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Cigna hsa reimbursement form

865625b Cigna HSA, HRA, and FSA Reimbursement Request Form. 865625b Interactive 2025

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The Cigna Health Care Reimbursement Request Form is designed for individuals to request payment from their HSA, HRA, FSA, or other related accounts. It requires complete and accurate information to ensure timely processing of claims. The document outlines necessary employee and patient details, the declaration of eligible expenses, and instructions for submitting the form along with required receipts. Additionally, it includes frequently asked questions to assist users in filling out the form correctly and understanding the reimbursement process.

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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 get FSA HSA reimbursement?

With an FSA, you submit a claim to the FSA (through your employer) with proof of the medical expense and a statement that it hasnt been covered by your plan. Then, youll get reimbursed for your costs.

How does Cigna reimbursement work?

You or your provider will need to submit a claim. If your provider does not submit a claim, you will need to submit one in order to be reimbursed. In both cases, you will be reimbursed based on the amount covered by your plan and subject to your plans deductible, copay, or coinsurance requirements.

How do I get my 1095-B form from Cigna?

To request your 1095-B form, you can: Log in to your myCigna account and download a copy from the Forms Center. Mail a request for statement to: 900 Cottage Grove Road. Bloomfield, CT 06152. Be sure to include your full name, account number, and customer ID or Social Security Number (SSN)

How does HRA reimbursement work?

The health savings account (HSA) gives employees ownership of a tax-exempt savings account they can use to contribute pre-tax dollars to pay for covered health care costs. The health reimbursement account (HRA) is employer-funded and, combined with a health plan, helps employees pay for covered health care costs.

How does Cigna HRA reimbursement work?

How an HRA works. Your employer contributes a sum of money into your HRA. This is usually on the first day you are covered under the Cigna HealthcareSM plan. Use your HRA to pay for eligible health care expenses for you and your covered dependents.

What is the difference between Cigna HRA and HSA?

Getting reimbursed To download the appropriate Health Care Reimbursement Request Form, visit Customer Forms. Read the claim form closely, and call us at 1 (800) 244-6224 if you have questions. One claim form can be used to request up to three expenses. Mail or fax claim forms to Cigna HealthcareSM

865625b Cigna HSA, HRA, and FSA Reimbursement Request Form. 865625b Interactive 2025

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