CIGNA refer to itself as a "global health services company." Health plans are operated by CIGNA Healthcare throughout many of the United States and in a growing list of countries around the world. The health care is headquartered in Bloomfield, Connecticut, though the corporate is headquartered at Two Liberty Place in Center City Philadelphia, Pennsylvania. CIGNA has approximately 29,300 employees. A global health service company, CIGNA takes its corporate social responsibility (CSR) very seriously. The mission of CIGNA is to improve health, well-being and security for all those it serves. CIGNA is committed to its customers and colleagues and to the communities in which they live and work. CIGNA operates with high ethical standards to serve the people, who rely on it.

Medical Claim form instructions:

To file a claim:

Print medical claim form instructions, they will guide you through the steps required to help ensure your claim is processed correctly. Download and print a ready-to-use PDF file claim form (PDF). Mail your completed claim form (s), with original itemized bill (s) attached, to the CIGNA HealthCare Claims Office printed on your CIGNA HealthCare ID card.

You can claim about three weeks, from the time you mail your claim form to the time you receive your Explanation of Benefits.

Important Filing Tips:

• Print or Type in black ink.
• Use a separate form for each participating family member each time you submit a claim. For example, do not include your spouse's medical receipts on the same claim form with yours.
• You can submit two or more health care bills together on the same claim form if they are for treatment of the same illness. For example, if you have bills from a specialist, an X-ray lab, and a pharmacy that are all for the treatment of an injury, you can submit one claim form.
• Please do not submit canceled checks or cash receipts as proof of payment.
• Always use original claim forms because they scan better than photocopied versions.

Remember: The “patient” is the person who received health care service from a provider, and the “insured” is the person who carries the health care insurance.

1. Medicare/Medicaid/CHAMPUS/CHAMPVA/Group Health Plan/FECA BLK LUNG/Other: This field is optional. In the box, place a check mark to indicate the insured's health care plan or program.
2. I.D. Number of Insured (For Program in Item 1): This field is required. On the insured's health care I.D. card, his/her I.D. number can be found.
3. Name of Patient: This field is required.
4. Birth Date and Sex of Patient: This field is required.
5. Name of Insured: This field is required.
6. Address of Patient: This field is required. Provide the patient's address (number, street, city, state, and ZIP code) and telephone number (including area code).
7. Relationship of Patient to Insured: This field is required. Indicate whether the patient is also the insured (Self), or is the insured's spouse, child, or other relation.
8. Address of Insured: This field is required. Provide the insured's address (number, street, city, state, and ZIP code) and telephone number (including area code).
9. Patient Status: This field is required. Indicate the patient's marital status (Single, Married or Other), and the patient's employment status (Employed, Full-time Student, or Part-time Student).
10. Other Insured's Name: Provide the name of the person who carries the other health benefit plan (if applicable). Note: Fields 9 and 9a through 9d are required only if the patient is also covered under another health benefit plan.
    1. Other Insured's Policy or Group Number: This number can be found on the other insured's health benefit plan ID card or other documentation.
    2. Other Insured's Date of Birth and Sex: Provide if applicable.
    3. Employers Name or School Name: Provide the name of the employer or school that provides the other insured's health benefit plan (if applicable).
    4. Insurance Plan Name or Program Name: Provide the name of the other insured's health benefit plan or program (if applicable).
11. a-c. Is Patient's Condition Related to: These fields are required. Indicate whether the patient's condition occurred as a result of (a.) a job-related injury at a current or present employer, (b.) an auto accident (please indicate the state in which it occurred), or (c.) another type of accident.
12. 10d.Reserved for Local Use: Do not write in this field.
13. Insured's Policy Group or FECA Number: This field is optional. The Group or FECA number can be found on the insured's I.D. card.
    1. Insured's Date of Birth and Sex: This field is required.
    2. Employer's Name or School Name: This field is optional. Provide the name of the employer or school that provides the other insured's health benefit plan.
    3. Insurance Plan Name or Program Name: This field is optional. Provide the name of the other insured's health benefit plan or program.
    4. Is There Another Health Benefit Plan?: This field is required. Indicate whether the patient is also covered under another health benefit plan. If "Yes", be sure to complete fields 9a-d.
14. Patient's or Authorized Person's Signature: A signature is required. An authorized person is the employee, the employee's spouse, or the dependent if he/she is the patient and is 18 years or older.
15. Insured's or Authorized Person's Signature: A signature is required only if the benefit payment should be sent to the provider. Do not sign here if the payment should be sent to the insured. An authorized person is the employee, the employee's spouse, or the dependent if he/she is the patient and is 18 years or older.
16. 14-33. These fields must be completed by the physician, or you can include the bill from the provider and leave these fields blank.

Before submitting your claim:

• Make photocopies of all receipts and completed claim forms. Receipts will not be returned to you.
• Write your CIGNA HealthCare ID number from your member ID card on all paperwork or bills you submit.
• Verify that printing is legible.
• Be sure that all required fields are completed.

Medical claim form:

Are you unsure about whether you are responsible for filing a claim? If so, then Reasons to file will help to answer your questions.

To file a claim:

• Download and print a ready-to-use claim form (PDF 74k). Follow the Instructions for Filing a Claim on page 2 to guide you through the steps required to help ensure your claim is processed correctly.
• Mail your completed claim form (s), with original itemized bill (s) attached, to the CIGNA HealthCare Claims Office printed on your CIGNA HealthCare ID card.

Allow approximately four weeks from the time you mail your claim form to the time you receive your Explanation Of Benefits.

Source: www.cigna.com

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