Get Cigna Choice Fund Reimbursement Request Form Health - Fordham

Filling out the CIGNA Choice Fund Reimbursement Request Form Health - Fordham online is essential for receiving reimbursement from your health accounts. This guide will provide clear and user-friendly instructions to help you successfully complete the form.

Follow the steps to effectively complete the reimbursement request form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Review the instructions provided on the back of the form to familiarize yourself with the requirements.
3. Complete the employee information section. This includes filling out your CIGNA ID number or Social Security number, name, date of birth, and contact details. Remember that fields marked with an asterisk (*) are mandatory.
4. Fill out the patient information section for each person receiving services, making sure to provide the patient’s name and date of birth.
5. List all itemized expenses in the appropriate fields. Referencing each expense, provide the date of service or purchase, type of service, amount requested for reimbursement, and necessary codes or descriptions.
6. If applicable, complete the payment instructions section. Use separate forms for each healthcare professional or facility if you wish to have CIGNA pay them directly.
7. Sign and date the certification and signature box, ensuring your signature is in Box 29. This verifies that all information is accurate and complete.
8. Submit the completed form with itemized receipts or explanation of benefits by faxing to the designated number or mailing to the provided address.
9. Keep copies of all submitted documents for your records and any future needs.

Complete your reimbursement request form online today to ensure timely processing of your payments.