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Note: Please be aware that effective 10/1/04, the Equity-League Health Trust Fund has a new Group Policy Number. The Group Policy Number will be 3209088.

Any claims that are occured on or after January 1, 2005, and need to be submitted to Cigna, please use the following claim form in which the OAP plan is in effect:

  CIGNA Claim Form (PDF, 25K) cigna_claim.pdf

1) CIGNA will accept HCFA and UB82 forms; however, if your doctor or provider would rather submit our claim form, you may use this form.

2) The participant must fill out all sections except the section labeled "PHYSICIAN or PROVIDER: Complete This Section." The provider must fill out section labeled "PHYSICIAN or PROVIDER: Complete This Section." If the provider gives you an itemized bill but you still prefer to use our claim form, simply attach the itemized bill and fill out your portion of the claim form.

3) Please mail the completed claim form to the address listed on the back of your Major Medical/Hospital ID Card.

The Address should be one of the following:

CIGNA HEALTHCARE
P.O. Box 5200
SCRANTON, PA 18505-5200

CIGNA HEALTHCARE
P.O. Box 182223
CHATTANOOGA, TN 37422-7223


4) If after processing your claim the insurance company requires further information, they will contact either you or the provider.


Any claims that were rendered from October 1, 2004 through December 31, 2004, please use the following claim form in which the PPO plan was still in effect:


  CIGNA Claim Form (PDF, 59K) cigna_claim-prior123104.pdf


1) CIGNA will accept HCFA and UB82 forms; however, if your doctor or provider would rather submit our claim form, you may use this form.

2) The participant must fill out all sections except the section labeled "PHYSICIAN or PROVIDER: Complete This Section." The provider must fill out section labeled "PHYSICIAN or PROVIDER: Complete This Section." If the provider gives you an itemized bill but you still prefer to use our claim form, simply attach the itemized bill and fill out your portion of the claim form.

3) Please mail the completed claim form to the address listed on the back of your Major Medical/Hospital ID Card.

The Address should be one of the following:

CIGNA HEALTHCARE
P.O. Box 5200
SCRANTON, PA 18505-5200

CIGNA HEALTHCARE
P.O. Box 188038
CHATTANOOGA, TN 37422-8038

4) If after processing your claim the insurance company requires further information, they will contact either you or the provider.


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