Claims Forms
Claims forms should be mailed directly to the address specified on each form.
CIGNA
CIGNA Choice Fund HRA - Retired Members Use this form for filing claims for the CIGNA Choice Fund HRA.
CIGNA Choice Fund HRA - Active Members Use this form for filing claims for the CIGNA Choice Fund HRA.
CIGNA claim for all options EXCEPT HRA - Active Members
CIGNA claim for all options EXCEPT HRA - Retirees
UnitedHealthcare
UHC Pharmacy Claim Form for PPO Members
UHC Health Claim Transmittal Form - Updated 2/18/08
Use this form for PPO and High Deductible Plan members for dates of services January 1, 2006 forward.