The Official Portal for the State of Georgia

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.

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