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Get Cigna Staples Wellness Claim Form
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How to fill out the CIGNA Staples Wellness Claim Form online
Filling out the CIGNA Staples Wellness Claim Form online can help you submit your wellness expenses efficiently. This guide provides step-by-step instructions to ensure you complete the form accurately and effectively.
Follow the steps to fill out the CIGNA Staples Wellness Claim Form online
- Click ‘Get Form’ button to obtain the form and open it in your editor.
- Begin by filling out your member information. Include your CIGNA ID number, last name, first name, middle initial, and address (number & street, city, state, zip code).
- Indicate your gender by selecting either 'Male' or 'Female'.
- Select the status of the claimant by checking the appropriate box (Subscriber, Spouse, or Dependent Child).
- In the claim information section, indicate the name of the Health Club, Weight Loss Program, or Fitness Equipment you are submitting for reimbursement.
- Enter the date your health club membership began, the weight loss program started, or the date of fitness equipment purchase.
- Provide the total amount you are submitting for reimbursement, ensuring it does not exceed the benefit maximum.
- Sign and date the certification and authorization section, confirming the accuracy of the information provided.
- Collect all required attachments, including itemized photocopies of receipts and contracts, ensuring they meet the specified guidelines.
- Save the changes you made. Options are available to download, print, or share the completed claim form.
Complete your CIGNA Staples Wellness Claim Form online today to ensure you receive your eligible wellness reimbursements.
Related links form
To obtain your Cigna Form 1095, log into your Cigna account and navigate to the tax documents section. Your Form 1095 will be available for download, which details your health coverage for the previous year. This document is important for completing your tax return, and you can use the CIGNA Staples Wellness Claim Form if you also need to file wellness claims.
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