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  • Cigna Sp1813 Form

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3 and fill types of health information, . Form be completed ink. FOR CIGNA USE ONLY CL: MRN: NO. PAGES RELEASED: RECORDS PREPARED AND TRANSMITTED BY (PRINT NAME): SIGNATURE: RECIPIENT - PRINT NAME (as listed in Part 2 only): DATE REQUEST RECEIVED: DATE: SIGNATURE: DATE: PART 1. PATIENT INFORMATION PATIENT NAME: DATE OF BIRTH: DAYTIME PHONE: IDENTIFICATION NUMBER: HOME PHONE: ADDRESS (Street, City, State, Zip Code): PART 2. DESTINATION OF RECORDS I hereby authorize CIGNA HealthCar.

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Getting reimbursed To download the appropriate Health Care Reimbursement Request Form, visit Customer Forms. Read the claim form closely, and call us at 1 (800) 244-6224 if you have questions. One claim form can be used to request up to three expenses. ... Mail or fax claim forms to Cigna.

With a renewed focus as a health benefits provider, the Cigna that you know and trust is evolving to Cigna Healthcare This link will open in a new tab., serving clients and customers through its U.S. Commercial, U.S. Government, and International Health businesses.

Make a copy of your prescription receipts. Keep a copy for your records. 8. You should mail your request to: Cigna-HealthSpring Attn: Claims P.O. Box 20002 Nashville, TN 37202-9640.

A health reimbursement account (HRA) is a fund of money in an account that your employer owns and contributes to. HRAs are only available to employees who receive health care coverage from an employer. A flexible spending account (FSA) is a spending account for different kinds of eligible expenses.

Once your request for reimbursement is approved, it can take up to 45 days for Cigna Medicare to send your reimbursement.

To submit a medical, dental, or mental health claim: Download and print the appropriate claim form (depending on the type of claim) Follow the instructions included on the form to complete it. Mail your completed claim to the address shown on the form.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232