privacyinformation/privacy-notices-and-forms/notice-of-privacy-practices-privacy-forms
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Notice of Privacy Practices

Notice of Privacy Practices-English
Notice of Privacy Practices-Spanish

Privacy Forms

Authorization/Notification to Release Protected Health Information-English
Authorization/Notification to Release Protected Health Information-Spanish
Request to Amend Personal Health Information (ENG) (SPA)
Request for Restriction on Disclosure of Personal Health Information
Request for Representative (ENG) (SPA)
Change/Revocation Request (ENG) (SPA)
Notification of Privacy/Confidential Communication (ENG) (SPA)

Please note: Cigna Medical Group will not disclose confidential information without your authorization unless it is necessary to provide your treatment, pay your Medical Group claims, administer health benefits, support Cigna HealthCare programs or services, or as otherwise required or permitted by law. We will not, for example, give your confidential information to a credit agency, a telemarketer or a prospective employer. We will not sell, rent or license the confidential information you provide to us including any information you provide within our public Web sites unless you authorize it. The Privacy Notice that each Cigna Medical Group patient receives from his/her physician describes more fully how we use your information. You may also read a copy of the Cigna Medical Group Privacy Notice on this Web site.

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Disclaimer

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.

 Selecting these links will take you away from Cigna.com to another website, which may be a non-Cigna website. Cigna may not control the content or links of non-Cigna websites. Details