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Click ‘Get Form’ to open the Cigna Vision Claim Form in our 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 identification number or SSN. Missing information may delay your claim.
Next, complete the Subscriber Information section with similar details about the subscriber. Include their employer name and insurance plan name.
In the Request for Reimbursement section, enter the amounts charged for services such as exams and lenses. Remember to check the type of lenses purchased.
Fill in the Provider Information section with the provider's name, address, and telephone number.
Attach original itemized receipts that detail the services received. Finally, sign and date the form before submission.
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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.
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.
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.
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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.
Related links
CIGNA Vision Claim Form
IMPORTANT: This claim form is intended for subscribers and covered dependents who receive services from providers outside the CIGNA Vision network.
Mar 19, 2021 Identify the previous filing by registration statement number, or the Form or Schedule and the date of its filing. (1) Amount Previously Paid: (
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