Cigna enrollment change form 2021-2026

1. Click ‘Get Form’ to open the Cigna Enrollment Change Form 2021 in our platform.
2. Begin by completing Section A, where your employer will provide necessary details such as Employer Name, Address, and CIGNA Account Number. Ensure the Effective Date of Add/Change/Cancellation is accurately filled.
3. In Sections B-G, as an employee, fill in your personal information including your name, date of birth, and contact details. Specify if you want coverage for dependents and list their names in Section B.
4. Proceed to select your Medical and Dental Benefit Options in Section C. Choose from available plans and indicate any changes regarding dependents in the respective fields.
5. Complete Sections D-I if applicable, detailing any additional coverage options like Life Insurance or Disability benefits. Make sure to sign and date the form at the end.

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