Covered employees or retirees calling CIGNA on a dependent’s behalf will need to complete and mail one of the forms attached. The address listed on the form. These forms can be found on both CIGNA.com and my.Cigna.com where customers will go to the locate section and choose forms. Once in member forms, scroll down to Privacy Forms and then search for the attached.
Personal Representative Request Form - The purpose of this form is to enable another individual to act on behalf with respect to making decisions about your health benefits, requesting and/or disclosing your private health information, and exercising all of the rights you have under your health benefit plan. If a Personal Representative is designated, the address on file will change to the Personal Representatives and all information will be sent to them. Authorization for disclosure of
Private Health Information Form - Completion of this form allows someone to call on a customers behalf and we disclose personal health information. |
