Reasons to File a Medical Claim Form

HMO
For most covered services, there's no paperwork. Just show your Cigna HealthCare ID card and pay your copayment; your provider will complete and submit the paperwork. If you receive out-of-network emergency care, you or your provider need to file a paper claim. You will receive an Explanation of Benefits identifying the costs covered by your plan and the charges you must pay.
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Network
For most covered services, there's no paperwork. Just show your Cigna HealthCare ID card and pay your copayment; your provider will complete and submit the paperwork. If you receive out-of-network emergency care, you or your provider need to file a paper claim. You will receive an Explanation of Benefits identifying the costs covered by your plan and the charges you must pay.
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Point of Service
There's no paperwork for in-network care. Just show your Cigna HealthCare ID card and pay your copayment; your provider will complete and submit the paperwork. If you visit an out-of-network provider, you or your provider only need to file a paper claim. You will receive an Explanation of Benefits identifying the costs covered by your plan and the charges you must pay.
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PPO/PPO+
There's no paperwork for in-network care. Just show your Cigna HealthCare ID card and pay your copayment; your provider will complete and submit the paperwork. If you visit an out-of-network provider, you or your provider need to file a paper claim. You will receive an Explanation of Benefits identifying the costs covered by your plan and the charges you must pay.
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EPO
For most covered services, there's no paperwork. Just show your Cigna HealthCare ID card and pay your copayment; your provider will complete and submit the paperwork. If you receive out-of-network emergency care, you or your provider need to file a paper claim. You will receive an Explanation of Benefits identifying the costs covered by your plan and the charges you must pay.
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Indemnity
You or your providers file medical claim forms for services. Most hospitals and some doctors require direct payment of benefits. In many cases the provider will photocopy your Cigna HealthCare ID card and also may ask you to complete an Assignment of Benefits form to arrange direct payment. However, in some instances your doctor may bill you directly, and you will need to submit a claim form  to Cigna HealthCare for reimbursement of a percentage of the covered expenses after you've met your annual deductible. You will receive an Explanation of Benefits identifying the costs covered by your plan and the charges you must pay.
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Filing Claims

Plan TypeWhen do I file claim forms?What if I receive out-of-network care?How do I know which charges are covered?
HMO Network EPO
    There's no paperwork. Just show your Cigna HealthCare ID card and pay your copayment; your providers will complete and submit the paperwork.
    Your plan includes coverage for out-of-network emergency care.In this instance, you will need to file a paper claim.
    When you or your provider file a paper claim, you will receive an Explanation of Benefits which will identify:
  • the costs covered by your plan
  • the charges you pay
Point of Service
    There's no paperwork for in-network care. Just show your Cigna HealthCare ID card and pay your copayment; your provider will complete and submit the paperwork.
    You will need to file a paper claim.
    When you or your provider file a paper claim, you will receive an Explanation of Benefits which will identify:
  • the costs covered by your plan
  • the charges you pay
Indemnity
    You or your providers file medical claim forms.
  • Most hospitals and many doctors require direct payment of benefits through an Assignment of Benefits form and will submit the claim for you.
  • In some instances your doctor may bill you directly, and you will need to submit a claim form to Cigna HealthCare for reimbursment of a percentage of the covered expenses after you've met your annual deductible.
    When you or your provider file a paper claim, you will receive an Explanation of Benefits which will identify:
  • the costs covered by your plan
  • the charges you pay