Health Risk Assessment Form

Health Risk Assessment

One of our primary goals is to help you stay as healthy as possible. One way we do this is by asking you some questions about your health and lifestyle and using that information to develop personalized care plans with your Primary Care Doctor. We call this series of questions, or survey, a Health Risk Assessment (or HRA).

By printing, completing, and mailing back this HRA form, you will help us match you to the health and wellness services that fit you best. Completing an HRA every year gets you 1 step closer to a plan for better health and wellness.

Filling out the HRA is easy, and should take less than 15 minutes to complete.

Steps for HRA Form Completion:

Customers living in the Arizona market:

Click link below to open the Arizona HRA
Arizona English Health Risk Assessment form
Formulario de evaluación de riesgos para la salud de Arizona
Print the HRA form
Complete and follow instructions on the HRA form
Mail the completed form to:

Cigna
Attn: Population Health Management
3003 N. 3rd Street
Phoenix, AZ 85012
If you have any questions regarding the form, please call our Customer Service representatives at:
1 (800) 627-7534 (TTY 711)
Monday - Friday, 8:00 am - 8:00 pm Mountain time
We are available 7 days a week October 1 - March 31.

Customers living in all other markets:

Click link below to open the HRA
English Health Risk Assessment form
Formulario de evaluación de riesgos para la salud
Print the HRA form
Complete and follow instructions on the HRA form
Mail or fax the completed form to:
Cigna Medicare
Attn: HRA Department
500 Great Circle Road
Nashville, TN 37228

HRA Fax: 1 (877) 440-9340
If you have any questions or need any help completing the form, please call our Health Risk Assessment representatives at:
1 (800) 331-6769 (TTY 711)
Monday - Friday, 8:00 am - 5:00 pm Central time

Your HRA information is completely confidential.

We will not share your HRA form with anyone except your care team. Your care team will use this information and work with you to develop your personalized care plan.

Language Assistance

Disclaimers

All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company, Cigna HealthCare of South Carolina, Inc., Cigna HealthCare of North Carolina, Inc., Cigna HealthCare of Georgia, Inc., Cigna HealthCare of Arizona, Inc., Cigna HealthCare of St. Louis, Inc., HealthSpring Life & Health Insurance Company, Inc., HealthSpring of Florida, Inc., Bravo Health Mid-Atlantic, Inc., and Bravo Health Pennsylvania, Inc. The Cigna name, logos, and other Cigna marks are owned by Cigna Intellectual Property, Inc.

Cigna-HealthSpring is contracted with Medicare for PDP plans, HMO and PPO plans in select states, and with select State Medicaid programs. Enrollment in Cigna-HealthSpring depends on contract renewal.

Medicare Supplement Policy Disclaimers

Website not approved for use in: Arkansas, Colorado, Florida, Idaho, Illinois, Kansas, Kentucky, Louisiana, Montana, North Dakota, Oregon, Pennsylvania, Tennessee, Virginia, and Washington.

AN OUTLINE OF COVERAGE IS AVAILABLE UPON REQUEST.

Our company and agents are not connected with or endorsed by the U.S. Government or the federal Medicare program. This is a solicitation for insurance. An insurance agent may contact you. Premium and benefits vary by plan selected. Plan availability varies by state. Medicare Supplement policies are underwritten by Cigna Health and Life Insurance Company, American Retirement Life Insurance Company or Loyal American Life Insurance Company. Each insurer has sole responsibility for its own products.

The following Medicare Supplement Plans are available to persons eligible for Medicare due to disability: Plan A in Connecticut, Maryland, Oklahoma & Texas; Plans A, F & N in California; Plans A & C in Michigan; Plans A & F in North Carolina; and Plan C in New Jersey for individuals aged 50-64.

Selecting these links will take you away from Cigna Medicare Advantage and Medicare Part D Prescription Drug Plan information.

This web site uses files in Adobe Acrobat Portable Document Format (PDF). This is useful for forms that you want to view and/or print. To view or print these files, you must download and install the free Adobe Acrobat Reader. Get Adobe Reader