For security reasons, Cigna.com no longer supports your browser version. Please update your browser, or use an alternative browser such as Google Chrome, Microsoft Edge, or Mozilla Firefox for the best Cigna.com experience.
Request a Medical ID card
Change Primary Care Physician
English
Medical Appeal Request: English | Spanish | Chinese
Medical Claim Form English | Spanish
Transition of Care / Continuity of Care (with Mental Health) Forms: English | Spanish | Chinese
Transition of Care / Individual and Family Plans
For California-specific forms and plan information, visit our Cigna in California page.
Arizona Specific Forms
Arizona Prior Authorization Form
Colorado Specific Forms
CO Customer Appeal Request Form
Florida Specific Forms
Florida Prior Authorization Form
Hawaii Specific Forms
Disclosure For Conflicts of Interest Evaluation Form
HI Request for External Review Form
HIPAA Authorization for Release of Information Form
Indiana Specific Forms
Indiana Prior Authorization Form
Massachusetts Specific Forms
MA Cardiac Imaging Prior Authorization Form
MA CT/CTA/MRI/MRA Prior Authorization Form
MA PET - PET CT Prior Authorization Form
Nebraska Specific Forms
NE External Appeals Request Form
New Jersey Specific Forms
New Jersey OON Provider Negotiation
New Mexico Specific Forms
New Mexico Prior Authorization Form
Texas Specific Forms
Texas Standard Prior Authorization Request Form for Health Care Services
Vermont Specific Forms
Uniform Medical Prior Authorization
Virginia Specific Forms
These forms may only be used if your employer is head quartered in the Commonwealth of Virginia, and you are enrolled in a medical, behavioral, pharmacy or dental plan that is underwritten by Cigna Health and Life Insurance Company. If you have any questions please contact us at the phone number listed on the back of your identification card.
Appointment of Authorized Representative
Physician Certification Expedited External Review Request Form
Physician Certification Experimental or Investigational Denials Form
West Virginia Specific Forms
Dental Claim Form English | Spanish
Patient Charge Schedule Request
Transition of Care/Continuity of Care Form English | Spanish | Chinese
Transition of Care/Continuity of Care Form-AZ Medicare English | Spanish
For California-specific forms and plan information, visit our Cigna in California page.
Virginia Specific Forms
These forms may only be used if your employer is head quartered in the Commonwealth of Virginia, and you are enrolled in a medical, behavioral, pharmacy or dental plan that is underwritten by Cigna Health and Life Insurance Company. If you have any questions please contact us at the phone number listed on the back of your identification card.
Appointment of Authorized Representative
Physician Certification Expedited External Review Request Form
Physician Certification Experimental or Investigational Denials Form
Cigna Home Delivery Pharmacy Prescription Order Form
Pharmacy Claim Form(Not for Medicare Customers — see Medicare Pharmacy Claim Form)
Pharmacy Claims - Helpful Hints
Medicare-B Assignment of Benefits
Virginia Specific Forms
These forms may only be used if your employer is head quartered in the Commonwealth of Virginia, and you are enrolled in a medical, behavioral, pharmacy or dental plan that is underwritten by Cigna Health and Life Insurance Company. If you have any questions please contact us at the phone number listed on the back of your identification card.
Appointment of Authorized Representative
Physician Certification Expedited External Review Request Form
Physician Certification Experimental or Investigational Denials Form
Behavioral Health Customer Claim Form
Indiana Specific Forms
Indiana Prior Authorization Form
Maryland Specific Forms
Maryland Uniform Treatment Plan Form
Massachusetts Specific Forms
Massachusetts Prior Authorization Form
Massachusetts Prior Authorization Form – Transcranial Magnetic Stimulation
New Mexico Specific Forms
New Mexico Prior Authorization Form
Vermont Specific Forms
Uniform Medical Prior Authorization
Virginia Specific Forms
These forms may only be used if your employer is head quartered in the Commonwealth of Virginia, and you are enrolled in a medical, behavioral, pharmacy or dental plan that is underwritten by Cigna Health and Life Insurance Company. If you have any questions please contact us at the phone number listed on the back of your identification card.
Appointment of Authorized Representative
Physician Certification Expedited External Review Request Form
Physician Certification Experimental or Investigational Denials Form
West Virginia Specific Forms
West Virginia Prior Authorization Form
For California-specific forms and plan information, visit our Cigna in California page.(Cigna in California | Cigna Companies, Products and Disclosures)
- Care for family member
- Military Leave
- Intermittent Absence Time Tracking Form
The Cigna Dental Oral Health Integration Program
This program provides reimbursement for certain eligible dental procedures for customers with qualifying medical conditions. Customers must enroll in the program prior to receiving dental services to be eligible for reimbursement. Reimbursement is applied to and subject to any applicable annual benefits maximum. See your plan documents or contact Cigna for complete program details.
The State of Colorado Notice-Access Plan
You may request a copy of our Access Plan. The Access Plan is designed to disclose all the policy information required under Colorado law. It is available for your review upon request and explains 1) Who participates in our provider network; (2) how we ensure that the network meets the health care needs of our members; (3) how our provider referral process works: (4) how care is continued if providers leave our network; (5) what steps we take to ensure medical quality and customer satisfaction; (6) where you can go for information on other policy services and features.