Enrollee Prescription Drug Claim Form - Cigna - Thank You Macyand#39;s 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by selecting the reason for reimbursement from the options provided. This helps clarify your request.
3. Fill in your enrollee information, including ID number, RxPCN, name, birth date, and sex. Ensure accuracy for a smooth processing.
4. In the Enrollee Certification section, confirm that all information is correct and sign where indicated. This step is crucial for validating your claim.
5. Complete the Prescription Information section for each medication you are claiming reimbursement for. Include details like date filled, drug name, quantity, and amount paid.
6. If applicable, fill out the Compound Prescription Information section with details provided by your pharmacy.
7. Review all sections to ensure completeness and accuracy before submitting your claim.

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