Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. In the employer use section, provide information such as employer name, policy number, employee name, class, and the coverage amount eligible to port. Ensure to include coverage termination dates for both the employee and dependents.
3. In the employee information section, enter your home address, phone numbers, social security number, and birthdate. Decide if you wish to continue the current amount of coverage, decrease it, or opt to increase.
4. Answer the tobacco use question and indicate if you have applied for conversion, waiver of premium, or accelerated benefits. Fill in application dates where applicable.
5. Proceed to the spouse information section. Provide your spouse's name, social security number, and birthdate. Indicate their coverage preferences, tobacco use, and any applications similar to those for the employee.
6. In the child(ren) information section, denote if you wish to continue coverage for your children. If eligible, refer to the separate Child Portability Form for coverage continuation.
7. Complete the beneficiary information section by specifying beneficiaries for employee, spouse, and children coverage, including their percentage distribution, social security numbers, birthdates, and relationships.
8. Sign and date the form in the employee signature section. If the owner of the coverage is different from the employee, complete the section for the owner's details and ensure their signature as well.
9. Review the general information section regarding rates, deadlines, effective dates, billing, increases, and termination policies. Make sure all terms and conditions are understood.
10. Once all sections are completed, save your changes, and download or print the completed form for submission.

Complete your CIGNA Life Family Portability Form - Passhe online today!