Get Cigna Vsp Reimbursement Form

Filling out the Cigna Vsp Reimbursement Form online can streamline the process of obtaining reimbursement for vision care services. This guide provides step-by-step instructions to help you accurately complete the form.

Follow the steps to complete the Cigna Vsp Reimbursement Form online

1. Click 'Get Form' button to access the Cigna Vsp Reimbursement Form and open it in your preferred editor.
2. Fill in the member information section. Enter the member’s name, date of birth, address, city, state, ZIP code, and member ID or social security number. Also, include the name of the group or employer.
3. Complete the patient information section. Provide the patient's name, date of birth, and relationship to the member. If the patient is a child aged over 18, indicate if they are a full-time student and include the name of their school. Additionally, specify if the child is physically impaired.
4. In the reimbursement request information section, record the date services were received. Circle the services received and enter the amount paid for each category, including exam, lenses (single vision, bifocal, trifocal, progressive, lenticular), lens options (tint, other), frame, contact lenses, and contact fitting/evaluation.
5. Include the provider or optical shop name, phone number, address, city, state, and ZIP code in the designated fields.
6. If you are coordinating benefits with another insurance carrier, attach a complete copy of the Explanation of Benefits from your primary insurance carrier.
7. After filling out all required sections, review your entries for accuracy. Save your changes, and then download, print, or share the completed Cigna Vsp Reimbursement Form as needed.

Start filling out your Cigna Vsp Reimbursement Form online today!