CIGNA International Expatriate Benefits Privacy Forms

If you need to make a request mentioned in the "CIGNA International Expatriate Benefits Notice of Privacy Practices," you must provide a request in writing. You can either send us a written request or use one of the forms* below that we've provided here for your convenience.

If you'd like to use a form to submit a request, select the appropriate link to print the form you need. Please send all signed and completed forms to the address below.

HIPAA Authorization* (PDF)

HIPAA Confidential Communication* (PDF)

HIPAA Personal Representative* (PDF)

HIPAA Request for Restriction* (PDF)

HIPAA Request for Access * (PDF)

HIPAA Request to Amend * (PDF)

HIPAA Request for an Accounting of Disclosures* (PDF)

Privacy Office
CIGNA International Expatriate Benefits
590 Naamans Road
Claymont, DE 19703

*If you do not have Adobe Acrobat Reader^®, please see our Acrobat Instructions for downloading, installing and using the free software.