Claims Forms
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.
Kaiser Permanente
No claim form required. Submit itemized bill containing the member name and ID number to: Kaiser Permanente, Claims, P.O. Box 190849, Atlanta, GA 31119-0849