Cigna Other Health Insurance Form

Tricare supplements don t qualify as other health insurance ohi.

Cigna other health insurance form. Follow the instructions for filing a claim on page 2 to guide you through the steps required to help ensure your claim is processed correctly. As indicated below some forms are available for online submission. 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. The forms are also to be used for cigna behavioral health.

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. To make a request print and complete the appropriate form and mail it to the address indicated on the form. Group universal life gul insurance plans are insured by cglic. If you want to obtain a copy of your health care information that cigna maintains or obtain a copy of your health care diagnosis and treatment code information use this form.

If you have any questions please contact us at the phone number listed on the back of your identification card. Customer forms these forms are related to your medicare plan from cigna. Louis inc healthspring life health insurance. Download and print a ready to use claim form.

Mail your completed claim form s with original itemized bill s attached to the cigna healthcare claims office printed on your cigna healthcare id card. Prepaid health maintenance plan hmo hip myes mno school insurance myes mno 28. Group universal life gul insurance plans are insured by cglic. Other health insurance complete this form to notify your contractor that you have other health insurance health insurance you have in addition to tricare such as medicare or an employer sponsored health insurance.

Have you or will you submit a claim against any other party for damages as a result of the illness or injury described in this form myes mno 29. All cigna products and services are provided exclusively by or through operating subsidiaries of cigna corporation including cigna health and life insurance company cigna healthcare of south carolina inc cigna healthcare of north carolina inc cigna healthcare of georgia inc cigna healthcare of arizona inc cigna healthcare of st. 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.