Cigna Insurance Reimbursement Form

Don’t gamble with your health, get the right cover at the right price.

AED 1 million Health cover starting @4/Day
Selecting health insurance for
  • Self Only
  • Both Self and Family
  • Family without Self
  • Domestic Workers
  • Investor
Health Insurance



Worldwide Coverage
Wide Choices
Expert Advice

The above plans and premiums are for AED 1,000,000 Sum insured for 1 Adult of 30 Years for Dubai city.

CIGNA commenced its journey as a marine insurance company named Insurance Company of North America (INA) in Philadelphia, the United States in 1792. INA became one of the most significant insurance companies in the US and soon it spread across the world. In 1982, the company (INA) combined with Connecticut General Corporation (CG) to form Cigna. Today, Cigna is one of the largest health insurance companies in the world providing pharmacy, health, dental, and supplemental insurance and medicare plans to individuals, businesses, and families in over 150 countries. The company is the preferred choice of over 95 million customers for the impeccable services it offers along with ease of claims. While filing the Cigna reimbursement form, you need to know several things. We’ll walk you through the entire reimbursement process.

Download Cigna Reimbursement Form PDF

Types of Cigna Insurance Claims

Cigna provides claims in two ways - cashless claims and reimbursement claims. When you receive treatment in Cigna network hospital, you are granted a cashless claim. This claim is usually directly submitted by the hospital to the insurance provider. Based on your treatment, the hospital sends a Cigna insurance reimbursement claim form to Cigna Company. The company sanctions the medical treatment bill and you receive treatment. However, in case of emergency or some cases you are not able to find a cashless network hospital and so you seek treatment in a hospital outside the insurance provider’s hospital network. In hospitals outside Cigna’s hospital network, you receive treatment and pay the medical bills yourself. Once you are discharged and the treatment or the emergency phase of treatment is completed, you can submit Cigna insurance reimbursement form and receive a reimbursement claim on the medical bills you paid.

Filing Cigna Reimbursement Claims

Download the form

The first step in filing the Cigna reimbursement claim is to download the Cigna reimbursement claim form. To download the form:

  • Visit Cigna webpage
  • Scroll down and at the left, corner bottom click on “find a form”
  • Select Medical form and download the form

How to fill Cigna Reimbursement form?

  • Once you have downloaded the form, begin with filling the Primary Customer Information section where you are required to enter your details such as Name, Address, Gender, and Date of Birth.
  • In the second row of the same section mention your mailing address, city, state, and zip code.
  • In the third row of column D of the first section, mention your ID number or primary customer social security number. Do not forget to mention the account number where you want the reimbursement amount to be deposited.
  • Columns ‘F’ and ‘G’ give details regarding your employer and employment status.
  • In case you are not the primary customer fill section 2 of the form.
  • In case you are filing the claim because of an accident or work-related illness or injury, fill section 3
  • If you are filling the Cigna reimbursement form for a dependent or a family member, complete section 4.
  • Do not forget to sign the form under the certification and payment instruction sections.
  • In section 5, you are required to state the nature of the illness. Here you can rely on the doctor’s diagnosis to mention the name of the illness identified.
  • In the next section, you need to specify if you have another health or travel insurance that will pay partial or full reimbursement for these expenses. In case you have another insurance plan, mention the policy number and address of the insurance company.
  • In the seventh section of the form, you need to mention payment details. Firstly, you need to enumerate the list of expenses for which reimbursement is claimed. Please make sure that you enter the amount with each nature of the expense.
  • If the list exceeds the number of columns, you can add another page of the list to it.
  • The 8th section will require you to mention the preferred currency for reimbursement.
  • In the following section, specify whether you wish to receive the payment via cheque or bank wire transfer.
  • Mention your account details and bank details in the 10th section. Do not forget to mention Swift code and IBAN with branch addresses.
  • Finalize the form by striking the signature at the end of the form.
  • The next two sections of the form will be filled by your treating physician where the physician will give a detailed diagnosis of the injury or illness along with symptoms and chronology of symptoms in the twelfth section.
  • In the thirteenth section of the form, the physician will offer a detailed description of the treatment provided.
  • In the 14th section, the physician will mention their name and stamp the form.
  • Finally, the physician will sign the form in the last section and your Cigna Reimbursement form will be completed.               

*Please note that in some cases even the hospitals outside Cigna’s hospital network file reimbursement claims. In such cases, you are not required to file Cigna reimbursement claims. Before filling Cigna reimbursement form, confirm with your hospital about the reimbursement claims to avoid any confusion.

Health insurance offer banner

Documents required to submit Cigna Reimbursement form

  • Cigna Reimbursement form duly filled and signed by the patient and physician with hospital’s stamp.
  • List of itemized bills along with original receipts of the expenses stamped by the hospital
  • Lab test bills.
  • Physical copy of Cigna health insurance Plan booklet or Cigna health insurance card.
  • Doctor’s prescription on hospital’s letterhead.
  • Payment receipt for prescription medicine reimbursement.

Submitting Cigna Reimbursement claim

You can submit Cigna Reimbursement claims online or offline.

Submitting the claim offline

To submit the claim offline, find the nearest Cigna branch and deposit the duly filled, signed, and stamped Cigna reimbursement form at the branch along with the required documents.

Submitting the claim online

Cigna offers you two pathways to submit your Cigna reimbursement forms online without any hassle.

Option 1: Through the Cigna webpage

  • Visit Cigna webpage
  • Click on the log in
  • Select the “my account” option
  • Click on “new claim”
  • Fill the Cigna Reimbursement form
  • Attach a photo of all the bills and invoices
  • Select “File claim”

Your claim will be filed.

Option 2: Through Cigna Envoy

Cigna insurance company has launched the Cigna envoy app to let you manage your policy and claims on the go. To file a claim through the app:

  • Register on Cigna envoy app
  • Select “my claims” option.
  • Select “new claim”
  • Fill in the Cigna reimbursement form
  • Upload required documents
  • Select “File claim”

Your claim will be filed.

Important points to remember before filling and submitting the Cigna Reimbursement form offline

  • If you fill this form electronically, click to the right of each field and type in the information. Once you have completed the form, click on the Clear Fields button on the bottom of page 1 after printing out the completed form.
  • In case you choose to fill this form by hand, use a printed form instead of a photocopy or duplicate printout so that the form can be easily scanned for the claim process.
  • The claim should be filed within 180 days from the date you received service.
  • Make duplicate copies of all the bills, receipts, and invoices you are depositing along with the Cigna Insurance reimbursement form.
  • The list of itemized bills must include:
    • Primary customer name
    • Date of Service ( in mm/dd/yyyy format)
    • Patient name
    • Type of service/Procedure code
    • Charge for the service
    • Health care professional name/credentials
    • Health care professionals address

How to check the status of your Cigna reimbursement claim?

You can check or review the status of your reimbursement claim on the Cigna Envoy app. You can also track your application online through your Cigna account. Cigna has also introduced an EDI system to enable the exchange of patient's information among health care providers, professionals, and the company safely. You can submit claim status inquiries through your EDI vendor or practice management system. Follow these steps:

  • Enter Patient’s ID number
  • Patient’s first and last name
  • Patient’s date of birth
  • Date of service
  • Cigna assigned claim number
  • Total submitted charges

You will receive all the details of your claim in a few minutes.


Submitting a Cigna reimbursement claim is a simple process. However, it can become tedious and difficult if you do not know the exact steps. While filling and depositing Cigna reimbursement forms, keep all the documents and information ready to avoid inconvenience. Arrange all your documents in line, make sure to get a signature and stamp from the hospital. If you are filling the form by hand to submit offline, you should note all the details separately first or fill the form with a pencil to avoid mistakes. In case you make a mistake, take another form. Make sure that you submit the Cigna reimbursement form before the deadline to avoid any delay or losses.

More From Health Insurance