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I understand that a photocopy/facsimile of this authorization is considered acceptable in lieu of the original. PATIENT SIGNATURE PARENT / GUARDIAN / POWER OF ATTORNEY SP1813 Rev. 01-05 RELATIONSHIP TO PATIENT White Chart Copy WITNESS/NOTARY Yellow Requestor File Legal/Correspondence IMPORTANT INFORMATION/NOTES FOR THE RECIPIENT It is CIGNA Medical Group s practice to release upon authorization and/or notification photocopies of medical records a...

How to fill out cigna sp1813 form

How to fill out cigna sp1813 form:

1. Start by carefully reading all the instructions provided on the form. Make sure you understand all the requirements and sections of the form before proceeding.
2. Begin by entering your personal information, such as your full name, date of birth, address, and contact details, in the designated fields. Ensure the accuracy of this information as it will be used for communication purposes.
3. Next, provide your insurance policy details, including your policy number and any relevant identification numbers.
4. Move on to the section where you need to describe the reason for filling out the form. Provide a clear and concise explanation of why you are submitting this form and the specific benefits or claims you are seeking.
5. If applicable, include any supporting documentation or medical records that may be required to substantiate your claim. Ensure that these documents are correctly labeled and attached securely to the form.
6. Review the entire form once you have completed filling it out to make sure all the fields are accurately filled. Double-check for any missing or incorrect information.
7. Sign and date the form at the appropriate sections to certify that all the information provided is truthful and accurate.
8. Keep a copy of the filled-out form and any supporting documents for your records.

Who needs cigna sp1813 form:

1. Individuals who are enrolled in a Cigna insurance policy and need to submit a claim for benefits or reimbursements.
2. Policyholders who are seeking coverage for specific medical services, treatments, or procedures that may require pre-authorization.
3. Individuals who are applying for coverage or making changes to their existing coverage under their Cigna insurance policy.

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What is cigna sp1813 form?

The cigna sp1813 form is a tax form used by Cigna to report information regarding health coverage provided to individuals.

Who is required to file cigna sp1813 form?

Employers or sponsors of self-insured health plans that provide health coverage to individuals must file the cigna sp1813 form.

How to fill out cigna sp1813 form?

The cigna sp1813 form should be filled out with accurate information regarding the health coverage provided, including the names and social security numbers of covered individuals.

What is the purpose of cigna sp1813 form?

The purpose of the cigna sp1813 form is to report information to the IRS about the health coverage provided to individuals, as required by the Affordable Care Act.

What information must be reported on cigna sp1813 form?

The information that must be reported on the cigna sp1813 form includes the names and social security numbers of covered individuals, as well as the months in which coverage was provided.