Cigna fmla form 2026

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The document is a certification form for health care providers related to pregnancy disability leave and serious health conditions under the Family and Medical Leave Act (FMLA). It outlines the process for employees to request leave, the necessary medical certification required from health care providers, and compliance with federal and state laws regarding medical information. The form includes sections for both employee and provider completion, detailing the employee's condition, expected duration of leave, and any necessary treatments.

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Click ‘Get Form’ to open the Cigna FMLA form in the editor.
Begin by filling out Section I, which requires your personal information such as Employee Name, Employer Name, and Leave ID. Clearly state the reason for requesting leave and specify the leave dates.
Once Section I is complete, provide the form to your healthcare provider for them to fill out Section II or III, depending on your situation. Ensure they include their signature and relevant medical details.
After receiving the completed sections from your healthcare provider, review all entries for accuracy before submitting. Use our platform’s tools to make any necessary edits easily.
Finally, return the completed certification form to Cigna Leave Solutions via mail or fax as indicated at the bottom of the form.

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