Important Forms

	Health Care
	Life, Accident & Disability
	International & Expatriate

• Change Your Primary Care Physician
• Request a CIGNA HealthCare ID Card
• Reimbursement Request Forms
  (Flexible Spending Accounts)
• Medical Claim Form
• Continuity of Care Request
• Update Your Plan Coverage
  (Spouse, Dependent Children, Medicare,
  Cancellation of Duplicate Coverage,
  Coordination of Benefits)
• Change Your Dentist
• Request a Dentist Directory
• Request a Patient Charge Schedule
• Request a CIGNA Dental Care ID Card
• Dental Claim Form
• Pharmacy Claim Form
• Prior Authorization Request Forms
• Reimbursement Forms

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• Submit a Disability Claim
• Disability Disclosure Authorization
• Enrollment Applications and Forms

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• Member Medical Claim Forms (multiple languages)
• Broker Enrollment & Change Form
• Wire Transfer Form
• Employer Medical Claim Forms

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Find doctors, hospitals and pharmacies, review medical and dental claim information, check your Prudential Retirement 401(k) or pension balance. It's simply the most convenient way to check your benefits information. Learn more.

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