memberrightsandresponsibilities/member-forms/medical-claim-form/reasons-to-file-a-medical-claim-form
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  • Reasons to file a Claim Form
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Reasons to File a Medical Claim Form

  • HMO
  • Network
  • Point of Service
  • PPO/PPO+
  • EPO
  • Indemnity
  • Filing Claims

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 reimbursement 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

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Individual and family medical and dental insurance plans are insured by Cigna Health and Life Insurance Company (CHLIC), Cigna HealthCare of Arizona, Inc., Cigna HealthCare of Illinois, Inc., and Cigna HealthCare of North Carolina, Inc. Group health insurance and health benefit plans are insured or administered by CHLIC, Connecticut General Life Insurance Company (CGLIC), or their affiliates (see a listing of the legal entities that insure or administer group HMO, dental HMO, and other products or services in your state). Group Universal Life (GUL) insurance plans are insured by CGLIC. Life (other than GUL), accident, critical illness, hospital indemnity, and disability plans are insured or administered by Life Insurance Company of North America, except in NY, where insured plans are offered by Cigna Life Insurance Company of New York (New York, NY). All insurance policies and group benefit plans contain exclusions and limitations. For availability, costs and complete details of coverage, contact a licensed agent or Cigna sales representative. This website is not intended for residents of New Mexico.

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