- Privacy Information
- Privacy Notices
- CIEB Privacy Forms
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: English | Español | Chinese
- HIPAA Confidential Communication: English | Español | Chinese
- HIPAA Personal Representative: English | Español | Chinese
- HIPAA Request for Restriction: English | Español | Chinese
- HIPAA Request for Access: English | Español | Chinese
- HIPAA Request to Amend: English | Español | Chinese
- HIPAA Request for an Accounting of Disclosures: English | Español | Chinese
- Request for Diagnosis and Treatment Code Information: English | Español | Chinese
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
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