Get Group/association - Short Term Disability Benefits - Cigna

Filling out the Group/Association - Short Term Disability Benefits form from Cigna can seem daunting, but this guide will help simplify the process. Follow the steps below to ensure you complete the form accurately and efficiently.

Follow the steps to fill out your disability benefits form accurately.

1. Click 'Get Form' button to obtain the form and access it for completion.
2. Begin by filling in the employee or association member's name, including last name, first name, and middle initial as prompted.
3. Enter the date of birth and the social security number of the employee or association member.
4. Provide the address, which includes the street, city, state, and zip code.
5. Input the telephone number and the policy number associated with the coverage.
6. Specify the occupation of the individual and check the appropriate blocks regarding their employment status.
7. Fill in the basic earnings per week and the date of the last change in earnings.
8. Indicate the date hired or when the member joined the association, and check if the insurance was issued based on a statement of physical condition.
9. Record the last day worked, date returned to work, and the contributions made regarding the insurance.
10. List all benefits the insured is receiving or is eligible to receive due to disability.
11. Complete the section related to the employer or administrator, providing the name, division, address, and telephone number.
12. Once all sections are completed, review for accuracy before saving changes, downloading, printing, or sharing the filled form.

Start completing your Group/Association - Short Term Disability Benefits form online today!