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Cigna vision claim form

Cigna vision claim form 2026

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The Cigna Vision Claim Form is designed for subscribers and dependents receiving services from non-participating providers. It outlines the necessary steps to complete the claim, including providing patient and provider information, attaching itemized receipts, and submitting the form to Cigna Vision. The document emphasizes the importance of accuracy to avoid delays or denials in claim payments and includes fraud warnings specific to various states.

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Click ‘Get Form’ to open the Cigna Vision Claim Form in the editor.
Begin by filling out the Patient Information section. Ensure you provide your last name, first name, street address, city, state, postal code, telephone number, birth date, and sex. This information is crucial for processing your claim.
Next, complete the Subscriber Information section with similar details about the subscriber. Include their employer name and insurance plan name as well.
If applicable, indicate if there is another health benefit plan by checking 'Yes' or 'No' and provide the Explanation of Benefits from that provider.
In the Request for Reimbursement section, enter the amounts charged for exams, frames, lenses (specifying type), and contacts. Remember to attach original itemized receipts.
Finally, sign and date the form at the bottom before submitting it to Cigna Vision at the provided address.

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Versions	Form popularity	Fillable & printable
2015	4.8 Satisfied (290 Votes)
2013	4.3 Satisfied (39 Votes)

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

How do I submit a claim to Cigna vision?

Fill out the Cigna Vision claim form. You can find it online on Cigna.com, or on myCigna.com, under Forms. Make sure to download the Cigna Vision claim form and not the medical form.

Is Cigna vision EyeMed or VSP?

For eligibility, coverage and claim status questions please contact: Cigna Vision services by EyeMed at 1.888. 353.2653.

Does Cigna cover eye vision?

Cigna Medical Plans Cover Non-routine Eye Care Our medical plans cover non-routine vision care. Non-routine care is the examination, treatment and management of an eye condition or disease such as cataracts, glaucoma, diabetic retinopathy, macular degeneration, infections, eye pain or injury.

Does Cigna insurance cover vision?

Services covered by your Vision Plan includes a vision and eye health evaluation including but not limited to eye health examination, dilation, refraction and prescription for glasses.

How do I submit a Cigna vision claim?

Call the toll-free number found on your Cigna insurance card and talk with a Cigna Vision customer service representative. verifying your eligibility. Send a completed Cigna Vision claim form and itemized receipt to: Cigna Vision, Claims Department: PO Box 997561, Sacramento, CA 95899-7561.

cigna vision out of network claim form

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Can you submit Cigna claims online?

Direct Electronic Claim Submission Submit electronic claims directly to Cigna using the Post-n-Track web service. This free, easy to use option is available through Post-n-Track for sending HIPAA standard ANSI 837 claim files.