receivables 363 276 Total accounts receivable, net $ 10,941 $ 10,473 (1) Includes $624 million at March 31, 2019 and $406 million at December 31, 2018 of receivables under noninsurance customer contracts.

Mergers and Acquisitions

Mergers and Acquisitions	3 Months Ended
	Mar. 31, 2019
Acquisitions and Dispositions [Abstract]
Acquisitions and Dispositions	Note 4 – Mergers and Acquisitions Acquisition of Express Scripts On December 20, 2018, Cigna acquired Express Scripts through a series of mergers (collectively, the “Merger”). Cigna Holding Company (formerly named Cigna Corporation and referred to as “Old Cigna”) and Express Scripts each merged with and into a wholly-owned subsidiary of Cigna. As a result of these transactions, Cigna became the parent of the combined company. Our 2018 Form 10-K includes detailed disclosures of merger consideration, purchase price allocation and intangible assets identified in this transaction. The purchase price allocation was based on management’s preliminary estimates of their fair values and may change as additional information becomes available. For the three months ended March 31, 2019, there were no changes to the purchase price allocation . Integration and Transaction-related C osts The Company incurred integration and transaction costs related to Express Scripts, the terminated merger with Anthem, Inc. (“Anthem”) and other transactions of $136 million pre-tax ($108 million after-tax) for the three months ended March 31, 2019, compared with $60 million pre-tax ($50 million after-tax) for the three months ended March 31, 2018. These costs consisted primarily of fees for legal, advisory and other professional services , certain employment-related costs and, in 2018, amortization of Bridge Facility fees.

Earnings Per Share

Earnings Per Share	3 Months Ended
	Mar. 31, 2019
Earnings Per Share [Abstract]
Earnings Per Share	Note 5 – E arnings P er S hare (“EPS”) Basic and diluted earnings per share were computed as follows: Three Months Ended March 31, 2019 March 31, 2018 (Shares in thousands, dollars in millions, except per share amounts) Effect of Effect of Basic Dilution Diluted Basic Dilution Diluted Shareholders’ net income $ 1,368 $ 1,368 $ 915 $ 915 Shares: Weighted average 379,387 379,387 242,179 242,179 Common stock equivalents 4,637 4,637 3,609 3,609 Total shares 379,387 4,637 384,024 242,179 3,609 245,788 EPS $ 3.61 $ (0.05) $ 3.56 $ 3.78 $ (0.06) $ 3.72 The following outstanding employee stock options were not included in the computation of diluted earnings per share because their effect w as anti - dilutive. Three Months Ended March 31, (In millions) 2019 2018 Anti-dilutive options 2.8 0.9

Debt

Debt	3 Months Ended
	Mar. 31, 2019
Debt Disclosure [Abstract]
Debt	Note 6 – Debt The outstanding amounts of debt and finance leases were as follows: March 31, December 31, (In millions) Issuer 2019 2018 Short-term debt Current maturities: $1,000 million, 2.25% Senior Notes Express Scripts $ 998 $ 995 Current maturities: $337 million, 7.25% Senior Notes ESI 340 343 Current maturities: $1,000 million, Floating Rate Notes due 2020 Cigna 998 - Commercial paper Old Cigna/Cigna 558 1,500 Other, including finance leases Other 21 117 Total short-term debt $ 2,915 $ 2,955 Long-term uncollateralized debt Cigna debt (issued to finance acquisition) $1,000 million, Floating Rate Notes due 2020 Cigna $ - $ 997 $1,750 million, 3.2% Notes due 2020 Cigna 1,744 1,743 $1,000 million, Floating Rate Notes due 2021 Cigna 997 996 $1,250 million, 3.4% Notes due 2021 Cigna 1,246 1,245 $2,000 million, Floating Rate Term Loan due 2021 Cigna 1,998 2,997 $700 million, Floating Rate Notes due 2023 Cigna 697 697 $3,100 million, 3.75% Notes due 2023 Cigna 3,085 3,085 $2,200 million, 4.125% Notes due 2025 Cigna 2,187 2,187 $3,800 million, 4.375% Notes due 2028 Cigna 3,774 3,774 $2,200 million, 4.8% Notes due 2038 Cigna 2,178 2,178 $3,000 million, 4.9% Notes due 2048 Cigna 2,964 2,964 Express Scripts debt (assumed in acquisition) $500 million, 4.125% Senior Notes due 2020 Medco 505 506 $500 million, 2.600% Senior Notes due 2020 Express Scripts 493 493 $400 million, Floating Rate Senior Notes due 2020 Express Scripts 400 399 $500 million, 3.300% Senior Notes due 2021 Express Scripts 499 499 $1,250 million, 4.750% Senior Notes due 2021 Express Scripts 1,282 1,285 $1,000 million, 3.900% Senior Notes due 2022 Express Scripts 998 998 $500 million, 3.050% Senior Notes due 2022 Express Scripts 482 481 $1,000 million, 3.000% Senior Notes due 2023 Express Scripts 961 959 $1,000 million, 3.500% Senior Notes due 2024 Express Scripts 968 966 $1,500 million, 4.500% Senior Notes due 2026 Express Scripts 1,507 1,508 $1,500 million, 3.400% Senior Notes due 2027 Express Scripts 1,390 1,386 $449 million, 6.125% Senior Notes due 2041 Express Scripts 493 493 $1,500 million, 4.800% Senior Notes due 2046 Express Scripts 1,465 1,465 Old Cigna debt (pre-acquisition) $250 million, 4.375% Notes due 2020 Old Cigna 248 248 $300 million, 5.125% Notes due 2020 Old Cigna 298 298 $78 million, 6.37% Notes due 2021 CGC 78 78 $300 million, 4.5% Notes due 2021 Old Cigna 297 297 $750 million, 4% Notes due 2022 Old Cigna 746 746 $100 million, 7.65% Notes due 2023 Old Cigna 100 100 $17 million, 8.3% Notes due 2023 Old Cigna 17 17 $900 million, 3.25% Notes due 2025 Old Cigna 895 895 $600 million, 3.05% Notes due 2027 Old Cigna 595 595 $259 million, 7.875% Debentures due 2027 Old Cigna 259 259 $45 million, 8.3% Step Down Notes due 2033 Old Cigna 45 45 $191 million, 6.15% Notes due 2036 Old Cigna 190 190 $121 million, 5.875% Notes due 2041 Old Cigna 119 119 $317 million, 5.375% Notes due 2042 Old Cigna 315 315 $1,000 million, 3.875% Notes due 2047 Old Cigna 988 988 Other, including finance leases Other 68 32 Total long-term debt $ 37,571 $ 39,523 Notes issued to fund the Express Scripts acquisition. As presented in the table above, the Company issued private placement Notes with registration rights in the third quarter of 2018 to finance the Express Scripts acquisition. Total proceeds were approximately $20.0 billion. Interest on this debt is generally paid semi-annually except for quarterly interest payments on the floating rate notes. Term Loan Credit Agreement. Cigna borrowed $3.0 billion under its Term Loan Credit Agreement (the “Term Loan Credit Agreement”) to finance the Merger and to pay fees and expenses of the Merger. The Term Loan Credit Agreement contains customary covenants and restrictions, including a financial covenant that Cigna’s leverage ratio may not exceed 60%. There is no remaining amount available for borrowing under this agreement. In the first quarter of 2019, the Company repaid $1 billion principal of the term loan. The remaining $2 billion term loan principal is diversified among 23 banks. Revolving Credit A greement. Cigna has a Revolving Credit and Letter of Credit Agreement (the “Revolving Credit Agreement”) that matures on April 6, 2023 and is diversified among 23 banks. Cigna can borrow up to $3.25 billion for general corporate purposes, with up to $500 million available for issuance of letters of credit, decreased by $22 million of letters of credit under the Revolving Credit Agreement as of March 31, 2019. The Revolving Credit Agreement also includes an option to increase the facility amount up to $50 0 million and an option to extend the termination date for additional one-year periods, subject to consent of the banks. The Revolving Credit Agreement contains customary covenants and restrictions including a financial covenant that the Company’s leverag e ratio may not exceed 60%. Cigna is the borrower under the Revolving Credit Agreement and the Term Loan Credit Agreement and certain subsidiaries of Cigna may be required to guarantee these obligation s under certain circumstances. Commercial P aper . The commercial paper program had approximately $560 million outstanding at March 31, 2019 at an average interest rate of 2.90%. The Company was in compliance with its debt covenants as of March 31, 2019 .

Insurance and Contractholder Li

Insurance and Contractholder Liabilities	3 Months Ended
	Mar. 31, 2019
Insurance and Contractholder Liabilities [Abstract]
Insurance and Contractholder Liabilities	N ote 7 – Insurance and Contractholder Liabilities Account Balances – Insurance and Contractholder Liabilities As of March 31, 2019 , December 31, 2018 and March 31, 2018 , t he Company’s insurance and contractholder liabilities were co mprised of the following: March 31, 2019 December 31, 2018 March 31, 2018 (In millions) Current Non-current Total Current Non-current Total Total Contractholder deposit funds $ 621 $ 7,326 $ 7,947 $ 641 $ 7,365 $ 8,006 $ 8,153 Future policy benefits 643 9,048 9,691 740 8,981 9,721 9,934 Unpaid claims and claim expenses Integrated Medical 2,943 18 2,961 2,678 19 2,697 2,638 Other segments 2,421 3,304 5,725 2,394 3,230 5,624 5,502 Unearned premiums 432 347 779 348 379 727 1,291 Total insurance and contractholder liabilities $ 7,060 $ 20,043 $ 27,103 $ 6,801 $ 19,974 $ 26,775 $ 27,518 Insurance and contractholder liabilities expected to be paid within one year are classified as current . Unpaid Claims and Claim Expenses – Integrated Medical This liability reflects estimates of the ultimate cost of claims that have been incurred but not reported, including expected development on reported claims, those that have been reported but not yet paid (reported claims in process), and other medical care expenses and services payable that are primarily comprised of accruals for incentives and other amounts payable to health care professionals and facilities. This liability no longer includes amount s from the international health care business now reported in International Markets following our change in segment reporting in the fourth quarter of 2018 . The prior year presentation has been updated to reflect this segment change. The total of incurred but not reported liabilities plus expected development on reported claims, including reported claims in process, was $ 2.7 billion at March 31, 2019 and $ 2.5 billion at March 31, 2018 . Activity in the unpaid claims liability for the Integrated Medical segment for the three months ended March 31 was as follows: Three Months Ended March 31, March 31, (In millions) 2019 2018 Beginning balance $ 2,697 $ 2,420 Less: Reinsurance and other amounts recoverable 264 262 Beginning balance, net 2,433 2,158 Incurred costs related to: Current year 6,095 5,284 Prior years (117) (115) Total incurred 5,978 5,169 Paid costs related to: Current year 3,786 3,382 Prior years 1,908 1,540 Total paid 5,694 4,922 Ending balance, net 2,717 2,405 Add: Reinsurance and other amounts recoverable 244 233 Ending balance $ 2,961 $ 2,638 Reinsurance and other amounts recoverable reflect amounts due from reinsurers and policyholders to cover incurred but not reported and pending claims for certain business where the Company administers the plan benefits but the right of offset does not exist. See Note 8 for additio nal information on reinsurance. Variances in incurred costs related to prior years’ unpaid claims and claims expenses that resulted from the differences between actual experience and the Company’s key assumptions were a s follows for the three months ended March 31: Three Months Ended (Dollars in millions) March 31, 2019 March 31, 2018 $ % (1) $ % (2) Actual completion factors $ 55 0.2 % $ 52 0.3 % Medical cost trend 62 0.3 54 0.3 Other - - 9 - Total favorable (unfavorable) variance $ 117 0.5 % $ 115 0.6 % (1) Percentage of current year incurred costs as reported for the year ended December 31, 2018. (2) Percentage of current year incurred costs as reported for the year ended December 31, 2017. Incurred costs related to prior years in the table above , although adjusted through shareholders’ net income, do not directly correspond to an increase or decrease to shareholders’ net income . The primary reason for this difference is that decreases to prior year incurred costs pertaining to the portion of the liability established for moderately adverse conditions are not considered as impacting shareholders’ net income if they are offset by increases in the current year provision f or moderately adverse conditions. P rior year development increased shareholders’ net income by $ 39 million ($ 50 million before tax) for the three months ended March 31, 2019 , compared with $ 40 million ($ 51 million before tax) for the three months ended March 31, 2018 . F avorable prior year development in both periods reflects low er than expected utilization of medical Unpaid Claims and Claim Expenses – International Markets and Group Disability and Other This liability now includes amounts from international health care following our change in segment reporting in 2018 as discussed in Note 1 . The prior year presentation has been updated to reflect this segment change. Liability balance details. The liability details for unpaid claims and claim expenses are as follows: (In millions) March 31, 2019 March 31, 2018 Group Disability and Other Group Disability and Life $ 4,786 $ 4,549 Other Operations 194 175 Total Group Disability and Other 4,980 4,724 International Markets 745 778 Unpaid claims and claim expenses Group Disability and Other and International Markets $ 5,725 $ 5,502 Interest is a ccreted and recognized in medical costs and other benefit expenses in the Consolidated Statement s of Income. Activity in the Company’s liabilities for unpaid claims and claim expenses, excluding Other Operations, are presented in the following table. Liabilities associated with Other Operations are excluded because they pertain to obligations for long-duration i nsurance contracts or, if short-duration, the liabilities have been fully reinsured. Three Months Ended (In millions) March 31, 2019 March 31, 2018 Beginning balance $ 5,432 $ 5,274 Less: Reinsurance 156 140 Beginning balance, net 5,276 5,134 Incurred claims related to: Current year 1,428 1,393 Prior years: Interest accretion 38 38 All other incurred (32) (61) Total incurred 1,434 1,370 Paid claims related to: Current year 474 471 Prior years 856 853 Total paid 1,330 1,324 Foreign currency (7) 2 Ending balance, net 5,373 5,182 Add: Reinsurance 158 145 Ending balance $ 5,531 $ 5,327 Reinsurance in the table above reflect s amounts due from reinsurers related to unpaid c laims liabilities. The Company’ s insurance subsidiaries enter into agreements with other companies primarily to limit losses from large exposures and to permit recovery of a portion of incurred losses. See Note 8 for additional information on reinsurance. The majority of the lia bility for unpaid claims and claim expenses is related to disability claims with long-tailed payouts. Interest earned on assets backing these liabilities is an integral part of pricing and reserving. Therefore, interest accreted on prior year balances is shown as a separate component of prior year incurred claims. This i nterest is calculated by applying the average discount rate used in determining the liability balance to the average liability balance over the period. The remaining prior year incurred claims amount primarily reflects updates to the Company’s liability estimates and variances between actual experience during the period relative to the assumptions and expectations reflected in determining the liability. Assumptions reflect the Company’s expectations over the life of the book of business and will vary from actual experience in any period, both favorably and unfavorably, with variation in resolution rates being the most significant driver for the long-term disability business. Favorable pr ior year incurred claims for the three months ended March 31, 2019 primarily reflect favorable life loss ratio experience, partially offset by unfavorable long-term disability resolution rate experience. Favorable prior year incurred claims reported for t he three months ended March 31, 2018 primarily reflected favorable life loss ratio experience.

Reinsurance

Reinsurance	3 Months Ended
	Mar. 31, 2019
Reinsurance Disclosures [Abstract]
Reinsurance	N ote 8 – R einsurance The Company’s insurance subsidiaries enter into agreements with other insurance companies to assume and cede reinsurance. Reinsurance is ceded primarily in acquisition and disposition transactions when the underwriting company is not being acquired. Reinsurance is also used to limit losses from large exposures and to permit recovery of a portion of direct or assumed losses. Reinsurance does not relieve the ori ginating insurer of liability. Therefore, reinsured liabilities mu st continue to be reported along with the related reinsurance recoverables. The Company regularly evaluates the financial condition of its reinsurers and monitors concentrations of its credit risk. Reinsurance Recoverables The majority of the Company’s reinsurance recoverables resulted from acquisition and disposition transactions in which the underwriting company was not acquired. Components of the Company’s reinsurance recoverables are presented in the following table. The table below includes $280 million as of March 31, 2019 and $297 million as of December 31, 2018 of current reinsurance recoverables that are reported in other current assets. (Dollars in millions) March 31, December 31 Collateral and Other Terms Line of Business Reinsurer(s) 2019 2018 at March 31, 2019 Ongoing Operations Integrated Medical, International Markets, Group Disability, COLI Various $ 470 $ 464 Balances range from less than $1 million up to $65 million. Over 70% of the balance is from companies rated as investment grade by Standard & Poor’s. Total recoverables related to ongoing operations 470 464 Acquisition, disposition or runoff activities Individual Life and Annuity (sold in 1998) Lincoln National Life and Lincoln Life & Annuity of New York 3,254 3,312 Both companies’ ratings were well above the level that would trigger a contractual obligation to fully secure the outstanding balance. GMDB (effectively exited in 2013) Berkshire 844 893 100% secured by assets in a trust. Retirement Benefits Business (sold in 2004) Prudential Retirement Insurance and Annuity 761 787 100% secured by assets in a trust. Supplemental Benefits Business (2012 acquisition) Great American Life 254 261 100% secured by assets in a trust. Other Various 82 87 100% secured by assets in a trust or other deposits. Total recoverables related to acquisition, disposition or runoff activities 5,195 5,340 Total reinsurance recoverables $ 5,665 $ 5,804 The Company bears the risk of loss if its reinsurers and retrocessionaires do not meet or are unable to meet their reinsurance obligations to the Company. The Company reviews its reinsurance arrangements and establishes reserves against the recoverables if recovery is not considered probable. Effects of Reinsurance The following table presents direct, assumed and ceded premiums for both short-duration and long-duration insurance contracts. It also presents reinsurance recoveries that have been netted against benefit expenses in the Company’s Consolidated Statements of Income. Three Months Ended (In millions) March 31, 2019 March 31, 2018 Ceded Premiums Individual life insurance and annuity business sold $ 34 $ 37 Other 96 98 Total ceded premiums 130 135 Reinsurance recoveries Individual life insurance and annuity business sold 55 57 Other 4 47 Total reinsurance recoveries $ 59 $ 104 The effects of reinsurance on written premiums for short-duration contracts were not materially different from the recognized premium amounts shown in the table above. Effective Exit of GMDB and GMIB Business The Company entered into an agreement with Berkshire to effectively exit the GMDB and GMIB business via a reinsurance transaction in 2013. Berkshire reinsured 100% of the Company’s future claim payments in this business, net of other reinsurance arrangements existing at that time. The reinsurance agreement is subject to an overall limit with approximately $ 3.3 billion remaining at March 31, 2019 . GMDB is accounted for as reinsurance and GMIB assets and liabilities are reported as derivatives at fair value as discussed below. GMIB assets are reported in other current assets and other assets, and GMIB liabilities are reported in accrued expenses and other liabilities and other non-current liabilities. GMDB The GMDB exposure arises under annuities written by ceding companies that guarantee the benefit received at death . The Company’s exposure arises when the guaranteed minimum death benefit exc eeds the fair value of the related mutual fund investments at the tim e of a contractholder’s death. The following table presents the account value, net amount at risk and the number of contractholders for guarantees assumed by the Company in the event of death. The net amount at risk is the amount that the Company would have to pay if all contractholders died as of the specified date. Unless the Berkshire reinsurance limit is exceeded, t he Company sh ould be reimbursed in full for these payments. March 31, December 31, (Dollars in millions, excludes impact of reinsurance ceded) 2019 2018 Account value $ 8,996 $ 8,402 Net amount at risk $ 1,943 $ 2,466 Number of contractholders (estimated) 215,000 220,000 GMIB The Company reinsured contracts with issuers of GMIB products. The Company’s exposure represents the excess of a contractually guaranteed amount over the level of variable annuity account values. Payment by the Company depends on the actual account value in the underlying mutual funds and the level of interest rates when the contractholders elect to receive minimum income payments that can only occur within 30 days of a policy anniversary after the appropriate waiting period . The Company has purchased retrocessional coverage (“GMIB assets”), including retrocessional coverage from Berkshire, for these contracts. Assumptions used in fair value measurement. GMIB assets and liabilities are established using capital market assumptions and assumptions related to future annuitant behavior (including mortality, lapse, and annuity election rates). The Company classifies GMIB assets and liabilities in Level 3 of the fair value hierarchy described in Note 10 because assumptions related to future annuitant behavior are largely unobservable. The only assumption expected to impact future shareholders’ net inc ome is non-performance risk. The non-performance risk adjustment reflects a market participant’s view of nonpayment risk by adding an additional spread to the discount rate in the calculation of both (a) the GMIB liabilities to be paid by the Company, and (b) the GMIB assets to be paid by the reinsurers, after considering collateral. The impact of non-performance risk was immaterial for the three months ended March 31, 2019 and 2018. GMIB liabilities totaling $700 million as of March 31, 2019 and $706 million as of December 31, 2018 were reported in accrued expenses and other liabilities and other non-current l iabilities. There were three reinsurers covering 100% of the GMIB exposures as of March 31, 2019 and December 31, 2018 as follows: (In millions) Line of Business Reinsurer March 31, 2019 December 31, 2018 Collateral and Other Terms at March 31, 2019 GMIB Berkshire $ 339 $ 341 100% were secured by assets in a trust. Sun Life Assurance Company of Canada 206 208 Liberty Re (Bermuda) Ltd. 183 184 94% were secured by assets in a trust. Total GMIB recoverables reported in other current assets and other assets $ 728 $ 733 Amounts included in shareholders net income for GMIB assets and liabilities were not material for the three months ended March 31, 2019 or 2018 .

Investments

Investments	3 Months Ended
	Mar. 31, 2019
Investments:
Investments	Note 9 – Investments Cigna’s investment portfolio consists of a broad range of investments including debt and equity securities, commercial mortgage loans, policy loans, other long-term investments, short-term investments and derivative financial instruments. The sections below provide more detail regarding our investment balance s, net investment income and realized investment gains and losses. See Note 10 for information about the valuation o f the Company’s investment portfolio. March 31, 2019 December 31, 2018 (In millions) Current Long-term Total Current Long-term Total Debt securities $ 1,363 $ 21,806 $ 23,169 $ 1,320 $ 21,608 $ 22,928 Equity securities - 210 210 377 171 548 Commercial mortgage loans 32 1,832 1,864 32 1,826 1,858 Policy loans - 1,403 1,403 - 1,423 1,423 Other long-term investments - 2,006 2,006 - 1,901 1,901 Short-term investments 267 - 267 316 - 316 Total $ 1,662 $ 27,257 $ 28,919 $ 2,045 $ 26,929 $ 28,974 Investment Portfolio Debt Securities The amortized cost and fair value by contractual maturity periods for debt securities were as follows at March 31, 2019 : Amortized Fair (In millions) Cost Value Due in one year or less $ 1,366 $ 1,370 Due after one year through five years 6,516 6,684 Due after five years through ten years 9,529 9,682 Due after ten years 4,231 4,925 Mortgage and other asset-backed securities 494 508 Total $ 22,136 $ 23,169 Actual maturities of these securities could differ from their contractual maturities used in the table above. This could occur because issuers may have the right to call or prepay obligations, with or without penalties. Gross unrealized appreciation (d epreciation) on debt securities by type of issuer is shown below . Amortized Unrealized Unrealized Fair (In millions) Cost Appreciation Depreciation Value March 31, 2019 Federal government and agency $ 513 $ 221 $ (1) $ 733 State and local government 851 77 - 928 Foreign government 2,126 183 (4) 2,305 Corporate 18,152 676 (133) 18,695 Mortgage and other asset-backed 494 21 (7) 508 Total $ 22,136 $ 1,178 $ (145) $ 23,169 Investments supporting liabilities of the Company’s run-off settlement annuity business (included in total above) (1) $ 2,269 $ 555 $ (13) $ 2,811 December 31, 2018 Federal government and agency $ 507 $ 204 $ (1) $ 710 State and local government 920 66 (1) 985 Foreign government 2,214 155 (7) 2,362 Corporate 18,403 411 (453) 18,361 Mortgage and other asset-backed 506 16 (12) 510 Total $ 22,550 $ 852 $ (474) $ 22,928 Investments supporting liabilities of the Company’s run-off settlement annuity business (included in total above) (1) $ 2,264 $ 479 $ (40) $ 2,703 (1) Net unrealized appreciation for these investments is excluded from accumulated other comprehensive income. Review of declines in fair value. Management reviews debt securities with a decline in fair value from cost for impairment based on criteria that include: length of time and severity of decline; financial health and specific near term prospects of the issuer; changes in the regulatory, economic or general market environment of the issuer’s industry or geographic region; and the Company’s intent to sell or the likelihood of a required sale prior to recovery. Management believes the unrealized depr eciation below to be temporary based on this review, and therefore has not impaired these amounts. The table below summarizes debt securities with a decline in fair value from amortized cost by the length of time these securities have been in an unrealiz ed loss position. March 31, 2019 December 31, 2018 Fair Amortized Unrealized Number Fair Amortized Unrealized Number (Dollars in millions) Value Cost Depreciation of Issues Value Cost Depreciation of Issues One year or less Investment grade $ 715 $ 734 $ (19) 190 $ 7,127 $ 7,367 $ (240) 1,324 Below investment grade $ 324 $ 328 $ (4) 393 $ 1,185 $ 1,240 $ (55) 1,190 More than one year Investment grade $ 4,431 $ 4,532 $ (101) 919 $ 3,023 $ 3,181 $ (158) 784 Below investment grade $ 455 $ 476 $ (21) 355 $ 249 $ 270 $ (21) 245 Commercial Mortgage Loans Mortgage loans held by the Company are made exclusively to commercial borrowers and are diversified by property type, location and borrower. Loans are generally issued at a fixed rate of interest and are secured by high quality, primarily completed and substantially leased operating properties. Commercial mortgage loans are classified as either current or long-term investments based on their contractual maturities. Credit quality . The Company regularly evaluates and monitors credit risk, beginning with the initial underwriting of a mortgage loan and continuing throughout the investment holding period. Mortgage origination professionals employ an internal credit quality rating sys tem designed to evaluate the relative risk of the transaction at origination that is then updated each year as part of the annual portfolio loan review. The Company evaluates and monitors credit quality on a consistent and ongoing basis, classifying each loan as a loan in good standing, potential problem loan or problem loan. Quality ratings are based on our evaluation of a number of key inputs related to the loan, including real estate market-related factors such as rental rates and vacancies, and proper ty-specific inputs such as growth rate assumptions and lease rollover statistics. However, the two most significant contributors to the credit quality rating are the debt service coverage and loan-to-value ratios. The debt service coverage ratio measures the amount of property cash flow available to meet annual interest and principal payments on debt, with a ratio below 1.0 indicating that there is not enough cash flow to cover the required loan payments. The loan-to-value ratio, commonly expressed as a percentage, compares the amount of the loan to the fair value of the underlying property collateralizing the loan. The following table summarizes the credit risk profile of the Company’s commercial mortgage loan portfolio based on loan-to-value and debt s ervice coverage ratios as of March 31, 2019 and December 31, 2018 : (Dollars in millions) March 31, 2019 December 31, 2018 Loan-to-Value Ratio Carrying Value Average Debt Service Coverage Ratio Average Loan-to-Value Ratio Carrying Value Average Debt Service Coverage Ratio Average Loan-to-Value Ratio Below 60% $ 1,167 2.12 $ 1,132 2.14 60% to 79% 621 1.92 650 1.93 80% to 100% 76 1.49 76 1.49 Total $ 1,864 2.03 58% $ 1,858 2.04 58% The Company’s annual in-depth review of its commercial mortgage loan investments is the primary mechanism for identifying emerging risks in the portfolio. The most recent review was completed by the Company’s investment professionals in the second quarter of 201 8 and included an analysis of each underlying property’s most recent annual financial statements, rent rolls, operating plans, budgets, a physical inspection of the property and other pertinent factors. Based on historical results, current l eases, lease expirations and rental conditions in each market, the Company estimated the current year and future stabilized property income and fair value for each loan. The Company re - evaluate s a loan’s credit quality between annual reviews if new proper ty information is received or an event such as delinquency or a borrower’s request for restructure causes management to believe that the Company’s estimate of financial performance, fair value or the risk profile of the underlying property has been impacte d. Impaired commercial mortgage loans. A commercial mortgage loan is considered impaired when it is probable that the Company will not collect all amounts due per the terms of the promissory note. Impaired loans are carried at the lower of the unpaid pr incipal balance or fair value of the underlying collateral. Interest income on impaired mortgage loans is only recognized when a payment is received There were no impaired commercial mortgage loans a s of March 31, 2019 or December 31, 2018 . Short-Term Investments and Cash Equivalents Short-term investments and cash equivalents included the following types of issuers: March 31, December 31, (In millions) 2019 2018 Corporate securities $ 1,531 $ 581 Federal government securities $ 127 $ 82 Foreign government securities $ 162 $ 238 Money market funds $ 855 $ 1,174 Realized Investment Gains a nd L osses The following realized g ains and losses on investments exclude amounts required to adjust future policy benefits for the run-off settlement annuity business , as well as realized gains and losses attributed to the Company’s separate accounts because those gains and losses generally accrue directly to separate account policyholders . Three Months Ended March 31, (In millions) 2019 2018 Net realized investment gains (losses), excluding investment asset write-downs $ 11 $ (16) Write-downs on debt securities (1) (13) Write-downs on other invested assets - (4) Net realized investment (losses) gains, before income taxes $ 10 $ (33) Net realized investment gains, excluding investment asset write-downs, for the three months ended March 31, 2019 represent primarily mark to market gains on equity securities. Net realized investment losses, excluding investment asset write-downs, for the three months ended March 31, 2018 represent primarily losses on sales of debt securities. Realized gains or losses on equity securities still held at March 31, 2019 and 2018 were not material. The following table presents s ales inf ormation for available-for-sal e debt securities. Gross gains on sales and gross losses on sales exclude amounts required to adjust future policy benefits for the run-off settlement annuity business. Three Months Ended March 31, (In millions) 2019 2018 Proceeds from sales $ 1,086 $ 499 Gross gains on sales $ 14 $ 5 Gross losses on sales $ (10) $ (22) Derivative Financial Instruments The Company uses derivative financial instruments to manage the characteristics of investment assets (such as duration, yield, currency and liquidity) to meet the varying demands of the related insurance and contract holder liabilities. The Company also uses derivative financial instruments to hedge the risk of changes in the net assets of certain of its foreign subsidiaries due to changes in foreign currency exchange rates. The Company has written and purchased GMIB reinsurance contracts in its run-off reinsurance business that are accounted for as freesta nding derivatives as discussed in Note 8. Derivatives in the Company’s separate accounts are excluded from the following discussion because associated gains and lo sses generally accrue directly to separate account policyholders. Derivative instruments used by the Company typically include foreign currency swap contracts and foreign currency forward contracts. Foreign currency swap contracts periodically exchange c ash flows between two currencies for principal and interest. Foreign currency forward contracts require the Company to purchase a foreign currency in exchange for the functional currency of its operating unit at a future date, generally within three month s from the contracts’ trade dates. The Company manages the credit risk of these derivative instruments by diversifying its portfolio among approved dealers of high credit quality, and through routine monitoring of credit risk exposures. Certain of the Co mpany’s over-the-counter derivative instruments require either the Company or the counterparty to post collateral or demand immediate payment depending on the amount of the net liability position of the derivative instrument and predefined financial streng th or credit rating thresholds. These collateral posting requirements vary by counterparty and amounts posted were not significant as of March 31, 2019 or December 31, 2018 . The Company’s derivative financial instruments are presented as follows: Fair value hedges of the foreign exchange-related changes in fair values of certain foreign-denominated bonds: Swap fair values are reported in long -term investments or o ther non-current liabilities. Changes in fair values attributable to foreign exchange risk of the swap contracts and the hedged bonds are reported in other realized investment gains and losses. Th e portion of the swap contracts’ changes in fair value excluded from the assessment of hedge effectiveness is recorded in accumulated other comprehensive income and recognized in net investment income as swap coupon payments are accrued, offsetting the foreign- denominated coupons received on the designated bonds. Ne t investment hedges of certain foreign subsidiaries that conduct their business principally in Euros: The fair values of the swap contracts are reported in o ther assets o r other non-current liabilities. The changes in fair values of these instruments are reported in other comprehensive income, specifically in translation of foreign currencies. The portion of the change in swap fair values relating to foreign exchange spot rates will be recognized in earnings upon deconsolidation of the hedged foreign sub sidiaries. The remaining changes in swap fair value are excluded from our effectiveness assessment and recognized in interest expense as swap coupon payments are accrued. The notional value of hedging instruments matches the hedged amount of subsidiary n et assets. Economic hedges for derivatives not designated as accounting hedges: Fair values of derivative instruments are reported in current investments or accrued ex penses and other liabilities . The c hanges in fair values are reported in net realized investment gains and losses. Gross fair values of our derivative financial instruments are presented in Note 10 . As of March 31, 2019 and December 31, 2018 , and for the thre e months ended March 31, 2019 and 2018 , the effects of derivative instruments on the Consolidated Financial Statements were not material, including gains or losses reclassified from accumulated other comprehensive income into shareholders’ net income, as well as amounts excluded from the asses sment of hedge effectiveness. The following table summarizes the types and notional quantity of derivative instruments held by the Company. Notional Value as of (In millions) March 31, December 31, Type of Instrument Purpose 2019 2018 Foreign currency swap contracts Fair value hedge: To hedge the foreign exchange-related changes in fair values of certain foreign-denominated bonds. The notional value of these derivatives matches the amortized cost of the hedged bonds. $ 593 $ 525 Foreign currency swap contracts Net investment hedge : To reduce the risk of changes in net assets due to changes in foreign currency spot exchange rates for certain foreign subsidiaries that conduct their business principally in Euros. The notional value of hedging instruments matches the hedged amount of subsidiary net assets. $ 439 $ 439 Foreign currency forward contracts Economic hedge: To hedge the foreign exchange related changes in fair values of a U.S. dollar-denominated bond portfolio to reflect the local currency for the Company‘s foreign subsidiary in South Korea. The notional value of hedging instruments generally aligns with the fair value of the hedged bond portfolio. $ 309 $ 309

Fair Value Measurements

Fair Value Measurements	3 Months Ended
	Mar. 31, 2019
Fair Value Disclosures [Abstract]
Fair value measurements	N ote 10 – Fair Value Measurements The Company carries certain financial instruments at fair value in the financial statements including debt securities , certain equity securities, short-term investments and derivatives. Other financial instruments are measured at fair value only under certain conditions, such as when impaired. Fair value is defined as the price at which an asset could be exchanged in an orderly transaction between market participants at the balance sheet date. A liability’s fair value is defined as the amount that would be paid to transfer the liability to a market participant, not the amount that would be paid to settle t he liability with the c reditor. The Company’s financial assets and liabilities carried at fair value have been classified based upon a hierarchy defined by GAAP. The hierarchy gives the highest ranking to fair values determined using unadjusted quoted prices in active markets for identical assets and liabilities (Level 1) and the lowest ranking to fair values determined using methodologies and models with unobservable inputs (Level 3). An asset’s or a liability’s classification is based on the lowest level of input that is sig nificant to its measurement. For example, a financial asset or liability carried at fair value would be classified in Level 3 if unobservable inputs were significant to the instrument’s fair value, even though the measurement may be derived using inputs t hat are both observable (Levels 1 and 2) and unobservable (Level 3). The Company estimates fair values using prices from third parties or internal pricing methods. Fair value estimates received from third-party pricing services are based on reported trad e activity and quoted market prices when available, and other market information that a market participant may use to estimate fair value. The internal pricing methods are performed by the Company’s investment professionals and generally involve using dis counted cash flow analyses, incorporating current market inputs for similar financial instruments with comparable terms and credit quality as well as other qualitative factors. In instances where there is little or no market activity for the same or simil ar instruments, fair value is estimated using methods, models and assumptions that the Company believes a hypothetical market participant would use to determine a current transaction price. These valuation techniques involve some level of estimation and j udgment that becomes significant with increasingly complex instruments or pricing models. The Company is respons ible for determining fair value and for assigning the appropriate level within the fair value hierarchy based on the significance of unobserv able inputs. The Company reviews methodologies, processes and controls of third-party pricing services and compares prices on a test basis to those obtained from other external pricing sources or internal estimates. The Company performs ongoing analyses of both prices received from third-party pricing services and those developed internally to determine that they represent appropriate estimates of fair value. The controls executed by the Company include evaluating changes in prices and monitoring for pot entially stale valuations. The Company also performs sample testing of sales values to confirm the accuracy of prior fair value estimates. The minimal e xceptions identified during these processes indicate that adjustments to prices are infrequent and do not significantly impact valuations. W e conduct an annual on-site visit of the most significant pricing service to review their processes, methodologies and controls. This on-site review includes a walk-through of inputs for a sample of securities held across various asset types to validate the documented pricing process. Financial Assets and Financial Liabilities Carried at Fair Value The following table provides information as of March 31, 2019 and December 31, 2018 about the Company’s financial assets and liabil ities carried at fair value. Separate account assets are also recorded at fair value on the Company’s Consolidated Balance Sheets and are reported separately in the Separate Accounts section below as gains and losses related to these assets generally a ccr ue directly to policyholders. (In millions) Quoted Prices in Active Markets for Identical Assets (Level 1) Significant Other Observable Inputs (Level 2) Significant Unobservable Inputs (Level 3) Total As of As of As of As of As of As of As of As of March 31, December 31, March 31, December 31, March 31, December 31, March 31, December 31, 2019 2018 2019 2018 2019 2018 2019 2018 Financial assets at fair value Debt securities Federal government and agency $ 212 $ 209 $ 521 $ 501 $ - $ - $ 733 $ 710 State and local government - - 928 985 - - 928 985 Foreign government - - 2,277 2,356 28 6 2,305 2,362 Corporate - - 18,458 18,127 237 234 18,695 18,361 Mortgage and other asset-backed - - 369 372 139 138 508 510 Total debt securities 212 209 22,553 22,341 404 378 23,169 22,928 Equity securities (1) 8 384 49 43 32 32 89 459 Short-term investments - - 267 316 - - 267 316 Derivative assets - - 58 53 - - 58 53 Real estate funds priced at NAV as a practical expedient (2) 230 239 Financial liabilities at fair value Derivative liabilities $ - $ - $ 14 $ 10 $ - $ - $ 14 $ 10 (1) Excludes certain equity securities that have no readily determinable fair value. (2) As a practical expedient, certain real estate funds are carried at fair value based on the Company’s ownership share of the equity of the investee (Net Asset Value (“NAV“)) including changes in the fair value of its underlying investments. The funds have a quarterly redemption frequency, 45-90 day redemption notice period and $58 million in unfunded commitments as of March 31, 2019. Level 1 Financial Assets Inputs for instruments classified in Level 1 include unadjusted quoted prices for identical assets in active markets accessible at the measurement date. Active markets provide pricing data for trades occurring at least weekly and include exchanges and dealer markets. Assets in Level 1 include actively-traded U.S. government bonds and exchange-listed equity securities. A relatively small portion of the Company’s investment assets are classified in this category given the narro w definition of Level 1 and the Company’s investment asset strategy to maximize investment returns. Level 2 Financial Assets and Financial Liabilities Inputs for instruments classified in Level 2 include quoted prices for similar assets or liabilities in active markets, quoted prices from those willing to trade in markets that are not active or other inputs that are market observable or can be corroborated by market data for the term of the instrument. Such other inputs include market interest rates and volatilities, spreads and yield curves. An instrument is classified in Level 2 if the Company determines that unobservable inputs are insignificant. Debt and equity securities. Approximately 97 % of the Company’s investments in debt and equit y securities are classified in Level 2 including most public and private corporate debt and hybrid equity securities, federal agency and municipal bonds, non-government mortgage-backed securities and preferred stocks. Third-party pricing services and inte rnal methods often use recent trades of securities with similar features and characteristics because many debt securities do not trade daily. Pricing models are used to determine these prices when recent trades are not available. These models calculate f air values by discounting future cash flows at estimated market interest rates. Such market rates are derived by calculating the appropriate spreads over comparable U.S. Treasury securities, based on the credit quality, industry and structure of the asset . Typical inputs and assumptions to pricing models include, but are not limited to, a combination of benchmark yields, reported trades, issuer spreads, liquidity, benchmark securities, bids, offers, reference data and industry and economic events. For mo rtgage-backed securities, inputs and assumptions may also include characteristics of the issuer, collateral attributes, prepayment speeds and credit rating. Nearly all of these instruments are valued using recent trades or pricing models. Less than 1 % of the fair value of investments classified in Level 2 represents foreign bonds that are valued using a single, unadjusted market-observable input derived by averaging multiple broker-dealer quotes, consistent with local market practice. Short-term investments are carried at fair value that approximates cost. The Company compares market prices for these securities to recorded amounts on a regular basis to validate that current carrying amounts approximate exit prices. The short-term nature of the i nvestments and corroboration of the reported amounts over the holding period support their classification in Level 2. Derivative assets and liabilities classified in Level 2 represent over-the-counter instruments such as foreign currency forward and swap contracts. Fair values for these instruments are determined using market observable inputs including forward currency and interest rate curves and widely published market observable indices. Credit risk related to the counterparty and the Company is cons idered when estimating the fair values of these derivatives. However, the Company is largely protected by collateral arrangements with counterparties and determined that no adjustment for credit risk was required as of March 31, 2019 or December 31, 2018 . The nature and use of these derivative financial instruments are described in Note 9 . Level 3 Financial Assets and Financial Liabilities Certain inputs for instruments classified in Level 3 are unobservable (supported by little or no market activity) and sign ificant to their resulting fair value measurement. Unobservable inputs reflect the Company’s best estimate of what hypothetical market participants would use to determine a transaction price for the asset or liability at the reporting date. The Company classifies certain newly-issued, privately-placed, complex or illiquid securities in Level 3. Approximately 2 % of debt and equity securities are priced using significant unobservable inputs and classified in this category. Fair values of mortgage and other asset-backed securities as well as corporate and government debt securities are primarily determined using pricing models that incorporate the specific characteristics of each asset and related assumptions including the investment type and structure, credit quality, industry and maturity date in comparison to current market indic es, spreads and liquidity of assets with similar characteristics. Inputs and assumptions for pricing may also include collateral attributes and prepayment speeds for mortgage and other asset-backed securities. Recent trades in the subject security or sim ilar securities are assessed when available, and the Company may also review published research in its evaluation as well as the issuer’s financial statements. Quantitative Information about Unobservable Inputs The following table summarizes the fair val ue and significant unobservable inputs used in pricing the following debt securities that were developed directly by the Company as of March 31, 2019 and December 31, 2018 . The range and weighted average basis point amounts (“bps”) for liquidity and credit spreads (ad justme nt to discount rates) reflect the Company’s best estimates of the unobservable adjustments a market participant would make to calculate the se fair values. Corporate and government debt securities . The significant unobservable input used to value the following corporate and government debt securities is an adjustment for liquidity. An adjustment is needed to reflect current market conditions and issuer circumstances when there is limited trading activity for the security. Mortgage and other asset -backed securities. The significant unobservable inputs used to value the following mortgage and other asset-backed securities are liquidity and weighting of credit spreads. An adjustment for liquidity is made as of the measurement date that considers cu rrent market conditions, issuer circumstances and complexity of the security structure when there is limited trading activity for the security. An adjustment to weight credit spreads is needed to value a more complex bond structure with multiple underlyin g collateral and no standard market valuation technique. The weighting of credit spreads is primarily based on the underlying collateral’s characteristics and their proportional cash flows supporting the bond obligations. Fair Value as of Unobservable Adjustment Range (Weighted Average) as of March 31, December 31, Unobservable Input March 31, 2019 March 31, December 31, (Fair value in millions ) 2019 2018 2019 2018 Debt securities Corporate and government debt securities $ 253 $ 229 Liquidity 80 - 930 (230) bps 50 - 930 (230) bps Mortgage and other asset-backed securities 139 138 Liquidity 60- 360 (70) bps 60- 340 (70) bps Weighting of credit spreads 210 - 380 (280) bps 190 - 340 (260) bps Securities not priced by the Company (1) 12 11 Total Level 3 debt securities $ 404 $ 378 (1) The fair values for these securities use single, unadjusted non-binding broker quotes not developed directly by the Company. Significant increases in liquidity or credit spreads would result in lower fair value measurement s while decreases in these inputs would result in higher fair value measurement s. T he unobservable inputs are generally not interrelated and a change in the assumption used for one unobservable input is not accompanied by a change in the other unobservable input. Changes in Level 3 Financial Assets and Financial Liabilities Carried at Fair Valu e The following table summarize s the changes in financial assets and financial liabilities classified in Level 3 for the three months ended March 31, 2019 and 2018 . G ains and losses reported in this table may include net changes in fair value that are attributable to both observable and unobservable inputs. Debt and Equity Securities (In millions) For the Three Months Ended March 31, 2019 2018 Balance at January 1, $ 410 $ 732 Total (losses) included in shareholders’ net income (1) (20) Gains (losses) included in other comprehensive income 7 (5) Gains (losses) required to adjust future policy benefits for settlement annuities (1) 2 (4) Purchases, sales, settlements Purchases - 10 Sales - (11) Settlements (1) (2) Total purchases, sales and settlements (1) (3) Transfers into/(out of) Level 3 Transfers into Level 3 20 20 Transfers out of Level 3 (2) (1) (124) Total transfers into/(out of) Level 3 19 (104) Balance at March 31, $ 436 $ 596 Total (losses) included in shareholders’ net income attributable to instruments held at the reporting date $ (1) $ (7) (1) Amounts do not accrue to shareholders. (2) Beginning in 2018, certain private equity securities are no longer carried at fair value under the policy election of ASU 2016-01 (Recognition and Measurement of Financial Assets and Financial Liabilities). Private equity securities of $70 million as of December 31, 2017 are included in the 2018 Transfers out of Level 3 amount. Total gains and losses included in shareholders’ net income in the table above are reflected in the Consolidated Statements of Income as realized investment gains (losses) and net investment income. Gains and losses included in other comprehensive income in the tables above are reflected in net unrealized appreciation (depreciation) on securities in the Consolidated Statements of Comprehensive Income. Trans fers into or out of the Level 3 category occur when unobservable inputs, such as the Company’s best estimate of what a market participant would use to determine a current transaction price, become more or less significant to the fair value measurement. T ransfers between Level 2 and Level 3 during 2019 and 2018 primarily reflect ed changes in liq uidity and credit risk estimates for certain private placement issuers across several sectors. As noted above, transfers out of Level 3 during 2018 also include $70 million of private equity securities that are no longer carried at fair value. Separate A ccount s The investment income and fair value gains and losses of separate account assets generally accrue directly to the contractholders and, together with their deposits and withdrawals, are excluded from the Company’s Consolidated Statements of Income and Cash Flows. See Note 10 to the Consolidated Financial Statements contained in the 2018 Form 10-K for additional policy information related to separate accounts. (In millions) Quoted Prices in Active Markets for Identical Assets (Level 1) Significant Other Observable Inputs (Level 2) Significant Unobservable Inputs (Level 3) Total March 31, December 31, March 31, December 31, March 31, December 31, March 31, December 31, 2019 2018 2019 2018 2019 2018 2019 2018 Guaranteed separate accounts (See Note 16) $ 204 $ 187 $ 264 $ 267 $ - $ - $ 468 $ 454 Non-guaranteed separate accounts (1) 1,328 1,204 5,346 5,216 244 233 6,918 6,653 Subtotal $ 1,532 $ 1,391 $ 5,610 $ 5,483 $ 244 $ 233 7,386 7,107 Non-guaranteed separate accounts priced at NAV as a practical expedient (1) 693 732 Total separate account assets $ 8,079 $ 7,839 (1) Non-guaranteed separate accounts included $3.9 billion as of March 31, 2019 and $3.8 billion as of December 31, 2018 in assets supporting the Company’s pension plans, including $0.2 billion classified in Level 3 as of March 31, 2019 and December 31, 2018. Separate account assets in Level 1 primarily include exchange-listed equity securities. Level 2 assets primarily include: corporate and structured bonds valued using recent trades of similar securities or pricing models that discount future cash flows at estimated market interest rates as described above; and actively-traded institutional and retail mutual fund investments . Separate account assets classified in Level 3 primarily support Cigna’s pension plans and include commercial mortgage loans as wel l as certain newly-issued, privately-placed, complex, or illiquid securities that are priced using methods discussed above. Activity, including transfers into and out of Level 3, was not material for the three months ended March 31, 2019 and 2018 . Separate account investments in securities partnerships, real estate, and hedge funds are generally valued based on the separate account’s ownership share of the equity of the investee (NAV as a practical expedient) including changes in the fair values of its underlying investments. Substantially all of these assets support the Cigna Pension Plans. The following table provides additional information on these investments. Unfunded Commitments Redemption Frequency Fair Value as of as of (if currently Redemption Notice (In millions) March 31, 2019 December 31, 2018 March 31, 2019 eligible) Period Securities partnerships $ 464 $ 477 $ 351 Not applicable Not applicable Real estate funds 216 237 - Quarterly 30-90 days Hedge funds 13 18 - Up to annually, varying by fund 30-90 days Total $ 693 $ 732 $ 351 Assets and Liabilities Measured at Fair Value under Certain Conditions Some financial assets and liabilities are not carried at fair value each reporting period, but may be measured using fair value only under certain conditions such as investments when they become impaired, including investment real estate and commercial mortgage loans, and certain equity securities with no readily determinable fair value. There were no such impaired investments written down to their fair values for the three months en ded March 31, 2019 . Recorded values for these asset types representing less than 1% of total investments, were written down to their fair values, resulting in immaterial realized investment losses for the three months ended March 31, 2018 . Fair Value Disclosures for Financial Instruments Not Carried at Fair Value The following table includes the Company’s financial instruments not recorded at fair value that are subject to fai r value disclosure requirements at March 31, 2019 and December 31, 2018 . In addition to universal life products and finance leases, f inancial instruments that are carried in the Company’s C onsolidated F inancial S tatements at amounts that approximate fair value are excluded from the following table. (In millions) March 31, 2019 December 31, 2018 Classification in Fair Value Hierarchy Fair Value Carrying Value Fair Value Carrying Value Commercial mortgage loans Level 3 $ 1,875 $ 1,864 $ 1,832 $ 1,858 Long-term debt, including current maturities, excluding finance leases Level 2 $ 41,027 $ 39,840 $ 40,819 $ 40,829 Fair values of off-balance sheet financial instruments were not material as of March 31, 2019 and December 31, 2018 .

Variable Interest Entities

Variable Interest Entities	3 Months Ended
	Mar. 31, 2019
Variable Interest Entities [Abstract]
Variable interest entities	Note 11 – Variable Interest Entities When the Company becomes involved with a variable interest entity and when the re is a change in the Company’s involvement with an entity , the Company must determine if it is the primary beneficiary and must consolidate the entity. The Company is considered the primary beneficiary if it has the power to direct the entity’s most significant economic activities or has the right to receive benefits or obligation to absorb losses that could be signifi cant to the entity. The Company evaluates the following criteria: the structure and purpose of the entity; the risks and rewards created by and shared through the entity; and the Company’s ability to direct its activities, receive its benefits and absorb its losses relative to the other parties involved with the entity including its sponsors, equity holders, guarantors, creditors and servicers. T he Company determined it was not a primary beneficiary in any material variable interest entities a s of March 31, 2019 or December 31, 2018 . The Company’s involvement in variable interest entities where it is not the primary beneficiary is described below. Securities limited partnerships and real estate limited partnerships . The Company owns interests in securities limited partnerships and real estate limited partnerships that are defined as variable interest entities . These partnerships invest in the equity or mezzanine debt of privately held companies and real estate properties. General partners unaffiliated with the Com pany control decisions that most significantly impact the partnership’s operations and the limited partners do not have substantive kick-out or participating rights. The Company’s maximum exposure to these entities of $ 3.3 billion across approximately 140 li mited partnerships as of March 31, 2019 includes $ 1.5 billion reported in long-term investments and commitments to contribute an additional $ 1.8 b illion. The Company’s noncontrolling interest in each of these limited partnerships is generally less than 10 % of the partnership ownership interests . Other asset-backed and corporate securities. In the normal course of its investing activities, the Company also makes passive investments in certain asset-backed and corporate securities that are issued by variable interest entities whose sponsors or issuers are unaffiliated with the Company . Th e Company receives fixed-rate cash flows from these investments and the maximum pote ntial exposure to loss is limited to the carrying amount of $ 0.6 b illion as of March 31, 2019 that is reported in debt securities . The Company’s combined ownership interests are insignificant relative to the total principal amount s issue d by these entities. The Company is also involved in real estate joint ventures, independent physician associat ions and a joint venture in India that are variable interest entities . The carrying values and maximum exposures associated with these arrangem ents are immaterial. The Company has not provided, and does not intend to provide, financial support to any of the above entities that it is not contractually required to provide. The Company performs ongoing qualitative analyses of its involvement with these variable interest entities to determine if consolidation is required.

Accumulated Other Comprehensive

Accumulated Other Comprehensive Income (Loss)	3 Months Ended
	Mar. 31, 2019
Accumulated Other Comprehensive Income (Loss) [Abstract]
Accumulated Other Comprehensive Income (Loss)	Note 12 – Accumulated Other Comprehensive Income ( Loss ) (“AOCI”) AOCI includes the Company’s share from entities accounted for using the equity method. AOCI excludes amounts required to adjust future policy benefits for the run-off settlement annuity business and a portion of deferred acquisition costs associated with the corporate-owned life insurance business. Generally, tax effects in AOCI are established at the currently enacted tax rate and reclassified to net income in the same period that the related pre-tax AOCI reclassifications are recognized. Changes in the components of AOCI were as follows: Three Months Ended March 31, (In millions) 2019 2018 Securities and Derivatives Beginning balance $ 18 $ 328 Reclassification adjustment to retained earnings related to U.S. tax reform legislation (1) - 65 Reclassification adjustment to retained earnings related to new financial instruments guidance (1) - (4) Reclassification adjustment from retained earnings related to new hedging guidance - (6) Adjusted beginning balance 18 383 Appreciation (depreciation) on securities and derivatives 565 (385) Tax (expense) benefit (122) 77 Net appreciation (depreciation) on securities and derivatives 443 (308) Reclassification adjustment for (gains) losses included in shareholders’ net income (net realized investment gains) (1) 30 Tax (expense) - (6) Net (gains) losses reclassified from AOCI to net income (1) 24 Other comprehensive income (loss), net of tax 442 (284) Ending balance $ 460 $ 99 Translation of foreign currencies Beginning balance $ (221) $ (65) Reclassification adjustment to retained earnings related to U.S. tax reform legislation (1) - (4) Adjusted beginning balance (221) (69) Translation of foreign currencies (23) 46 Tax (expense) (1) (1) Net translation of foreign currencies (24) 45 Ending balance $ (245) $ (24) Postretirement benefits liability Beginning balance $ (1,508) $ (1,345) Reclassification adjustment to retained earnings related to U.S. tax reform legislation (1) - (290) Adjusted beginning balance (1,508) (1,635) Reclassification adjustment for amortization of net losses from past experience and prior service costs (selling, general and administrative expenses) 15 17 Reclassification adjustment for settlement (selling, general and administrative expenses) 10 - Tax (expense) (14) (4) Other comprehensive income, net of tax 11 13 Ending balance $ (1,497) $ (1,622) (1) See Note 2 in Cigna’s 2018 Form 10-K for further information about the Company’s adoption of new accounting standards in 2018.

Pension and Other Postretiremen

Pension and Other Postretirement Benefit Plans	3 Months Ended
	Mar. 31, 2019
Pension and Other Postretirement Benefit Plans [Abstract]
Pension and Other Postretirement Benefit Plans	Note 13 – Pension and Other Postretirement Benefit Plans About our Plans Pension plans . F uture benefit accruals for the Company’s domestic defined benefit pension plans are frozen . The Company also has foreign pension and other postretirement benefit plans that are immaterial to our results of operations, liquidity and financial position. Other postretirement benefit plans. The Company’s postretirement medical plan w as frozen in 2013. The Company also offers certain po stretirement life insurance benefits through various plans. Cost of Our Plans Net pension and other postretirement benefits cost was as follows for the three months ended March 31: Pension Benefits Other Postretirement Benefits Three Months Ended Three Months Ended March 31, March 31, (In millions) 2019 2018 2019 2018 Service cost $ 1 $ 1 $ - $ - Interest cost 49 42 2 2 Expected long-term return on plan assets (56) (64) - - Amortization of: Net loss from past experience 16 17 - - Prior service cost - - (1) - Litigation settlement - plan amendment 142 - - - Settlement loss 10 - - - Net cost $ 162 $ (4) $ 1 $ 2 As further discussed in Note 16 , Old Cigna and the Cigna Pension Plan are defendants in a class action lawsuit related to the Plan’s conversion of certain employees from an annuity to a cash balance benefit in 1997. In the first quarter of 2019, the Plan was amended to reflect the additional benefits required by the Court Order. In addition, class participants were notified of their increased benefits and payment of benefits commenced. This activity resulted in a one-time expense of $142 million r epresenting the present value of the additional pension benefits under the Court Order. An offsetting expense credit was also recorded to reduce the litigation reserve held. Pension and other postretirement benefits expense is reported in “interest exp ense and other” in the Consolidated Statements of Income. The Company did not make any contributions to the domestic qualified pension plans for the three months ended March 31, 2019. Contributions to these plans are expected to be immaterial for the rem ainder of 2019.

Leases

Leases	3 Months Ended
	Mar. 31, 2019
Leases [Abstract]
Leases	Note 14 – Leases As discussed in Note 2, the Company adopted ASU 2016-02, Leases, as of January 1, 2019. As permitted by the standard, the Company did not restate its Consolidated Financial Statements for periods prior to the adoption date and the required disclosures presented below are prospective only. The Company’s operating leases are primarily for office space and certain computer and other equipment, and have terms ranging from one month to 18 years. Accounting policy. The Company det ermines if an arra ngement is a lease and its lease classific ation (operating or finance) at inception . Beginning in the first quarter of 2019, b oth operating and finance leases result in (1) a right-of-use ( “ ROU ” ) asset that represents our right to use the underlying asset for the lease term, and (2) a lease liability that represents our obligation to make lease payments arising from the lease. ROU assets and lease liabilities are reflected in the following lines in the Company’s Consolidated Balance Sh eet: ROU Asset Current Lease Liability Non-Current Lease Liability Operating lease Other Assets Accrued expenses and other liabilities (current) Other liabilities (non-current) Finance lease Property and equipment Short-term debt Long-term debt These lease assets and liabilities are recognized at the lease commencement date based on the present value of the lease payments over the lease term. Most of the Company’s leases do not provide an implicit rate, so the Company uses its incremental borrowing rate based on the information available at commencement date in determining the present value of lease payments. The ROU asset also includes any lease pre-payments made and excludes lease incentives for operating leases . The Company’s lease terms may include options to extend or terminate a lease when it is reasonably certain that the Company will exercise that option. The Company has lease agreements with lease and non-lease components, which are accounted for as a single lease compon ent . Variable lease payments are expensed as incurred and represent amounts that are not fixed in nature, such as maintenance and other services provided by the lessor, and are not tied to an index or rate. The components of lease expense were as follows : (In millions) Three Months Ended March 31, 2019 Operating lease cost $ 47 Finance lease cost: Amortization of ROU assets 8 Interest on lease liabilities 1 Total finance lease cost 9 Variable lease cost 12 Total lease cost $ 68 Supplemental cash flow information related to leases was as follows: (In millions) Three Months Ended March 31, 2019 Cash paid for amounts included in the measurement of lease liabilities: Operating cash outflows from operating leases $ 42 Operating cash outflows from finance leases $ 1 Financing cash outflows from finance leases $ 6 ROU assets obtained in exchange for lease obligations: Operating leases $ 26 Finance leases $ 45 Operating and finance lease ROU assets and lease liabilities were as follows at the balance sheet date: (In millions) March 31, 2019 Operating leases: Operating lease ROU assets $ 602 Accrued expenses and other current liabilities 160 Other non-current liabilities 524 Total operating lease liabilities $ 684 Finance leases: Property and equipment, gross $ 99 Accumulated depreciation (8) Property and equipment, net $ 91 Short-term debt $ 21 Long-term debt 68 Total finance lease liabilities $ 89 The weighted av erage remaining lease term was 5 yea rs for operating leases and 6 years for finance leases. The weighted average discount ra te for operating leases was 3.88% and 3.86 % for finance leases. (In millions) Operating Leases Finance Leases 2019 $ 129 $ 18 2020 169 23 2021 140 14 2022 121 14 2023 81 9 Thereafter 124 22 Total lease payments 764 100 Less: imputed interest 80 11 Total $ 684 $ 89 Disclosures regarding minimum lease payments under previous lease accounting guidance can be found in the Company’s 2018 Form 10-K.

Income Taxes

Income Taxes	3 Months Ended
	Mar. 31, 2019
Income Taxes [Abstract]
Income Taxes	Note 15 – Income Taxes Income Tax Expense The effective tax rate for the three months ended March 31, 2019 of 23.3% was lower than the 24.7% rate for the same period in 2018. The decline was due to suspension of the non-deductible health insurance industry tax. The Company continues to retain a significant portion of its foreign earnings overseas, where they are generally subject to a higher tax rate than that imposed in the United States. Additional deferred tax liabilities of $137 million for foreign withholding taxes would have been recorded if these earnings were intended to be remitted domestically. A portion of these withholding taxes may be eligible for credit against the Company’s U.S. tax liability. B. Uncertain Tax Positions and Other Tax Matters Changes in uncertain tax positions for the three months ended March 31, 2019 and 2018 were immaterial. There were no significant updates to tax return audits in the first quarter of 2019.

Contingencies and Other Matters

Contingencies and Other Matters	3 Months Ended
	Mar. 31, 2019
Contingencies And Other Matters [Abstract]
Contingencies and Other Matters	N ote 16 – Contingencies and Other Matters The Company, through its subsidiaries, is contingently liable for various guarantees provided in the ordinary course of business. Financial Guarantees: Retiree and Life Insurance Benefits The Company guarantees that separate account assets will be sufficient to pay certain life insurance or retiree benefits. For the majority of these benefits, the sponsoring employers are primarily responsible for ensuring that assets are sufficient to pay these benef its and are required to maintain assets that exceed a certain percentage of benefit obligations. If employers fail to do so, the Company or an affiliate of the buyer of the retirement benefits business (Prudential Retirement Insurance and Annuity Company or “Prudential”) has the right to redirect the management of the related assets to provide for benefit payments. As of March 31, 2019 , employers maintained assets that exceeded the benefit obligations under these arrangements of approximately $ 455 million. A pproximately 11 % of these are reinsured by Prudential . The remaining guarantees are provided by the Company with minimal reinsurance from third parties. The Company establishes an additional liability if management believes that the Company will be required to make payment under the guarantees; t here were no additional liabilities required for th ese guarantees, net of reinsurance, as of March 31, 2019 . Separate account assets supporting these guarantees are classified in Levels 1 and 2 of the GAAP fair value hierarchy (s ee Note 10 ). The Company does not expect that these financial guarantees will have a material effect on the Company’s consolidated results of operations, liquidity or financial condition. B. Certain Other Guarantees The Company had indemnification obligations as of March 31, 2019 in connection with acquisition and disposition transactions. These indemnification obligations are triggered by the breach of representations or covenants provided by the Company, such as representations for the presentation of financial statements, the filing of t ax returns, compliance with law or the identification of outstanding litigation. These obligations are typically subject to various time limitations, defined by the contract or b y operation of law, such as statutes of limitation. In some cases, the maximum potential amount due is subject to contractual limitations based on a percentage of the transaction purchase price, while in other cases limitations are not specified or applic able. The Company does not believe that it is possible to determine the maximum potential amount due under these obligations because not all amounts due under these indemnification obligations are subject to limitation. There were no liabilities for t hese indemnification obligations as of March 31, 2019 . C. Guaranty Fund Assessments The Company operates in a regulatory environment that may require its participation in assessments under state insurance guaranty association laws. The Company’s exposure to assessments for certain obligations of insolvent insurance companies to policyholders and claimants is based on its share of business written in the relevant jurisdictions. There were no material impacts related to existing or new guaranty fund assessments for the three months ended March 31, 2019. D. Legal and Reg ulatory Matters The Company is routinely involved in numerous claims, lawsuits, regulatory inquiries and audits, government investigations, including under the federal False Claims Act and state false claims acts initiated by a government in vestigating body or by a qui tam relator’s filing of a complaint under court seal, and other legal matters arising, for the most part, in the ordinary course of managing a global health service business. Additionally, the Company has received and is coope rating with subpoenas or similar processes from various governmental agencies requesting information, all arising in the normal course of its business. Disputed tax matters arising from audits by the Internal Revenue Service or other state and foreign jur isdictions, including those resulting in litigation, are accounted for under GAAP guidance for uncertain tax positions. Further information on income tax matters can be found in Note 16 . Pending litigation and legal or regulatory matters that the Company has identified with a reasonably possible material loss are described below. When litigation and regulatory matters present loss contingencies that are both probable and estimable, the Company accrues the estimated loss by a charge to shareholders ’ net income. The estimated loss is the Company’s best estimate of the probable loss at the time or an amount within a range of estimated losses reflecting the most likely outcome or the minimum amount of the range (if no amount is better than any other estimated amount in the range). F or material pending litigation and legal or regulatory matters discussed below, the Company provides disclosure in the aggregate of accruals and range of loss, or a statement that such information cannot be estimated. In l ight of the uncertainties involved in these matters, there is no assurance that their ultimate resolution will not exceed the amounts currently accrued by the Company. The Company’s accruals for the matters discussed below under “Litigation Matters”, as w ell as litigation related to certain of the Company’s claim operating practices and disputes around reimbursement rates to providers, are immaterial. Due to numerous uncertain factors presented in these cases, it is not possible to estimate an aggregate r ange of loss (if any) for these matters at this time. An adverse outcome in one or more of these matters could be material to the Company’s results of operations, financial condition or liquidity for any particular period. The outcomes of lawsuits are in herently unpredictable, and we may be unsuccessful in these ongoing litigation matters or any future claims or litigation. Litigation Matters Amara cash balance pension plan litigation. In December 2001, Janice Amara filed a class action lawsuit in the U.S. District Court for the District of Connecticut against Cigna Corporation (now Old Cigna) and the Cigna Pension Plan on behalf of herself and other similarly situated Plan participants affected by the 1998 conversion to a cash balance formula. The pl aintiffs allege various violations of the Employee Retirement Income Security Act of 1974 (“ERISA”), including that the Plan’s cash balance formula discriminates against older employees; that the conversion resulted in a wear-away period (when the pre-conv ersion accrued benefit exceeded the post-conversion benefit); and that the Plan communications contained inaccurate or inadequate disc losures about these conditions. In 2008, the District Court (1) affirmed the Company’s right to convert to a cash balan ce plan prospectively beginning in 1998; (2) found for plaintiffs on the disclosure claim only; and (3) required the Company to pay pre-1998 benefits under the pre-conversion traditional annuity formula and post-1997 benefits under the post-c onversion cash balance formula. From 2008 through 2015, this case has undergone a series of court proceedings that resulted in the original District Co urt Order being largely upheld. In 2015, the Company submitted to the District Court its proposed method for calculat ing the additional pension benefits due to class members and plaintiffs responded in August 2015. Since then, there has been continued litigation regarding the calculation of benefits, attorneys’ fees, and the administration of the remedy payments. On November 29, 2018, the Court ordered the Pension Plan to pay attorneys’ and incentive fees of $32 million, and to pay any past due lump sums and back benefits within 90 days of the Order. The attorneys’ fees were paid as ordered in December 2018. In the first quarter of 2019, the Company amended the Plan, notified class participants of their increased benefi ts and commenced remedy benefit payments out of the Plan, including the past due lump sums and back benefits. See Note 13 for additional information. In April 2019, plaintiffs challenged certain aspects of the methodology used to calculate and pay benefits. The Company and the Plan are vigorously opposing plaintiffs’ motion. Cigna Litigation with Anthem . In February 2017, the Company delivered a notice to Anthem terminating the 2015 merger agreement, and notifying Anthem that it must pay the Comp any the $1.85 billion reverse termination fee pursuant to the terms of the merger agreement. Also in February 2017, the Company filed suit against Anthem in the Delaware Court of Chancery (the “Chancery Court”) seeking declaratory judgments that the Compa ny’s termination of the merger agreement was valid and that Anthem was not permitted to extend the termination date. The complaint also sought payment of the reverse termination fee and additional damages in an amount exceeding $13 billion, including the lost premium value to the Company’s shareholders caused by Anthem’s willful breaches of the merger agreement. Anthem has countersued, alleging its own claims for damages. On February 15, 2017, the Chancery Court granted Anthem’s motion for a temporary res training order and temporarily enjoined the Company from terminating the merger agreement. In May 2017, the Chancery Court denied Anthem’s motion for a preliminary injunction to enjoin Cigna from terminating the merger agreement but stayed its ruling pend ing Anthem’s determination as to whether to seek an appeal. Anthem subsequently notified Cigna and the Chancery Court that it did not intend to appeal the Chancery Court’s decision. As a result, the merger agreement was terminated. The litigation betwee n the parties remains pending. A trial was held during the first quarter of 2019. Oral arguments on post-trial briefs have been set for September 2019 and we expect the judge to issue a decision before the end of the year . We believe in the merits of our claims and dispute Anthem’s claims, and we intend to vigorously defend ourselves and pursue our claims. Express Scripts Litigation with Anthem. In March 2016, Anthem filed a lawsuit in the United States District Court for the Southern District of New York alleging various breach of contract claims against Express Scripts relating to the parties’ rights and obligations under the periodic pricing review section of the pharmacy benefit management agreement between the parties including allegations that Ex press Scripts failed to negotiate new pricing concessions in good faith, as well as various alleged service issues. Anthem also request ed that the court enter declaratory judgment that Express Script s is required to provide Anthem competitive benchmark pricing, that Anthem can terminate the agreement, and that Express Script s is required to provide Anthem with post-termination services at competitive benchmark pricing for one year following any termina tion by Anthem. Anthem claims it is entitled to $13.0 billion in additional pricing concessions over the remaining term of the agreement , as well as $1.8 billion for one year following any contract termination by Anthem and $150 million in damages for ser vice issues (“Anthem’s Allegations”). On April 19, 2016, in response to Anthem’s complaint, Express Script s filed its answer denying Anthem’s Allegations in their entirety and asserting affirmative defenses and counterclaims against Anthem. The court sub sequently granted Anthem’s motion to dismiss two of six counts of Express Script s’ amended counterclaims. The current scheduling order runs through the completion of summary judgment briefing in February 2020 . There is no tentative trial date. We believ e in the merits of our claims and dispute Anthem’s claims, and we intend to vigorously defend ourselves and pursue our claims. Regulatory Matters Civil Investigative Demand. The U.S. Department of Justice (“DOJ”) is conducting an industry review of Medi care Advantage organizations’ risk adjustment practices under Medicare Parts C and D including medical chart reviews and health exams. The Company is currently responding to information requests (civil investigative demands) received from the DOJ (U.S. At torney’s Offices for the Eastern District of Pennsylvania and the Southern District of New York). We will continue to cooperate with the DOJ’s investigation. Disability claims regulatory matter. The Company is subject to an agreement with the Department s of Insurance for Maine, Massachusetts, Pennsylvania, Connecticut and California (together, the “Lead S tates”), originally entered into in 2013, that relates to the Company’s long-term disability claims handling practices. The agreement provides for enhanced procedures related to documentation and disposition. Cigna has cooperated fully with the Lead States and we believe we have addressed the requirements of the agreement. The Lead States recently initiated a re-examination of our practices. Accor dingly, the Company may be subject to additional costs , penalties and requests to change its business practices that could negatively impact future earnings for this business.

Condensed Consolidating Financi

Condensed Consolidating Financial Information	3 Months Ended
	Mar. 31, 2019
Organization Consolidation And Presentation Of Financial Statements [Abstract]
Condensed Consolidating Financial Information	Note 17 – Condensed Consolidating Financial I nformation Effective with the Merger that closed on December 20, 2018 (see Note 4 for further information) t he senior notes issued by Cigna, Old Cigna, E SI , Medco, and Express Scripts became jointly and severally and fully and unconditionally (subject to certain customary release provisions, including sale, exchange, transfer or liquidation of the guarantor subsidiary) guaranteed by Cigna, Old Cigna, ESI, Medco and Express Scripts , as applica ble. Details of these debt obligations are presented in Note 6 . The following condensed consolidating financial information has been prepared in accordance with the requirements as prescribed by the SEC in Regulation S -X . The condensed consolidati ng financial information presented below is not indicative of what the financial position, results of operations or cash flows would have been had each of the entities operated as an independent company during the periods for various reasons, including, bu t not limited to, intercompany transactions and integration of systems. The condensed consolidating financial information is presented separately for: (i) Cigna (the Parent Company), guarantor, the issuer of additional guaranteed obligations; (ii) Old Cigna (former Parent Company), guarantor, the issuer of additional guaranteed obligations; (iii) Express Scripts, guarantor, the issuer of additional guaranteed obligations; (iv) ESI, guarantor, the issuer of additional guaranteed obligations; (v) Medco, guarantor, the issuer of additional guaranteed obligations; (vi) Non-guarantor subsidiaries, on a combined basis; (vii) Consolidating entries and eliminations representing adjustments to (a) eliminate intercompan y transactions between or among Cig na, Old Cigna, Express Scripts, ESI, Medco and the non-guarantor subsidiaries, (b) eliminate the investments in our subsidiaries and (c) record consolidating entries; and (viii) Cigna and subsidiaries on a consolidated basis. Condensed Consolidating Statements of Income For the three months ended March 31, 2019 (In millions) Cigna Old Cigna Express Scripts Holding Company Express Scripts, Inc. Medco Health Solutions, Inc. Non-Guarantors Eliminations and Consolidation Adjustments Consolidated Revenues Pharmacy revenues $ - $ - $ - $ 17,622 $ 3,763 $ 14,142 $ (10,348) $ 25,179 Premiums - - - - - 9,971 - 9,971 Fees and other revenues - - - 190 84 3,101 (925) 2,450 Net investment income (loss) (9) - 15 3 2 335 - 346 Total revenues (9) - 15 17,815 3,849 27,549 (11,273) 37,946 Benefits and expenses Pharmacy and other service costs - - - 16,363 3,689 14,346 (10,348) 24,050 Medical costs and other benefit expenses - - - - - 7,620 - 7,620 Selling, general and administrative expenses (99) 73 13 835 87 3,319 (925) 3,303 Amortization of acquired intangible assets - - - 577 83 83 - 743 Total benefits and expenses (99) 73 13 17,775 3,859 25,368 (11,273) 35,716 Income (loss) from operations 90 (73) 2 40 (10) 2,181 - 2,230 Interest and other income (expense) (237) (87) (124) (4) (9) 9 - (452) Intercompany interest income (expense) (31) (3) 124 (62) (39) 11 - - Net realized investment gains - - - - - 10 - 10 Income (loss) before income taxes (178) (163) 2 (26) (58) 2,211 - 1,788 Total income tax (benefit) expense (37) (31) 1 (17) (17) 517 - 416 Income (loss) before equity in earnings of subsidiaries (141) (132) 1 (9) (41) 1,694 - 1,372 Equity in earnings of subsidiaries 1,509 1,152 488 432 84 - (3,665) - Net income 1,368 1,020 489 423 43 1,694 (3,665) 1,372 Less: Net income attributable to noncontrolling interests - - - - - 4 - 4 Shareholders’ net income $ 1,368 $ 1,020 $ 489 $ 423 $ 43 $ 1,690 $ (3,665) $ 1,368 Other comprehensive income, net of tax 429 429 1 1 - 412 (843) 429 Shareholders’ comprehensive income $ 1,797 $ 1,449 $ 490 $ 424 $ 43 $ 2,102 $ (4,508) $ 1,797 Condensed Consolidating Statements of Income For the three months ended March 31, 2018 (In millions) Cigna Old Cigna Express Scripts Holding Company Express Scripts, Inc. Medco Health Solutions, Inc. Non-Guarantors Eliminations and Consolidation Adjustments Consolidated Revenues Premiums $ - $ - $ - $ - $ - $ 8,999 $ - $ 8,999 Fees and other revenues - - - - - 1,368 - 1,368 Pharmacy revenues - - - - - 717 - 717 Net investment income - - - - - 329 - 329 Total revenues - - - - - 11,413 - 11,413 Benefits and expenses Medical costs and other benefit expenses - - - - - 6,772 - 6,772 Pharmacy and other service costs - - - - - 561 - 561 Selling, general and administrative expenses - 64 - - - 2,681 - 2,745 Amortization of acquired intangible assets - - - - - 27 - 27 Total benefits and expenses - 64 - - - 10,041 - 10,105 Income (loss) from operations - (64) - - - 1,372 - 1,308 Interest and other (expense) - (85) - - - 28 - (57) Intercompany interest income (expense) - (16) - - - 16 - - Net realized investment (losses) - - - - - (33) - (33) Income (loss) before income taxes - (165) - - - 1,383 - 1,218 Total income tax (benefit) expense - (39) - - - 340 - 301 Income (loss) before equity in earnings of subsidiaries - (126) - - - 1,043 - 917 Equity in earnings of subsidiaries 915 1,041 - - - - (1,956) - Net income 915 915 - - - 1,043 (1,956) 917 Less: net income attributable to noncontrolling interests - - - - - 2 - 2 Shareholders’ net income $ 915 $ 915 $ - $ - $ - $ 1,041 $ (1,956) $ 915 Other comprehensive (loss), net of tax (226) (226) - - - (237) 463 (226) Shareholders’ comprehensive income $ 689 $ 689 $ - $ - $ - $ 804 $ (1,493) $ 689 Condensed Consolidating Balance Sheets As of March 31, 2019 (In millions) Cigna Old Cigna Express Scripts Holding Company Express Scripts, Inc. Medco Health Solutions, Inc. Non-Guarantors Eliminations and Consolidation Adjustments Consolidated Assets Cash and cash equivalents $ - $ - $ 1,596 $ 44 $ - $ 3,336 $ - $ 4,976 Investments 417 6 - - - 1,239 - 1,662 Accounts receivable, net - 2 - 4,670 626 5,643 - 10,941 Inventories - - - - - 2,382 - 2,382 Other current assets - 131 - 282 3 1,042 (283) 1,175 Total current assets 417 139 1,596 4,996 629 13,642 (283) 21,136 Long-term investments - 10 - - - 27,247 - 27,257 Reinsurance recoverables - - - - - 5,385 - 5,385 Deferred policy acquisition costs - - - - - 2,817 - 2,817 Property and equipment - - - 2,386 - 2,137 - 4,523 Investments in subsidiaries 70,036 28,174 52,560 17,551 8,205 - (176,526) - Intercompany receivables, net - 3,054 - 8,371 2,222 26,839 (40,486) - Goodwill - - 31,049 - - 13,488 - 44,537 Other intangible assets - - 8,400 18,489 6,958 4,491 - 38,338 Other assets 27 227 - 152 78 2,001 (209) 2,276 Separate account assets - - - - - 8,079 - 8,079 TOTAL ASSETS $ 70,480 $ 31,604 $ 93,605 $ 51,945 $ 18,092 $ 106,126 $ (217,504) $ 154,348 Liabilities Current insurance and contractholder liabilities $ - $ - $ - $ - $ - $ 7,060 $ - $ 7,060 Pharmacy and service costs payable - - - 9,245 1,291 609 - 11,145 Accounts payable 22 - 2 833 4 3,627 - 4,488 Accrued expenses and other liabilities 719 288 92 1,522 276 4,747 (283) 7,361 Short-term debt 1,556 - 998 352 - 9 - 2,915 Total current liabilities 2,297 288 1,092 11,952 1,571 16,052 (283) 32,969 Non-current insurance and contractholder liabilities - - - - - 20,043 - 20,043 Deferred tax liabilities, net - - 1,999 4,898 1,664 1,051 (209) 9,403 Other non-current liabilities - 715 - 577 241 2,299 - 3,832 Intercompany payables, net 4,904 4,477 30,552 - - 553 (40,486) - Long-term debt 20,871 5,112 10,938 41 505 104 - 37,571 Separate account liabilities - - - - - 8,079 - 8,079 TOTAL LIABILITIES 28,072 10,592 44,581 17,468 3,981 48,181 (40,978) 111,897 Redeemable noncontrolling interests - - - - - 38 - 38 TOTAL SHAREHOLDERS’ EQUITY 42,408 21,012 49,024 34,477 14,111 57,902 (176,526) 42,408 Noncontrolling interests - - - - - 5 - 5 TOTAL EQUITY 42,408 21,012 49,024 34,477 14,111 57,907 (176,526) 42,413 TOTAL LIABILITIES AND EQUITY $ 70,480 $ 31,604 $ 93,605 $ 51,945 $ 18,092 $ 106,126 $ (217,504) $ 154,348 Condensed Consolidating Balance Sheets As of December 31, 2018 (In millions) Cigna Old Cigna Express Scripts Holding Company Express Scripts, Inc. Medco Health Solutions, Inc. Non-Guarantors Eliminations and Consolidation Adjustments Consolidated Assets Cash and cash equivalents $ 243 $ - $ 633 $ 43 $ - $ 2,936 $ - $ 3,855 Investments - - - - - 2,045 - 2,045 Accounts receivable, net - - - 4,206 748 5,519 - 10,473 Inventories - - - - - 2,821 - 2,821 Other current assets 14 59 - 310 - 1,063 (210) 1,236 Total current assets 257 59 633 4,559 748 14,384 (210) 20,430 Long-term investments - 10 - - - 26,919 - 26,929 Reinsurance recoverables - - - - - 5,507 - 5,507 Deferred policy acquisition costs - - - - - 2,821 - 2,821 Property and equipment - - - 2,432 - 2,130 - 4,562 Investments in subsidiaries 68,969 27,544 52,035 17,115 8,117 - (173,780) - Intercompany receivables, net - 4,505 - 7,425 2,335 24,882 (39,147) - Goodwill - - 31,049 - - 13,456 - 44,505 Other intangible assets - - 8,400 18,962 7,040 4,601 - 39,003 Other assets 48 198 - 68 74 1,488 (246) 1,630 Separate account assets - - - - - 7,839 - 7,839 TOTAL ASSETS $ 69,274 $ 32,316 $ 92,117 $ 50,561 $ 18,314 $ 104,027 $ (213,383) $ 153,226 Liabilities Current insurance and contractholder liabilities $ - $ - $ - $ - $ - $ 6,801 $ - $ 6,801 Pharmacy and service costs payable - - - 8,422 1,579 701 - 10,702 Accounts payable 22 - - 834 4 3,506 - 4,366 Accrued expenses and other liabilities 396 182 129 1,387 189 4,998 (210) 7,071 Short-term debt - 1,500 995 353 - 107 - 2,955 Total current liabilities 418 1,682 1,124 10,996 1,772 16,113 (210) 31,895 Non-current insurance and contractholder liabilities - - - - - 19,974 - 19,974 Deferred tax liabilities, net - - 2,001 5,012 1,685 1,001 (246) 9,453 Other non-current liabilities - 685 - 497 290 1,998 - 3,470 Intercompany payables, net 4,965 4,361 29,569 - - 252 (39,147) - Long-term debt 22,863 5,110 10,932 24 506 88 - 39,523 Separate account liabilities - - - - - 7,839 - 7,839 TOTAL LIABILITIES 28,246 11,838 43,626 16,529 4,253 47,265 (39,603) 112,154 Redeemable noncontrolling interests - - - - - 37 - 37 TOTAL SHAREHOLDERS’ EQUITY 41,028 20,478 48,491 34,032 14,061 56,718 (173,780) 41,028 Noncontrolling interest - - - - - 7 - 7 TOTAL EQUITY 41,028 20,478 48,491 34,032 14,061 56,725 (173,780) 41,035 TOTAL LIABILITIES AND EQUITY $ 69,274 $ 32,316 $ 92,117 $ 50,561 $ 18,314 $ 104,027 $ (213,383) $ 153,226 Condensed Consolidating Cash Flow Statements For the Three Months Ended March 31, 2019 (In millions) Cigna Old Cigna Express Scripts Holding Company Express Scripts, Inc. Medco Health Solutions, Inc. Non-Guarantors Eliminations and Consolidation Adjustments Consolidated Net cash (used in) provided by operating activities $ 1,102 $ 947 $ (6) $ 1,802 $ (110) $ 1,295 $ (1,838) $ 3,192 Cash Flows from Investing Activities Net change in loans due (from) affiliates - 1,600 (1,700) - - 141 (41) - Proceeds from investments sold: Debt securities and equity securities - - - - - 1,471 - 1,471 Investment maturities and repayments: Debt securities and equity securities - - - - - 319 - 319 Commercial mortgage loans - - - - - 89 - 89 Other sales, maturities and repayments (primarily short-term and other long-term investments) - - - - - 367 - 367 Investments purchased or originated: Debt securities and equity securities - - - - - (1,088) - (1,088) Commercial mortgage loans - - - - - (95) - (95) Other sales, maturities and repayments (primarily short-term and other long-term investments) (417) (6) - - - 35 - (388) Property and equipment purchases, net - - - (55) - (139) - (194) Acquisitions, net of cash acquired - - - - - (6) - (6) NET CASH (USED IN) PROVIDED BY INVESTING ACTIVITIES (417) 1,594 (1,700) (55) - 1,094 (41) 475 Cash Flows from Financing Activities Net change in amounts due to (from) affiliates, net - (141) 2,669 (1,744) 110 (935) 41 - Intercompany dividends paid - (900) - - - (922) 1,822 - Deposits and interest credited to contractholder deposit funds - - - - - 247 - 247 Withdrawals and benefit payments from contractholder deposit funds - - - - - (251) - (251) Net change in short-term debt 558 (1,500) - - - (106) - (1,048) Repayment of long-term debt (1,000) - - - - - - (1,000) Repurchase of common stock (462) - - - - - - (462) Issuance of common stock 53 - - - - - - 53 Other, net (77) - - (2) - (10) 16 (73) NET CASH (USED IN) PROVIDED BY FINANCING ACTIVITIES (928) (2,541) 2,669 (1,746) 110 (1,977) 1,879 (2,534) Effect of foreign currency rate changes on cash and cash equivalents - - - - - (12) - (12) Net (decrease) increase in cash and cash equivalents (243) - 963 1 - 400 - 1,121 Cash and cash equivalents, January 1, 243 - 633 43 - 2,936 - 3,855 Cash and cash equivalents, March 31, $ - $ - $ 1,596 $ 44 $ - $ 3,336 $ - $ 4,976 Condensed Consolidating Cash Flow Statements For the Three Months Ended March 31, 2018 (In millions) Cigna Old Cigna Express Scripts Holding Company Express Scripts, Inc. Medco Health Solutions, Inc. Non-Guarantors Eliminations and Consolidation Adjustments Consolidated Net cash provided by operating activities $ - $ 641 $ - $ - $ - $ 1,833 $ (449) $ 2,025 Cash Flows from Investing Activities Net change in loans due to affiliates - - - - - 102 (102) - Proceeds from investments sold: Debt securities and equity securities - - - - - 499 - 499 Investment maturities and repayments: Debt securities and equity securities - - - - - 297 - 297 Commercial mortgage loans - - - - - 28 - 28 Other sales, maturities and repayments (primarily short-term and other long-term investments) - - - - - 112 - 112 Investments purchased or originated: Debt securities and equity securities - - - - - (2,259) - (2,259) Commercial mortgage loans - - - - - (68) - (68) Other sales, maturities and repayments (primarily short-term and other long-term investments) - (2) - - - (204) - (206) Property and equipment purchases, net - - - - - (103) - (103) NET CASH (USED IN) INVESTING ACTIVITIES - (2) - - - (1,596) (102) (1,700) Cash Flows from Financing Activities Net change in amounts due (from) affiliates, net - (102) - - - - 102 - Intercompany dividends paid - - - - - (449) 449 - Deposits and interest credited to contractholder deposit funds - - - - - 292 - 292 Withdrawals and benefit payments from contractholder deposit funds - - - - - (306) - (306) Net change in short-term debt - - - - - (3) - (3) Repayment of long-term debt - (131) - - - - - (131) Repurchase of common stock - (310) - - - - - (310) Issuance of common stock - 20 - - - - - 20 Other, net - (125) - - - 33 - (92) NET CASH (USED IN) FINANCING ACTIVITIES - (648) - - - (433) 551 (530) Effect of foreign currency rate changes on cash and cash equivalents - - - - - 4 - 4 Net (decrease) in cash and cash equivalents - (9) - - - (192) - (201) Cash and cash equivalents, January 1, - 9 - - - 2,963 - 2,972 Cash and cash equivalents, March 31, $ - $ - $ - $ - $ - $ 2,771 $ - $ 2,771

Segment Information

Segment Information	3 Months Ended
	Mar. 31, 2019
Segment Information [Abstract]
Segment Information [Text Block]	Note 18 – Segment Information See Note 1 for a description of our segments that changed effective with the fourth quarter of 2018 along with one of our principal financial measures of segment operating performance, which is now pre-tax adjusted income from operations. Prior year segment information reported in this Form 10-Q has been adjusted to reflect these changes. In addition, effective with the first quarter of 2019, the Comp any began allocating compensation cost for stock options to the segments. Prior year segment information was not restated for this change. A description of our basis for reporting segment operating results is outlined below. Intersegment transactions pr imarily reflect pharmacy sales to insured customers of the Integrated Medical segment. These transactions are eliminated in consolidation. The Company uses “pre-tax adjusted income from operations” and “adjusted revenues” as its principal financial meas ures of segment operating performance because management believes they best reflect the underlying results of business operations and permit analysis of trends in underlying revenue, expenses and profitability. Pre-tax adjusted income from operations is d efined as income before taxes excluding realized investment results, amortization of acquired intangible assets, results of transitioning clients Anthem Inc. and Coventry Health Care, Inc. (the “transitioning clients”) and special items. Adjusted revenues is defined as revenues excluding: 1) revenue contributions from transitioning clients; 2) the Company’s share of certain realized investment results of its joint ventures reported in the International Markets segment using the equity method of accounting; and 3) special items, if any. Income or expense amounts that are excluded from adjusted income from operations because they are not indicative of underlying performance or the responsibility of operating segment management include: Realized investment gains (losses) including changes in market values of certain financial instruments between balance sheet dates, as well as gains and losses associa ted with invested asset sales Amortization of acquired intangible assets because these relate to costs incurred for acquisitions Results of transitioning clients because those results are not indicative of ongoing results Special items, if any, that management believes are not representative of the underlying results of operations due to the natu re or size of these matters. Further context about these items is provided in the footnotes listed in the table below. The following table presents the special items recorded by the Compa ny for the three months ended March 31, 2019 and 2018 . Three Months Ended (In millions) March 31, 2019 March 31, 2018 Description of Special Item Charges (Benefits) and Financial Statement Line Item(s) After-tax Before-tax After-tax Before-tax Integration and transaction-related costs (selling, general and administrative expenses) $ 108 $ 136 $ 50 $ 60 Summarized segment financial information for the three months ended March 31 was as follows: (In millions) Health Services Integrated Medical International Markets Group Disability and Other Corporate and Eliminations Total Three Months Ended March 31, 2019 Revenues from external customers (1) $ 26,197 $ 8,910 $ 1,384 $ 1,109 $ - $ 37,600 Inter-segment revenues 737 162 - 7 (906) - Net investment income (loss) 15 123 38 180 (10) 346 Total revenues 26,949 9,195 1,422 1,296 (916) 37,946 Revenue contributions from transitioning clients (4,489) - - - - (4,489) Net realized investment results from equity method subsidiaries (2) - - (28) - - (28) Adjusted revenues $ 22,460 $ 9,195 $ 1,394 $ 1,296 $ (916) $ 33,429 Income (loss) before taxes $ 942 $ 1,157 $ 222 $ 93 $ (626) $ 1,788 Pre-tax adjustments to reconcile to adjusted income from operations Adjustment for transitioning clients (660) - - - - (660) (Income) attributable to noncontrolling interests (1) - (4) - - (5) Net realized investment (gains) (2) - (5) (23) (10) - (38) Amortization of acquired intangible assets 713 18 11 1 - 743 Special items Integration and transaction-related costs - - - - 136 136 Pre-tax adjusted income (loss) from operations $ 994 $ 1,170 $ 206 $ 84 $ (490) $ 1,964 (In millions) Health Services Integrated Medical International Markets Group Disability and Other Corporate and Eliminations Total Three Months Ended March 31, 2018 Revenues from external customers (1) $ 786 $ 7,903 $ 1,302 $ 1,093 $ - $ 11,084 Inter-segment revenues 284 136 - 3 (423) - Net investment income 1 111 37 175 5 329 Total revenues 1,071 8,150 1,339 1,271 (418) 11,413 Net realized investment results from equity method subsidiaries (2) - - 2 - - 2 Adjusted revenues $ 1,071 $ 8,150 $ 1,341 $ 1,271 $ (418) $ 11,415 Income (loss) before taxes $ 83 $ 972 $ 213 $ 103 $ (153) $ 1,218 Pre-tax adjustments to reconcile to adjusted income from operations (Income) attributable to noncontrolling interests - - (4) - - (4) Net realized investment losses (2) - 18 4 12 1 35 Amortization of acquired intangible assets - 22 4 1 - 27 Special items Integration and transaction-related costs - - - - 60 60 Pre-tax adjusted income (loss) from operations $ 83 $ 1,012 $ 217 $ 116 $ (92) $ 1,336 (1) Includes the Company’s share of the earnings of its joint ventures reported in the International Markets segment using the equity method of accounting. (2) Includes the Company’s share of certain realized investment gains (losses) of its joint ventures reported in the International Markets segment using the equity method of accounting. Revenue from external customers includes pharmacy revenues , p remiums and fees and other revenues. The following table presents these revenues by premium, service and product type for the three months ended March 31: Three Months Ended March 31, (In millions) 2019 2018 Products (Pharmacy revenues) (ASC 606) Home delivery and specialty revenues $ 11,784 $ 717 Network revenues 12,273 - Other 1,122 - Total pharmacy revenues 25,179 717 Insurance premiums Integrated Medical premiums (ASC 944) Commercial Premiums Risk 3,039 2,611 Stop loss 1,069 980 Other 278 258 Government Medicare Advantage 1,607 1,498 Medicare Part D 525 228 Other 1,065 1,101 Total Integrated Medical premiums 7,583 6,676 International Markets premiums 1,304 1,260 Domestic disability, life and accident premiums 1,047 998 Other premiums 37 65 Total premiums 9,971 8,999 Services (ASC 606) Fees 2,390 1,352 Other external revenues 60 16 Total services 2,450 1,368 Total revenues from external customers $ 37,600 $ 11,084 The Health Services segment may provide certain financial an d performance guarantees in its pharmacy benefit management contracts including a minimum level of discounts a client may receive, generic utilization rates and various service levels. Clients may be entitled to receive performance penalties if we fail to meet guarantees. Actual performance is compared to the guarantee fo r each measure throughout the period and the Company defers revenue for any estimated payouts within accrued expenses and other liabilities (current). These estimates are adjusted at the end of the guarantee period. Historically, adjustments to original estimates have not been material. The balance was $1.0 billion as of March 31, 2019 and $895 million as of December 31, 2018 . The Company recognized revenues as follows from Anthem and the Department of Defense for th e three months ended March 31, 2019 . The Company did not recognize revenue from these two customers for the three months ended March 31, 2018. These revenues were reported in the Health Services segment. Three Months Ended March 31, 2019 Anthem 12% Department of Defense 8%

Accounting Policies (Policies)

Accounting Policies (Policies)	3 Months Ended
	Mar. 31, 2019
Accounting Policies [Abstract]
Basis of Presentation	Basis of Presentation The Consolidated Financial Statements include the accounts of Cigna Corporation and its consolidated subsidiaries. Intercompany transactions and accounts have been eliminated in consolidation. These Consolidated Financial Statements were prepared in conformity with accounting principles generally accepted in the United States of America (“GAAP”). The Company adopted Article 5 of Regulation S-X issued by the Securit ies and Exchange Commission (“SEC”) effective December 31, 2018 in conjunction with the acquisition of Express Scripts. As a result, the Company now presents current assets and liabilities on its balance sheet. The Company reclassified realized investmen t gains (losses) from revenue and now reports them below income from operations with interest expense in our Consolidated Statements of I ncome, in conformity with Article 5 . Prior year s’ information was reclassified to conform to this new presentation. A mounts recorded in the Consolidated F inancial S tatements necessarily reflect management’s estimates and assumptions about medical costs, investment and receivable valuation s , interest rates and other factors. Significant estimates are discussed throughout these Notes; however, actual results could differ from those estimates. The impact of a change in estimate is generally included in earnings in the period of adjustment. These interim Consolidated Financial Statements are unaudited but include all adju stments (including normal recurring adjustments) necessary, in the opinion of management, for a fair statement of financial position and results of operations for the periods reported. The interim Consolidated Financial Statements and Notes should be read in conjunction with the Consolidated Financial Statements and Notes included in the 2018 Annual Report on Form 10-K (“2018 Form 10-K”). The preparation of interim Consolidated Financial Statements necessarily relies heavily on estimates. This and certai n other factors, including the seasonal nature of portions of the health care and related benefits business, as well as competitive and other market conditions, call for caution in estimating full-year results based on interim results of operations.
Recent Accounting Changes	The Company adopted Accounting Standards Update (“ASU”) 2016-02, Leases¸ as of January 1, 2019 (the adoption date) on a modified retrospective basis for leases in effect as of and after the adoption date. This new guidance requires balance sheet recognition of assets and liabilities arising from leases, as well as additional disclosures regarding the amount, timing and uncertainty of cash flows from leases. The Company implemented a new lease system and corresponding internal controls to administer our leases and facilitate compliance with this new standard. The Company elec ted the practical expedient package, allowing the Company to carry forward the assessment of 1) whether our contracts contain or are leases, 2) lease classification and 3) whether previously capitalized costs continue to qualify as initial direct costs. U pon adoption, the Company recognized new right-of-use assets and lease liabilities related to our operating leases, because finance (capital) leases were already reflected on the Company’s Consolidated Balance Sheets. The impact of adoption on the Company ’s net assets and retained earnings was not material, nor was there a material impact on our Consolidated Statements of Income or Cash Flows. See Note 14 for additional disclosures about the Company’s leases. Accounting Standard and Effective Date Requirements and Expected Effects of New Guidance Not Yet Adopted Measurement of Credit Losses on Financial Instruments (ASU 2016-13) Required as of January 1, 2020 Requires: • A new approach using expected credit losses to estimate and recognize credit losses for certain financial instruments (such as mortgage loans, reinsurance recoverables and other receivables) when such instruments are first originated or acquired. • Changes in the criteria for impairment of available-for-sale debt securities • Adoption using a modified retrospective approach with a cumulative-effect adjustment recorded in retained earnings Expected effects: • The Company is continuing to evaluate this new standard and its expected effects on our financial statements and disclosures. We will adopt the standard as of January 1, 2020. • An additional allowance for future expected credit losses for certain financial instruments will be required at adoption.
Contractholder Deposit Funds	This liability reflects estimates of the ultimate cost of claims that have been incurred but not reported, including expected development on reported claims, those that have been reported but not yet paid (reported claims in process), and other medical care expenses and services payable that are primarily comprised of accruals for incentives and other amounts payable to health care professionals and facilities. The majority of the lia bility for unpaid claims and claim expenses is related to disability claims with long-tailed payouts. Interest earned on assets backing these liabilities is an integral part of pricing and reserving. Therefore, interest accreted on prior year balances is shown as a separate component of prior year incurred claims. This i nterest is calculated by applying the average discount rate used in determining the liability balance to the average liability balance over the period. The remaining prior year incurred claims amount primarily reflects updates to the Company’s liability estimates and variances between actual experience during the period relative to the assumptions and expectations reflected in determining the liability. Assumptions reflect the Company’s expectations over the life of the book of business and will vary from actual experience in any period, both favorably and unfavorably, with variation in resolution rates being the most significant driver for the long-term disability business.
Reinsurance	Reinsurance does not relieve the ori ginating insurer of liability. Therefore, reinsured liabilities mu st continue to be reported along with the related reinsurance recoverables. GMDB is accounted for as reinsurance and GMIB assets and liabilities are reported as derivatives at fair value as discussed below. GMIB assets are reported in other current assets and other assets, and GMIB liabilities are reported in accrued expenses and other liabilities and other non-current liabilities.
Fair Value Measurements	Assumptions used in fair value measurement. GMIB assets and liabilities are established using capital market assumptions and assumptions related to future annuitant behavior (including mortality, lapse, and annuity election rates). The Company classifies GMIB assets and liabilities in Level 3 of the fair value hierarchy described in Note 10 because assumptions related to future annuitant behavior are largely unobservable. The only assumption expected to impact future shareholders’ net inc ome is non-performance risk. The non-performance risk adjustment reflects a market participant’s view of nonpayment risk by adding an additional spread to the discount rate in the calculation of both (a) the GMIB liabilities to be paid by the Company, and (b) the GMIB assets to be paid by the reinsurers, after considering collateral. The impact of non-performance risk was immaterial for the three months ended March 31, 2019 and 2018. The Company carries certain financial instruments at fair value in the financial statements including debt securities , certain equity securities, short-term investments and derivatives. Other financial instruments are measured at fair value only under certain conditions, such as when impaired. Fair value is defined as the price at which an asset could be exchanged in an orderly transaction between market participants at the balance sheet date. A liability’s fair value is defined as the amount that would be paid to transfer the liability to a market participant, not the amount that would be paid to settle t he liability with the c reditor. The Company’s financial assets and liabilities carried at fair value have been classified based upon a hierarchy defined by GAAP. The hierarchy gives the highest ranking to fair values determined using unadjusted quoted prices in active markets for identical assets and liabilities (Level 1) and the lowest ranking to fair values determined using methodologies and models with unobservable inputs (Level 3). An asset’s or a liability’s classification is based on the lowest level of input that is sig nificant to its measurement. For example, a financial asset or liability carried at fair value would be classified in Level 3 if unobservable inputs were significant to the instrument’s fair value, even though the measurement may be derived using inputs t hat are both observable (Levels 1 and 2) and unobservable (Level 3). The Company estimates fair values using prices from third parties or internal pricing methods. Fair value estimates received from third-party pricing services are based on reported trad e activity and quoted market prices when available, and other market information that a market participant may use to estimate fair value. The internal pricing methods are performed by the Company’s investment professionals and generally involve using dis counted cash flow analyses, incorporating current market inputs for similar financial instruments with comparable terms and credit quality as well as other qualitative factors. In instances where there is little or no market activity for the same or simil ar instruments, fair value is estimated using methods, models and assumptions that the Company believes a hypothetical market participant would use to determine a current transaction price. These valuation techniques involve some level of estimation and j udgment that becomes significant with increasingly complex instruments or pricing models. The Company is respons ible for determining fair value and for assigning the appropriate level within the fair value hierarchy based on the significance of unobserv able inputs. The Company reviews methodologies, processes and controls of third-party pricing services and compares prices on a test basis to those obtained from other external pricing sources or internal estimates. The Company performs ongoing analyses of both prices received from third-party pricing services and those developed internally to determine that they represent appropriate estimates of fair value. The controls executed by the Company include evaluating changes in prices and monitoring for pot entially stale valuations. The Company also performs sample testing of sales values to confirm the accuracy of prior fair value estimates. The minimal e xceptions identified during these processes indicate that adjustments to prices are infrequent and do not significantly impact valuations. W e conduct an annual on-site visit of the most significant pricing service to review their processes, methodologies and controls. This on-site review includes a walk-through of inputs for a sample of securities held across various asset types to validate the documented pricing process. Level 1 Financial Assets Inputs for instruments classified in Level 1 include unadjusted quoted prices for identical assets in active markets accessible at the measurement date. Active markets provide pricing data for trades occurring at least weekly and include exchanges and dealer markets. Assets in Level 1 include actively-traded U.S. government bonds and exchange-listed equity securities. A relatively small portion of the Company’s investment assets are classified in this category given the narro w definition of Level 1 and the Company’s investment asset strategy to maximize investment returns. Level 2 Financial Assets and Financial Liabilities Inputs for instruments classified in Level 2 include quoted prices for similar assets or liabilities in active markets, quoted prices from those willing to trade in markets that are not active or other inputs that are market observable or can be corroborated by market data for the term of the instrument. Such other inputs include market interest rates and volatilities, spreads and yield curves. An instrument is classified in Level 2 if the Company determines that unobservable inputs are insignificant. Debt and equity securities. Approximately 97 % of the Company’s investments in debt and equit y securities are classified in Level 2 including most public and private corporate debt and hybrid equity securities, federal agency and municipal bonds, non-government mortgage-backed securities and preferred stocks. Third-party pricing services and inte rnal methods often use recent trades of securities with similar features and characteristics because many debt securities do not trade daily. Pricing models are used to determine these prices when recent trades are not available. These models calculate f air values by discounting future cash flows at estimated market interest rates. Such market rates are derived by calculating the appropriate spreads over comparable U.S. Treasury securities, based on the credit quality, industry and structure of the asset . Typical inputs and assumptions to pricing models include, but are not limited to, a combination of benchmark yields, reported trades, issuer spreads, liquidity, benchmark securities, bids, offers, reference data and industry and economic events. For mo rtgage-backed securities, inputs and assumptions may also include characteristics of the issuer, collateral attributes, prepayment speeds and credit rating. Nearly all of these instruments are valued using recent trades or pricing models. Less than 1 % of the fair value of investments classified in Level 2 represents foreign bonds that are valued using a single, unadjusted market-observable input derived by averaging multiple broker-dealer quotes, consistent with local market practice. Short-term investments are carried at fair value that approximates cost. The Company compares market prices for these securities to recorded amounts on a regular basis to validate that current carrying amounts approximate exit prices. The short-term nature of the i nvestments and corroboration of the reported amounts over the holding period support their classification in Level 2. Derivative assets and liabilities classified in Level 2 represent over-the-counter instruments such as foreign currency forward and swap contracts. Fair values for these instruments are determined using market observable inputs including forward currency and interest rate curves and widely published market observable indices. Credit risk related to the counterparty and the Company is cons idered when estimating the fair values of these derivatives. However, the Company is largely protected by collateral arrangements with counterparties and determined that no adjustment for credit risk was required as of March 31, 2019 or December 31, 2018 . The nature and use of these derivative financial instruments are described in Note 9 . Level 3 Financial Assets and Financial Liabilities Certain inputs for instruments classified in Level 3 are unobservable (supported by little or no market activity) and sign ificant to their resulting fair value measurement. Unobservable inputs reflect the Company’s best estimate of what hypothetical market participants would use to determine a transaction price for the asset or liability at the reporting date. The Company classifies certain newly-issued, privately-placed, complex or illiquid securities in Level 3. Approximately 2 % of debt and equity securities are priced using significant unobservable inputs and classified in this category. Fair values of mortgage and other asset-backed securities as well as corporate and government debt securities are primarily determined using pricing models that incorporate the specific characteristics of each asset and related assumptions including the investment type and structure, credit quality, industry and maturity date in comparison to current market indic es, spreads and liquidity of assets with similar characteristics. Inputs and assumptions for pricing may also include collateral attributes and prepayment speeds for mortgage and other asset-backed securities. Recent trades in the subject security or sim ilar securities are assessed when available, and the Company may also review published research in its evaluation as well as the issuer’s financial statements. Corporate and government debt securities . The significant unobservable input used to value the following corporate and government debt securities is an adjustment for liquidity. An adjustment is needed to reflect current market conditions and issuer circumstances when there is limited trading activity for the security. Mortgage and other asset -backed securities. The significant unobservable inputs used to value the following mortgage and other asset-backed securities are liquidity and weighting of credit spreads. An adjustment for liquidity is made as of the measurement date that considers cu rrent market conditions, issuer circumstances and complexity of the security structure when there is limited trading activity for the security. An adjustment to weight credit spreads is needed to value a more complex bond structure with multiple underlyin g collateral and no standard market valuation technique. The weighting of credit spreads is primarily based on the underlying collateral’s characteristics and their proportional cash flows supporting the bond obligations. Significant increases in liquidity or credit spreads would result in lower fair value measurement s while decreases in these inputs would result in higher fair value measurement s. T he unobservable inputs are generally not interrelated and a change in the assumption used for one unobservable input is not accompanied by a change in the other unobservable input. Total gains and losses included in shareholders’ net income in the table above are reflected in the Consolidated Statements of Income as realized investment gains (losses) and net investment income. Gains and losses included in other comprehensive income in the tables above are reflected in net unrealized appreciation (depreciation) on securities in the Consolidated Statements of Comprehensive Income. Trans fers into or out of the Level 3 category occur when unobservable inputs, such as the Company’s best estimate of what a market participant would use to determine a current transaction price, become more or less significant to the fair value measurement. Separate account assets in Level 1 primarily include exchange-listed equity securities. Level 2 assets primarily include: corporate and structured bonds valued using recent trades of similar securities or pricing models that discount future cash flows at estimated market interest rates as described above; and actively-traded institutional and retail mutual fund investments . Separate account assets classified in Level 3 primarily support Cigna’s pension plans and include commercial mortgage loans as wel l as certain newly-issued, privately-placed, complex, or illiquid securities that are priced using methods discussed above. Separate account investments in securities partnerships, real estate, and hedge funds are generally valued based on the separate account’s ownership share of the equity of the investee (NAV as a practical expedient) including changes in the fair values of its underlying investments. Substantially all of these assets support the Cigna Pension Plans. Some financial assets and liabilities are not carried at fair value each reporting period, but may be measured using fair value only under certain conditions such as investments when they become impaired, including investment real estate and commercial mortgage loans, and certain equity securities with no readily determinable fair value.
Investments	Debt Securities Review of declines in fair value. Management reviews debt securities with a decline in fair value from cost for impairment based on criteria that include: length of time and severity of decline; financial health and specific near term prospects of the issuer; changes in the regulatory, economic or general market environment of the issuer’s industry or geographic region; and the Company’s intent to sell or the likelihood of a required sale prior to recovery. Credit quality . The Company regularly evaluates and monitors credit risk, beginning with the initial underwriting of a mortgage loan and continuing throughout the investment holding period. Mortgage origination professionals employ an internal credit quality rating sys tem designed to evaluate the relative risk of the transaction at origination that is then updated each year as part of the annual portfolio loan review. The Company evaluates and monitors credit quality on a consistent and ongoing basis, classifying each loan as a loan in good standing, potential problem loan or problem loan. Quality ratings are based on our evaluation of a number of key inputs related to the loan, including real estate market-related factors such as rental rates and vacancies, and proper ty-specific inputs such as growth rate assumptions and lease rollover statistics. However, the two most significant contributors to the credit quality rating are the debt service coverage and loan-to-value ratios. The debt service coverage ratio measures the amount of property cash flow available to meet annual interest and principal payments on debt, with a ratio below 1.0 indicating that there is not enough cash flow to cover the required loan payments. The loan-to-value ratio, commonly expressed as a percentage, compares the amount of the loan to the fair value of the underlying property collateralizing the loan. The Company re - evaluate s a loan’s credit quality between annual reviews if new proper ty information is received or an event such as delinquency or a borrower’s request for restructure causes management to believe that the Company’s estimate of financial performance, fair value or the risk profile of the underlying property has been impacte d. Impaired commercial mortgage loans. A commercial mortgage loan is considered impaired when it is probable that the Company will not collect all amounts due per the terms of the promissory note. Impaired loans are carried at the lower of the unpaid pr incipal balance or fair value of the underlying collateral. Interest income on impaired mortgage loans is only recognized when a payment is received The Company’s derivative financial instruments are presented as follows: Fair value hedges of the foreign exchange-related changes in fair values of certain foreign-denominated bonds: Swap fair values are reported in long -term investments or o ther non-current liabilities. Changes in fair values attributable to foreign exchange risk of the swap contracts and the hedged bonds are reported in other realized investment gains and losses. Th e portion of the swap contracts’ changes in fair value excluded from the assessment of hedge effectiveness is recorded in accumulated other comprehensive income and recognized in net investment income as swap coupon payments are accrued, offsetting the foreign- denominated coupons received on the designated bonds. Ne t investment hedges of certain foreign subsidiaries that conduct their business principally in Euros: The fair values of the swap contracts are reported in o ther assets o r other non-current liabilities. The changes in fair values of these instruments are reported in other comprehensive income, specifically in translation of foreign currencies. The portion of the change in swap fair values relating to foreign exchange spot rates will be recognized in earnings upon deconsolidation of the hedged foreign sub sidiaries. The remaining changes in swap fair value are excluded from our effectiveness assessment and recognized in interest expense as swap coupon payments are accrued. The notional value of hedging instruments matches the hedged amount of subsidiary n et assets. Economic hedges for derivatives not designated as accounting hedges: Fair values of derivative instruments are reported in current investments or accrued ex penses and other liabilities . The c hanges in fair values are reported in net realized investment gains and losses.
Derivative Financial Instruments	The Company uses derivative financial instruments to manage the characteristics of investment assets (such as duration, yield, currency and liquidity) to meet the varying demands of the related insurance and contract holder liabilities. The Company also uses derivative financial instruments to hedge the risk of changes in the net assets of certain of its foreign subsidiaries due to changes in foreign currency exchange rates. The Company has written and purchased GMIB reinsurance contracts in its run-off reinsurance business that are accounted for as freesta nding derivatives as discussed in Note 8. Derivatives in the Company’s separate accounts are excluded from the following discussion because associated gains and lo sses generally accrue directly to separate account policyholders.
Variable Interest Entities	When the Company becomes involved with a variable interest entity and when the re is a change in the Company’s involvement with an entity , the Company must determine if it is the primary beneficiary and must consolidate the entity. The Company is considered the primary beneficiary if it has the power to direct the entity’s most significant economic activities or has the right to receive benefits or obligation to absorb losses that could be signifi cant to the entity. The Company evaluates the following criteria: the structure and purpose of the entity; the risks and rewards created by and shared through the entity; and the Company’s ability to direct its activities, receive its benefits and absorb its losses relative to the other parties involved with the entity including its sponsors, equity holders, guarantors, creditors and servicers.
Segment Information	See Note 1 for a description of our segments that changed effective with the fourth quarter of 2018 along with one of our principal financial measures of segment operating performance, which is now pre-tax adjusted income from operations. Prior year segment information reported in this Form 10-Q has been adjusted to reflect these changes. In addition, effective with the first quarter of 2019, the Comp any began allocating compensation cost for stock options to the segments. Prior year segment information was not restated for this change. A description of our basis for reporting segment operating results is outlined below. Intersegment transactions pr imarily reflect pharmacy sales to insured customers of the Integrated Medical segment. These transactions are eliminated in consolidation. The Company uses “pre-tax adjusted income from operations” and “adjusted revenues” as its principal financial meas ures of segment operating performance because management believes they best reflect the underlying results of business operations and permit analysis of trends in underlying revenue, expenses and profitability. Pre-tax adjusted income from operations is d efined as income before taxes excluding realized investment results, amortization of acquired intangible assets, results of transitioning clients Anthem Inc. and Coventry Health Care, Inc. (the “transitioning clients”) and special items. Adjusted revenues is defined as revenues excluding: 1) revenue contributions from transitioning clients; 2) the Company’s share of certain realized investment results of its joint ventures reported in the International Markets segment using the equity method of accounting; and 3) special items, if any. Income or expense amounts that are excluded from adjusted income from operations because they are not indicative of underlying performance or the responsibility of operating segment management include: Realized investment gains (losses) including changes in market values of certain financial instruments between balance sheet dates, as well as gains and losses associa ted with invested asset sales Amortization of acquired intangible assets because these relate to costs incurred for acquisitions Results of transitioning clients because those results are not indicative of ongoing results Special items, if any, that management believes are not representative of the underlying results of operations due to the natu re or size of these matters. Further context about these items is provided in the footnotes listed in the table below.

Summary of Significant Accoun_2

Summary of Significant Accounting Policies (Tables)	3 Months Ended
	Mar. 31, 2019
Accounting Policies [Abstract]
Requirements and Effects of New Accounting Guidance	Accounting Standard and Effective Date Requirements and Expected Effects of New Guidance Not Yet Adopted Measurement of Credit Losses on Financial Instruments (ASU 2016-13) Required as of January 1, 2020 Requires: • A new approach using expected credit losses to estimate and recognize credit losses for certain financial instruments (such as mortgage loans, reinsurance recoverables and other receivables) when such instruments are first originated or acquired. • Changes in the criteria for impairment of available-for-sale debt securities • Adoption using a modified retrospective approach with a cumulative-effect adjustment recorded in retained earnings Expected effects: • The Company is continuing to evaluate this new standard and its expected effects on our financial statements and disclosures. We will adopt the standard as of January 1, 2020. • An additional allowance for future expected credit losses for certain financial instruments will be required at adoption.

Earnings Per Share (Tables)

Earnings Per Share (Tables)	3 Months Ended
	Mar. 31, 2019
Earnings Per Share [Abstract]
Earnings per Share	Three Months Ended March 31, 2019 March 31, 2018 (Shares in thousands, dollars in millions, except per share amounts) Effect of Effect of Basic Dilution Diluted Basic Dilution Diluted Shareholders’ net income $ 1,368 $ 1,368 $ 915 $ 915 Shares: Weighted average 379,387 379,387 242,179 242,179 Common stock equivalents 4,637 4,637 3,609 3,609 Total shares 379,387 4,637 384,024 242,179 3,609 245,788 EPS $ 3.61 $ (0.05) $ 3.56 $ 3.78 $ (0.06) $ 3.72
Antidilutive Options Table	Three Months Ended March 31, (In millions) 2019 2018 Anti-dilutive options 2.8 0.9

Debt (Tables)

Debt (Tables)	3 Months Ended
	Mar. 31, 2019
Debt [Table] [Abstract]
Short-term and Long-term Debt	March 31, December 31, (In millions) Issuer 2019 2018 Short-term debt Current maturities: $1,000 million, 2.25% Senior Notes Express Scripts $ 998 $ 995 Current maturities: $337 million, 7.25% Senior Notes ESI 340 343 Current maturities: $1,000 million, Floating Rate Notes due 2020 Cigna 998 - Commercial paper Old Cigna/Cigna 558 1,500 Other, including finance leases Other 21 117 Total short-term debt $ 2,915 $ 2,955 Long-term uncollateralized debt Cigna debt (issued to finance acquisition) $1,000 million, Floating Rate Notes due 2020 Cigna $ - $ 997 $1,750 million, 3.2% Notes due 2020 Cigna 1,744 1,743 $1,000 million, Floating Rate Notes due 2021 Cigna 997 996 $1,250 million, 3.4% Notes due 2021 Cigna 1,246 1,245 $2,000 million, Floating Rate Term Loan due 2021 Cigna 1,998 2,997 $700 million, Floating Rate Notes due 2023 Cigna 697 697 $3,100 million, 3.75% Notes due 2023 Cigna 3,085 3,085 $2,200 million, 4.125% Notes due 2025 Cigna 2,187 2,187 $3,800 million, 4.375% Notes due 2028 Cigna 3,774 3,774 $2,200 million, 4.8% Notes due 2038 Cigna 2,178 2,178 $3,000 million, 4.9% Notes due 2048 Cigna 2,964 2,964 Express Scripts debt (assumed in acquisition) $500 million, 4.125% Senior Notes due 2020 Medco 505 506 $500 million, 2.600% Senior Notes due 2020 Express Scripts 493 493 $400 million, Floating Rate Senior Notes due 2020 Express Scripts 400 399 $500 million, 3.300% Senior Notes due 2021 Express Scripts 499 499 $1,250 million, 4.750% Senior Notes due 2021 Express Scripts 1,282 1,285 $1,000 million, 3.900% Senior Notes due 2022 Express Scripts 998 998 $500 million, 3.050% Senior Notes due 2022 Express Scripts 482 481 $1,000 million, 3.000% Senior Notes due 2023 Express Scripts 961 959 $1,000 million, 3.500% Senior Notes due 2024 Express Scripts 968 966 $1,500 million, 4.500% Senior Notes due 2026 Express Scripts 1,507 1,508 $1,500 million, 3.400% Senior Notes due 2027 Express Scripts 1,390 1,386 $449 million, 6.125% Senior Notes due 2041 Express Scripts 493 493 $1,500 million, 4.800% Senior Notes due 2046 Express Scripts 1,465 1,465 Old Cigna debt (pre-acquisition) $250 million, 4.375% Notes due 2020 Old Cigna 248 248 $300 million, 5.125% Notes due 2020 Old Cigna 298 298 $78 million, 6.37% Notes due 2021 CGC 78 78 $300 million, 4.5% Notes due 2021 Old Cigna 297 297 $750 million, 4% Notes due 2022 Old Cigna 746 746 $100 million, 7.65% Notes due 2023 Old Cigna 100 100 $17 million, 8.3% Notes due 2023 Old Cigna 17 17 $900 million, 3.25% Notes due 2025 Old Cigna 895 895 $600 million, 3.05% Notes due 2027 Old Cigna 595 595 $259 million, 7.875% Debentures due 2027 Old Cigna 259 259 $45 million, 8.3% Step Down Notes due 2033 Old Cigna 45 45 $191 million, 6.15% Notes due 2036 Old Cigna 190 190 $121 million, 5.875% Notes due 2041 Old Cigna 119 119 $317 million, 5.375% Notes due 2042 Old Cigna 315 315 $1,000 million, 3.875% Notes due 2047 Old Cigna 988 988 Other, including finance leases Other 68 32 Total long-term debt $ 37,571 $ 39,523

Insurance and Contractholder _2

Insurance and Contractholder Liabilities (Tables)	3 Months Ended
	Mar. 31, 2019
Liability For Unpaid Claims And Claims Adjustment Expense [Line Items]
Liability balance details / activity	March 31, 2019 December 31, 2018 March 31, 2018 (In millions) Current Non-current Total Current Non-current Total Total Contractholder deposit funds $ 621 $ 7,326 $ 7,947 $ 641 $ 7,365 $ 8,006 $ 8,153 Future policy benefits 643 9,048 9,691 740 8,981 9,721 9,934 Unpaid claims and claim expenses Integrated Medical 2,943 18 2,961 2,678 19 2,697 2,638 Other segments 2,421 3,304 5,725 2,394 3,230 5,624 5,502 Unearned premiums 432 347 779 348 379 727 1,291 Total insurance and contractholder liabilities $ 7,060 $ 20,043 $ 27,103 $ 6,801 $ 19,974 $ 26,775 $ 27,518
Integrated Medical [Member]
Liability For Unpaid Claims And Claims Adjustment Expense [Line Items]
Liability balance details / activity	Three Months Ended March 31, March 31, (In millions) 2019 2018 Beginning balance $ 2,697 $ 2,420 Less: Reinsurance and other amounts recoverable 264 262 Beginning balance, net 2,433 2,158 Incurred costs related to: Current year 6,095 5,284 Prior years (117) (115) Total incurred 5,978 5,169 Paid costs related to: Current year 3,786 3,382 Prior years 1,908 1,540 Total paid 5,694 4,922 Ending balance, net 2,717 2,405 Add: Reinsurance and other amounts recoverable 244 233 Ending balance $ 2,961 $ 2,638
Variances in incurred costs related to prior years' medical costs payable	Three Months Ended (Dollars in millions) March 31, 2019 March 31, 2018 $ % (1) $ % (2) Actual completion factors $ 55 0.2 % $ 52 0.3 % Medical cost trend 62 0.3 54 0.3 Other - - 9 - Total favorable variance $ 117 0.5 % $ 115 0.6 % (1) Percentage of current year incurred costs as reported for the year ended December 31, 2018. (2) Percentage of current year incurred costs as reported for the year ended December 31, 2017.
Other Segments [Member]
Liability For Unpaid Claims And Claims Adjustment Expense [Line Items]
Liability balance details / activity	(In millions) March 31, 2019 March 31, 2018 Group Disability and Other Group Disability and Life $ 4,786 $ 4,549 Other Operations 194 175 Total Group Disability and Other 4,980 4,724 International Markets 745 778 Unpaid claims and claim expenses Group Disability and Other and International Markets $ 5,725 $ 5,502
Intenational Markets and Global Disability and Life [Member]
Liability For Unpaid Claims And Claims Adjustment Expense [Line Items]
Liability balance details / activity	Three Months Ended (In millions) March 31, 2019 March 31, 2018 Beginning balance $ 5,432 $ 5,274 Less: Reinsurance 156 140 Beginning balance, net 5,276 5,134 Incurred claims related to: Current year 1,428 1,393 Prior years: Interest accretion 38 38 All other incurred (32) (61) Total incurred 1,434 1,370 Paid claims related to: Current year 474 471 Prior years 856 853 Total paid 1,330 1,324 Foreign currency (7) 2 Ending balance, net 5,373 5,182 Add: Reinsurance 158 145 Ending balance $ 5,531 $ 5,327

Reinsurance (Tables)

Reinsurance (Tables)	3 Months Ended
	Mar. 31, 2019
Effects Of Reinsurance [Line Items]
Components of reinsurance recoverables	(Dollars in millions) March 31, December 31 Collateral and Other Terms Line of Business Reinsurer(s) 2019 2018 at March 31, 2019 Ongoing Operations Integrated Medical, International Markets, Group Disability, COLI Various $ 470 $ 464 Balances range from less than $1 million up to $65 million. Over 70% of the balance is from companies rated as investment grade by Standard & Poor’s. Total recoverables related to ongoing operations 470 464 Acquisition, disposition or runoff activities Individual Life and Annuity (sold in 1998) Lincoln National Life and Lincoln Life & Annuity of New York 3,254 3,312 Both companies’ ratings were well above the level that would trigger a contractual obligation to fully secure the outstanding balance. GMDB (effectively exited in 2013) Berkshire 844 893 100% secured by assets in a trust. Retirement Benefits Business (sold in 2004) Prudential Retirement Insurance and Annuity 761 787 100% secured by assets in a trust. Supplemental Benefits Business (2012 acquisition) Great American Life 254 261 100% secured by assets in a trust. Other Various 82 87 100% secured by assets in a trust or other deposits. Total recoverables related to acquisition, disposition or runoff activities 5,195 5,340 Total reinsurance recoverables $ 5,665 $ 5,804
Effects of Reinsurance	Three Months Ended (In millions) March 31, 2019 March 31, 2018 Ceded Premiums Individual life insurance and annuity business sold $ 34 $ 37 Other 96 98 Total ceded premiums 130 135 Reinsurance recoveries Individual life insurance and annuity business sold 55 57 Other 4 47 Total reinsurance recoveries $ 59 $ 104
Variable Annuity [Member] | Guaranteed Minimum Death Benefit [Member]
Effects Of Reinsurance [Line Items]
Account value, net amount at risk and number of contractholders	March 31, December 31, (Dollars in millions, excludes impact of reinsurance ceded) 2019 2018 Account value $ 8,996 $ 8,402 Net amount at risk $ 1,943 $ 2,466 Number of contractholders (estimated) 215,000 220,000
Variable Annuity [Member] | Guaranteed Minimum Income Benefit [Member]
Effects Of Reinsurance [Line Items]
Components of reinsurance recoverables	(In millions) Line of Business Reinsurer March 31, 2019 December 31, 2018 Collateral and Other Terms at March 31, 2019 GMIB Berkshire $ 339 $ 341 100% were secured by assets in a trust. Sun Life Assurance Company of Canada 206 208 Liberty Re (Bermuda) Ltd. 183 184 94% were secured by assets in a trust. Total GMIB recoverables reported in other current assets and other assets $ 728 $ 733

Investments (Tables)

Investments (Tables)	3 Months Ended
	Mar. 31, 2019
Investment [Line Items]
Investments by category	March 31, 2019 December 31, 2018 (In millions) Current Long-term Total Current Long-term Total Debt securities $ 1,363 $ 21,806 $ 23,169 $ 1,320 $ 21,608 $ 22,928 Equity securities - 210 210 377 171 548 Commercial mortgage loans 32 1,832 1,864 32 1,826 1,858 Policy loans - 1,403 1,403 - 1,423 1,423 Other long-term investments - 2,006 2,006 - 1,901 1,901 Short-term investments 267 - 267 316 - 316 Total $ 1,662 $ 27,257 $ 28,919 $ 2,045 $ 26,929 $ 28,974
Schedule of short-term investments and cash equivalents	March 31, December 31, (In millions) 2019 2018 Corporate securities $ 1,531 $ 581 Federal government securities $ 127 $ 82 Foreign government securities $ 162 $ 238 Money market funds $ 855 $ 1,174
Schedule of derivative instruments	Notional Value as of (In millions) March 31, December 31, Type of Instrument Purpose 2019 2018 Foreign currency swap contracts Fair value hedge: To hedge the foreign exchange-related changes in fair values of certain foreign-denominated bonds. The notional value of these derivatives matches the amortized cost of the hedged bonds. $ 593 $ 525 Foreign currency swap contracts Net investment hedge : To reduce the risk of changes in net assets due to changes in foreign currency spot exchange rates for certain foreign subsidiaries that conduct their business principally in Euros. The notional value of hedging instruments matches the hedged amount of subsidiary net assets. $ 439 $ 439 Foreign currency forward contracts Economic hedge: To hedge the foreign exchange related changes in fair values of a U.S. dollar-denominated bond portfolio to reflect the local currency for the Company‘s foreign subsidiary in South Korea. The notional value of hedging instruments generally aligns with the fair value of the hedged bond portfolio. $ 309 $ 309
Realized gains and losses on investments	Three Months Ended March 31, (In millions) 2019 2018 Net realized investment gains (losses), excluding investment asset write-downs $ 11 $ (16) Write-downs on debt securities (1) (13) Write-downs on other invested assets - (4) Net realized investment (losses) gains, before income taxes $ 10 $ (33)
Sales information for available-for-sale fixed maturities and equity securities	Three Months Ended March 31, (In millions) 2019 2018 Proceeds from sales $ 1,086 $ 499 Gross gains on sales $ 14 $ 5 Gross losses on sales $ (10) $ (22)
Debt Securities [Member]
Investment [Line Items]
Investment maturities	Amortized Fair (In millions) Cost Value Due in one year or less $ 1,366 $ 1,370 Due after one year through five years 6,516 6,684 Due after five years through ten years 9,529 9,682 Due after ten years 4,231 4,925 Mortgage and other asset-backed securities 494 508 Total $ 22,136 $ 23,169
Gross unrealized appreciation (depreciation) on debt securities	Amortized Unrealized Unrealized Fair (In millions) Cost Appreciation Depreciation Value March 31, 2019 Federal government and agency $ 513 $ 221 $ (1) $ 733 State and local government 851 77 - 928 Foreign government 2,126 183 (4) 2,305 Corporate 18,152 676 (133) 18,695 Mortgage and other asset-backed 494 21 (7) 508 Total $ 22,136 $ 1,178 $ (145) $ 23,169 Investments supporting liabilities of the Company’s run-off settlement annuity business (included in total above) (1) $ 2,269 $ 555 $ (13) $ 2,811 December 31, 2018 Federal government and agency $ 507 $ 204 $ (1) $ 710 State and local government 920 66 (1) 985 Foreign government 2,214 155 (7) 2,362 Corporate 18,403 411 (453) 18,361 Mortgage and other asset-backed 506 16 (12) 510 Total $ 22,550 $ 852 $ (474) $ 22,928 Investments supporting liabilities of the Company’s run-off settlement annuity business (included in total above) (1) $ 2,264 $ 479 $ (40) $ 2,703 (1) Net unrealized appreciation for these investments is excluded from accumulated other comprehensive income.
Debt securities with a decline in fair value from amortized cost	March 31, 2019 December 31, 2018 Fair Amortized Unrealized Number Fair Amortized Unrealized Number (Dollars in millions) Value Cost Depreciation of Issues Value Cost Depreciation of Issues One year or less Investment grade $ 715 $ 734 $ (19) 190 $ 7,127 $ 7,367 $ (240) 1,324 Below investment grade $ 324 $ 328 $ (4) 393 $ 1,185 $ 1,240 $ (55) 1,190 More than one year Investment grade $ 4,431 $ 4,532 $ (101) 919 $ 3,023 $ 3,181 $ (158) 784 Below investment grade $ 455 $ 476 $ (21) 355 $ 249 $ 270 $ (21) 245
Commercial mortgage loans [Member]
Investment [Line Items]
Credit risk profile of commercial mortgage loan portfolio	(Dollars in millions) March 31, 2019 December 31, 2018 Loan-to-Value Ratio Carrying Value Average Debt Service Coverage Ratio Average Loan-to-Value Ratio Carrying Value Average Debt Service Coverage Ratio Average Loan-to-Value Ratio Below 60% $ 1,167 2.12 $ 1,132 2.14 60% to 79% 621 1.92 650 1.93 80% to 100% 76 1.49 76 1.49 Total $ 1,864 2.03 58% $ 1,858 2.04 58%

Fair Value Measurements (Tables

Fair Value Measurements (Tables)	3 Months Ended
	Mar. 31, 2019
Fair Value Disclosures [Abstract]
Financial assets and liabilities carried at fair value	(In millions) Quoted Prices in Active Markets for Identical Assets (Level 1) Significant Other Observable Inputs (Level 2) Significant Unobservable Inputs (Level 3) Total As of As of As of As of As of As of As of As of March 31, December 31, March 31, December 31, March 31, December 31, March 31, December 31, 2019 2018 2019 2018 2019 2018 2019 2018 Financial assets at fair value Debt securities Federal government and agency $ 212 $ 209 $ 521 $ 501 $ - $ - $ 733 $ 710 State and local government - - 928 985 - - 928 985 Foreign government - - 2,277 2,356 28 6 2,305 2,362 Corporate - - 18,458 18,127 237 234 18,695 18,361 Mortgage and other asset-backed - - 369 372 139 138 508 510 Total debt securities 212 209 22,553 22,341 404 378 23,169 22,928 Equity securities (1) 8 384 49 43 32 32 89 459 Short-term investments - - 267 316 - - 267 316 Derivative assets - - 58 53 - - 58 53 Real estate funds priced at NAV as a practical expedient (2) 230 239 Financial liabilities at fair value Derivative liabilities $ - $ - $ 14 $ 10 $ - $ - $ 14 $ 10 (1) Excludes certain equity securities that have no readily determinable fair value. (2) As a practical expedient, certain real estate funds are carried at fair value based on the Company’s ownership share of the equity of the investee (Net Asset Value (“NAV“)) including changes in the fair value of its underlying investments. The funds have a quarterly redemption frequency, 45-90 day redemption notice period and $58 million in unfunded commitments as of March 31, 2019.
Level 3 debt and equity securities priced using significant unobservable inputs	Fair Value as of Unobservable Adjustment Range (Weighted Average) as of March 31, December 31, Unobservable Input March 31, 2019 March 31, December 31, (Fair value in millions ) 2019 2018 2019 2018 Debt securities Corporate and government debt securities $ 253 $ 229 Liquidity 80 - 930 (230) bps 50 - 930 (230) bps Mortgage and other asset-backed securities 139 138 Liquidity 60- 360 (70) bps 60- 340 (70) bps Weighting of credit spreads 210 - 380 (280) bps 190 - 340 (260) bps Securities not priced by the Company (1) 12 11 Total Level 3 debt securities $ 404 $ 378 (1) The fair values for these securities use single, unadjusted non-binding broker quotes not developed directly by the Company.
Changes in level 3 financial assets and liabilities carried at fair value	Debt and Equity Securities (In millions) For the Three Months Ended March 31, 2019 2018 Balance at January 1, $ 410 $ 732 Total (losses) included in shareholders’ net income (1) (20) Gains (losses) included in other comprehensive income 7 (5) Gains (losses) required to adjust future policy benefits for settlement annuities (1) 2 (4) Purchases, sales, settlements Purchases - 10 Sales - (11) Settlements (1) (2) Total purchases, sales and settlements (1) (3) Transfers into/(out of) Level 3 Transfers into Level 3 20 20 Transfers out of Level 3 (2) (1) (124) Total transfers into/(out of) Level 3 19 (104) Balance at March 31, $ 436 $ 596 Total (losses) included in shareholders’ net income attributable to instruments held at the reporting date $ (1) $ (7) (1) Amounts do not accrue to shareholders. (2) Beginning in 2018, certain private equity securities are no longer carried at fair value under the policy election of ASU 2016-01 (Recognition and Measurement of Financial Assets and Financial Liabilities). Private equity securities of $70 million as of December 31, 2017 are included in the 2018 Transfers out of Level 3 amount.
Separate account assets schedule	(In millions) Quoted Prices in Active Markets for Identical Assets (Level 1) Significant Other Observable Inputs (Level 2) Significant Unobservable Inputs (Level 3) Total March 31, December 31, March 31, December 31, March 31, December 31, March 31, December 31, 2019 2018 2019 2018 2019 2018 2019 2018 Guaranteed separate accounts (See Note 16) $ 204 $ 187 $ 264 $ 267 $ - $ - $ 468 $ 454 Non-guaranteed separate accounts (1) 1,328 1,204 5,346 5,216 244 233 6,918 6,653 Subtotal $ 1,532 $ 1,391 $ 5,610 $ 5,483 $ 244 $ 233 7,386 7,107 Non-guaranteed separate accounts priced at NAV as a practical expedient (1) 693 732 Total separate account assets $ 8,079 $ 7,839 (1) Non-guaranteed separate accounts included $3.9 billion as of March 31, 2019 and $3.8 billion as of December 31, 2018 in assets supporting the Company’s pension plans, including $0.2 billion classified in Level 3 as of March 31, 2019 and December 31, 2018.
Separate account assets priced at net asset value	Unfunded Commitments Redemption Frequency Fair Value as of as of (if currently Redemption Notice (In millions) March 31, 2019 December 31, 2018 March 31, 2019 eligible) Period Securities partnerships $ 464 $ 477 $ 351 Not applicable Not applicable Real estate funds 216 237 - Quarterly 30-90 days Hedge funds 13 18 - Up to annually, varying by fund 30-90 days Total $ 693 $ 732 $ 351
Financial instruments not carried at fair value	(In millions) March 31, 2019 December 31, 2018 Classification in Fair Value Hierarchy Fair Value Carrying Value Fair Value Carrying Value Commercial mortgage loans Level 3 $ 1,875 $ 1,864 $ 1,832 $ 1,858 Long-term debt, including current maturities, excluding finance leases Level 2 $ 41,027 $ 39,840 $ 40,819 $ 40,829

Accumulated Other Comprehensi_2

Accumulated Other Comprehensive Income (Loss) (Tables)	3 Months Ended
	Mar. 31, 2019
Accumulated Other Comprehensive Income (Loss) [Abstract]
Changes in accumulated other comprehensive income (loss)	Three Months Ended March 31, (In millions) 2019 2018 Securities and Derivatives Beginning balance $ 18 $ 328 Reclassification adjustment to retained earnings related to U.S. tax reform legislation (1) - 65 Reclassification adjustment to retained earnings related to new financial instruments guidance (1) - (4) Reclassification adjustment from retained earnings related to new hedging guidance - (6) Adjusted beginning balance 18 383 Appreciation (depreciation) on securities and derivatives 565 (385) Tax (expense) benefit (122) 77 Net appreciation (depreciation) on securities and derivatives 443 (308) Reclassification adjustment for (gains) losses included in shareholders’ net income (net realized investment gains) (1) 30 Tax (expense) - (6) Net (gains) losses reclassified from AOCI to net income (1) 24 Other comprehensive income (loss), net of tax 442 (284) Ending balance $ 460 $ 99 Translation of foreign currencies Beginning balance $ (221) $ (65) Reclassification adjustment to retained earnings related to U.S. tax reform legislation (1) - (4) Adjusted beginning balance (221) (69) Translation of foreign currencies (23) 46 Tax (expense) (1) (1) Net translation of foreign currencies (24) 45 Ending balance $ (245) $ (24) Postretirement benefits liability Beginning balance $ (1,508) $ (1,345) Reclassification adjustment to retained earnings related to U.S. tax reform legislation (1) - (290) Adjusted beginning balance (1,508) (1,635) Reclassification adjustment for amortization of net losses from past experience and prior service costs (selling, general and administrative expenses) 15 17 Reclassification adjustment for settlement (selling, general and administrative expenses) 10 - Tax (expense) (14) (4) Other comprehensive income, net of tax 11 13 Ending balance $ (1,497) $ (1,622) (1) See Note 2 in Cigna’s 2018 Form 10-K for further information about the Company’s adoption of new accounting standards in 2018.

Pension and Other Postretirem_2

Pension and Other Postretirement Benefit Plans (Tables)	3 Months Ended
	Mar. 31, 2019
Defined Benefit Plans and Other Postretirement Benefit Plans Table Text Block [Line Items]
Components of net defined benefit plan costs	Pension Benefits Other Postretirement Benefits Three Months Ended Three Months Ended March 31, March 31, (In millions) 2019 2018 2019 2018 Service cost $ 1 $ 1 $ - $ - Interest cost 49 42 2 2 Expected long-term return on plan assets (56) (64) - - Amortization of: Net loss from past experience 16 17 - - Prior service cost - - (1) - Litigation settlement - plan amendment 142 - - - Settlement loss 10 - - - Net cost $ 162 $ (4) $ 1 $ 2

Leases (Tables)

Leases (Tables)	3 Months Ended
	Mar. 31, 2019
Leases [Abstract]
Components of lease expense	(In millions) Three Months Ended March 31, 2019 Operating lease cost $ 47 Finance lease cost: Amortization of ROU assets 8 Interest on lease liabilities 1 Total finance lease cost 9 Variable lease cost 12 Total lease cost $ 68
Supplemental cash flows information related to leases	(In millions) Three Months Ended March 31, 2019 Cash paid for amounts included in the measurement of lease liabilities: Operating cash outflows from operating leases $ 42 Operating cash outflows from finance leases $ 1 Financing cash outflows from finance leases $ 6 ROU assets obtained in exchange for lease obligations: Operating leases $ 26 Finance leases $ 45
Operating and finance lease ROU assets and lease liabilities	(In millions) March 31, 2019 Operating leases: Operating lease ROU assets $ 602 Accrued expenses and other current liabilities 160 Other non-current liabilities 524 Total operating lease liabilities $ 684 Finance leases: Property and equipment, gross $ 99 Accumulated depreciation (8) Property and equipment, net $ 91 Short-term debt $ 21 Long-term debt 68 Total finance lease liabilities $ 89
Maturities of operating lease liabilities	(In millions) Operating Leases Finance Leases 2019 $ 129 $ 18 2020 169 23 2021 140 14 2022 121 14 2023 81 9 Thereafter 124 22 Total lease payments 764 100 Less: imputed interest 80 11 Total $ 684 $ 89
Maturities of finance lease liabilities	(In millions) Operating Leases Finance Leases 2019 $ 129 $ 18 2020 169 23 2021 140 14 2022 121 14 2023 81 9 Thereafter 124 22 Total lease payments 764 100 Less: imputed interest 80 11 Total $ 684 $ 89

Condensed Consolidating Finan_2

Condensed Consolidating Financial Information (Tables)	3 Months Ended
	Mar. 31, 2019
Organization Consolidation And Presentation Of Financial Statements [Abstract]
Condensed Consolidating Statements of Income	Condensed Consolidating Statements of Income For the three months ended March 31, 2019 (In millions) Cigna Old Cigna Express Scripts Holding Company Express Scripts, Inc. Medco Health Solutions, Inc. Non-Guarantors Eliminations and Consolidation Adjustments Consolidated Revenues Pharmacy revenues $ - $ - $ - $ 17,622 $ 3,763 $ 14,142 $ (10,348) $ 25,179 Premiums - - - - - 9,971 - 9,971 Fees and other revenues - - - 190 84 3,101 (925) 2,450 Net investment income (loss) (9) - 15 3 2 335 - 346 Total revenues (9) - 15 17,815 3,849 27,549 (11,273) 37,946 Benefits and expenses Pharmacy and other service costs - - - 16,363 3,689 14,346 (10,348) 24,050 Medical costs and other benefit expenses - - - - - 7,620 - 7,620 Selling, general and administrative expenses (99) 73 13 835 87 3,319 (925) 3,303 Amortization of acquired intangible assets - - - 577 83 83 - 743 Total benefits and expenses (99) 73 13 17,775 3,859 25,368 (11,273) 35,716 Income (loss) from operations 90 (73) 2 40 (10) 2,181 - 2,230 Interest and other income (expense) (237) (87) (124) (4) (9) 9 - (452) Intercompany interest income (expense) (31) (3) 124 (62) (39) 11 - - Net realized investment gains - - - - - 10 - 10 Income (loss) before income taxes (178) (163) 2 (26) (58) 2,211 - 1,788 Total income tax (benefit) expense (37) (31) 1 (17) (17) 517 - 416 Income (loss) before equity in earnings of subsidiaries (141) (132) 1 (9) (41) 1,694 - 1,372 Equity in earnings of subsidiaries 1,509 1,152 488 432 84 - (3,665) - Net income 1,368 1,020 489 423 43 1,694 (3,665) 1,372 Less: Net income attributable to noncontrolling interests - - - - - 4 - 4 Shareholders’ net income $ 1,368 $ 1,020 $ 489 $ 423 $ 43 $ 1,690 $ (3,665) $ 1,368 Other comprehensive income, net of tax 429 429 1 1 - 412 (843) 429 Shareholders’ comprehensive income $ 1,797 $ 1,449 $ 490 $ 424 $ 43 $ 2,102 $ (4,508) $ 1,797 Condensed Consolidating Statements of Income For the three months ended March 31, 2018 (In millions) Cigna Old Cigna Express Scripts Holding Company Express Scripts, Inc. Medco Health Solutions, Inc. Non-Guarantors Eliminations and Consolidation Adjustments Consolidated Revenues Premiums $ - $ - $ - $ - $ - $ 8,999 $ - $ 8,999 Fees and other revenues - - - - - 1,368 - 1,368 Pharmacy revenues - - - - - 717 - 717 Net investment income - - - - - 329 - 329 Total revenues - - - - - 11,413 - 11,413 Benefits and expenses Medical costs and other benefit expenses - - - - - 6,772 - 6,772 Pharmacy and other service costs - - - - - 561 - 561 Selling, general and administrative expenses - 64 - - - 2,681 - 2,745 Amortization of acquired intangible assets - - - - - 27 - 27 Total benefits and expenses - 64 - - - 10,041 - 10,105 Income (loss) from operations - (64) - - - 1,372 - 1,308 Interest and other (expense) - (85) - - - 28 - (57) Intercompany interest income (expense) - (16) - - - 16 - - Net realized investment (losses) - - - - - (33) - (33) Income (loss) before income taxes - (165) - - - 1,383 - 1,218 Total income tax (benefit) expense - (39) - - - 340 - 301 Income (loss) before equity in earnings of subsidiaries - (126) - - - 1,043 - 917 Equity in earnings of subsidiaries 915 1,041 - - - - (1,956) - Net income 915 915 - - - 1,043 (1,956) 917 Less: net income attributable to noncontrolling interests - - - - - 2 - 2 Shareholders’ net income $ 915 $ 915 $ - $ - $ - $ 1,041 $ (1,956) $ 915 Other comprehensive (loss), net of tax (226) (226) - - - (237) 463 (226) Shareholders’ comprehensive income $ 689 $ 689 $ - $ - $ - $ 804 $ (1,493) $ 689
Condensed Consolidating Balance Sheets	Condensed Consolidating Balance Sheets As of March 31, 2019 (In millions) Cigna Old Cigna Express Scripts Holding Company Express Scripts, Inc. Medco Health Solutions, Inc. Non-Guarantors Eliminations and Consolidation Adjustments Consolidated Assets Cash and cash equivalents $ - $ - $ 1,596 $ 44 $ - $ 3,336 $ - $ 4,976 Investments 417 6 - - - 1,239 - 1,662 Accounts receivable, net - 2 - 4,670 626 5,643 - 10,941 Inventories - - - - - 2,382 - 2,382 Other current assets - 131 - 282 3 1,042 (283) 1,175 Total current assets 417 139 1,596 4,996 629 13,642 (283) 21,136 Long-term investments - 10 - - - 27,247 - 27,257 Reinsurance recoverables - - - - - 5,385 - 5,385 Deferred policy acquisition costs - - - - - 2,817 - 2,817 Property and equipment - - - 2,386 - 2,137 - 4,523 Investments in subsidiaries 70,036 28,174 52,560 17,551 8,205 - (176,526) - Intercompany receivables, net - 3,054 - 8,371 2,222 26,839 (40,486) - Goodwill - - 31,049 - - 13,488 - 44,537 Other intangible assets - - 8,400 18,489 6,958 4,491 - 38,338 Other assets 27 227 - 152 78 2,001 (209) 2,276 Separate account assets - - - - - 8,079 - 8,079 TOTAL ASSETS $ 70,480 $ 31,604 $ 93,605 $ 51,945 $ 18,092 $ 106,126 $ (217,504) $ 154,348 Liabilities Current insurance and contractholder liabilities $ - $ - $ - $ - $ - $ 7,060 $ - $ 7,060 Pharmacy and service costs payable - - - 9,245 1,291 609 - 11,145 Accounts payable 22 - 2 833 4 3,627 - 4,488 Accrued expenses and other liabilities 719 288 92 1,522 276 4,747 (283) 7,361 Short-term debt 1,556 - 998 352 - 9 - 2,915 Total current liabilities 2,297 288 1,092 11,952 1,571 16,052 (283) 32,969 Non-current insurance and contractholder liabilities - - - - - 20,043 - 20,043 Deferred tax liabilities, net - - 1,999 4,898 1,664 1,051 (209) 9,403 Other non-current liabilities - 715 - 577 241 2,299 - 3,832 Intercompany payables, net 4,904 4,477 30,552 - - 553 (40,486) - Long-term debt 20,871 5,112 10,938 41 505 104 - 37,571 Separate account liabilities - - - - - 8,079 - 8,079 TOTAL LIABILITIES 28,072 10,592 44,581 17,468 3,981 48,181 (40,978) 111,897 Redeemable noncontrolling interests - - - - - 38 - 38 TOTAL SHAREHOLDERS’ EQUITY 42,408 21,012 49,024 34,477 14,111 57,902 (176,526) 42,408 Noncontrolling interests - - - - - 5 - 5 TOTAL EQUITY 42,408 21,012 49,024 34,477 14,111 57,907 (176,526) 42,413 TOTAL LIABILITIES AND EQUITY $ 70,480 $ 31,604 $ 93,605 $ 51,945 $ 18,092 $ 106,126 $ (217,504) $ 154,348 Condensed Consolidating Balance Sheets As of December 31, 2018 (In millions) Cigna Old Cigna Express Scripts Holding Company Express Scripts, Inc. Medco Health Solutions, Inc. Non-Guarantors Eliminations and Consolidation Adjustments Consolidated Assets Cash and cash equivalents $ 243 $ - $ 633 $ 43 $ - $ 2,936 $ - $ 3,855 Investments - - - - - 2,045 - 2,045 Accounts receivable, net - - - 4,206 748 5,519 - 10,473 Inventories - - - - - 2,821 - 2,821 Other current assets 14 59 - 310 - 1,063 (210) 1,236 Total current assets 257 59 633 4,559 748 14,384 (210) 20,430 Long-term investments - 10 - - - 26,919 - 26,929 Reinsurance recoverables - - - - - 5,507 - 5,507 Deferred policy acquisition costs - - - - - 2,821 - 2,821 Property and equipment - - - 2,432 - 2,130 - 4,562 Investments in subsidiaries 68,969 27,544 52,035 17,115 8,117 - (173,780) - Intercompany receivables, net - 4,505 - 7,425 2,335 24,882 (39,147) - Goodwill - - 31,049 - - 13,456 - 44,505 Other intangible assets - - 8,400 18,962 7,040 4,601 - 39,003 Other assets 48 198 - 68 74 1,488 (246) 1,630 Separate account assets - - - - - 7,839 - 7,839 TOTAL ASSETS $ 69,274 $ 32,316 $ 92,117 $ 50,561 $ 18,314 $ 104,027 $ (213,383) $ 153,226 Liabilities Current insurance and contractholder liabilities $ - $ - $ - $ - $ - $ 6,801 $ - $ 6,801 Pharmacy and service costs payable - - - 8,422 1,579 701 - 10,702 Accounts payable 22 - - 834 4 3,506 - 4,366 Accrued expenses and other liabilities 396 182 129 1,387 189 4,998 (210) 7,071 Short-term debt - 1,500 995 353 - 107 - 2,955 Total current liabilities 418 1,682 1,124 10,996 1,772 16,113 (210) 31,895 Non-current insurance and contractholder liabilities - - - - - 19,974 - 19,974 Deferred tax liabilities, net - - 2,001 5,012 1,685 1,001 (246) 9,453 Other non-current liabilities - 685 - 497 290 1,998 - 3,470 Intercompany payables, net 4,965 4,361 29,569 - - 252 (39,147) - Long-term debt 22,863 5,110 10,932 24 506 88 - 39,523 Separate account liabilities - - - - - 7,839 - 7,839 TOTAL LIABILITIES 28,246 11,838 43,626 16,529 4,253 47,265 (39,603) 112,154 Redeemable noncontrolling interests - - - - - 37 - 37 TOTAL SHAREHOLDERS’ EQUITY 41,028 20,478 48,491 34,032 14,061 56,718 (173,780) 41,028 Noncontrolling interest - - - - - 7 - 7 TOTAL EQUITY 41,028 20,478 48,491 34,032 14,061 56,725 (173,780) 41,035 TOTAL LIABILITIES AND EQUITY $ 69,274 $ 32,316 $ 92,117 $ 50,561 $ 18,314 $ 104,027 $ (213,383) $ 153,226
Condensed Consolidating Cash Flow Statements	Condensed Consolidating Cash Flow Statements For the Three Months Ended March 31, 2019 (In millions) Cigna Old Cigna Express Scripts Holding Company Express Scripts, Inc. Medco Health Solutions, Inc. Non-Guarantors Eliminations and Consolidation Adjustments Consolidated Net cash (used in) provided by operating activities $ 1,102 $ 947 $ (6) $ 1,802 $ (110) $ 1,295 $ (1,838) $ 3,192 Cash Flows from Investing Activities Net change in loans due (from) affiliates - 1,600 (1,700) - - 141 (41) - Proceeds from investments sold: Debt securities and equity securities - - - - - 1,471 - 1,471 Investment maturities and repayments: Debt securities and equity securities - - - - - 319 - 319 Commercial mortgage loans - - - - - 89 - 89 Other sales, maturities and repayments (primarily short-term and other long-term investments) - - - - - 367 - 367 Investments purchased or originated: Debt securities and equity securities - - - - - (1,088) - (1,088) Commercial mortgage loans - - - - - (95) - (95) Other sales, maturities and repayments (primarily short-term and other long-term investments) (417) (6) - - - 35 - (388) Property and equipment purchases, net - - - (55) - (139) - (194) Acquisitions, net of cash acquired - - - - - (6) - (6) NET CASH (USED IN) PROVIDED BY INVESTING ACTIVITIES (417) 1,594 (1,700) (55) - 1,094 (41) 475 Cash Flows from Financing Activities Net change in amounts due to (from) affiliates, net - (141) 2,669 (1,744) 110 (935) 41 - Intercompany dividends paid - (900) - - - (922) 1,822 - Deposits and interest credited to contractholder deposit funds - - - - - 247 - 247 Withdrawals and benefit payments from contractholder deposit funds - - - - - (251) - (251) Net change in short-term debt 558 (1,500) - - - (106) - (1,048) Repayment of long-term debt (1,000) - - - - - - (1,000) Repurchase of common stock (462) - - - - - - (462) Issuance of common stock 53 - - - - - - 53 Other, net (77) - - (2) - (10) 16 (73) NET CASH (USED IN) PROVIDED BY FINANCING ACTIVITIES (928) (2,541) 2,669 (1,746) 110 (1,977) 1,879 (2,534) Effect of foreign currency rate changes on cash and cash equivalents - - - - - (12) - (12) Net (decrease) increase in cash and cash equivalents (243) - 963 1 - 400 - 1,121 Cash and cash equivalents, January 1, 243 - 633 43 - 2,936 - 3,855 Cash and cash equivalents, March 31, $ - $ - $ 1,596 $ 44 $ - $ 3,336 $ - $ 4,976 Condensed Consolidating Cash Flow Statements For the Three Months Ended March 31, 2018 (In millions) Cigna Old Cigna Express Scripts Holding Company Express Scripts, Inc. Medco Health Solutions, Inc. Non-Guarantors Eliminations and Consolidation Adjustments Consolidated Net cash provided by operating activities $ - $ 641 $ - $ - $ - $ 1,833 $ (449) $ 2,025 Cash Flows from Investing Activities Net change in loans due to affiliates - - - - - 102 (102) - Proceeds from investments sold: Debt securities and equity securities - - - - - 499 - 499 Investment maturities and repayments: Debt securities and equity securities - - - - - 297 - 297 Commercial mortgage loans - - - - - 28 - 28 Other sales, maturities and repayments (primarily short-term and other long-term investments) - - - - - 112 - 112 Investments purchased or originated: Debt securities and equity securities - - - - - (2,259) - (2,259) Commercial mortgage loans - - - - - (68) - (68) Other sales, maturities and repayments (primarily short-term and other long-term investments) - (2) - - - (204) - (206) Property and equipment purchases, net - - - - - (103) - (103) NET CASH (USED IN) INVESTING ACTIVITIES - (2) - - - (1,596) (102) (1,700) Cash Flows from Financing Activities Net change in amounts due (from) affiliates, net - (102) - - - - 102 - Intercompany dividends paid - - - - - (449) 449 - Deposits and interest credited to contractholder deposit funds - - - - - 292 - 292 Withdrawals and benefit payments from contractholder deposit funds - - - - - (306) - (306) Net change in short-term debt - - - - - (3) - (3) Repayment of long-term debt - (131) - - - - - (131) Repurchase of common stock - (310) - - - - - (310) Issuance of common stock - 20 - - - - - 20 Other, net - (125) - - - 33 - (92) NET CASH (USED IN) FINANCING ACTIVITIES - (648) - - - (433) 551 (530) Effect of foreign currency rate changes on cash and cash equivalents - - - - - 4 - 4 Net (decrease) in cash and cash equivalents - (9) - - - (192) - (201) Cash and cash equivalents, January 1, - 9 - - - 2,963 - 2,972 Cash and cash equivalents, March 31, $ - $ - $ - $ - $ - $ 2,771 $ - $ 2,771

Segment Information (Tables)

Segment Information (Tables)	3 Months Ended
	Mar. 31, 2019
Segment Information [Abstract]
Special item charges	Three Months Ended (In millions) March 31, 2019 March 31, 2018 Description of Special Item Charges (Benefits) and Financial Statement Line Item(s) After-tax Before-tax After-tax Before-tax Integration and transaction-related costs (selling, general and administrative expenses) $ 108 $ 136 $ 50 $ 60
Summarized segment financial information	(In millions) Health Services Integrated Medical International Markets Group Disability and Other Corporate and Eliminations Total Three Months Ended March 31, 2019 Revenues from external customers (1) $ 26,197 $ 8,910 $ 1,384 $ 1,109 $ - $ 37,600 Inter-segment revenues 737 162 - 7 (906) - Net investment income (loss) 15 123 38 180 (10) 346 Total revenues 26,949 9,195 1,422 1,296 (916) 37,946 Revenue contributions from transitioning clients (4,489) - - - - (4,489) Net realized investment results from equity method subsidiaries (2) - - (28) - - (28) Adjusted revenues $ 22,460 $ 9,195 $ 1,394 $ 1,296 $ (916) $ 33,429 Income (loss) before taxes $ 942 $ 1,157 $ 222 $ 93 $ (626) $ 1,788 Pre-tax adjustments to reconcile to adjusted income from operations Adjustment for transitioning clients (660) - - - - (660) (Income) attributable to noncontrolling interests (1) - (4) - - (5) Net realized investment (gains) (2) - (5) (23) (10) - (38) Amortization of acquired intangible assets 713 18 11 1 - 743 Special items Integration and transaction-related costs - - - - 136 136 Pre-tax adjusted income (loss) from operations $ 994 $ 1,170 $ 206 $ 84 $ (490) $ 1,964 (In millions) Health Services Integrated Medical International Markets Group Disability and Other Corporate and Eliminations Total Three Months Ended March 31, 2018 Revenues from external customers (1) $ 786 $ 7,903 $ 1,302 $ 1,093 $ - $ 11,084 Inter-segment revenues 284 136 - 3 (423) - Net investment income 1 111 37 175 5 329 Total revenues 1,071 8,150 1,339 1,271 (418) 11,413 Net realized investment results from equity method subsidiaries (2) - - 2 - - 2 Adjusted revenues $ 1,071 $ 8,150 $ 1,341 $ 1,271 $ (418) $ 11,415 Income (loss) before taxes $ 83 $ 972 $ 213 $ 103 $ (153) $ 1,218 Pre-tax adjustments to reconcile to adjusted income from operations (Income) attributable to noncontrolling interests - - (4) - - (4) Net realized investment losses (2) - 18 4 12 1 35 Amortization of acquired intangible assets - 22 4 1 - 27 Special items Integration and transaction-related costs - - - - 60 60 Pre-tax adjusted income (loss) from operations $ 83 $ 1,012 $ 217 $ 116 $ (92) $ 1,336 (1) Includes the Company’s share of the earnings of its joint ventures reported in the International Markets segment using the equity method of accounting. (2) Includes the Company’s share of certain realized investment gains (losses) of its joint ventures reported in the International Markets segment using the equity method of accounting.
Revenue from external customers	Three Months Ended March 31, (In millions) 2019 2018 Products (Pharmacy revenues) (ASC 606) Home delivery and specialty revenues $ 11,784 $ 717 Network revenues 12,273 - Other 1,122 - Total pharmacy revenues 25,179 717 Insurance premiums Integrated Medical premiums (ASC 944) Commercial Premiums Risk 3,039 2,611 Stop loss 1,069 980 Other 278 258 Government Medicare Advantage 1,607 1,498 Medicare Part D 525 228 Other 1,065 1,101 Total Integrated Medical premiums 7,583 6,676 International Markets premiums 1,304 1,260 Domestic disability, life and accident premiums 1,047 998 Other premiums 37 65 Total premiums 9,971 8,999 Services (ASC 606) Fees 2,390 1,352 Other external revenues 60 16 Total services 2,450 1,368 Total revenues from external customers $ 37,600 $ 11,084
Revenues from major customers	Three Months Ended March 31, 2019 Anthem 12% Department of Defense 8%

Summary of Significant Accoun_3

Summary of Significant Accounting Policies (Details) - USD ($) $ in Millions	Jan. 01, 2019		Jan. 01, 2018
New Accounting Pronouncements Or Change In Accounting Principle [Line Items]
Cumulative effect on equity in period of adoption	$ (15)	[1]	$ 58
[1]	See Note 2 for further information about the Company's adoption of new leasing guidance (ASU 2016-02).

Accounts Receivable, Net (Detai

Accounts Receivable, Net (Details) - USD ($) $ in Millions	Mar. 31, 2019	Dec. 31, 2018
Accounts Receivable, Net [Abstract]
Insurance customer receivables	$ 2,261	$ 1,888
Noninsurance customer receivables	4,635	4,988
Pharmaceutical manufacturer receivable	3,682	3,321
Other receivables	363	276
Total accounts receivable, net	10,941	10,473
Pharmaceutical manufacturer receivables under noninsurance customer contracts	624	406
Allowance for doubtful accounts, customer credit allowances and contractual allowances	$ 456	$ 217

Mergers and Acquisitions - Purc

Mergers and Acquisitions - Purchase Price Allocation (Details) - USD ($) $ in Millions	Mar. 31, 2019	Dec. 31, 2018
Purchase price allocation [Abstract]
Goodwill	$ 44,537	$ 44,505

Mergers and Acquisitions - Pro

Mergers and Acquisitions - Pro Forma Information (Details) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Unaudited pro forma information [Abstract]
Total revenues	$ 37,946	$ 11,413

Mergers and Acquisitions - Tran

Mergers and Acquisitions - Transaction-related Costs (Details) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Before-tax [Abstract]
Transaction-related costs, net	$ 136	$ 60
After-tax [Abstract]
Transaction-related costs, net - after-tax	$ 108	$ 50

Earnings Per Share (Details)

Earnings Per Share (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Millions	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Earnings Per Share [Abstract]
Shareholders' net income	$ 1,368	$ 915
Shares:
Weighted average	379,387	242,179
Common stock equivalents	4,637	3,609
Total shares	384,024	245,788
EPS, basic	$ 3.61	$ 3.78
EPS, effect of dilution	(0.05)	(0.06)
EPS, diluted	$ 3.56	$ 3.72
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Antidilutive options	2,800	900

Debt - Short-term and Long-term

Debt - Short-term and Long-term Debt (Details) - USD ($)	Mar. 31, 2019	Dec. 31, 2018
Short-term debt [Abstract]
Commercial paper	$ 558,000,000	$ 1,500,000,000
Other, including finance leases	21,000,000	117,000,000
Total short-term debt	2,915,000,000	2,955,000,000
Long-term uncollateralized debt [Abstract]
Long-term debt, excluding finance lease obligations		39,523,000,000
Other, including finance leases	68,000,000	32,000,000
Total long-term debt	$ 37,571,000,000	39,523,000,000
Commercial Paper [Member]
Long-term uncollateralized debt [Abstract]
Weighted average interest rate, commercial paper	2.90%
2.25% Senior Notes [Member]
Short-term debt [Abstract]
Current maturities	$ 998,000,000	995,000,000
Long-term uncollateralized debt [Abstract]
Long-term debt, face value	$ 1,000,000,000	$ 1,000,000,000
Long-term debt, stated interest rate	2.25%	2.25%
7.25% Senior Notes [Member]
Short-term debt [Abstract]
Current maturities	$ 340,000,000	$ 343,000,000
Long-term uncollateralized debt [Abstract]
Long-term debt, face value	$ 337	$ 337,000,000
Long-term debt, stated interest rate	7.25%	7.25%
$1,000 million, Floating Rate Notes due 2020
Short-term debt [Abstract]
Current maturities	$ 998,000,000	$ 0
Long-term uncollateralized debt [Abstract]
Long-term debt, face value	1,000,000,000	1,000,000,000
Long-term debt, excluding finance lease obligations	0	997,000,000
$1,750 million, 3.2% Notes due 2020
Long-term uncollateralized debt [Abstract]
Long-term debt, face value	$ 1,750,000,000	$ 1,750,000,000
Long-term debt, stated interest rate	3.20%	3.20%
Long-term debt, excluding finance lease obligations	$ 1,744,000,000	$ 1,743,000,000
$1,000 million, Floating Rate Notes due 2021
Long-term uncollateralized debt [Abstract]
Long-term debt, face value	1,000,000,000	1,000,000,000
Long-term debt, excluding finance lease obligations	997,000,000	996,000,000
$1,250 million, 3.4% Notes due 2021
Long-term uncollateralized debt [Abstract]
Long-term debt, face value	$ 1,250,000,000	$ 1,250,000,000
Long-term debt, stated interest rate	3.40%	3.40%
Long-term debt, excluding finance lease obligations	$ 1,246,000,000	$ 1,245,000,000
$2,000 million Floating Rate Term Loan due 2021
Long-term uncollateralized debt [Abstract]
Long-term debt, face value	3,000,000,000	3,000,000,000
Long-term debt, excluding finance lease obligations	1,998,000,000	2,997,000,000
$700 million, Floating Rate Notes due 2023
Long-term uncollateralized debt [Abstract]
Long-term debt, face value	700,000,000	700,000,000
Long-term debt, excluding finance lease obligations	697,000,000	697,000,000
$3,100 million, 3.75% Notes due 2023
Long-term uncollateralized debt [Abstract]
Long-term debt, face value	$ 3,100,000,000	$ 3,100,000,000
Long-term debt, stated interest rate	3.75%	3.75%
Long-term debt, excluding finance lease obligations	$ 3,085,000,000	$ 3,085,000,000
$2,200 million, 4.125% Notes due 2025
Long-term uncollateralized debt [Abstract]
Long-term debt, face value	$ 2,200,000,000	$ 2,200,000,000
Long-term debt, stated interest rate	4.125%	4.125%
Long-term debt, excluding finance lease obligations	$ 2,187,000,000	$ 2,187,000,000
$3,800 million, 4.375% Notes due 2028
Long-term uncollateralized debt [Abstract]
Long-term debt, face value	$ 3,800,000,000	$ 3,800,000,000
Long-term debt, stated interest rate	4.375%	4.375%
Long-term debt, excluding finance lease obligations	$ 3,774,000,000	$ 3,774,000,000
$2,200 million, 4.8% Notes due 2038
Long-term uncollateralized debt [Abstract]
Long-term debt, face value	$ 2,200,000,000	$ 2,200,000,000
Long-term debt, stated interest rate	4.80%	4.80%
Long-term debt, excluding finance lease obligations	$ 2,178,000,000	$ 2,178,000,000
$3,000 million, 4.9% Notes due 2048
Long-term uncollateralized debt [Abstract]
Long-term debt, face value	$ 3,000,000,000	$ 3,000,000,000
Long-term debt, stated interest rate	4.90%	4.90%
Long-term debt, excluding finance lease obligations	$ 2,964,000,000	$ 2,964,000,000
$500 million, 4.125% Senior Notes due 2020
Long-term uncollateralized debt [Abstract]
Long-term debt, face value	$ 500,000,000	$ 500,000,000
Long-term debt, stated interest rate	4.125%	4.125%
Long-term debt, excluding finance lease obligations	$ 505,000,000	$ 506,000,000
$500 million, 2.600% Senior Notes due 2020
Long-term uncollateralized debt [Abstract]
Long-term debt, face value	$ 500,000,000	$ 500,000,000
Long-term debt, stated interest rate	2.60%	2.60%
Long-term debt, excluding finance lease obligations	$ 493,000,000	$ 493,000,000
$400 million, Floating Rate Senior Notes due 2020
Long-term uncollateralized debt [Abstract]
Long-term debt, face value	400,000,000	400,000,000
Long-term debt, excluding finance lease obligations	400,000,000	399,000,000
$500 million, 3.300% Senior Notes due 2021
Long-term uncollateralized debt [Abstract]
Long-term debt, face value	$ 500,000,000	$ 500,000,000
Long-term debt, stated interest rate	3.30%	3.30%
Long-term debt, excluding finance lease obligations	$ 499,000,000	$ 499,000,000
$1,250 million, 4.750% Senior Notes due 2021
Long-term uncollateralized debt [Abstract]
Long-term debt, face value	$ 1,250,000,000	$ 1,250,000,000
Long-term debt, stated interest rate	4.75%	4.75%
Long-term debt, excluding finance lease obligations	$ 1,282,000,000	$ 1,285,000,000
$1,000 million, 3.900% Senior Notes due 2022
Long-term uncollateralized debt [Abstract]
Long-term debt, face value	$ 1,000,000,000	$ 1,000,000,000
Long-term debt, stated interest rate	3.90%	3.90%
Long-term debt, excluding finance lease obligations	$ 998,000,000	$ 998,000,000
$500 million, 3.050% Senior Notes due 2022
Long-term uncollateralized debt [Abstract]
Long-term debt, face value	$ 500,000,000	$ 500,000,000
Long-term debt, stated interest rate	3.05%	3.05%
Long-term debt, excluding finance lease obligations	$ 482,000,000	$ 481,000,000
$1,000 million, 3.000% Senior Notes due 2023
Long-term uncollateralized debt [Abstract]
Long-term debt, face value	$ 1,000,000,000	$ 1,000,000,000
Long-term debt, stated interest rate	3.00%	3.00%
Long-term debt, excluding finance lease obligations	$ 961,000,000	$ 959,000,000
$1,000 million, 3.500% Senior Notes due 2024
Long-term uncollateralized debt [Abstract]
Long-term debt, face value	$ 1,000,000,000	$ 1,000,000,000
Long-term debt, stated interest rate	3.50%	3.50%
Long-term debt, excluding finance lease obligations	$ 968,000,000	$ 966,000,000
$1,500 million, 4.500% Senior Notes due 2026
Long-term uncollateralized debt [Abstract]
Long-term debt, face value	$ 1,500,000,000	$ 1,500,000,000
Long-term debt, stated interest rate	4.50%	4.50%
Long-term debt, excluding finance lease obligations	$ 1,507,000,000	$ 1,508,000,000
$1,500 million, 3.400% Senior Notes due 2027
Long-term uncollateralized debt [Abstract]
Long-term debt, face value	$ 1,500,000,000	$ 1,500,000,000
Long-term debt, stated interest rate	3.40%	3.40%
Long-term debt, excluding finance lease obligations	$ 1,390,000,000	$ 1,386,000,000
$449 million, 6.125% Senior Notes due 2041
Long-term uncollateralized debt [Abstract]
Long-term debt, face value	$ 449,000,000	$ 449,000,000
Long-term debt, stated interest rate	6.125%	6.125%
Long-term debt, excluding finance lease obligations	$ 493,000,000	$ 493,000,000
$1,500 million, 4.800% Senior Notes due 2046
Long-term uncollateralized debt [Abstract]
Long-term debt, face value	$ 1,500,000,000	$ 1,500,000,000
Long-term debt, stated interest rate	4.80%	4.80%
Long-term debt, excluding finance lease obligations	$ 1,465,000,000	$ 1,465,000,000
$250 million, 4.375% Notes due 2020 [Member]
Long-term uncollateralized debt [Abstract]
Long-term debt, face value	$ 250,000,000	$ 250,000,000
Long-term debt, stated interest rate	4.375%	4.375%
Long-term debt, excluding finance lease obligations	$ 248,000,000	$ 248,000,000
$300 million, 5.125% Notes due 2020 [Member]
Long-term uncollateralized debt [Abstract]
Long-term debt, face value	$ 300,000,000	$ 300,000,000
Long-term debt, stated interest rate	5.125%	5.125%
Long-term debt, excluding finance lease obligations	$ 298,000,000	$ 298,000,000
$78 million, 6.37% Notes due 2021 [Member]
Long-term uncollateralized debt [Abstract]
Long-term debt, face value	$ 78,000,000	$ 78,000,000
Long-term debt, stated interest rate	6.37%	6.37%
Long-term debt, excluding finance lease obligations	$ 78,000,000	$ 78,000,000
$300 million, 4.5% Notes due 2021 [Member]
Long-term uncollateralized debt [Abstract]
Long-term debt, face value	$ 300,000,000	$ 300,000,000
Long-term debt, stated interest rate	4.50%	4.50%
Long-term debt, excluding finance lease obligations	$ 297,000,000	$ 297,000,000
$750 million, 4% Notes due 2022 [Member]
Long-term uncollateralized debt [Abstract]
Long-term debt, face value	$ 750,000,000	$ 750,000,000
Long-term debt, stated interest rate	4.00%	4.00%
Long-term debt, excluding finance lease obligations	$ 746,000,000	$ 746,000,000
$100 million, 7.65% Notes due 2023 [Member]
Long-term uncollateralized debt [Abstract]
Long-term debt, face value	$ 100,000,000	$ 100,000,000
Long-term debt, stated interest rate	7.65%	7.65%
Long-term debt, excluding finance lease obligations	$ 100,000,000	$ 100,000,000
$17 million, 8.3% Notes due 2023 [Member]
Long-term uncollateralized debt [Abstract]
Long-term debt, face value	$ 17,000,000	$ 17,000,000
Long-term debt, stated interest rate	8.30%	8.30%
Long-term debt, excluding finance lease obligations	$ 17,000,000	$ 17,000,000
$900 million, 3.25% Notes Due 2025 [Member]
Long-term uncollateralized debt [Abstract]
Long-term debt, face value	$ 900,000,000	$ 900,000,000
Long-term debt, stated interest rate	3.25%	3.25%
Long-term debt, excluding finance lease obligations	$ 895,000,000	$ 895,000,000
$600 million, 3.05% Notes due 2027
Long-term uncollateralized debt [Abstract]
Long-term debt, face value	$ 600,000,000	$ 600,000,000
Long-term debt, stated interest rate	3.05%	3.05%
Long-term debt, excluding finance lease obligations	$ 595,000,000	$ 595,000,000
$259 million, 7.875% Debentures due 2027 [Member]
Long-term uncollateralized debt [Abstract]
Long-term debt, face value	$ 259,000,000	$ 259,000,000
Long-term debt, stated interest rate	7.875%	7.875%
Long-term debt, excluding finance lease obligations	$ 259,000,000	$ 259,000,000
$45 million, 8.3% Step Down Notes due 2033 [Member]
Long-term uncollateralized debt [Abstract]
Long-term debt, face value	$ 45,000,000	$ 45,000,000
Long-term debt, stated interest rate	8.30%	8.30%
Long-term debt, excluding finance lease obligations	$ 45,000,000	$ 45,000,000
$191 million, 6.15% Notes due 2036 [Member]
Long-term uncollateralized debt [Abstract]
Long-term debt, face value	$ 191,000,000	$ 191,000,000
Long-term debt, stated interest rate	6.15%	6.15%
Long-term debt, excluding finance lease obligations	$ 190,000,000	$ 190,000,000
$121 million, 5.875% Notes due 2041 [Member]
Long-term uncollateralized debt [Abstract]
Long-term debt, face value	$ 121,000,000	$ 121,000,000
Long-term debt, stated interest rate	5.875%	5.875%
Long-term debt, excluding finance lease obligations	$ 119,000,000	$ 119,000,000
$317 million, 5.375% Notes due 2042 [Member]
Long-term uncollateralized debt [Abstract]
Long-term debt, face value	$ 317,000,000	$ 317,000,000
Long-term debt, stated interest rate	5.375%	5.375%
Long-term debt, excluding finance lease obligations	$ 315,000,000	$ 315,000,000
$1,000 million, 3.875% Notes due 2047
Long-term uncollateralized debt [Abstract]
Long-term debt, face value	$ 1,000,000,000	$ 1,000,000,000
Long-term debt, stated interest rate	3.875%	3.875%
Long-term debt, excluding finance lease obligations	$ 988,000,000	$ 988,000,000

Debt - Long-tem Debt Issued (De

Debt - Long-tem Debt Issued (Details) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2019	Dec. 31, 2018
Debt Instrument [Line Items]
Amount net of discount and fees	$ 37,571	$ 39,523
Commercial paper	558	1,500
$1,000 million, Floating Rate Notes due 2020
Debt Instrument [Line Items]
Long-term debt, face value	1,000	1,000
$1,750 million, 3.2% Notes due 2020
Debt Instrument [Line Items]
Long-term debt, face value	$ 1,750	$ 1,750
Long-term debt, stated interest rate	3.20%	3.20%
$1,000 million, Floating Rate Notes due 2021
Debt Instrument [Line Items]
Long-term debt, face value	$ 1,000	$ 1,000
$1,250 million, 3.4% Notes due 2021
Debt Instrument [Line Items]
Long-term debt, face value	$ 1,250	$ 1,250
Long-term debt, stated interest rate	3.40%	3.40%
$700 million, Floating Rate Notes due 2023
Debt Instrument [Line Items]
Long-term debt, face value	$ 700	$ 700
$3,100 million, 3.75% Notes due 2023
Debt Instrument [Line Items]
Long-term debt, face value	$ 3,100	$ 3,100
Long-term debt, stated interest rate	3.75%	3.75%
$2,200 million, 4.125% Notes due 2025
Debt Instrument [Line Items]
Long-term debt, face value	$ 2,200	$ 2,200
Long-term debt, stated interest rate	4.125%	4.125%
$3,800 million, 4.375% Notes due 2028
Debt Instrument [Line Items]
Long-term debt, face value	$ 3,800	$ 3,800
Long-term debt, stated interest rate	4.375%	4.375%
$2,200 million, 4.8% Notes due 2038
Debt Instrument [Line Items]
Long-term debt, face value	$ 2,200	$ 2,200
Long-term debt, stated interest rate	4.80%	4.80%
$2,000 million Floating Rate Term Loan due 2021
Debt Instrument [Line Items]
Long-term debt, face value	$ 3,000	$ 3,000
$3,000 million, 4.9% Notes due 2048
Debt Instrument [Line Items]
Long-term debt, face value	$ 3,000	$ 3,000
Long-term debt, stated interest rate	4.90%	4.90%
Notes Issued Third Quarter 2017 [Member]
Debt Instrument [Line Items]
Long-term debt, issuance date	Sep. 14, 2017
Long-term debt, face value		$ 1,600
$600 million, 3.05% Notes due 2027
Debt Instrument [Line Items]
Long-term debt, face value	$ 600	$ 600
Long-term debt, stated interest rate	3.05%	3.05%
$1,000 million, 3.875% Notes due 2047
Debt Instrument [Line Items]
Long-term debt, face value	$ 1,000	$ 1,000
Long-term debt, stated interest rate	3.875%	3.875%

Debt - Revolving Credit and Let

Debt - Revolving Credit and Letter of Credit (Details) $ in Millions	3 Months Ended
	Mar. 31, 2019USD ($)Banks	Dec. 31, 2018USD ($)	Mar. 31, 2018USD ($)Banks
Line of Credit Facility [Line Items]
Repayment of long-term debt	$ 1,000		$ 131
Bridge Loan [Member]
Line of Credit Facility [Line Items]
Number of participating banks | Banks			23
Credit agreement term		364 days
Maximum borrowing capacity			$ 26,700
Fees incurred		$ 140
Revolving Credit And Letter Of Credit Facility [Member]
Line of Credit Facility [Line Items]
Number of participating banks | Banks	23
Expiration date	Apr. 6, 2023
Maximum borrowing capacity	$ 3,250
Amount by which credit facilty amount can be increased	$ 500
Leverage ratio covenant	60.00%
Debt covenant compliance	The Company was in compliance with its debt covenants as of December 31, 2019.
Letter of Credit [Member]
Line of Credit Facility [Line Items]
Maximum borrowing capacity	$ 500
Letters of credit outstanding	$ 22
Term Loan Credit Agreement [Member]
Line of Credit Facility [Line Items]
Number of participating banks | Banks	23
Aggregate principal amount	$ 2,000
Remaining amount available for borrowing	$ 0
Leverage ratio covenant	60.00%
Repayment of long-term debt	$ 1,000

Common and Preferred Stock (Det

Common and Preferred Stock (Details) - $ / shares shares in Millions	Mar. 31, 2019	Dec. 31, 2018
Common Stock, par value and shares authorized
Common stock, par value per share	$ 0.01	$ 0.01
Common stock shares authorized	600	600

Insurance and Contractholder _3

Insurance and Contractholder Liabilities - Summary (Details) - USD ($) $ in Millions	Mar. 31, 2019	Dec. 31, 2018	Mar. 31, 2018	Dec. 31, 2017
Insurance and Contractholder Liabilities [Line Items]
Contractholder deposit funds, current	$ 621	$ 641
Future policy benefits, current	643	740
Unearned premiums, current	432	348
Total insurance and contractholder liabilities, current	7,060	6,801
Contractholder deposit funds, non-current	7,326	7,365
Future policy benefits, non-current	9,048	8,981
Unearned premiums, non-current	347	379
Total insurance and contractholder liabilities, non-current	20,043	19,974
Contractholder deposit funds	7,947	8,006	$ 8,153
Future policy benefits	9,691	9,721	9,934
Unearned premiums	779	727	1,291
Total insurance and contractholder liabilities	27,103	26,775	27,518
Integrated Medical [Member]
Insurance and Contractholder Liabilities [Line Items]
Unpaid claims and claim expenses, current	2,943	2,678
Unpaid claims and claim expenses, non-current	18	19
Total liability for unpaid claims and claims expenses	2,961	2,697	2,638	$ 2,420
Other Segments [Member]
Insurance and Contractholder Liabilities [Line Items]
Unpaid claims and claim expenses, current	2,421	2,394
Unpaid claims and claim expenses, non-current	3,304	3,230
Total liability for unpaid claims and claims expenses	$ 5,725	$ 5,624	$ 5,502

Insurance and Contractholder _4

Insurance and Contractholder Liabilities - Integrated Medical - Activity (Details) - Integrated Medical [Member] - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018	Dec. 31, 2018	Dec. 31, 2017
Medical Claims Payable Activity [Abstract]
Beginning balance, unpaid claims, gross	$ 2,697	$ 2,420
Less: Reinsurance and other amounts recoverable	264	262
Beginning balance, unpaid claims, net	2,433	2,158
Incurred claims related to:
Current year	6,095	5,284
Prior years	(117)	(115)
Total incurred	5,978	5,169
Paid claims related to:
Current year	3,786	3,382
Prior years	1,908	1,540
Total paid	5,694	4,922
Ending balance, unpaid claims, net	2,717	2,405
Add: Reinsurance and other amounts recoverable	244	233
Ending balance, unpaid claims, gross	$ 2,961	$ 2,638
Total of incurred but not reported liabilities plus expected claim development on reported claims, including reported claims in process			$ 2,700	$ 2,500

Insurance and Contractholder _5

Insurance and Contractholder Liabilities - Integrated Medical - Prior Year Development (Details) - Integrated Medical [Member] - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Causes of Increase (Decrease) in Liability for Unpaid Claims and Claims Adjustment Expense [Abstract]
Variance (unfavorable) in incurred costs related to prior years' claims payable	$ 117	$ 115
Variance (unfavorable) in incurred costs related to prior years' claims payable, percentage	0.50%	0.60%
Favorable (unfavorable) impact of prior year development on shareholders' net income	$ 39	$ 40
Favorable (unfavorable) impact of prior year development on pre-tax income	50	51
Completion Factors [Member]
Causes of Increase (Decrease) in Liability for Unpaid Claims and Claims Adjustment Expense [Abstract]
Variance (unfavorable) in incurred costs related to prior years' claims payable	$ 55	$ 52
Variance (unfavorable) in incurred costs related to prior years' claims payable, percentage	0.20%	0.30%
Medical Cost Trend [Member]
Causes of Increase (Decrease) in Liability for Unpaid Claims and Claims Adjustment Expense [Abstract]
Variance (unfavorable) in incurred costs related to prior years' claims payable	$ 62	$ 54
Variance (unfavorable) in incurred costs related to prior years' claims payable, percentage	0.30%	0.30%
Other [Member]
Causes of Increase (Decrease) in Liability for Unpaid Claims and Claims Adjustment Expense [Abstract]
Variance (unfavorable) in incurred costs related to prior years' claims payable	$ 0	$ 9
Variance (unfavorable) in incurred costs related to prior years' claims payable, percentage	0.00%	0.00%

Insurance and Contractholder _6

Insurance and Contractholder Liabilities - Integrated Medical - Unpaid Claims Development (Details) - Integrated Medical [Member] - USD ($) $ in Millions	Mar. 31, 2019	Dec. 31, 2018	Mar. 31, 2018	Dec. 31, 2017
Claims Development [Line Items]
Liability for unpaid claims and claims expenses, net of reinsurance	$ 2,717	$ 2,433	$ 2,405	$ 2,158
Reinsurance recoverable on unpaid claims	244	264	233	262
Total liability for unpaid claims and claims expenses	$ 2,961	$ 2,697	$ 2,638	$ 2,420

Insurance and Contractholder _7

Insurance and Contractholder Liabilities - Other Segments - Liability Balance Details (Details) - USD ($) $ in Millions	Mar. 31, 2019	Dec. 31, 2018	Mar. 31, 2018
Other Segments [Member]
Liability For Unpaid Claims And Claims Adjustment Expense [Line Items]
Total liability for unpaid claims and claims expenses	$ 5,725	$ 5,624	$ 5,502
Group Disability and Other [Member]
Liability For Unpaid Claims And Claims Adjustment Expense [Line Items]
Total liability for unpaid claims and claims expenses	4,980		4,724
Group Disability And Life [Member]
Liability For Unpaid Claims And Claims Adjustment Expense [Line Items]
Total liability for unpaid claims and claims expenses	4,786		4,549
Other Operations [Member]
Liability For Unpaid Claims And Claims Adjustment Expense [Line Items]
Total liability for unpaid claims and claims expenses	194		175
International Markets [Member]
Liability For Unpaid Claims And Claims Adjustment Expense [Line Items]
Total liability for unpaid claims and claims expenses	$ 745		$ 778

Insurance and Contractholder _8

Insurance and Contractholder Liabilities - Other Segments - Activity in Liabilities for Unpaid Claims and Claims Expenses (Details) - Intenational Markets and Global Disability and Life [Member] - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Liability For Unpaid Claims And Claims Adjustment Expense [Line Items]
Beginning balance, unpaid claims, gross	$ 5,432	$ 5,274
Less: Reinsurance and other amounts recoverable	156	140
Beginning balance, unpaid claims, net	5,276	5,134
Incurred claims related to:
Current year	1,428	1,393
Interest accretion	38	38
All other prior years	(32)	(61)
Total incurred	1,434	1,370
Paid claims related to:
Current year	474	471
Prior years	856	853
Total paid	1,330	1,324
Foreign currency	(7)	2
Ending balance, unpaid claims, net	5,373	5,182
Add: Reinsurance and other amounts recoverable	158	145
Ending balance, unpaid claims, gross	$ 5,531	$ 5,327

Insurance and Contractholder _9

Insurance and Contractholder Liabilities - Other Segments - Reconciliation to the Liability for Unpaid Claims and Claims Expense (Details) - USD ($) $ in Millions	Mar. 31, 2019	Dec. 31, 2018	Mar. 31, 2018
Other Segments [Member]
Short-duration Insurance Contracts, Reconciliation of Claims Development to Liability [Line Items]
Total liability for unpaid claims and claims expenses	$ 5,725	$ 5,624	$ 5,502
International Markets [Member]
Short-duration Insurance Contracts, Reconciliation of Claims Development to Liability [Line Items]
Total liability for unpaid claims and claims expenses	745		778
Group Disability And Life [Member]
Short-duration Insurance Contracts, Reconciliation of Claims Development to Liability [Line Items]
Total liability for unpaid claims and claims expenses	4,786		4,549
Other Operations [Member]
Short-duration Insurance Contracts, Reconciliation of Claims Development to Liability [Line Items]
Total liability for unpaid claims and claims expenses	$ 194		$ 175

Reinsurance - Reinsurance Recov

Reinsurance - Reinsurance Recoverables (Details) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2019	Dec. 31, 2018
Ceded Credit Risk [Line Items]
Current reinsurance recoverables	$ 280	$ 297
Reinsurance recoverables	5,665	5,804
Integrated Medical, International Markets, Group Disability, COLI [Member]
Ceded Credit Risk [Line Items]
Reinsurance recoverables	470	464
Maximum reinsurance recoverable from a single reinsurer	65
Integrated Medical, International Markets, Group Disability, COLI [Member] | Maximum [Member]
Ceded Credit Risk [Line Items]
Minimum reinsurance recoverable from a single reinsurer	$ 1
Integrated Medical, International Markets, Group Disability, COLI [Member] | Minimum [Member] | Standard & Poor's Investment Grade [Member] | Reinsurance Recoverable [Member]
Ceded Credit Risk [Line Items]
Concentration Risk, Percentage	70.00%
Acquisition, disposition or runoff activities [Member]
Ceded Credit Risk [Line Items]
Reinsurance recoverables	$ 5,195	5,340
The Lincoln National Life Insurance Company And Lincoln Life And Annuity Of New York [Member] | Individual Life Insurance And Annuity (sold in 1998) [Member]
Ceded Credit Risk [Line Items]
Reinsurance recoverables	3,254	3,312
Berkshire [Member] | Guaranteed Minimum Death Benefits [Member]
Ceded Credit Risk [Line Items]
Reinsurance recoverables	$ 844	893
Berkshire [Member] | Guaranteed Minimum Death Benefits [Member] | Ceded Credit Risk Secured [Member] | Reinsurance Recoverable [Member]
Ceded Credit Risk [Line Items]
Concentration Risk, Percentage	100.00%
Prudential Retirement Insurance And Annuity Company [Member] | Retirement Benefits Business (sold in 2004) [Member]
Ceded Credit Risk [Line Items]
Reinsurance recoverables	$ 761	787
Prudential Retirement Insurance And Annuity Company [Member] | Retirement Benefits Business (sold in 2004) [Member] | Ceded Credit Risk Secured [Member] | Reinsurance Recoverable [Member]
Ceded Credit Risk [Line Items]
Concentration Risk, Percentage	100.00%
Great American Life Insurance Company [Member] | Supplemental Benefits Business (2012 acquistion) [Member]
Ceded Credit Risk [Line Items]
Reinsurance recoverables	$ 254	261
Great American Life Insurance Company [Member] | Supplemental Benefits Business (2012 acquistion) [Member] | Ceded Credit Risk Secured [Member] | Reinsurance Recoverable [Member]
Ceded Credit Risk [Line Items]
Concentration Risk, Percentage	100.00%
Other Retrocessionaires [Member] | Other run-off reinsurance [Member]
Ceded Credit Risk [Line Items]
Reinsurance recoverables	$ 82	$ 87
Other Retrocessionaires [Member] | Other run-off reinsurance [Member] | Ceded Credit Risk Secured [Member] | Reinsurance Recoverable [Member]
Ceded Credit Risk [Line Items]
Concentration Risk, Percentage	100.00%

Reinsurance - Effects of Reinsu

Reinsurance - Effects of Reinsurance (Details) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Premiums Earned, Net [Abstract]
Ceded	$ 130	$ 135
Premiums Earned Net	9,971	8,999
Reinsurance Recoveries [Abstract]
Reinsurance recoveries	59	104
Individual Life Insurance And Annuity Business Sold [Member]
Premiums Earned, Net [Abstract]
Ceded	34	37
Reinsurance Recoveries [Abstract]
Reinsurance recoveries	55	57
Other Subsegments [Member]
Premiums Earned, Net [Abstract]
Ceded	96	98
Reinsurance Recoveries [Abstract]
Reinsurance recoveries	4	47
Short Duration Contracts [Member]
Premiums Written, Net [Abstract]
Ceded Premiums Written Versus Earned

Reinsurance - Effective Exit of

Reinsurance - Effective Exit of GMDB and GMIB Business (Details) - Berkshire Hathway Life Insurance Company Of Nebraska [Member] - Variable Annuity [Member] $ in Billions	Mar. 31, 2019USD ($)
Ceded Credit Risk [Line Items]
Percent of future claim payments reinsured	100.00%
Ceded Reinsurance Agreement, Coverage Limit, Amount Remaining	$ 3.3

Reinsurance - Account Value, Ne

Reinsurance - Account Value, Net Amount at Risk and Contractholders for GMDB Business (Details) - Variable Annuity [Member] - Guaranteed Minimum Death Benefit [Member] $ in Millions	3 Months Ended	12 Months Ended
	Mar. 31, 2019USD ($)Contractholders	Dec. 31, 2018USD ($)Contractholders
Guaranteed Minimum Death Benefits Account Value, Net Amount at Risk And Average Age Table [Line Items]
Account value	$ 8,996	$ 8,402
Net amount at risk	$ 1,943	$ 2,466
Number of contractholders | Contractholders	215,000	220,000

Reinsurance - GMIB Reinsurers (

Reinsurance - GMIB Reinsurers (Details) - Guaranteed Minimum Income Benefit [Member] Reinsurers in Thousands, $ in Millions	3 Months Ended
	Mar. 31, 2019USD ($)Reinsurers	Dec. 31, 2018USD ($)
Ceded Credit Risk [Line Items]
Annuitization election period	30 days
Number of external reinsurers | Reinsurers	3
GMIB Assets	$ 728	$ 733
GMIB liabilities	700	706
Berkshire [Member]
Ceded Credit Risk [Line Items]
GMIB Assets	$ 339	341
Berkshire [Member] | Ceded Credit Risk Secured [Member] | GMIB Assets [Member]
Ceded Credit Risk [Line Items]
Concentration percentage	100.00%
Sun Life Assurance Company Of Canada [Member]
Ceded Credit Risk [Line Items]
GMIB Assets	$ 206	208
Liberty Re (Bermuda) Ltd. [Member]
Ceded Credit Risk [Line Items]
GMIB Assets	$ 183	$ 184
Liberty Re (Bermuda) Ltd. [Member] | Ceded Credit Risk Secured [Member] | GMIB Assets [Member]
Ceded Credit Risk [Line Items]
Concentration percentage	94.00%

Investments - Debt Securities b

Investments - Debt Securities by Contractual Maturity Periods (Details) - USD ($) $ in Millions	Mar. 31, 2019	Dec. 31, 2018
Amortized Cost:
Due in one year or less	$ 1,366
Due after one year through five years	6,516
Due after five years through ten years	9,529
Due after ten years	4,231
Mortgage and other asset-backed securities	494
Amortized Cost	22,136	$ 22,550
Fair Value:
Due in one year or less	1,370
Due after one year through five years	6,684
Due after five years through ten years	9,682
Due after ten years	4,925
Mortgage and other asset-backed securities	508
Total fair value	$ 23,169

Investments - Gross Unrealized

Investments - Gross Unrealized Appreciation (Depreciation) on Debt Securities (Details) - USD ($) $ in Millions	Mar. 31, 2019	Dec. 31, 2018
Schedule of Available-for-sale Securities [Line Items]
Amortized Cost	$ 22,136	$ 22,550
Unrealized Appreciation	1,178	852
Unrealized (Depreciation)	(145)	(474)
Total Fair Value	23,169	22,928
Run-off Settlement Annuity Business [Member]
Schedule of Available-for-sale Securities [Line Items]
Amortized Cost	2,269	2,264
Unrealized Appreciation	555	479
Unrealized (Depreciation)	(13)	(40)
Total Fair Value	2,811	2,703
Federal government and agency [Member]
Schedule of Available-for-sale Securities [Line Items]
Amortized Cost	513	507
Unrealized Appreciation	221	204
Unrealized (Depreciation)	(1)	(1)
Total Fair Value	733	710
State and local government [Member]
Schedule of Available-for-sale Securities [Line Items]
Amortized Cost	851	920
Unrealized Appreciation	77	66
Unrealized (Depreciation)	0	(1)
Total Fair Value	928	985
Foreign government [Member]
Schedule of Available-for-sale Securities [Line Items]
Amortized Cost	2,126	2,214
Unrealized Appreciation	183	155
Unrealized (Depreciation)	(4)	(7)
Total Fair Value	2,305	2,362
Corporate [Member]
Schedule of Available-for-sale Securities [Line Items]
Amortized Cost	18,152	18,403
Unrealized Appreciation	676	411
Unrealized (Depreciation)	(133)	(453)
Total Fair Value	18,695	18,361
Mortgage and other asset-backed [Member]
Schedule of Available-for-sale Securities [Line Items]
Amortized Cost	494	506
Unrealized Appreciation	21	16
Unrealized (Depreciation)	(7)	(12)
Total Fair Value	$ 508	$ 510

Investments - Investments by Ca

Investments - Investments by Category (Details) - USD ($) $ in Millions	Mar. 31, 2019	Dec. 31, 2018
Schedule of Investments [Line Items]
Current investments	$ 1,662	$ 2,045
Non-current investments	27,257	26,929
Total investments	28,919	28,974
Debt Securities [Member]
Schedule of Investments [Line Items]
Current investments	1,363	1,320
Non-current investments	21,806	21,608
Total investments	23,169	22,928
Equity securities [Member]
Schedule of Investments [Line Items]
Current investments	0	377
Non-current investments	210	171
Total investments	210	548
Commercial mortgage loans [Member]
Schedule of Investments [Line Items]
Current investments	32	32
Non-current investments	1,832	1,826
Total investments	1,864	1,858
Policy loans [Member]
Schedule of Investments [Line Items]
Current investments	0	0
Non-current investments	1,403	1,423
Total investments	1,403	1,423
Short-term investments [Member]
Schedule of Investments [Line Items]
Current investments	267	316
Non-current investments	0	0
Total investments	267	316
Other long-term investments [Member]
Schedule of Investments [Line Items]
Current investments	0	0
Non-current investments	2,006	1,901
Total investments	$ 2,006	$ 1,901

Investments - Securities with a

Investments - Securities with a Decline in Fair Value (Details) - Debt Securities [Member] $ in Millions	Mar. 31, 2019USD ($)	Dec. 31, 2018USD ($)
Investment Grade [Member]
Available-for-sale Securities, Continuous Unrealized Loss Position [Abstract]
Fair value, one year or less	$ 715	$ 7,127
Amortized cost, one year or less	734	7,367
Unrealized depreciation, one year or less	(19)	(240)
Fair value, more than one year	4,431	3,023
Amortized cost, more than one year	4,532	3,181
Unrealized depreciation, more than one year	$ (101)	$ (158)
Investment Grade [Member] | One Year Or Less [Member]
Available-for-sale Securities, Continuous Unrealized Loss Position [Abstract]
Number of issues, total	190	1,324
Investment Grade [Member] | More Than One Year [Member]
Available-for-sale Securities, Continuous Unrealized Loss Position [Abstract]
Number of issues, total	919	784
Below Investment Grade [Member]
Available-for-sale Securities, Continuous Unrealized Loss Position [Abstract]
Fair value, one year or less	$ 324	$ 1,185
Amortized cost, one year or less	328	1,240
Unrealized depreciation, one year or less	(4)	(55)
Fair value, more than one year	455	249
Amortized cost, more than one year	476	270
Unrealized depreciation, more than one year	$ (21)	$ (21)
Below Investment Grade [Member] | One Year Or Less [Member]
Available-for-sale Securities, Continuous Unrealized Loss Position [Abstract]
Number of issues, total	393	1,190
Below Investment Grade [Member] | More Than One Year [Member]
Available-for-sale Securities, Continuous Unrealized Loss Position [Abstract]
Number of issues, total	355	245

Investments - Credit Risk Profi

Investments - Credit Risk Profile, Commercial Mortgage Loans (Details) $ in Millions	3 Months Ended	12 Months Ended
	Mar. 31, 2019USD ($)	Dec. 31, 2018USD ($)
Financing Receivable, Recorded Investment [Line Items]
Commercial mortgage loan	$ 1,864	$ 1,858
Weighted Average [Member]
Financing Receivable, Recorded Investment [Line Items]
Average Debt Service Coverage Ratio	2.03	2.04
Average Loan-to-Value Ratio	58.00%	58.00%
Below 60% [Member]
Financing Receivable, Recorded Investment [Line Items]
Commercial mortgage loan	$ 1,167	$ 1,132
Below 60% [Member] | Weighted Average [Member]
Financing Receivable, Recorded Investment [Line Items]
Average Debt Service Coverage Ratio	2.12	2.14
60% to 79% [Member]
Financing Receivable, Recorded Investment [Line Items]
Commercial mortgage loan	$ 621	$ 650
60% to 79% [Member] | Weighted Average [Member]
Financing Receivable, Recorded Investment [Line Items]
Average Debt Service Coverage Ratio	1.92	1.93
80% to 100% [Member]
Financing Receivable, Recorded Investment [Line Items]
Commercial mortgage loan	$ 76	$ 76
80% to 100% [Member] | Weighted Average [Member]
Financing Receivable, Recorded Investment [Line Items]
Average Debt Service Coverage Ratio	1.49	1.49

Investments - Impaired Commerci

Investments - Impaired Commercial Mortgage Loans (Details) - USD ($)	Mar. 31, 2019	Dec. 31, 2018
Mortgage Loans on Real Estate [Member]
Financing Receivable, Impaired [Line Items]
Impaired commercial mortgage loans, gross	$ 0	$ 0

Investments - Short-Term Invest

Investments - Short-Term Investments and Cash Equivalents (Details) - USD ($) $ in Millions	Mar. 31, 2019	Dec. 31, 2018
Corporate Securities [Member]
Short Term Investments And Cash Equivalents [Line Items]
Short-term investments and cash equivalents	$ 1,531	$ 581
Federal goverment securities
Short Term Investments And Cash Equivalents [Line Items]
Short-term investments and cash equivalents	127	82
Foreign government [Member]
Short Term Investments And Cash Equivalents [Line Items]
Short-term investments and cash equivalents	162	238
Money Market Funds [Member]
Short Term Investments And Cash Equivalents [Line Items]
Short-term investments and cash equivalents	$ 855	$ 1,174

Investments - Derivative Financ

Investments - Derivative Financial Instruments (Details) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018	Dec. 31, 2018
Derivative [Line Items]
Derivative contract term	3 months
Fair Value
Net liability position of derivatives that contain certain credit risk-related contingent features
Gain (Loss) Recognized in Income Statement
Gain (Loss) Recognized in Other Comprehensive Income
Gains (losses) reclassified from other comprehensive income into shareholders' net income
Amounts excluded from assessment of hedge effectiveness
Designated as Hedging Instrument [Member] | Fair Value Hedging [Member] | Foreign Currency Swaps [Member]
Derivative [Line Items]
Notional Amount	593		$ 525
Designated as Hedging Instrument [Member] | Net Investment Hedge [Member] | Foreign Currency Swaps [Member]
Derivative [Line Items]
Notional Amount	439		439
Non designated [Member] | Forward Contracts [Member]
Derivative [Line Items]
Notional Amount	$ 309		$ 309

Investments - Net Investment In

Investments - Net Investment Income (Details) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Schedule Of Investment Income Reported Amounts By Category [Line Items]
Net investment income	$ 346	$ 329

Investments - Realized Gains an

Investments - Realized Gains and Losses (Details) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Pre-Tax Realized Gains and Losses [Line Items]
Net realized investement gains (losses), excluding investment asset writedowns	$ 11	$ (16)
Net realized investment gains (losses), before income taxes	10	(33)
Sales Information for available-for-sale debt securities [Abstract]
Proceeds from sales, debt securities	1,086	499
Gross gains on sales	14	5
Gross losses on sales	(10)	(22)
Debt Securities [Member]
Pre-Tax Realized Gains and Losses [Line Items]
Write-downs	(1)	(13)
Other [Member]
Pre-Tax Realized Gains and Losses [Line Items]
Write-downs	0	(4)
Equity securities [Member]
Pre-Tax Realized Gains and Losses [Line Items]
Realized gains (losses) on investments still held at reporting date

Fair Value Measurements - Finan

Fair Value Measurements - Financial Assets and Financial Liabilities Carried at Fair Value (Details) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2019	Dec. 31, 2018
Financial assets at fair value:
Debt securities	$ 23,169	$ 22,928
Financial liabilities at fair value:
Redemption Frequency	Quarterly redemption frequency
Unfunded Commitments	$ 58
Minimum [Member]
Financial liabilities at fair value:
Redemption Notice Period	45 days
Maximum [Member]
Financial liabilities at fair value:
Redemption Notice Period	90 days
Fair Value, Measurements, Recurring [Member]
Financial assets at fair value:
Debt securities	$ 23,169	22,928
Equity securities	89	459
Short-term investments	267	316
Real estate funds priced at NAV as a practical expedient	230	239
Other derivatives [Member] | Fair Value, Measurements, Recurring [Member]
Financial assets at fair value:
Derivative assets	58	53
Financial liabilities at fair value:
Derivative liabilities	14	10
Federal government and agency [Member]
Financial assets at fair value:
Debt securities	733	710
Federal government and agency [Member] | Fair Value, Measurements, Recurring [Member]
Financial assets at fair value:
Debt securities	733	710
State and local government [Member]
Financial assets at fair value:
Debt securities	928	985
State and local government [Member] | Fair Value, Measurements, Recurring [Member]
Financial assets at fair value:
Debt securities	928	985
Foreign government [Member]
Financial assets at fair value:
Debt securities	2,305	2,362
Foreign government [Member] | Fair Value, Measurements, Recurring [Member]
Financial assets at fair value:
Debt securities	2,305	2,362
Corporate [Member]
Financial assets at fair value:
Debt securities	18,695	18,361
Corporate [Member] | Fair Value, Measurements, Recurring [Member]
Financial assets at fair value:
Debt securities	18,695	18,361
Mortgage and other asset-backed [Member]
Financial assets at fair value:
Debt securities	508	510
Mortgage and other asset-backed [Member] | Fair Value, Measurements, Recurring [Member]
Financial assets at fair value:
Debt securities	508	510
Fair Value Inputs Level 1 [Member] | Fair Value, Measurements, Recurring [Member]
Financial assets at fair value:
Debt securities	212	209
Equity securities	8	384
Short-term investments	0	0
Fair Value Inputs Level 1 [Member] | Other derivatives [Member] | Fair Value, Measurements, Recurring [Member]
Financial assets at fair value:
Derivative assets	0	0
Financial liabilities at fair value:
Derivative liabilities	0	0
Fair Value Inputs Level 1 [Member] | Federal government and agency [Member] | Fair Value, Measurements, Recurring [Member]
Financial assets at fair value:
Debt securities	212	209
Fair Value Inputs Level 1 [Member] | State and local government [Member] | Fair Value, Measurements, Recurring [Member]
Financial assets at fair value:
Debt securities	0	0
Fair Value Inputs Level 1 [Member] | Foreign government [Member] | Fair Value, Measurements, Recurring [Member]
Financial assets at fair value:
Debt securities	0	0
Fair Value Inputs Level 1 [Member] | Corporate [Member] | Fair Value, Measurements, Recurring [Member]
Financial assets at fair value:
Debt securities	0	0
Fair Value Inputs Level 1 [Member] | Mortgage and other asset-backed [Member] | Fair Value, Measurements, Recurring [Member]
Financial assets at fair value:
Debt securities	0	0
Fair Value Inputs Level 2 [Member] | Fair Value, Measurements, Recurring [Member]
Financial assets at fair value:
Debt securities	22,553	22,341
Equity securities	49	43
Short-term investments	267	316
Fair Value Inputs Level 2 [Member] | Other derivatives [Member] | Fair Value, Measurements, Recurring [Member]
Financial assets at fair value:
Derivative assets	58	53
Financial liabilities at fair value:
Derivative liabilities	14	10
Fair Value Inputs Level 2 [Member] | Federal government and agency [Member] | Fair Value, Measurements, Recurring [Member]
Financial assets at fair value:
Debt securities	521	501
Fair Value Inputs Level 2 [Member] | State and local government [Member] | Fair Value, Measurements, Recurring [Member]
Financial assets at fair value:
Debt securities	928	985
Fair Value Inputs Level 2 [Member] | Foreign government [Member] | Fair Value, Measurements, Recurring [Member]
Financial assets at fair value:
Debt securities	2,277	2,356
Fair Value Inputs Level 2 [Member] | Corporate [Member] | Fair Value, Measurements, Recurring [Member]
Financial assets at fair value:
Debt securities	18,458	18,127
Fair Value Inputs Level 2 [Member] | Mortgage and other asset-backed [Member] | Fair Value, Measurements, Recurring [Member]
Financial assets at fair value:
Debt securities	369	372
Fair Value Inputs Level 3 [Member] | Fair Value, Measurements, Recurring [Member]
Financial assets at fair value:
Debt securities	404	378
Equity securities	32	32
Subtotal	404	378
Short-term investments	0	0
Fair Value Inputs Level 3 [Member] | Other derivatives [Member] | Fair Value, Measurements, Recurring [Member]
Financial assets at fair value:
Derivative assets	0	0
Financial liabilities at fair value:
Derivative liabilities	0	0
Fair Value Inputs Level 3 [Member] | Federal government and agency [Member] | Fair Value, Measurements, Recurring [Member]
Financial assets at fair value:
Debt securities	0	0
Fair Value Inputs Level 3 [Member] | State and local government [Member] | Fair Value, Measurements, Recurring [Member]
Financial assets at fair value:
Debt securities	0	0
Fair Value Inputs Level 3 [Member] | Foreign government [Member] | Fair Value, Measurements, Recurring [Member]
Financial assets at fair value:
Debt securities	28	6
Fair Value Inputs Level 3 [Member] | Corporate [Member] | Fair Value, Measurements, Recurring [Member]
Financial assets at fair value:
Debt securities	237	234
Fair Value Inputs Level 3 [Member] | Mortgage and other asset-backed [Member] | Fair Value, Measurements, Recurring [Member]
Financial assets at fair value:
Debt securities	$ 139	$ 138

Fair Value Measurements - Level

Fair Value Measurements - Level 2 Financial Assets and Financial Liabilities (Details) - USD ($) $ in Millions	Mar. 31, 2019	Dec. 31, 2018
Fair Value Disclosures [Abstract]
Percent of debt and equity securities classified in Level 2	97.00%
Maximum percentage of investments classified in Level 2 representing foreign bonds priced using unadjusted broker quotes	1.00%
Other derivatives [Member] | Fair Value Inputs Level 2 [Member]
Derivative [Line Items]
Adjustment for credit risk on derivatives assets	$ 0	$ 0
Adjustment for credit risk on derivatives liabilities	$ 0	$ 0

Fair Value Measurements - Lev_2

Fair Value Measurements - Level 3 Financial Assets and Liabilities (Details) - USD ($) $ in Millions	Mar. 31, 2019	Dec. 31, 2018
Fair Value Disclosures [Abstract]
Percent of debt and equity securities classified in Level 3	2.00%
Fair Value, Measurements, Recurring [Member] | Fair Value Inputs Level 3 [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis, Valuation Techniques [Line Items]
Debt securities	$ 404	$ 378
Fair Value, Measurements, Recurring [Member] | Fair Value Inputs Level 3 [Member] | Securities not priced by the Company [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis, Valuation Techniques [Line Items]
Debt securities	12	11
Fair Value, Measurements, Recurring [Member] | Fair Value Inputs Level 3 [Member] | Corporate and government fixed maturities [Member] | Unobservable Inputs Developed By Company [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis, Valuation Techniques [Line Items]
Debt securities	$ 253	$ 229
Fair Value, Measurements, Recurring [Member] | Fair Value Inputs Level 3 [Member] | Corporate and government fixed maturities [Member] | Maximum [Member] | Unobservable Inputs Developed By Company [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis, Valuation Techniques [Line Items]
Unobservable adjustment, liquidity	9.30%	9.30%
Fair Value, Measurements, Recurring [Member] | Fair Value Inputs Level 3 [Member] | Corporate and government fixed maturities [Member] | Minimum [Member] | Unobservable Inputs Developed By Company [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis, Valuation Techniques [Line Items]
Unobservable adjustment, liquidity	0.80%	0.50%
Fair Value, Measurements, Recurring [Member] | Fair Value Inputs Level 3 [Member] | Corporate and government fixed maturities [Member] | Weighted Average [Member] | Unobservable Inputs Developed By Company [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis, Valuation Techniques [Line Items]
Unobservable adjustment, liquidity	2.30%	2.30%
Fair Value, Measurements, Recurring [Member] | Fair Value Inputs Level 3 [Member] | Mortgage and other asset-backed securities [Member] | Unobservable Inputs Developed By Company [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis, Valuation Techniques [Line Items]
Debt securities	$ 139	$ 138
Fair Value, Measurements, Recurring [Member] | Fair Value Inputs Level 3 [Member] | Mortgage and other asset-backed securities [Member] | Maximum [Member] | Unobservable Inputs Developed By Company [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis, Valuation Techniques [Line Items]
Unobservable adjustment, liquidity	3.60%	3.40%
Unobservable adjustment, weighting of credit spreads	3.80%	3.40%
Fair Value, Measurements, Recurring [Member] | Fair Value Inputs Level 3 [Member] | Mortgage and other asset-backed securities [Member] | Minimum [Member] | Unobservable Inputs Developed By Company [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis, Valuation Techniques [Line Items]
Unobservable adjustment, liquidity	0.60%	0.60%
Unobservable adjustment, weighting of credit spreads	2.10%	1.90%
Fair Value, Measurements, Recurring [Member] | Fair Value Inputs Level 3 [Member] | Mortgage and other asset-backed securities [Member] | Weighted Average [Member] | Unobservable Inputs Developed By Company [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis, Valuation Techniques [Line Items]
Unobservable adjustment, liquidity	0.70%	0.70%
Unobservable adjustment, weighting of credit spreads	2.80%	2.60%

Fair Value Measurements - Chang

Fair Value Measurements - Changes in Level 3 Financial Assets (Details) - Debt and Equity Securities [Member] - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Fair Value Assets Measured On Recurring Basis Unobservable Input Reconciliation [Line Items]
Beginning Balance	$ 410	$ 732
Total gains (losses) included in shareholders' net income	(1)	(20)
Gains (losses) included in other comprehensive income	7	(5)
Gains (losses) required to adjust future policy benefits for settlement annuities	2	(4)
Purchases, sales, and settlements:
Purchases	0	10
Sales	0	(11)
Settlements	(1)	(2)
Total purchases, sales, settlements	(1)	(3)
Transfers into/(out of) Level 3:
Transfers into Level 3	20	20
Transfers out of Level 3	(1)	(124)
Total transfers into/(out of) Level 3	19	(104)
Ending Balance	436	596
Total gains (losses) included in income attributable to instruments held at the reporting date	$ (1)	(7)
Accounting Standards Update 2016-01 [Member]
Transfers into/(out of) Level 3:
Transfers out of Level 3		$ (70)

Fair Value Measurements - Separ

Fair Value Measurements - Separate Account Assets (Details) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2019	Dec. 31, 2018
Financial assets and financial liabilities carried at fair value [Line Items]
Guaranteed separate accounts	$ 468	$ 454
Non-guaranteed separate accounts	6,918	6,653
Subtotal	7,386	7,107
Non-guaranteed separate accounts priced at NAV as a practical expedient	693	732
Total separate account assets	8,079	7,839
Pension Benefits [Member]
Financial assets and financial liabilities carried at fair value [Line Items]
Non-guaranteed separate accounts	3,900	3,800
Fair Value Inputs Level 1 [Member]
Financial assets and financial liabilities carried at fair value [Line Items]
Guaranteed separate accounts	204	187
Non-guaranteed separate accounts	1,328	1,204
Subtotal	1,532	1,391
Fair Value Inputs Level 2 [Member]
Financial assets and financial liabilities carried at fair value [Line Items]
Guaranteed separate accounts	264	267
Non-guaranteed separate accounts	5,346	5,216
Subtotal	5,610	5,483
Fair Value Inputs Level 3 [Member]
Financial assets and financial liabilities carried at fair value [Line Items]
Guaranteed separate accounts	0	0
Non-guaranteed separate accounts	244	233
Subtotal	244	233
Fair Value Inputs Level 3 [Member] | Pension Benefits [Member]
Financial assets and financial liabilities carried at fair value [Line Items]
Non-guaranteed separate accounts	200	$ 200
Separate Account Assets [Member]
Fair Value Assets Measured On Recurring Basis Unobservable Input Reconciliation [Line Items]
Financial assets classified in Level 3, period increase (decrease)

Fair Value Measurements - Sep_2

Fair Value Measurements - Separate Account Assets Priced at NAV (Details) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2019	Dec. 31, 2018
Fair Value Investments, Entities That Calculate Net Asset Value Per Share [Line Items]
Unfunded Commitments	$ 58
Redemption Frequency	Quarterly redemption frequency
Minimum [Member]
Fair Value Investments, Entities That Calculate Net Asset Value Per Share [Line Items]
Redemption Notice Period	45 days
Maximum [Member]
Fair Value Investments, Entities That Calculate Net Asset Value Per Share [Line Items]
Redemption Notice Period	90 days
Fair Value, Measurements, Recurring [Member]
Fair Value Investments, Entities That Calculate Net Asset Value Per Share [Line Items]
Fair Value	$ 230	$ 239
Separate Account Assets [Member]
Fair Value Investments, Entities That Calculate Net Asset Value Per Share [Line Items]
Unfunded Commitments	351
Separate Account Assets [Member] | Fair Value, Measurements, Recurring [Member]
Fair Value Investments, Entities That Calculate Net Asset Value Per Share [Line Items]
Fair Value	693	732
Security Partnerships [Member] | Separate Account Assets [Member]
Fair Value Investments, Entities That Calculate Net Asset Value Per Share [Line Items]
Unfunded Commitments	$ 351
Redemption Frequency	Not applicable
Security Partnerships [Member] | Separate Account Assets [Member] | Fair Value, Measurements, Recurring [Member]
Fair Value Investments, Entities That Calculate Net Asset Value Per Share [Line Items]
Fair Value	$ 464	477
Real Estate Funds [Member] | Separate Account Assets [Member]
Fair Value Investments, Entities That Calculate Net Asset Value Per Share [Line Items]
Unfunded Commitments	$ 0
Redemption Frequency	Quarterly
Real Estate Funds [Member] | Separate Account Assets [Member] | Minimum [Member]
Fair Value Investments, Entities That Calculate Net Asset Value Per Share [Line Items]
Redemption Notice Period	30 days
Real Estate Funds [Member] | Separate Account Assets [Member] | Maximum [Member]
Fair Value Investments, Entities That Calculate Net Asset Value Per Share [Line Items]
Redemption Notice Period	90 days
Real Estate Funds [Member] | Separate Account Assets [Member] | Fair Value, Measurements, Recurring [Member]
Fair Value Investments, Entities That Calculate Net Asset Value Per Share [Line Items]
Fair Value	$ 216	237
Hedge Funds [Member] | Separate Account Assets [Member]
Fair Value Investments, Entities That Calculate Net Asset Value Per Share [Line Items]
Unfunded Commitments	$ 0
Redemption Frequency	Up to annually, varying by fund
Hedge Funds [Member] | Separate Account Assets [Member] | Minimum [Member]
Fair Value Investments, Entities That Calculate Net Asset Value Per Share [Line Items]
Redemption Notice Period	30 days
Hedge Funds [Member] | Separate Account Assets [Member] | Maximum [Member]
Fair Value Investments, Entities That Calculate Net Asset Value Per Share [Line Items]
Redemption Notice Period	90 days
Hedge Funds [Member] | Separate Account Assets [Member] | Fair Value, Measurements, Recurring [Member]
Fair Value Investments, Entities That Calculate Net Asset Value Per Share [Line Items]
Fair Value	$ 13	$ 18

Fair Value Measurements - Measu

Fair Value Measurements - Measured Under Certain Conditions (Details) - USD ($)	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Financing Receivable, Impaired [Line Items]
Realized investment losses on assets measured at fair value under certain conditions, after-tax	$ 0
Maximum [Member]
Financing Receivable, Impaired [Line Items]
Assets measured at fair value under certain conditions as a percent of total investments		1.00%

Fair Value Measurements - Not C

Fair Value Measurements - Not Carried at Fair Value (Details) - USD ($) $ in Millions	Mar. 31, 2019	Dec. 31, 2018
Fair Value Balance Sheet Grouping Financial Statement Captions [Line Items]
Commercial mortgage loans	$ 1,864	$ 1,858
Estimate Of Fair Value Fair Value Disclosure [Member] | Fair Value Inputs Level 2 [Member]
Fair Value Balance Sheet Grouping Financial Statement Captions [Line Items]
Long-term debt, including current maturities, excluding finance leases	41,027	40,819
Estimate Of Fair Value Fair Value Disclosure [Member] | Fair Value Inputs Level 3 [Member]
Fair Value Balance Sheet Grouping Financial Statement Captions [Line Items]
Commercial mortgage loans	1,875	1,832
Carrying Reported Amount Fair Value Disclosure [Member]
Fair Value Balance Sheet Grouping Financial Statement Captions [Line Items]
Commercial mortgage loans	1,864	1,858
Long-term debt, including current maturities, excluding finance leases	$ 39,840	$ 40,829

Fair Value Measurements - Off-B

Fair Value Measurements - Off-Balance Sheet Financial Instruments (Details) - USD ($)	Mar. 31, 2019	Dec. 31, 2018
Fair Value Disclosures [Abstract]
Fair value of off-balance-sheet financial assets
Fair value of off-balance-sheet financial liabilities

Variable Interest Entities (Det

Variable Interest Entities (Details) $ in Billions	3 Months Ended
	Mar. 31, 2019USD ($)LimitedPartnerships
Variable Interest Entity [Line Items]
Methodology for determining whether the Company is primary beneficiary	When the Company becomes involved with a variable interest entity and when there is a change in the Company’s involvement with an entity, the Company must determine if it is the primary beneficiary and must consolidate the entity. The Company is considered the primary beneficiary if it has the power to direct the entity’s most significant economic activities or has the right to receive benefits or obligation to absorb losses that could be significant to the entity. The Company evaluates the following criteria: the structure and purpose of the entity; the risks and rewards created by and shared through the entity; and the Company’s ability to direct its activities, receive its benefits and absorb its losses relative to the other parties involved with the entity including its sponsors, equity holders, guarantors, creditors and servicers.
Securities limited partnerships and real estate limited partnerships [Member]
Variable Interest Entity [Line Items]
Maximum exposure to loss related to arrangements with variable interest entity	$ 3.3
Number of limited partnerships defined as variable interest entities | LimitedPartnerships	140
Carrying amount of assets	$ 1.5
Commitments to contribute additional cash, amount	$ 1.8
Securities limited partnerships and real estate limited partnerships [Member] | Maximum [Member]
Variable Interest Entity [Line Items]
Non-controlling interest percentage	10.00%
Other asset-backed and corporate securities [Member]
Variable Interest Entity [Line Items]
Maximum exposure to loss related to arrangements with variable interest entity	$ 0.6
Carrying amount of assets	$ 0.6
Non-controlling interest percentage
Real estate joint ventures [Member]
Variable Interest Entity [Line Items]
Maximum exposure to loss related to arrangements with variable interest entity
Carrying amount of assets
Independent physician associations [Member]
Variable Interest Entity [Line Items]
Maximum exposure to loss related to arrangements with variable interest entity
Carrying amount of assets
India Joint Venture [Member]
Variable Interest Entity [Line Items]
Maximum exposure to loss related to arrangements with variable interest entity
Carrying amount of assets

Accumulated Other Comprehensi_3

Accumulated Other Comprehensive Income (Loss) (Details) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Accumulated Other Comprehensive Income Loss [Line Items]
Accumulated other comprehensive income (loss), beginning	$ (1,711)
Shareholders' other comprehensive income (loss), net of tax	429	$ (226)
Accumulated other comprehensive income (loss), ending	(1,282)
Securities and Derivatives [ Member]
Accumulated Other Comprehensive Income Loss [Line Items]
Accumulated other comprehensive income (loss), beginning	18	383
Other comprehensive income (loss) before reclassifications, pre-tax	565	(385)
Other comprehensive income (loss) before reclassifications, tax (expense) benefit	(122)	77
Other comprehensive income (loss) before reclassifications, after-tax	443	(308)
Reclassification adjustment, pre-tax	(1)	30
Reclassification adjustment, tax (expense) benefit	0	(6)
Reclassification adjustment, after-tax	(1)	24
Shareholders' other comprehensive income (loss), net of tax	442	(284)
Accumulated other comprehensive income (loss), ending	460	99
Securities and Derivatives [ Member] | Previously Reported [Member]
Accumulated Other Comprehensive Income Loss [Line Items]
Accumulated other comprehensive income (loss), beginning	18	328
Securities and Derivatives [ Member] | Restatement Adjustment [Member] | Reclassification adjustment to retained earnings related to U.S. tax reform legislation [Member]
Accumulated Other Comprehensive Income Loss [Line Items]
Accumulated other comprehensive income (loss), beginning	0	65
Securities and Derivatives [ Member] | Restatement Adjustment [Member] | Reclassification adjustment to retained earnings related to new financial instruments guidance [Member]
Accumulated Other Comprehensive Income Loss [Line Items]
Accumulated other comprehensive income (loss), beginning	0	(4)
Securities and Derivatives [ Member] | Restatement Adjustment [Member] | Reclassification adjustment to retained earnings related to new hedging guidance [Member]
Accumulated Other Comprehensive Income Loss [Line Items]
Accumulated other comprehensive income (loss), beginning	0	(6)
Translation of foreign currencies [Member]
Accumulated Other Comprehensive Income Loss [Line Items]
Accumulated other comprehensive income (loss), beginning	221	(69)
Other comprehensive income (loss) before reclassifications, pre-tax	(23)	46
Other comprehensive income (loss) before reclassifications, tax (expense) benefit	(1)	(1)
Shareholders' other comprehensive income (loss), net of tax	(24)	45
Accumulated other comprehensive income (loss), ending	245	(24)
Translation of foreign currencies [Member] | Previously Reported [Member]
Accumulated Other Comprehensive Income Loss [Line Items]
Accumulated other comprehensive income (loss), beginning	(221)	(65)
Translation of foreign currencies [Member] | Restatement Adjustment [Member] | Reclassification adjustment to retained earnings related to U.S. tax reform legislation [Member]
Accumulated Other Comprehensive Income Loss [Line Items]
Accumulated other comprehensive income (loss), beginning	0	(4)
Postretirement benefits liability [Member]
Accumulated Other Comprehensive Income Loss [Line Items]
Accumulated other comprehensive income (loss), beginning	(1,508)	(1,635)
Reclassification adjustment, tax (expense) benefit	(14)	(4)
Shareholders' other comprehensive income (loss), net of tax	11	13
Accumulated other comprehensive income (loss), ending	(1,497)	(1,622)
Postretirement benefits liability [Member] | Previously Reported [Member]
Accumulated Other Comprehensive Income Loss [Line Items]
Accumulated other comprehensive income (loss), beginning	(1,508)	(1,345)
Postretirement benefits liability [Member] | Restatement Adjustment [Member] | Reclassification adjustment to retained earnings related to U.S. tax reform legislation [Member]
Accumulated Other Comprehensive Income Loss [Line Items]
Accumulated other comprehensive income (loss), beginning	0	(290)
Reclassification adjustment for amortization of net losses from past experience and prior service costs [Member]
Accumulated Other Comprehensive Income Loss [Line Items]
Reclassification adjustment, pre-tax	15	17
Reclassification adjustment for settlement losses [Member]
Accumulated Other Comprehensive Income Loss [Line Items]
Reclassification adjustment, pre-tax	$ 10	$ 0

Accumulated Other Comprehensi_4

Accumulated Other Comprehensive Income - Reclassifications out of Accumulated Other Comprehensive Income (Details) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Reclassification Adjustment Out Of Accumulated Other Comprehensive Income [Line Items]
Realized investment (gains) losses	$ (10)	$ 33
Selling, general and administrative expenses	3,303	2,745
Translation of foreign currencies [Member] | Reclassification Out Of Accumulated Other Comprehensive Income [Member]
Reclassification Adjustment Out Of Accumulated Other Comprehensive Income [Line Items]
Realized investment (gains) losses	(1)	30
Reclassification adjustment for amortization of net losses from past experience and prior service costs [Member] | Reclassification Out Of Accumulated Other Comprehensive Income [Member]
Reclassification Adjustment Out Of Accumulated Other Comprehensive Income [Line Items]
Selling, general and administrative expenses	15	17
Reclassification adjustment for settlement losses [Member] | Reclassification Out Of Accumulated Other Comprehensive Income [Member]
Reclassification Adjustment Out Of Accumulated Other Comprehensive Income [Line Items]
Selling, general and administrative expenses	$ 10	$ 0

Pension and Other Postretirem_3

Pension and Other Postretirement Benefits - About our Plans (Details) - United States [Member] - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Pension Benefits [Member]
Defined Benefit Plan Disclosure [Line Items]
Defined benefit plan cost	$ 162	$ (4)
Other Postretirement Benefits [Member]
Defined Benefit Plan Disclosure [Line Items]
Defined benefit plan cost	$ 1	$ 2

Pension and Other Postretirem_4

Pension and Other Postretirement Benefits - Funded Status (Details) - United States [Member] - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Pension Benefits [Member]
Change in benefit obligation [Abstract]
Service cost	$ 1	$ 1
Interest cost	49	42
Other Postretirement Benefits [Member]
Change in benefit obligation [Abstract]
Service cost	0	0
Interest cost	$ 2	$ 2

Pension and Other Postretirem_5

Pension and Other Postretirement Benefits - Cost of our Plans (Details) - United States [Member] - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Pension Benefits [Member]
Components of net pension and other postretirement benefits cost [Abstract]
Service cost	$ 1	$ 1
Interest cost	49	42
Expected long-term return on plan assets	(56)	(64)
Amortization of net loss from past experience	16	17
Amortization of prior service cost	0	0
Litigation settlement - plan ammendment	142	0
Settlement loss	10	0
Net plan cost	162	(4)
Other Postretirement Benefits [Member]
Components of net pension and other postretirement benefits cost [Abstract]
Service cost	0	0
Interest cost	2	2
Expected long-term return on plan assets	0	0
Amortization of net loss from past experience	0	0
Amortization of prior service cost	(1)	0
Litigation settlement - plan ammendment	0	0
Settlement loss	0	0
Net plan cost	$ 1	$ 2

Goodwill, Other Intangibles, an

Goodwill, Other Intangibles, and Property and Equipment - Goodwill Activity (Details) $ in Millions	Mar. 31, 2019USD ($)
Goodwill [Line Items]
Goodwill, Beginning Balance	$ 44,505
Goodwill, Ending Balance	$ 44,537

Goodwill, Other Intangibles, _2

Goodwill, Other Intangibles, and Property and Equipment - Other Intangible Assets (Details) - USD ($) $ in Millions	Mar. 31, 2019	Dec. 31, 2018
Finite Lived Intangible Assets Net [Line Items]
Intangible assets, net	$ 38,338	$ 39,003

Goodwill, Other Intangibles, _3

Goodwill, Other Intangibles, and Property and Equipment - Property and Equipment (Details) - USD ($) $ in Millions	Mar. 31, 2019	Dec. 31, 2018
Property Plant And Equipment [Line Items]
Net carrying value	$ 4,523	$ 4,562

Goodwill, Other Intangibles, _4

Goodwill, Other Intangibles, and Property and Equipment - Depreciation and Amortization (Details) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Depreciation And Amortization By Type [Line Items]
Depreciation and amortization	$ 897	$ 140

Leases (Details)

Leases (Details) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2019	Dec. 31, 2018
Supplemental cash flow information related to leases [Abstract]
Operating cash flows from operating leases	$ 42
Operating cash flows from finance leases	1
Financing cash flows from financing leases	6
Right-of-use asset obtained in exchange for operating lease obligations	26
Right-of-use asset obtained in exchange for financing lease obligations	45
Operating and finance lease ROU assets and liabilities [Abstract]
Operating lease right-of-use assets	602
Accrued expenses and other current liabilities	160
Other non-current liabilities	524
Total operating lease liabilities	$ 684
Operating Lease, Right-of-Use Asset, Statement of Financial Position [Extensible List]	Other assets noncurrent
Operating Lease, Liability, Current, Statement of Financial Position [Extensible List]	Accrued Expenses And Other Liabilities
Operating Lease, Liability, Noncurrent, Statement of Financial Position [Extensible List]	Other non-current liabilities
Finance leases: Property and equipment, net	$ 91
Finance leases: Short-term debt	21	$ 117
Finance leases: Long-term debt	68	$ 32
Total finance lease liabilities	$ 89
Finance Lease, Right-of-Use Asset, Statement of Financial Position [Extensible List]	Property and equipment
Finance Lease, Liability, Current, Statement of Financial Position [Extensible List]	Short Term Borrowings And Long Term Debt Current
Finance Lease, Liability, Noncurrent, Statement of Financial Position [Extensible List]	Long-term debt, carrying value
Weighted average remaining lease term, operating leases	5 years
Weighted average remaining lease term, finance leases	6 years
Weighted average discount rate, operating leases	3.88%
Weighted average discount rate, finance leases	3.86%
Property and equipment, gross [Member]
Operating and finance lease ROU assets and liabilities [Abstract]
Finance leases: Property and equipment, net	$ 99
Accumulated depreciation [Member]
Operating and finance lease ROU assets and liabilities [Abstract]
Finance leases: Property and equipment, net	$ (8)
Minimum [Member]
Leases [Line Items]
Term length for operating leases	1 month
Maximum [Member]
Leases [Line Items]
Term length for operating leases	18 years

Leases - Maturities (Details)

Leases - Maturities (Details) $ in Millions	Mar. 31, 2019USD ($)
Maturities of operating lease liabilities [Abstract]
2019	$ 129
2020	169
2021	140
2022	121
2023	81
Thereafter	124
Total operating lease payments	764
Less: imputed interest, operating leases	80
Total operating lease liabilities	684
Maturities of finance lease liabilities [Abstract]
2019	18
2020	23
2021	14
2022	14
2023	9
Thereafter	22
Total finance lease payments	100
Less: imputed interest, finance leases	11
Total finance lease liabilities	$ 89

Income Taxes - Income Tax Expen

Income Taxes - Income Tax Expense (Details) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Deferred taxes (benefits)
Total income taxes	$ 416	$ 301

Income Taxes - Reconciliation t

Income Taxes - Reconciliation to Nominal Tax Rate (Details) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Reconciliation of total taxes to nominal federal rate, amount [Abstract]
Total income taxes	$ 416	$ 301
Reconciliation of total taxes to nominal federal rate, percent [Abstract]
Total income taxes	23.30%	24.70%

Income Taxes - Effective Tax Ra

Income Taxes - Effective Tax Rates (Details) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Income Taxes [Abstract]
Consolidated effective tax rate	23.30%	24.70%
Cumulative unrecognized deferred tax liabilities related to unremitted foreign earnings	$ 137

Income Taxes - Uncertain Tax Po

Income Taxes - Uncertain Tax Positions (Details) - USD ($)	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Reconciliation of unrecognized tax benefits details [Abstract]
Changes in uncertain tax positions

Contingencies and Other Matte_2

Contingencies and Other Matters - Guarantees (Details)	3 Months Ended
	Mar. 31, 2019USD ($)
Financial Guarantee [Member] | Retiree and Life Insurance Benefits [Member]
Guarantee Obligations [Line Items]
Maximum Exposure, Undiscounted	$ 455,000,000
Percentage of benefit obligations reinsured	11.00%
Guarantee obligations carrying value	$ 0
Financial Guarantee [Member] | Retiree and Life Insurance Benefits [Member] | Minimum [Member]
Guarantee Obligations [Line Items]
Assets maintained by employers	455,000,000
Indemnification Guarantee [Member]
Guarantee Obligations [Line Items]
Guarantee obligations carrying value	$ 0

Contingencies and Other Matte_3

Contingencies and Other Matters - Legal and Regulatory Matters (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Amara cash balance pension plan litigation [Member]
Contingency Accrual [Roll Forward]
Amounts paid for loss contigency	$ 32,280
Guaranty Fund Assessments [Member]
Contingency Accrual [Roll Forward]
Charges for loss contingency, pre-tax		$ 130,000
Charges for loss contingency, after-tax		$ 85,000
Loss Contingency, Insurance-related Assessment [Abstract]
Recorded liability, Penn Treaty assessment	42,000
Pending Litigation [Member]
Contingency Accrual [Roll Forward]
Reserves for litigation matters, pre-tax	45,000
Reserves for litigation matters, after-tax	35,000
Pending Litigation [Member] | Pricing concessions through remaining contract term [Member] | Express Scripts litigation with Antherm [Member]
Loss Contingency, Information about Litigation Matters [Abstract]
Loss Contingency, Damages Sought	13,000,000
Pending Litigation [Member] | Pricing concessions after remaining term of agreement [Member] | Express Scripts litigation with Antherm [Member]
Loss Contingency, Information about Litigation Matters [Abstract]
Loss Contingency, Damages Sought	1,800,000
Pending Litigation [Member] | Damages for service issues [Member] | Express Scripts litigation with Antherm [Member]
Loss Contingency, Information about Litigation Matters [Abstract]
Loss Contingency, Damages Sought	$ 150,000

Contingencies and Other Matte_4

Contingencies and Other Matters - Anthem Litigation (Details) $ in Millions	Mar. 31, 2019USD ($)
Contingencies And Other Matters [Abstract]
Termination fee payable to Company	$ 1,850
Positive Outcome Of Litigation [Member] | Minimum [Member]
Gain Contingencies [Line Items]
Damages sought	$ 13,000

Condensed Consolidating Finan_3

Condensed Consolidating Financial Information - Statements of Income (Details) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Revenues
Premiums	$ 9,971	$ 8,999
Net investment income	346	329
Total revenues	37,946	11,413
Benefits and Expenses
Medical costs and other benefit expenses	7,620	6,772
Pharmacy and other service costs	24,050	561
Selling, general and administrative expenses	3,303	2,745
Amortization of other acquired intangible assets	743	27
Total benefits and expenses	35,716	10,105
Income from operations	2,230	1,308
Interest and other income (expense)	(452)	(57)
Net realized investment gains (losses)	10	(33)
Income (loss) before income taxes	1,788	1,218
Total income taxes	416	301
Net Income	1,372	917
Less: net income (loss) attributable to noncontrolling interests	4	2
Shareholders' net income	1,368	915
Other comprehensive income (loss), net of tax	429	(226)
Shareholders' comprehensive income (loss)	1,797	689
Fees and other revenues [Member]
Revenues
Pharmacy revenues, fees and other revenues	2,450	1,368
Pharmacy revenues [Member]
Revenues
Pharmacy revenues, fees and other revenues	25,179	717
Consolidation, Eliminations [Member]
Revenues
Premiums	0	0
Net investment income	0	0
Total revenues	(11,273)	0
Benefits and Expenses
Medical costs and other benefit expenses	0	0
Pharmacy and other service costs	(10,348)	0
Selling, general and administrative expenses	(925)	0
Amortization of other acquired intangible assets	0	0
Total benefits and expenses	(11,273)	0
Income from operations	0	0
Interest and other income (expense)	0	0
Intercompany interest income (expense)	0	0
Debt extinguishment costs		0
Net realized investment gains (losses)	0	0
Income (loss) before income taxes	0	0
Total income taxes	0	0
Income before equity in earnings of subsidiaries	0	0
Equity in income from subsidiaries	(3,665)	(1,956)
Net Income	(3,665)	(1,956)
Less: net income (loss) attributable to noncontrolling interests	0	0
Shareholders' net income	(3,665)	(1,956)
Other comprehensive income (loss), net of tax	(843)	463
Shareholders' comprehensive income (loss)	(4,508)	(1,493)
Consolidation, Eliminations [Member] | Fees and other revenues [Member]
Revenues
Pharmacy revenues, fees and other revenues	(925)	0
Consolidation, Eliminations [Member] | Pharmacy revenues [Member]
Revenues
Pharmacy revenues, fees and other revenues	(10,348)	0
Cigna [Member] | Reportable Legal Entities [Member]
Revenues
Premiums	0	0
Net investment income	(9)	0
Total revenues	(9)	0
Benefits and Expenses
Medical costs and other benefit expenses	0	0
Pharmacy and other service costs	0	0
Selling, general and administrative expenses	(99)	0
Amortization of other acquired intangible assets	0	0
Total benefits and expenses	(99)	0
Income from operations	90	0
Interest and other income (expense)	(237)	0
Intercompany interest income (expense)	(31)	0
Debt extinguishment costs		0
Net realized investment gains (losses)	0	0
Income (loss) before income taxes	(178)	0
Total income taxes	(37)	0
Income before equity in earnings of subsidiaries	(141)	0
Equity in income from subsidiaries	1,509	915
Net Income	1,368	915
Less: net income (loss) attributable to noncontrolling interests	0	0
Shareholders' net income	1,368	915
Other comprehensive income (loss), net of tax	429	(226)
Shareholders' comprehensive income (loss)	1,797	689
Cigna [Member] | Reportable Legal Entities [Member] | Fees and other revenues [Member]
Revenues
Pharmacy revenues, fees and other revenues	0	0
Cigna [Member] | Reportable Legal Entities [Member] | Pharmacy revenues [Member]
Revenues
Pharmacy revenues, fees and other revenues	0	0
Old Cigna [Member] | Reportable Legal Entities [Member]
Revenues
Premiums	0	0
Net investment income	0	0
Total revenues	0	0
Benefits and Expenses
Medical costs and other benefit expenses	0	0
Pharmacy and other service costs	0	0
Selling, general and administrative expenses	73	64
Amortization of other acquired intangible assets	0	0
Total benefits and expenses	73	64
Income from operations	(73)	(64)
Interest and other income (expense)	(87)	(85)
Intercompany interest income (expense)	(3)	(16)
Debt extinguishment costs		0
Net realized investment gains (losses)	0	0
Income (loss) before income taxes	(163)	(165)
Total income taxes	(31)	(39)
Income before equity in earnings of subsidiaries	(132)	(126)
Equity in income from subsidiaries	1,152	1,041
Net Income	1,020	915
Less: net income (loss) attributable to noncontrolling interests	0	0
Shareholders' net income	1,020	915
Other comprehensive income (loss), net of tax	429	(226)
Shareholders' comprehensive income (loss)	1,449	689
Old Cigna [Member] | Reportable Legal Entities [Member] | Fees and other revenues [Member]
Revenues
Pharmacy revenues, fees and other revenues	0	0
Old Cigna [Member] | Reportable Legal Entities [Member] | Pharmacy revenues [Member]
Revenues
Pharmacy revenues, fees and other revenues	0	0
Express Scripts Holding Company [Member] | Reportable Legal Entities [Member]
Revenues
Premiums	0	0
Net investment income	15	0
Total revenues	15	0
Benefits and Expenses
Medical costs and other benefit expenses	0	0
Pharmacy and other service costs	0	0
Selling, general and administrative expenses	13	0
Amortization of other acquired intangible assets	0	0
Total benefits and expenses	13	0
Income from operations	2	0
Interest and other income (expense)	(124)	0
Intercompany interest income (expense)	124	0
Debt extinguishment costs		0
Net realized investment gains (losses)	0	0
Income (loss) before income taxes	2	0
Total income taxes	1	0
Income before equity in earnings of subsidiaries	1	0
Equity in income from subsidiaries	488	0
Net Income	489	0
Less: net income (loss) attributable to noncontrolling interests	0	0
Shareholders' net income	489	0
Other comprehensive income (loss), net of tax	1	0
Shareholders' comprehensive income (loss)	490	0
Express Scripts Holding Company [Member] | Reportable Legal Entities [Member] | Fees and other revenues [Member]
Revenues
Pharmacy revenues, fees and other revenues	0	0
Express Scripts Holding Company [Member] | Reportable Legal Entities [Member] | Pharmacy revenues [Member]
Revenues
Pharmacy revenues, fees and other revenues	0	0
Express Scripts Incorporated [Member] | Reportable Legal Entities [Member]
Revenues
Premiums	0	0
Net investment income	3	0
Total revenues	17,815	0
Benefits and Expenses
Medical costs and other benefit expenses	0	0
Pharmacy and other service costs	16,363	0
Selling, general and administrative expenses	835	0
Amortization of other acquired intangible assets	577	0
Total benefits and expenses	17,775	0
Income from operations	40	0
Interest and other income (expense)	(4)	0
Intercompany interest income (expense)	(62)	0
Debt extinguishment costs		0
Net realized investment gains (losses)	0	0
Income (loss) before income taxes	(26)	0
Total income taxes	(17)	0
Income before equity in earnings of subsidiaries	(9)	0
Equity in income from subsidiaries	432	0
Net Income	423	0
Less: net income (loss) attributable to noncontrolling interests	0	0
Shareholders' net income	423	0
Other comprehensive income (loss), net of tax	1	0
Shareholders' comprehensive income (loss)	424	0
Express Scripts Incorporated [Member] | Reportable Legal Entities [Member] | Fees and other revenues [Member]
Revenues
Pharmacy revenues, fees and other revenues	190	0
Express Scripts Incorporated [Member] | Reportable Legal Entities [Member] | Pharmacy revenues [Member]
Revenues
Pharmacy revenues, fees and other revenues	17,622	0
Medco Health Solutions Incorporated [Member] | Reportable Legal Entities [Member]
Revenues
Premiums	0	0
Net investment income	2	0
Total revenues	3,849	0
Benefits and Expenses
Medical costs and other benefit expenses	0	0
Pharmacy and other service costs	3,689	0
Selling, general and administrative expenses	87	0
Amortization of other acquired intangible assets	83	0
Total benefits and expenses	3,859	0
Income from operations	(10)	0
Interest and other income (expense)	(9)	0
Intercompany interest income (expense)	(39)	0
Debt extinguishment costs		0
Net realized investment gains (losses)	0	0
Income (loss) before income taxes	(58)	0
Total income taxes	(17)	0
Income before equity in earnings of subsidiaries	(41)	0
Equity in income from subsidiaries	84	0
Net Income	43	0
Less: net income (loss) attributable to noncontrolling interests	0	0
Shareholders' net income	43	0
Other comprehensive income (loss), net of tax	0	0
Shareholders' comprehensive income (loss)	43	0
Medco Health Solutions Incorporated [Member] | Reportable Legal Entities [Member] | Fees and other revenues [Member]
Revenues
Pharmacy revenues, fees and other revenues	84	0
Medco Health Solutions Incorporated [Member] | Reportable Legal Entities [Member] | Pharmacy revenues [Member]
Revenues
Pharmacy revenues, fees and other revenues	3,763	0
Non-Guarantor Subsidiaries [Member] | Reportable Legal Entities [Member]
Revenues
Premiums	9,971	8,999
Net investment income	335	329
Total revenues	27,549	11,413
Benefits and Expenses
Medical costs and other benefit expenses	7,620	6,772
Pharmacy and other service costs	14,346	561
Selling, general and administrative expenses	3,319	2,681
Amortization of other acquired intangible assets	83	27
Total benefits and expenses	25,368	10,041
Income from operations	2,181	1,372
Interest and other income (expense)	9	28
Intercompany interest income (expense)	11	16
Debt extinguishment costs		0
Net realized investment gains (losses)	10	(33)
Income (loss) before income taxes	2,211	1,383
Total income taxes	517	340
Income before equity in earnings of subsidiaries	1,694	1,043
Equity in income from subsidiaries	0	0
Net Income	1,694	1,043
Less: net income (loss) attributable to noncontrolling interests	4	2
Shareholders' net income	1,690	1,041
Other comprehensive income (loss), net of tax	412	(237)
Shareholders' comprehensive income (loss)	2,102	804
Non-Guarantor Subsidiaries [Member] | Reportable Legal Entities [Member] | Fees and other revenues [Member]
Revenues
Pharmacy revenues, fees and other revenues	3,101	1,368
Non-Guarantor Subsidiaries [Member] | Reportable Legal Entities [Member] | Pharmacy revenues [Member]
Revenues
Pharmacy revenues, fees and other revenues	$ 14,142	$ 717

Condensed Consolidating Finan_4

Condensed Consolidating Financial Information - Balance Sheets (Details) - USD ($) $ in Millions	Mar. 31, 2019	Dec. 31, 2018	Mar. 31, 2018	Dec. 31, 2017
Assets
Cash and cash equivalents	$ 4,976	$ 3,855	$ 2,771	$ 2,972
Investments	1,662	2,045
Accounts receivable, net	10,941	10,473
Inventories	2,382	2,821
Other current assets	1,175	1,236
Total current assets	21,136	20,430
Long-term investments	27,257	26,929
Reinsurance recoverables	5,385	5,507
Deferred policy acquisition costs	2,817	2,821
Property and equipment	4,523	4,562
Investments in subsidiaries	0	0
Intercompany receivables	0	0
Goodwill	44,537	44,505
Other intangible assets	38,338	39,003
Other assets	2,276	1,630
Separate account assets	8,079	7,839
TOTAL ASSETS	154,348	153,226
Liabilities Abstract
Current insurance and contractholder liabilities	7,060	6,801
Pharmacy and service costs payable	11,145	10,702
Accounts payable	4,488	4,366
Accrued expenses and other liabilities	7,361	7,071
Short-term debt	2,915	2,955
Total current liabilities	32,969	31,895
Non-current insurance and contractholder liabilities	20,043	19,974
Deferred tax liabilities, net	9,403	9,453
Other non-current liabilities	3,832	3,470
Intercompany payables	0	0
Long-term debt	37,571	39,523
Separate account liabilities	8,079	7,839
TOTAL LIABILITIES	111,897	112,154
Redeemable noncontrolling interest	38	37
Total shareholders' equity	42,408	41,028
Other noncontrolling interests	5	7
Total Equity	42,413	41,035	14,195	13,711
Total liabilities and equity	154,348	153,226
Consolidation, Eliminations [Member]
Assets
Cash and cash equivalents	0	0	0	0
Investments	0	0
Accounts receivable, net	0	0
Inventories	0	0
Other current assets	(283)	(210)
Total current assets	(283)	(210)
Long-term investments	0	0
Reinsurance recoverables	0	0
Deferred policy acquisition costs	0	0
Property and equipment	0	0
Investments in subsidiaries	(176,526)	(173,780)
Intercompany receivables	(40,486)	(39,147)
Goodwill	0	0
Other intangible assets	0	0
Other assets	(209)	(246)
Separate account assets	0	0
TOTAL ASSETS	(217,504)	(213,383)
Liabilities Abstract
Current insurance and contractholder liabilities	0	0
Pharmacy and service costs payable	0	0
Accounts payable	0	0
Accrued expenses and other liabilities	(283)	(210)
Short-term debt	0	0
Total current liabilities	(283)	(210)
Non-current insurance and contractholder liabilities	0	0
Deferred tax liabilities, net	(209)	(246)
Other non-current liabilities	0	0
Intercompany payables	(40,486)	(39,147)
Long-term debt	0	0
Separate account liabilities	0	0
TOTAL LIABILITIES	(40,978)	(39,603)
Redeemable noncontrolling interest	0	0
Total shareholders' equity	(176,526)	(173,780)
Other noncontrolling interests	0	0
Total Equity	(176,526)	(173,780)
Total liabilities and equity	(217,504)	(213,383)
Cigna [Member] | Reportable Legal Entities [Member]
Assets
Cash and cash equivalents	0	243	0	0
Investments	417	0
Accounts receivable, net	0	0
Inventories	0	0
Other current assets	0	14
Total current assets	417	257
Long-term investments	0	0
Reinsurance recoverables	0	0
Deferred policy acquisition costs	0	0
Property and equipment	0	0
Investments in subsidiaries	70,036	68,969
Intercompany receivables	0	0
Goodwill	0	0
Other intangible assets	0	0
Other assets	27	48
Separate account assets	0	0
TOTAL ASSETS	70,480	69,274
Liabilities Abstract
Current insurance and contractholder liabilities	0	0
Pharmacy and service costs payable	0	0
Accounts payable	22	22
Accrued expenses and other liabilities	719	396
Short-term debt	1,556	0
Total current liabilities	2,297	418
Non-current insurance and contractholder liabilities	0	0
Deferred tax liabilities, net	0	0
Other non-current liabilities	0	0
Intercompany payables	4,904	4,965
Long-term debt	20,871	22,863
Separate account liabilities	0	0
TOTAL LIABILITIES	28,072	28,246
Redeemable noncontrolling interest	0	0
Total shareholders' equity	42,408	41,028
Other noncontrolling interests	0	0
Total Equity	42,408	41,028
Total liabilities and equity	70,480	69,274
Old Cigna [Member] | Reportable Legal Entities [Member]
Assets
Cash and cash equivalents	0	0	0	9
Investments	6	0
Accounts receivable, net	2	0
Inventories	0	0
Other current assets	131	59
Total current assets	139	59
Long-term investments	10	10
Reinsurance recoverables	0	0
Deferred policy acquisition costs	0	0
Property and equipment	0	0
Investments in subsidiaries	28,174	27,544
Intercompany receivables	3,054	4,505
Goodwill	0	0
Other intangible assets	0	0
Other assets	227	198
Separate account assets	0	0
TOTAL ASSETS	31,604	32,316
Liabilities Abstract
Current insurance and contractholder liabilities	0	0
Pharmacy and service costs payable	0	0
Accounts payable	0	0
Accrued expenses and other liabilities	288	182
Short-term debt	0	1,500
Total current liabilities	288	1,682
Non-current insurance and contractholder liabilities	0	0
Deferred tax liabilities, net	0	0
Other non-current liabilities	715	685
Intercompany payables	4,477	4,361
Long-term debt	5,112	5,110
Separate account liabilities	0	0
TOTAL LIABILITIES	10,592	11,838
Redeemable noncontrolling interest	0	0
Total shareholders' equity	21,012	20,478
Other noncontrolling interests	0	0
Total Equity	21,012	20,478
Total liabilities and equity	31,604	32,316
Express Scripts Holding Company [Member] | Reportable Legal Entities [Member]
Assets
Cash and cash equivalents	1,596	633	0	0
Investments	0	0
Accounts receivable, net	0	0
Inventories	0	0
Other current assets	0	0
Total current assets	1,596	633
Long-term investments	0	0
Reinsurance recoverables	0	0
Deferred policy acquisition costs	0	0
Property and equipment	0	0
Investments in subsidiaries	52,560	52,035
Intercompany receivables	0	0
Goodwill	31,049	31,049
Other intangible assets	8,400	8,400
Other assets	0	0
Separate account assets	0	0
TOTAL ASSETS	93,605	92,117
Liabilities Abstract
Current insurance and contractholder liabilities	0	0
Pharmacy and service costs payable	0	0
Accounts payable	2	0
Accrued expenses and other liabilities	92	129
Short-term debt	998	995
Total current liabilities	1,092	1,124
Non-current insurance and contractholder liabilities	0	0
Deferred tax liabilities, net	1,999	2,001
Other non-current liabilities	0	0
Intercompany payables	30,552	29,569
Long-term debt	10,938	10,932
Separate account liabilities	0	0
TOTAL LIABILITIES	44,581	43,626
Redeemable noncontrolling interest	0	0
Total shareholders' equity	49,024	48,491
Other noncontrolling interests	0	0
Total Equity	49,024	48,491
Total liabilities and equity	93,605	92,117
Express Scripts Incorporated [Member] | Reportable Legal Entities [Member]
Assets
Cash and cash equivalents	44	43	0	0
Investments	0	0
Accounts receivable, net	4,670	4,206
Inventories	0	0
Other current assets	282	310
Total current assets	4,996	4,559
Long-term investments	0	0
Reinsurance recoverables	0	0
Deferred policy acquisition costs	0	0
Property and equipment	2,386	2,432
Investments in subsidiaries	17,551	17,115
Intercompany receivables	8,371	7,425
Goodwill	0	0
Other intangible assets	18,489	18,962
Other assets	152	68
Separate account assets	0	0
TOTAL ASSETS	51,945	50,561
Liabilities Abstract
Current insurance and contractholder liabilities	0	0
Pharmacy and service costs payable	9,245	8,422
Accounts payable	833	834
Accrued expenses and other liabilities	1,522	1,387
Short-term debt	352	353
Total current liabilities	11,952	10,996
Non-current insurance and contractholder liabilities	0	0
Deferred tax liabilities, net	4,898	5,012
Other non-current liabilities	577	497
Intercompany payables	0	0
Long-term debt	41	24
Separate account liabilities	0	0
TOTAL LIABILITIES	17,468	16,529
Redeemable noncontrolling interest	0	0
Total shareholders' equity	34,477	34,032
Other noncontrolling interests	0	0
Total Equity	34,477	34,032
Total liabilities and equity	51,945	50,561
Medco Health Solutions Incorporated [Member] | Reportable Legal Entities [Member]
Assets
Cash and cash equivalents	0	0	0	0
Investments	0	0
Accounts receivable, net	626	748
Inventories	0	0
Other current assets	3	0
Total current assets	629	748
Long-term investments	0	0
Reinsurance recoverables	0	0
Deferred policy acquisition costs	0	0
Property and equipment	0	0
Investments in subsidiaries	8,205	8,117
Intercompany receivables	2,222	2,335
Goodwill	0	0
Other intangible assets	6,958	7,040
Other assets	78	74
Separate account assets	0	0
TOTAL ASSETS	18,092	18,314
Liabilities Abstract
Current insurance and contractholder liabilities	0	0
Pharmacy and service costs payable	1,291	1,579
Accounts payable	4	4
Accrued expenses and other liabilities	276	189
Short-term debt	0	0
Total current liabilities	1,571	1,772
Non-current insurance and contractholder liabilities	0	0
Deferred tax liabilities, net	1,664	1,685
Other non-current liabilities	241	290
Intercompany payables	0	0
Long-term debt	505	506
Separate account liabilities	0	0
TOTAL LIABILITIES	3,981	4,253
Redeemable noncontrolling interest	0	0
Total shareholders' equity	14,111	14,061
Other noncontrolling interests	0	0
Total Equity	14,111	14,061
Total liabilities and equity	18,092	18,314
Non-Guarantor Subsidiaries [Member] | Reportable Legal Entities [Member]
Assets
Cash and cash equivalents	3,336	2,936	$ 2,771	$ 2,963
Investments	1,239	2,045
Accounts receivable, net	5,643	5,519
Inventories	2,382	2,821
Other current assets	1,042	1,063
Total current assets	13,642	14,384
Long-term investments	27,247	26,919
Reinsurance recoverables	5,385	5,507
Deferred policy acquisition costs	2,817	2,821
Property and equipment	2,137	2,130
Investments in subsidiaries	0	0
Intercompany receivables	26,839	24,882
Goodwill	13,488	13,456
Other intangible assets	4,491	4,601
Other assets	2,001	1,488
Separate account assets	8,079	7,839
TOTAL ASSETS	106,126	104,027
Liabilities Abstract
Current insurance and contractholder liabilities	7,060	6,801
Pharmacy and service costs payable	609	701
Accounts payable	3,627	3,506
Accrued expenses and other liabilities	4,747	4,998
Short-term debt	9	107
Total current liabilities	16,052	16,113
Non-current insurance and contractholder liabilities	20,043	19,974
Deferred tax liabilities, net	1,051	1,001
Other non-current liabilities	2,299	1,998
Intercompany payables	553	252
Long-term debt	104	88
Separate account liabilities	8,079	7,839
TOTAL LIABILITIES	48,181	47,265
Redeemable noncontrolling interest	38	37
Total shareholders' equity	57,902	56,718
Other noncontrolling interests	5	7
Total Equity	57,907	56,725
Total liabilities and equity	$ 106,126	$ 104,027

Condensed Consolidating Finan_5

Condensed Consolidating Financial Information - Cash Flow Statements (Details) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Condensed Cash Flow Statements, Captions [Line Items]
Net cash provided by operating activities	$ 3,192	$ 2,025
Cash Flows from Investing Activities
Net change in loans due to (from) affiliates	0	0
Proceeds from investments sold:
Fixed maturities and equity securities	1,471	499
Investment maturities and repayments:
Fixed maturities and equity securities	319	297
Commercial mortgage loans	89	28
Other sales, maturities and repayments (primarily short-term and other long-term investments)	367	112
Investments purchased or originated:
Fixed maturities and equity securities	(1,088)	(2,259)
Commercial mortgage loans	(95)	(68)
Other (primarily short-term and other long-term investments)	(388)	(206)
Property and equipment purchases, net	(194)	(103)
Acquisitions, net of cash acquired	(6)	0
Net cash provided by (used in) investing activities	475	(1,700)
Cash Flows from Financing Activities
Net change in amounts due to (from) affiliates	0	0
Intercompany dividends paid	0	0
Deposits and interest credited to contractholder deposit funds	247	292
Withdrawals and benefit payments from contractholder deposit funds	(251)	(306)
Net change in short-term debt	(1,048)	(3)
Repayment of long-term debt	(1,000)	(131)
Repurchase of common stock	(462)	(310)
Issuance of common stock	53	20
Other, net	(73)	(92)
Net cash provided by (used in) financing activities	(2,534)	(530)
Effect of foreign currency rate changes on cash and cash equivalents	(12)	4
Net increase in cash and cash equivalents	1,121	(201)
Cash and cash equivalents, January 1,	3,855	2,972
Cash and cash equivalents, March 31,	4,976	2,771
Consolidation, Eliminations [Member]
Condensed Cash Flow Statements, Captions [Line Items]
Net cash provided by operating activities	(1,838)	(449)
Cash Flows from Investing Activities
Net change in loans due to (from) affiliates	(41)	(102)
Proceeds from investments sold:
Fixed maturities and equity securities	0	0
Investment maturities and repayments:
Fixed maturities and equity securities	0	0
Commercial mortgage loans	0	0
Other sales, maturities and repayments (primarily short-term and other long-term investments)	0	0
Investments purchased or originated:
Fixed maturities and equity securities	0	0
Commercial mortgage loans	0	0
Other (primarily short-term and other long-term investments)	0	0
Property and equipment purchases, net	0	0
Acquisitions, net of cash acquired	0
Net cash provided by (used in) investing activities	(41)	(102)
Cash Flows from Financing Activities
Net change in amounts due to (from) affiliates	41	102
Intercompany dividends paid	1,822	449
Deposits and interest credited to contractholder deposit funds	0	0
Withdrawals and benefit payments from contractholder deposit funds	0	0
Net change in short-term debt	0	0
Repayment of long-term debt	0	0
Repurchase of common stock	0	0
Issuance of common stock	0	0
Other, net	16	0
Net cash provided by (used in) financing activities	1,879	551
Effect of foreign currency rate changes on cash and cash equivalents	0	0
Net increase in cash and cash equivalents	0	0
Cash and cash equivalents, January 1,	0	0
Cash and cash equivalents, March 31,	0	0
Cigna [Member] | Reportable Legal Entities [Member]
Condensed Cash Flow Statements, Captions [Line Items]
Net cash provided by operating activities	1,102	0
Cash Flows from Investing Activities
Net change in loans due to (from) affiliates	0	0
Proceeds from investments sold:
Fixed maturities and equity securities	0	0
Investment maturities and repayments:
Fixed maturities and equity securities	0	0
Commercial mortgage loans	0	0
Other sales, maturities and repayments (primarily short-term and other long-term investments)	0	0
Investments purchased or originated:
Fixed maturities and equity securities	0	0
Commercial mortgage loans	0	0
Other (primarily short-term and other long-term investments)	(417)	0
Property and equipment purchases, net	0	0
Acquisitions, net of cash acquired	0
Net cash provided by (used in) investing activities	(417)	0
Cash Flows from Financing Activities
Net change in amounts due to (from) affiliates	0	0
Intercompany dividends paid	0	0
Deposits and interest credited to contractholder deposit funds	0	0
Withdrawals and benefit payments from contractholder deposit funds	0	0
Net change in short-term debt	558	0
Repayment of long-term debt	(1,000)	0
Repurchase of common stock	(462)	0
Issuance of common stock	53	0
Other, net	(77)	0
Net cash provided by (used in) financing activities	(928)	0
Effect of foreign currency rate changes on cash and cash equivalents	0	0
Net increase in cash and cash equivalents	(243)	0
Cash and cash equivalents, January 1,	243	0
Cash and cash equivalents, March 31,	0	0
Old Cigna [Member] | Reportable Legal Entities [Member]
Condensed Cash Flow Statements, Captions [Line Items]
Net cash provided by operating activities	947	641
Cash Flows from Investing Activities
Net change in loans due to (from) affiliates	1,600	0
Proceeds from investments sold:
Fixed maturities and equity securities	0	0
Investment maturities and repayments:
Fixed maturities and equity securities	0	0
Commercial mortgage loans	0	0
Other sales, maturities and repayments (primarily short-term and other long-term investments)	0	0
Investments purchased or originated:
Fixed maturities and equity securities	0	0
Commercial mortgage loans	0	0
Other (primarily short-term and other long-term investments)	(6)	(2)
Property and equipment purchases, net	0	0
Acquisitions, net of cash acquired	0
Net cash provided by (used in) investing activities	1,594	(2)
Cash Flows from Financing Activities
Net change in amounts due to (from) affiliates	(141)	(102)
Intercompany dividends paid	(900)	0
Deposits and interest credited to contractholder deposit funds	0	0
Withdrawals and benefit payments from contractholder deposit funds	0	0
Net change in short-term debt	(1,500)	0
Repayment of long-term debt	0	(131)
Repurchase of common stock	0	(310)
Issuance of common stock	0	20
Other, net	0	(125)
Net cash provided by (used in) financing activities	(2,541)	(648)
Effect of foreign currency rate changes on cash and cash equivalents	0	0
Net increase in cash and cash equivalents	0	(9)
Cash and cash equivalents, January 1,	0	9
Cash and cash equivalents, March 31,	0	0
Express Scripts Holding Company [Member] | Reportable Legal Entities [Member]
Condensed Cash Flow Statements, Captions [Line Items]
Net cash provided by operating activities	(6)	0
Cash Flows from Investing Activities
Net change in loans due to (from) affiliates	(1,700)	0
Proceeds from investments sold:
Fixed maturities and equity securities	0	0
Investment maturities and repayments:
Fixed maturities and equity securities	0	0
Commercial mortgage loans	0	0
Other sales, maturities and repayments (primarily short-term and other long-term investments)	0	0
Investments purchased or originated:
Fixed maturities and equity securities	0	0
Commercial mortgage loans	0	0
Other (primarily short-term and other long-term investments)	0	0
Property and equipment purchases, net	0	0
Acquisitions, net of cash acquired	0
Net cash provided by (used in) investing activities	(1,700)	0
Cash Flows from Financing Activities
Net change in amounts due to (from) affiliates	2,669	0
Intercompany dividends paid	0	0
Deposits and interest credited to contractholder deposit funds	0	0
Withdrawals and benefit payments from contractholder deposit funds	0	0
Net change in short-term debt	0	0
Repayment of long-term debt	0	0
Repurchase of common stock	0	0
Issuance of common stock	0	0
Other, net	0	0
Net cash provided by (used in) financing activities	2,669	0
Effect of foreign currency rate changes on cash and cash equivalents	0	0
Net increase in cash and cash equivalents	963	0
Cash and cash equivalents, January 1,	633	0
Cash and cash equivalents, March 31,	1,596	0
Express Scripts Incorporated [Member] | Reportable Legal Entities [Member]
Condensed Cash Flow Statements, Captions [Line Items]
Net cash provided by operating activities	1,802	0
Cash Flows from Investing Activities
Net change in loans due to (from) affiliates	0	0
Proceeds from investments sold:
Fixed maturities and equity securities	0	0
Investment maturities and repayments:
Fixed maturities and equity securities	0	0
Commercial mortgage loans	0	0
Other sales, maturities and repayments (primarily short-term and other long-term investments)	0	0
Investments purchased or originated:
Fixed maturities and equity securities	0	0
Commercial mortgage loans	0	0
Other (primarily short-term and other long-term investments)	0	0
Property and equipment purchases, net	(55)	0
Acquisitions, net of cash acquired	0
Net cash provided by (used in) investing activities	(55)	0
Cash Flows from Financing Activities
Net change in amounts due to (from) affiliates	(1,744)	0
Intercompany dividends paid	0	0
Deposits and interest credited to contractholder deposit funds	0	0
Withdrawals and benefit payments from contractholder deposit funds	0	0
Net change in short-term debt	0	0
Repayment of long-term debt	0	0
Repurchase of common stock	0	0
Issuance of common stock	0	0
Other, net	(2)	0
Net cash provided by (used in) financing activities	(1,746)	0
Effect of foreign currency rate changes on cash and cash equivalents	0	0
Net increase in cash and cash equivalents	1	0
Cash and cash equivalents, January 1,	43	0
Cash and cash equivalents, March 31,	44	0
Medco Health Solutions Incorporated [Member] | Reportable Legal Entities [Member]
Condensed Cash Flow Statements, Captions [Line Items]
Net cash provided by operating activities	(110)	0
Cash Flows from Investing Activities
Net change in loans due to (from) affiliates	0	0
Proceeds from investments sold:
Fixed maturities and equity securities	0	0
Investment maturities and repayments:
Fixed maturities and equity securities	0	0
Commercial mortgage loans	0	0
Other sales, maturities and repayments (primarily short-term and other long-term investments)	0	0
Investments purchased or originated:
Fixed maturities and equity securities	0	0
Commercial mortgage loans	0	0
Other (primarily short-term and other long-term investments)	0	0
Property and equipment purchases, net	0	0
Acquisitions, net of cash acquired	0
Net cash provided by (used in) investing activities	0	0
Cash Flows from Financing Activities
Net change in amounts due to (from) affiliates	110	0
Intercompany dividends paid	0	0
Deposits and interest credited to contractholder deposit funds	0	0
Withdrawals and benefit payments from contractholder deposit funds	0	0
Net change in short-term debt	0	0
Repayment of long-term debt	0	0
Repurchase of common stock	0	0
Issuance of common stock	0	0
Other, net	0	0
Net cash provided by (used in) financing activities	110	0
Effect of foreign currency rate changes on cash and cash equivalents	0	0
Net increase in cash and cash equivalents	0	0
Cash and cash equivalents, January 1,	0	0
Cash and cash equivalents, March 31,	0	0
Non-Guarantor Subsidiaries [Member] | Reportable Legal Entities [Member]
Condensed Cash Flow Statements, Captions [Line Items]
Net cash provided by operating activities	1,295	1,833
Cash Flows from Investing Activities
Net change in loans due to (from) affiliates	141	102
Proceeds from investments sold:
Fixed maturities and equity securities	1,471	499
Investment maturities and repayments:
Fixed maturities and equity securities	319	297
Commercial mortgage loans	89	28
Other sales, maturities and repayments (primarily short-term and other long-term investments)	367	112
Investments purchased or originated:
Fixed maturities and equity securities	(1,088)	(2,259)
Commercial mortgage loans	(95)	(68)
Other (primarily short-term and other long-term investments)	35	(204)
Property and equipment purchases, net	(139)	(103)
Acquisitions, net of cash acquired	(6)
Net cash provided by (used in) investing activities	1,094	(1,596)
Cash Flows from Financing Activities
Net change in amounts due to (from) affiliates	(935)	0
Intercompany dividends paid	(922)	(449)
Deposits and interest credited to contractholder deposit funds	247	292
Withdrawals and benefit payments from contractholder deposit funds	(251)	(306)
Net change in short-term debt	(106)	(3)
Repayment of long-term debt	0	0
Repurchase of common stock	0	0
Issuance of common stock	0	0
Other, net	(10)	33
Net cash provided by (used in) financing activities	(1,977)	(433)
Effect of foreign currency rate changes on cash and cash equivalents	(12)	4
Net increase in cash and cash equivalents	400	(192)
Cash and cash equivalents, January 1,	2,936	2,963
Cash and cash equivalents, March 31,	$ 3,336	$ 2,771

Segment Information - Special I

Segment Information - Special Items (Details) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Before-tax [Abstract]
Integration and transaction-related costs	$ 136	$ 60
After-tax [Abstract]
Integration and transaction-related costs	$ 108	$ 50

Segment Information - Summarize

Segment Information - Summarized Segment Financial Information (Details) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Segment Reporting Information [Line Items]
Revenues from external customers	$ 37,600	$ 11,084
Net investment income	346	329
Total revenues	37,946	11,413
Revenue from transitioning clients	(4,489)
Net realized investment results from equity method subsidiaries	(28)	2
Adjusted revenues	33,429	11,415
Income (loss) before income taxes	1,788	1,218
Pre-tax adjustments to reconcile adjusted income from operations [Abstract]
Adjustment for transitioning clients	(660)
(Income) loss attributable to non-controlling interests	(5)	(4)
Net realized investments (gains) losses	(38)	35
Amortization of acquired intangible assets	743	27
Special items [Abstract]
Integration and transaction-related costs	136	60
Pre-tax adjusted income (loss) from operations	1,964	1,336
Integrated Medical [Member]
Segment Reporting Information [Line Items]
Revenues from external customers	8,910	7,903
Health Services [Member]
Segment Reporting Information [Line Items]
Revenues from external customers	26,197	786
International Markets [Member]
Segment Reporting Information [Line Items]
Revenues from external customers	1,384	1,302
Group Disability and Other [Member]
Segment Reporting Information [Line Items]
Revenues from external customers	1,109	1,093
Operating Segments [Member]
Segment Reporting Information [Line Items]
Net realized investment results from equity method subsidiaries		0
Operating Segments [Member] | Integrated Medical [Member]
Segment Reporting Information [Line Items]
Net investment income	123	111
Total revenues	9,195	8,150
Revenue from transitioning clients	0
Net realized investment results from equity method subsidiaries	0	0
Adjusted revenues	9,195	8,150
Income (loss) before income taxes	1,157	972
Pre-tax adjustments to reconcile adjusted income from operations [Abstract]
Adjustment for transitioning clients	0
(Income) loss attributable to non-controlling interests	0	0
Net realized investments (gains) losses	(5)	18
Amortization of acquired intangible assets	18	22
Special items [Abstract]
Integration and transaction-related costs	0	0
Pre-tax adjusted income (loss) from operations	1,170	1,012
Operating Segments [Member] | Health Services [Member]
Segment Reporting Information [Line Items]
Net investment income	15	1
Total revenues	26,949	1,071
Revenue from transitioning clients	(4,489)
Net realized investment results from equity method subsidiaries	0	0
Adjusted revenues	22,460	1,071
Income (loss) before income taxes	942	83
Pre-tax adjustments to reconcile adjusted income from operations [Abstract]
Adjustment for transitioning clients	(660)
(Income) loss attributable to non-controlling interests	(1)	0
Net realized investments (gains) losses	0	0
Amortization of acquired intangible assets	713	0
Special items [Abstract]
Integration and transaction-related costs	0	0
Pre-tax adjusted income (loss) from operations	994	83
Operating Segments [Member] | International Markets [Member]
Segment Reporting Information [Line Items]
Net investment income	38	37
Total revenues	1,422	1,339
Revenue from transitioning clients	0
Net realized investment results from equity method subsidiaries	(28)	2
Adjusted revenues	1,394	1,341
Income (loss) before income taxes	222	213
Pre-tax adjustments to reconcile adjusted income from operations [Abstract]
Adjustment for transitioning clients	0
(Income) loss attributable to non-controlling interests	(4)	(4)
Net realized investments (gains) losses	(23)	4
Amortization of acquired intangible assets	11	4
Special items [Abstract]
Integration and transaction-related costs	0	0
Pre-tax adjusted income (loss) from operations	206	217
Operating Segments [Member] | Group Disability and Other [Member]
Segment Reporting Information [Line Items]
Net investment income	180	175
Total revenues	1,296	1,271
Revenue from transitioning clients	0
Net realized investment results from equity method subsidiaries	0	0
Adjusted revenues	1,296	1,271
Income (loss) before income taxes	93	103
Pre-tax adjustments to reconcile adjusted income from operations [Abstract]
Adjustment for transitioning clients	0
(Income) loss attributable to non-controlling interests	0	0
Net realized investments (gains) losses	(10)	12
Amortization of acquired intangible assets	1	1
Special items [Abstract]
Integration and transaction-related costs	0	0
Pre-tax adjusted income (loss) from operations	84	116
Corporate and eliminations [Member]
Segment Reporting Information [Line Items]
Total revenues	(916)	(418)
Revenue from transitioning clients	0
Net realized investment results from equity method subsidiaries	0
Adjusted revenues	(916)	(418)
Income (loss) before income taxes	(626)	(153)
Pre-tax adjustments to reconcile adjusted income from operations [Abstract]
Adjustment for transitioning clients	0
(Income) loss attributable to non-controlling interests	0	0
Net realized investments (gains) losses	0	1
Amortization of acquired intangible assets	0	0
Special items [Abstract]
Integration and transaction-related costs	136	60
Pre-tax adjusted income (loss) from operations	(490)	(92)
Corporate Non-segment [Member]
Segment Reporting Information [Line Items]
Revenues from external customers	0	0
Net investment income	(10)	5
Intersegment eliminations [Member]
Segment Reporting Information [Line Items]
Revenues from external customers	(906)	(423)
Intersegment eliminations [Member] | Integrated Medical [Member]
Segment Reporting Information [Line Items]
Revenues from external customers	(162)	(136)
Intersegment eliminations [Member] | Health Services [Member]
Segment Reporting Information [Line Items]
Revenues from external customers	(737)	(284)
Intersegment eliminations [Member] | International Markets [Member]
Segment Reporting Information [Line Items]
Revenues from external customers	0	0
Intersegment eliminations [Member] | Group Disability and Other [Member]
Segment Reporting Information [Line Items]
Revenues from external customers	$ (7)	$ (3)

Segment Information - Revenue f

Segment Information - Revenue from External Customers (Details) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Revenue from External Customer [Line Items]
Premiums	$ 9,971	$ 8,999
Revenues from external customers	37,600	11,084
Integrated Medical [Member]
Revenue from External Customer [Line Items]
Premiums	7,583	6,676
Revenues from external customers	8,910	7,903
International Markets [Member]
Revenue from External Customer [Line Items]
Premiums	1,304	1,260
Revenues from external customers	1,384	1,302
Health Services [Member]
Revenue from External Customer [Line Items]
Revenues from external customers	26,197	786
Group Disability and Other [Member]
Revenue from External Customer [Line Items]
Revenues from external customers	1,109	1,093
Product [Member]
Revenue from External Customer [Line Items]
Pharmacy revenues, fees and other revenues	25,179	717
Home Delivery And Specialty [Member]
Revenue from External Customer [Line Items]
Pharmacy revenues, fees and other revenues	11,784	717
Network Pharmacy [Member]
Revenue from External Customer [Line Items]
Pharmacy revenues, fees and other revenues	12,273	0
Other Pharmacy [Member]
Revenue from External Customer [Line Items]
Pharmacy revenues, fees and other revenues	1,122	0
Service [Member]
Revenue from External Customer [Line Items]
Fees	2,390	1,352
Other external revenues	60	16
Pharmacy revenues, fees and other revenues	2,450	1,368
Medical Risk Products [Member] | Integrated Medical [Member]
Revenue from External Customer [Line Items]
Premiums	3,039	2,611
Stop Loss [Member] | Integrated Medical [Member]
Revenue from External Customer [Line Items]
Premiums	1,069	980
Other Commercial Medical Products [Member] | Integrated Medical [Member]
Revenue from External Customer [Line Items]
Premiums	278	258
Medicare Advantage [Member] | Integrated Medical [Member]
Revenue from External Customer [Line Items]
Premiums	1,607	1,498
Medicare Part D [Member] | Integrated Medical [Member]
Revenue from External Customer [Line Items]
Premiums	525	228
Other Government Products [Member] | Integrated Medical [Member]
Revenue from External Customer [Line Items]
Premiums	1,065	1,101
Disability Life Accident [Member] | Group Disability and Other [Member]
Revenue from External Customer [Line Items]
Premiums	1,047	998
Other [Member] | Group Disability and Other [Member]
Revenue from External Customer [Line Items]
Premiums	$ 37	$ 65

Segment Information - Performan

Segment Information - Performance Guarantee (Details) - USD ($) $ in Millions	Mar. 31, 2019	Dec. 31, 2018
Performance Guarantee [Member]
Loss Contingencies [Line Items]
Reserves for performance guarantees	$ 1,000	$ 895

Segment Information - Foreign a

Segment Information - Foreign and U.S. Revenues (Details) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Revenues from External Customers and Long-Lived Assets [Line Items]
Revenues from external customers	$ 37,600	$ 11,084

Segment Information - Concentra

Segment Information - Concentration Risk (Details) - Revenue Consolidated [Member] - Customer Concentration Risk [Member]	3 Months Ended
	Mar. 31, 2019
Anthem [Member]
Concentration Risk [Line Items]
Concentration Risk, Percentage	12.00%
Concentration Risk, Benchmark Description	Consolidated revenues
Concentration Risk, Additional Characteristic	Anthem
Department Of Defense [Member]
Concentration Risk [Line Items]
Concentration Risk, Percentage	8.00%
Concentration Risk, Benchmark Description	Consolidated revenues
Concentration Risk, Additional Characteristic	Department of Defense

Quarterly Financial Data (Detai

Quarterly Financial Data (Details) - USD ($) $ / shares in Units, $ in Millions	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Consolidated Results
Total revenues	$ 37,946	$ 11,413
Income (loss) before income taxes	1,788	1,218
Shareholders' net income	$ 1,368	$ 915
Shareholders' net income per share:
EPS, basic	$ 3.61	$ 3.78
EPS, diluted	$ 3.56	$ 3.72
Special items
Integration and transaction-related costs	$ 108	$ 50

Schedule I - Condensed Financia

Schedule I - Condensed Financial Information, Statements of Income (Details) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Revenues
Net investment (income)	$ (346)	$ (329)
Total revenues	37,946	11,413
Operating expenses:
Selling, Genernal and Administrative Expense	3,303	2,745
Total benefits and expenses	35,716	10,105
Income from operations	2,230	1,308
Interest expense and other	(452)	(57)
Realized investment (gains) losses	(10)	33
Income (loss) before income taxes	1,788	1,218
Income tax expense (benefit)	416	301
Shareholders' net income	1,368	915
Shareholders' other comprehensive income (loss), net of tax:
Net unrealized appreciation (depreciation) on securities and derivatives	442	(284)
Net translation (losses) gains on foreign currencies	(24)	45
Postretirement benefits liability adjustment	11	13
Shareholders' other comprehensive income (loss)	429	(226)
Shareholders' comprehensive income (loss)	$ 1,797	$ 689

Schedule I - Condensed Financ_2

Schedule I - Condensed Financial Information, Balance Sheets (Details) - USD ($) $ in Millions		Mar. 31, 2019	Dec. 31, 2018	Mar. 31, 2018	Dec. 31, 2017
Assets
Cash and cash equivalents		$ 4,976	$ 3,855	$ 2,771	$ 2,972
Other current assets		1,175	1,236
Total current assets		21,136	20,430
Investments in subsidiaries		0	0
Other noncurrent assets		2,276	1,630
TOTAL ASSETS		154,348	153,226
Liabilities:
Short-term debt		2,915	2,955
Total current liabilities		32,969	31,895
Long-term debt		37,571	39,523
Other non-current liabilities		3,832	3,470
TOTAL LIABILITIES		111,897	112,154
Shareholders Equity:
Common stock (shares issued, 296; authorized, 600)	[1]	4	4
Additional paid-in capital		27,855	27,751
Accumulated other comprehensive loss		(1,282)	(1,711)
Retained earnings		16,426	15,088
Less: treasury stock, at cost		(595)	(104)
Total shareholders' equity		42,408	41,028
Total liabilities and shareholders' equity		$ 154,348	$ 153,226
[1]	Par value per share, $0.01; shares issued, 384 million as of March 31, 2019 and 381 million as of December 31, 2018; authorized shares; 600 million.

Schedule I - Condensed Financ_3

Schedule I - Condensed Financial Information, Balance Sheets - Parentheticals (Details) - shares shares in Millions	Mar. 31, 2019	Dec. 31, 2018
Consolidated Balance Sheets
Common stock shares issued	384	381
Common stock shares authorized	600	600

Schedule I - Condensed Financ_4

Schedule I - Condensed Financial Information, Statements of Cash Flows (Details) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Cash Flows from Operating Activities
Shareholders' net income	$ 1,368	$ 915
Adjustments to reconcile shareholders' net income to net cash provided by (used in) operating activities:
Other liabilities	91	193
Other, net	83	(8)
Net cash provided by (used in) operating activities	3,192	2,025
Cash Flows from Investing Activities
Short term investments purchased	(388)	(206)
Net cash provided by (used in) investing activities	475	(1,700)
Cash Flows from Financing Activities
Net change in amounts due to (from) affiliates	0	0
Net change in short-term debt	(1,048)	(3)
Repayment of long-term debt	(1,000)	(131)
Issuance of common stock	53	20
Repurchase of common stock	(462)	(310)
Other, net	(73)	(92)
Net cash provided by (used in) financing activities	(2,534)	(530)
Net increase (decrease) in cash and cash equivalents	1,121	(201)
Cash and cash equivalents, January 1,	3,855	2,972
Cash and cash equivalents, March 31,	$ 4,976	$ 2,771

Uncategorized Items - ci-201903

Label	Element	Value
Retained Earnings [Member]
Cumulative effect on equity in period of adoption	us-gaap_CumulativeEffectOfNewAccountingPrincipleInPeriodOfAdoption	$ (15,000,000)	[1]
Cumulative effect on equity in period of adoption	us-gaap_CumulativeEffectOfNewAccountingPrincipleInPeriodOfAdoption	68,000,000
Accumulated Other Comprehensive Income [Member]
Cumulative effect on equity in period of adoption	us-gaap_CumulativeEffectOfNewAccountingPrincipleInPeriodOfAdoption	(10,000,000)
Shareholders' Equity [Member]
Cumulative effect on equity in period of adoption	us-gaap_CumulativeEffectOfNewAccountingPrincipleInPeriodOfAdoption	58,000,000
Cumulative effect on equity in period of adoption	us-gaap_CumulativeEffectOfNewAccountingPrincipleInPeriodOfAdoption	$ (15,000,000)	[1]
[1]	See Note 2 for further information about the Company's adoption of new leasing guidance (ASU 2016-02).