Form Center

We know you (and your employees) don't have time to wait for important forms to arrive in the mail. Now you can get the forms you need right here.

It's easier than ever to submit a claim. Expatriate employees can simply download the claim form, then mail or fax the completed form to the location provided on their CIGNA International ID card.

All forms will open in a new window. If you don't have Adobe® Acrobat® Reader to view PDF documents, download it from the Adobe® site.

Please check your policy to determine your respective coverage and limitations.

Forms

Medical/Dental/Vision Claim
Life/Accidental Death and Dismemberment/Short-Term Disability Claim
Long-Term Disability Claim
Supplementary Long-Term Disability Claim
Travel, Sickness and Accident (MBA) Claim Forms
Statement of Physical Condition
Electronic Fund Transfer
Wire Transfer Form
Enrollment and Change Form
CIGNA Life Insurance of Canada Forms

Medical/Dental/Vision Claim
Select a language below to access the Medical/Dental/Vision claim form.

Language Arabic Chinese Czech English French German Russian Spanish Japanese Thai Portuguese Italian

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Life/Accidental Death and Dismemberment/Short-Term Disability Claim

Group Proof of Loss Accidental Dismemberment
Group Proof of Loss Accidental Death
Group Proof of Loss Short-Term Disability

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Long-Term Disability Claim

When submitting an LTD claim, please complete each of these forms in their entirety, in order for your request to be processed as quickly as possible. Contact information, such as phone number and email address is essential so that we may update you on the status of the claim. Please contact CIEB Customer Service with any questions regarding these forms (800 441 2668 or 302 797 3100).

Group LTD Claim
Group LTD Claim - Spanish
Activities of Daily Living
Medications List
Treating Physician List

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Supplementary Long-Term Disability Claim

Supplementary LTD Claim

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Travel, Sickness and Accident (MBA) Claim Forms
Select a language below to access the MBA claim form.

Language Chinese Czech English French German Russian Spanish Japanese Italian

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Statement of Physical Condition

The Statement of Physical Condition form may be required to determine if you're eligible under your policy provisions.

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Electronic Fund Transfer

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Wire Transfer Form

Download now

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Enrollment and Change Form
Select a language below to access the Enrollment and Change Form.

Language English Spanish

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CIGNA Life Insurance of Canada Forms

Medical/Dental/Vision Claim - English
Medical/Dental/Vision Claim - French
Statement of Physical Condition Form
MBA Claim Form - English
MBA Claim Form - French
MBA Employer Verification Form
Life/Accidental Death Claim Form
Life/Accidental Dismemberment Claim Form - English
Life/Accidental Dismemberment Claim Form - French
Long-Term Disability Claim - English
Long-Term Disability Claim - French

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