Customer Forms
- Medical Forms
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Request a Medical ID card
Change Primary Care Physician
EnglishMedical Appeal Request: English | Spanish | Chinese
Medical Claim Form English | SpanishTransition of Care / Continuity of Care (with Mental Health) Forms: English | Spanish | Chinese
Transition of Care / Continuity of Care (without Mental Health) Forms: English | Spanish | ChineseTransition of Care / Individual and Family Plans
Update your Health Plan coverage-Spouse
Update your Health Plan coverage-Child
Update your Health Plan coverage-Medicare
Update your Health Plan coverage-DuplicateFor California-specific forms and plan information, visit our Cigna in California page.
Colorado Specific Forms
CO Customer Appeal Request Form
Hawaii Specific Forms
Disclosure For Conflicts of Interest Evaluation FormHI Request for External Review FormHIPAA Authorization for Release of Information Form
Indiana Specific Forms
Indiana Prior Authorization Form
Massachusetts Specific Forms
MA Cardiac Imaging Prior Authorization FormMA CT/CTA/MRI/MRA Prior Authorization FormMA PET - PET CT Prior Authorization Form
Nebraska Specific Forms
NE External Appeals Request Form
New Jersey Specific Forms
New Jersey OON Provider Negotiation
New Mexico Specific Forms
New Mexico Prior Authorization Form
Texas Specific Forms
Texas Standard Prior Authorization Request Form for Health Care Services
Vermont Specific Forms
Uniform Medical Prior Authorization
Virginia Specific Forms
External Review Request FormAppointment of Authorized RepresentativePhysician Certification Expedited External Review Request FormPhysician Certification Experimental or Investigational Denials Form
West Virginia Specific Forms
- Dental Forms
Dental Claim Form English | Spanish
- Dentist Directory Request
- Patient Charge Schedule Request
- Cigna Dental Oral Health Integration Program® Registration Form (for customers with certain medical conditions)
- Formulario de inscripción en el programa Oral Health Integration Program® de Cigna Dental (para personas con determinadas afecciones médicas)
For California-specific forms and plan information, visit our Cigna in California page.
- Pharmacy Forms
Cigna Home Delivery Pharmacy Prescription Order Form
Pharmacy Claim Form(Not for Medicare Customers — see Medicare Pharmacy Claim Form)
Pharmacy Claims - Helpful HintsMedicare-B Assignment of Benefits
- Vision Forms
Cigna Vision Claim Forms: English | Spanish
Cigna Vision Claim Forms (fillable version): English | Spanish
- Behavioral Forms
Behavioral Health Customer Claim Form
Indiana Specific Forms
Indiana Prior Authorization Form
Maryland Specific Forms
Maryland Uniform Treatment Plan Form
Massachusetts Specific Forms
Massachusetts Prior Authorization Form
Massachusetts Prior Authorization Form – Transcranial Magnetic Stimulation
New Mexico Specific Forms
New Mexico Prior Authorization Form
Vermont Specific Forms
Uniform Medical Prior Authorization
West Virginia Specific Forms
West Virginia Prior Authorization Form
For California-specific forms and plan information, visit our Cigna in California page.
- Disability/Accident/Life Forms
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Long Term Disabilty-Educator Plan
Disability Disclosure Authorization
How to Submit a Life and Accident Claim Proof of Loss Job Aid Funeral Assignment Job Aid Life and Accidental Death Physician’s Statement of Disability Total and Permanent Disability / Waiver of Premium Dismemberment Accelerated Death Benefits Disclosure Auth for Deceased Insured Claim Disclosure Auth for Living Insured Claim State Income Tax Withholding Request for Federal Income Tax Withholding Electronic Fund Transfer Authorization Verbal Authorization Information Accidental Dismemberment or Disability GUL Cignaassurance Claim Form GUL Non-Cignaassurance Claim Form Customer Authorization Form
- Accidental Injury, Critical Illness, Hospital Care and Wellness Incentive Claim Forms
- Bonding Leave
- Care for family member
- Military Leave
- Intermittent Absence Time Tracking Form
- Cigna Choice Fund HRA/FSA Claim Forms
Debit Card Validation FSA Dependent Care Reimbursement Dependent Care FSA Reimbursement Helpful Hints FSA Reimbursement HRA Reimbursement FSA and HRA Reimbursement Helpful Hints
- International Forms
Login to Cigna Envoy for Cigna Global Health Benefits forms.
- Healthy Working Life Forms