At Speedy Template, You can download Cigna Medical Claim Form . There are a few ways to find the forms or templates you need. You can choose forms in your state, use search feature to find the related forms. At the end of each page, there is "Download" button for the forms you are looking form if the forms don't display properly on the page, the Word or Excel or PDF files should give you a better reivew of the page.
Member Claim Form
591692a Rev. 10/2008
FAMILY/OTHER COVERAGE INFORMATION:
Complete only if claim is for a dependent and/or other coverage is in effect
NAME OF HEALTH INSURANCE COMPANYEFFECTIVE DATE OF COVERAGE
EMPLOYEEINFORMATION:Employee complete thissection
If yes, provide:
TYPE OF PLAN (HMO OR PPO) IF KNOWN
C. DESCRIPTION OF HOW ACCIDENT OR WORK RELATED ILLNESS/INJURY OCCURRED
PATIENT INFORMATION:Completeonly if patient is otherthanemployee
ACCIDENT/OCCUPATIONAL CLAIM INFORMATION:
Complete only if claim is a result of an accident or occupational (work related) illness/injury
Speedy Template provides all kinds of legal templates, forms and waivers in different editable formats. Use the template search on the top to find the customized templates that fit your needs with absolutely no cost. Those templates are collected online so we do not claim the ownership of those templates. You can think this website as a legal document search portal and use it to find the printable templates and download them to your local computers and make appropriate adjustments from your end. There is no need to create an account or provide your credit card information. Feel free to download those Word, Excel, PowerPoint or PDF files while we continue to improve this website. Hope you can find those free printable templates useful for business or personal purposes.