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Get Ltd Conversion - Cigna Admin Er. 874486 Dg/th Print
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How to fill out the LTD Conversion - Cigna Admin ER. 874486 DG/TH Print online
This guide provides clear instructions for users on how to complete the LTD Conversion - Cigna Admin ER. 874486 DG/TH Print form online. With careful attention to detail, users can ensure they fill out the necessary sections accurately to secure their disability conversion insurance.
Follow the steps to complete the LTD Conversion form successfully.
- Press the ‘Get Form’ button to acquire the form and open it in the editor.
- Begin by entering your personal information in the Employee Information section. Provide your full name, gender, date of birth, address, and telephone number. Make sure all details are accurate to prevent processing delays.
- Indicate your group policy number and the name of your employer. These details are essential for identifying your insurance setup.
- Complete the eligibility questions regarding your current or previous long-term disability insurance. Be prepared to identify any other group long-term disability plans that cover you.
- If applicable, select your desired benefit waiting period, choosing between 90 days and 180 days based on your eligibility.
- Review and sign the application. Ensure that you date your signature accurately. Your signature confirms that the statements provided are true and complete.
- Attach a check or money order for the non-refundable $25 administrative fee. This payment must accompany your application form.
- Submit the completed form along with the payment to the Cigna Individual Conversion Unit at the provided address. Ensure you follow any specific mailing instructions to avoid delays.
- After submitting, keep a copy of the completed form and any correspondence for your records. Monitor for the receipt of your Certificate of Insurance and respond accordingly to maintain your coverage.
Complete your LTD Conversion form online today to secure your disability insurance coverage.
The Cigna Healthy Foods Card is a monthly allowance, for dual-eligible customers, to use toward the purchase of healthy and nutritious foods from participating retailers in your area. * The card can be used to purchase approved grocery items such as fruits and vegetables, meat, deli, dairy, bread, and canned food.
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