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Cigna Voluntary Term Life Insurance Enrollment Form

Cigna Voluntary Term Life Insurance Enrollment Form 2026

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The document is a Voluntary Term Life Insurance Application from the Life Insurance Company of North America (LINA), a Cigna Company. It outlines the necessary information and steps for employees to apply for life insurance coverage, including personal details, medical history, and beneficiary designation. The application requires employer verification and includes sections for medical questions that must be answered if coverage exceeds guaranteed amounts or if applying after the eligibility period. The applicant must sign and date the form, acknowledging the terms and conditions of the insurance.

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Click ‘Get Form’ to open it in the editor.
Begin by filling out the Employer section, including details such as your employer's name, class, location/paycode number, date of hire, and annual salary. Ensure all information is accurate for processing.
In the Employee section, select your title (Mr., Mrs., Ms.) and provide your full name, Social Security number, birthdate, address, and contact numbers. This information is crucial for identification purposes.
Complete the coverage selection by indicating the requested amount and whether you are accepting or declining coverage. If applicable, specify any beneficiaries along with their percentage distribution.
Fill out the medical questions thoroughly. If you answer 'Yes' to any question regarding health conditions or treatments in Sections A and B, provide additional details as required.
Sign and date the form in the designated areas to validate your application. Remember to review all sections before submission.

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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 to activate Cigna?

To activate your myCigna account, register at myCigna.com1 or on the myCigna App. Once youre registered, youll be able to: Find in-network doctors and care. Check estimated costs before medical visits and procedures.

How do I get an authorization letter from Cigna?

If you are unable to use electronic prior authorization, you can call us at 800.88Cigna (882.4462) to submit a prior authorization request. For Inpatient/partial hospitalization programs, call 800.926.2273. Submit the appropriate form for outpatient care precertifications. Visit the form center.

How to get a prior authorization form?

Heres how it typically works: Consult Your Doctor. Start by discussing your treatment plan and any specific medications your provider recommends. Contact Your Insurance Provider. Call your insurance company or log into their online portal to check if prior authorization is required. Submit the Request. Await Approval.

Can I request my own prior authorization?

You can submit a request on your own. Find the appropriate prescription drug or medical procedure authorization form for your situation.

Is Cigna a life insurance?

Cigna Health and Life Insurance Company is a subsidiary company of Parent Company Cigna. Cigna and its subsidiary company specialize in providing Medicare Supplement Plans (also called Medigap plans), along with disability, health, accident and life products.

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