Form Center

We know you 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. Simply download the claim form, then mail or fax the completed form to the location provided on your CIGNA International ID card.

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

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

Available Forms

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

Medical/Dental/Vision Claim

Select a language below to access the Medical/Dental/Vision claim form.
Language
Language Arabic Chinese Czech Dutch English French German Hindi Italian Japanese Korean Portuguese Russian Spanish Thai

Colonial Medical/Dental/Vision Claim - English
Colonial Medical/Dental/Vision Claim - French

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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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Travel, Sickness and Accident (MBA) Claim Forms

Select a language below to access the MBA claim form.
Language
Language Chinese Czech English French German Hindi Portuguese Russian Spanish Thai Japanese Italian

Medical Benefits Abroad Eligibility Verification Form

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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
Colonial Group LTD Claim
Activities of Daily Living
Medications List
Treating Physician List

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Supplementary Long-Term Disability Claim

Supplementary LTD Claim
Colonial Supplementary LTD Claim

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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.

Statement of Physical Condition
Colonial Statement of Physical Condition

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Statement of Dental Condition

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

Download now

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CIGNA Life Insurance of Canada Forms

Medical/Dental/Vision Claim - English
Medical/Dental/Vision Claim - French
Enrollment and Change Form - English
Enrollment and Change Form - 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
Long-Term Disability Claim - English
Long-Term Disability Claim - French

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Electronic Fund Transfer

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Wire Transfer Form

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Not all of the coverages/forms listed here may be applicable to your plan - please check with your employer to confirm availability.