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Cigna coordination of benefits form 2026

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The Spousal Coverage Questionnaire Form is designed for employees enrolled in a CIGNA HealthCare plan to provide information about their spouse's health benefits coverage. It facilitates coordination of benefits between CIGNA and other health care carriers, ensuring accurate claims processing. The form must be completed and mailed to the CIGNA HealthCare Claims Center, as online submission is not permitted. It includes sections for personal details, employment status, health coverage specifics, and Medicare information.

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Click ‘Get Form’ to open the Cigna Coordination of Benefits form in our platform's editor.
Begin by filling in your personal information, including your name, address, and Cigna Healthcare member ID number. Ensure accuracy for prompt processing.
Next, provide details about your spouse, including their name, date of birth, and social security number. Indicate if they are employed and provide their employer's information if applicable.
Complete the sections regarding your spouse’s health benefits plan. Specify the carrier's name, policy number, and coverage dates. This information is crucial for coordinating benefits.
Finally, review all entries for completeness and accuracy. Once satisfied, print the form using our platform’s print function or your browser’s print option before mailing it to the designated claims center.

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