Cigna Global Health Benefits Privacy Forms

If you need to make a request mentioned in the "Cigna Global Health Benefits Notice of Privacy Practices," you must provide a request in writing. You can either send us a written request or use one of the forms* below that we've provided here for your convenience.

If you'd like to use a form to submit a request, select the appropriate link to print the form you need. Please send all signed and completed forms to the address below.

U.S. Privacy Customer Forms

HIPAA Authorization
HIPAA Confidential Communication
HIPAA Personal Representative
HIPAA Request for Restriction
HIPAA Request for Access
HIPAA Request to Amend
HIPAA Request for an Accounting of Disclosures
Request for Diagnosis and Treatment Code Information

Canadian Privacy Customer Forms

CLIC Consent to Disclose Personal Health Information
CLIC Privacy Notice

Privacy Office
Cigna Global Health Benefits
300 Bellevue Parkway
Willmington, DE 19809