- Medical Forms
- Change Primary Care Physician
Transition of Care / Continuity of Care with Mental Health | Continuidad de la atención médica | Transition of Care / Continuity of Care without Mental Health Update your Health Plan coverage-Spouse Update your Health Plan coverage-Child Update your Health Plan coverage-Medicare Update your Health Plan coverage-Duplicate
California Specific Forms
CA Continuity of Care Form | Formulario de de continuidad de la atención médica para CA |
CA Transition of Care Form | Formulario de transición de la atención médica para CA |
Language Assistance Disclosure
Colorado Specific Forms
Nebraska Specific Forms
- Dental Forms
- Pharmacy Forms
Pharmacy Claim Form(Not for Medicare Customers — see Medicare Pharmacy Claim Form)
You or your health care professional can submit an online prior authorization request for prescription drugs covered under the Cigna pharmacy benefit or the Cigna medical benefit at: https://cigna.promptpa.com .
This easy tool will walk you through submitting an online prior authorization request for your medication. Once your request is submitted, Cigna will contact your health care professional to complete the process.
- Vision Forms
- Behavioral Forms
- Disability/Accident/Life/Critical Illness Forms
Life and Accidental Death Physician’s Statement of Disability Total and Permanent Disability / Waiver of Premium Dismemberment Accelerated Death Benefits Disclosure Auth for Deceased Insured Claim Disclosure Auth for Living Insured Claim State Income Tax Withholding Request for Federal Income Tax Withholding Electronic Fund Transfer Authorization Verbal Authorization Information Accidental Dismemberment, Injury or Disability Critical Illness
- Cigna Choice Fund HRA/FSA Claim Forms
- Re-Employment Solutions
- International Forms
Login to Cigna Envoy for Cigna Global Health Benefits forms.
- Stay-at-Work Services