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  CIGNA Prescriptions, Direct Reimbursement Claim Form (PDF, 67K) cigna_prescription.pdf

1) Use this form for out-of-network providers when the Equity-League is your primary insurance carrier. In-network providers will bill CIGNA Prescriptions directly.

2) The participant must fill out all sections .

3) Please mail the completed claim form to:

Connecticut General Life Insurance Company
Pharmacy Service Center
P.O. Box 3598
Scranton, PA 18505-0598


4) CIGNA Prescriptions will then process your claim for payment. If additional information is required in order to process the claim, CIGNA will contact you. Please note that CIGNA Prescriptions can only make payment to the participant.


For more information about the CIGNA Prescription Benefit Plan, call 1.800 TEL DRUG = 1.800.835-3784

You'll need the free Acrobat Reader to view these forms.

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