Get Cigna Hipaa Authorization Form

Completing the CIGNA HIPAA Authorization Form is essential for obtaining access to your private health information managed by CIGNA. This guide provides clear, step-by-step instructions to help you fill out the form accurately and effectively.

Follow the steps to complete the CIGNA HIPAA Authorization Form online.

1. Press the ‘Get Form’ button to obtain the form and open it in your online editor.
2. In the verification section, input your name, date of birth, and a reachable phone number for processing your request. Provide your social security number, member/participant ID card number if applicable, and your group or account number as stated on your ID card.
3. Indicate the subscriber's name and relationship to you, along with the subscriber's employer name and social security number if they differ from yours.
4. If you have additional coverage with CIGNA, complete the section with the details of the other employer and provide corresponding member/participant ID card number and group or account number.
5. In the request section, provide the address where CIGNA should send your requested information.
6. Select the type of information you are requesting from CIGNA records. Options include processed claims, enrollment or eligibility information, case management, medical utilization information, or other specified information.
7. Specify which benefits the information pertains to by checking the appropriate boxes for CIGNA Medical, Behavioral Health, or Dental benefits.
8. Read the important notes regarding the completeness of the form and your entitlements to private health information.
9. Complete the signature and notarization section by signing and dating the form. If signed by someone other than yourself, indicate their relationship to you.
10. Once all sections of the form are complete, you can save your changes, download, print, or share the form as needed.

Start filling out your CIGNA HIPAA Authorization Form online today for a smoother process.