CIGNA International Expatriate Benefits Privacy Forms

If you need to make a request mentioned in the "CIGNA International Expatriate Benefits Notice of Privacy Practices," you must provide a request in writing. You can either send us a written request or use one of the forms* below that we've provided here for your convenience.

If you'd like to use a form to submit a request, select the appropriate link to print the form you need. Please send all signed and completed forms to the address below.

HIPAA Authorization (PDF)

HIPAA Confidential Communication (PDF)

HIPAA Personal Representative (PDF)

HIPAA Request for Restriction (PDF)

HIPAA Request for Access (PDF)

HIPAA Request to Amend (PDF)

HIPAA Request for an Accounting of Disclosures (PDF)

Privacy Office
CIGNA International Expatriate Benefits
590 Naamans Road
Claymont, DE 19703