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Supplemental Health Claim Form
File an accidental injury, critical illness, hospital care, or wellness claim.
Are you a member?
Activate your myCigna account for access to all plan details and live, 24/7 support.
File Your Claim
If you are a policyholder, activate your myCigna account to access all plan details, file a claim, track claim status, sign up for Direct Deposit and more.
How to Prepare Your Claim
1. Review the required supporting documentation for each claim type. You can find more details below:
Note: For Wellness claims, no supporting documentation is required.
2. Gather information for both the policy-holding employee and the claimant if the claimant is an employee’s dependent.
3. Have your provider fill out the form below that corresponds to your claim type before starting your claim:
- Accidental Injury Physician Statement [PDF]
- Accidental Injury Physician Statement Follow-Up [PDF]
- Critical Illness Physician Statement [PDF]
- Hospital Care Physician Statement [PDF]
How to Submit Your Claim
The best way to file a claim is via myCigna.com.
Claims submitted through myCigna® are processed faster than other submission methods.
If you can’t access myCigna, scroll and read through the Notice below, click the acknowledgement box, and click "Continue" to start your claim.
Remember that all fields are required unless marked optional.
If you can’t submit your claim online, you may also submit your claim by downloading, printing, and completing the appropriate claim form and emailing to SuppHealthClaims@cigna.com:
- Accidental Injury Claim Form [PDF]
- Critical Illness Claim Form [PDF]
- Hospital Care Claim Form [PDF]
- Wellness Incentive Claim Form [PDF]
If at any time you have questions or need assistance with myCigna.com or with filing your claim online, please call 1 (800) 754-3207. We are available Monday through Friday 8 am - 8 pm, ET.
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Disclaimer
Product availability may vary by location and plan type and is subject to change. All health insurance policies and health benefit plans contain exclusions and limitations. For costs and details of coverage, review your plan documents or contact a Cigna Healthcare representative.
All Cigna Healthcare products and services are provided exclusively by or through operating subsidiaries of The Cigna Group Corporation, including Cigna Health and Life Insurance Company, Cigna HealthCare of Arizona, Inc., Cigna HealthCare of Georgia, Inc., Cigna HealthCare of Illinois, Inc., Cigna HealthCare of North Carolina, Inc. and Cigna HealthCare of Texas, 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). Accidental Injury, Critical Illness, and Hospital Care plans or insurance policies are distributed exclusively by or through operating subsidiaries of The Cigna Group Corporation, are administered by Cigna Health and Life Insurance Company, and are insured by either (i) Cigna Health and Life Insurance Company (Bloomfield, CT). The Cigna Healthcare name, logo, and other Cigna Healthcare marks are owned by Cigna Intellectual Property, Inc. This website is not intended for residents of Arizona and New Mexico.