Get Personal Representative Document

This guide provides a clear and supportive approach to filling out the Personal Representative Document online. Whether you are acting on behalf of someone or need assistance in designating a representative, this step-by-step guide will help ensure all necessary information is completed accurately.

Follow the steps to complete the Personal Representative Document.

1. Press the ‘Get Form’ button to access the Personal Representative Document and open it in your online editor.
2. Begin by entering the identification details for the Member/Participant. You will need to provide their full name, date of birth, phone number, and Social Security number. Ensure all entered information is accurate to avoid processing delays.
3. Include the Member/Participant ID card number and group or account number, if applicable. This information helps to verify the individual’s health benefit plan.
4. Identify the Personal Representative by entering their name. Keep in mind that only one individual can be named. Also, include the relationship to the Member/Participant and their date of birth in the specified format.
5. Provide the address where future communications about the Member/Participant should be sent. Make sure the address is correct to ensure proper delivery.
6. State the reason for the request clearly. This section helps clarify the context for the appointment of the Personal Representative.
7. Complete the verification questions. These include the last four digits of your favorite credit card or any four-digit number, and your mother’s date of birth in the specified format.
8. If the Personal Representative is legally appointed, ensure they complete and sign section A. If designated by the Member/Participant, proceed to sections B and C for the required authorizations and notarization.
9. Review the form for completeness. Any missing information may delay the processing of your request.
10. Finally, save your changes, and download or print the completed form for your records. Follow the mailing instructions to return the form to CIGNA Behavioral Health.

Start filling out your Personal Representative Document online today to ensure your health benefits are managed effectively.