This page requires you to enable JavaScript in your web browser for complete functionality.

Request ID Card

Please complete this form for a new CIGNA HealthCare ID for you or your dependents. Your new card(s) should arrive within two weeks. If you need services before your card arrives, ask the health care provider to call CIGNA HealthCare Customer Service to verify coverage information. Please note, ID cards will be sent to the address on record.

* Indicates required field

Your Information

 

Member Information

* Please enter your
CIGNA HealthCare ID:
 (EX: U23456789) * Member First Name:
* First Name: * Member Last Name:
* Last Name: * Address1:
* E-mail:   Address2:
    I do not have an email address. * City:
  * State:
  Telephone: * Zip Code:
* Relationship to the Member: * Member Date of Birth:  /   /   mm  /   dd   /   yyyy


Number of ID card(s) to request:   
 
* First Name: * Date of Birth:  /   /  mm / dd / yyyy * Reason: