- Member Rights & Responsibilities
- Customer Forms
- Medical Claim Form
- Reasons to file a Claim Form
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 Type | When do I file claim forms? | What if I receive out-of-network care? | How do I know which charges are covered? |
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HMO Network EPO | There's no paperwork.
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Point of Service | There's no paperwork for in-network care.
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Indemnity |
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