Get the free Dental Claim Form Cigna dental plans are insured and or ...

CHINA Dental Enrollment Reinsured and/or Administered by CHINA Health and Life Insurance CompanyEmployer: Complete Section A Employee: Complete Sections B, C & Please print and thank you for providing

How to fill out dental claim form cigna

How to fill out dental claim form cigna

1. To fill out a dental claim form for Cigna, follow these steps:
2. Begin by entering your personal information, such as your name, date of birth, and address.
3. Next, provide your employer or plan sponsor details, including the company name and address.
4. Indicate your Cigna dental plan information, including the policy or group number, and the name of the primary subscriber if applicable.
5. Specify the date of the dental treatment or service received.
6. Fill in the dental provider's information, including their name, address, and contact details.
7. Use the designated sections to provide a detailed description of the dental treatment or services rendered. Include the procedure codes, tooth numbers, and any additional information requested.
8. If you have other dental insurance coverage, indicate the primary carrier's details and any coordination of benefits information.
9. For each service or treatment, include the provider's charges and indicate the amount covered by insurance.
10. Finally, review the completed form for accuracy and sign and date it.
11. Ensure you have attached any necessary supporting documents, such as a copy of the dental invoice or receipt.
12. Submit the filled-out dental claim form to Cigna according to their specified submission method, such as mailing it to the provided address or submitting it online through their member portal.

Who needs dental claim form cigna?

1. Anyone with a Cigna dental insurance plan may need to fill out a dental claim form. This includes individuals who have received dental treatment or services and wish to seek reimbursement from their insurance provider. It is also necessary for dependents covered under a Cigna dental plan who received dental care. Essentially, anyone who wants to submit a dental claim to Cigna for coverage or reimbursement of dental expenses would require the dental claim form.

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What is dental claim form cigna?

Dental claim form cigna is a form used to request reimbursement for dental expenses from the insurance provider Cigna.

Who is required to file dental claim form cigna?

Any individual who has received dental services covered by Cigna insurance and wishes to be reimbursed for those expenses is required to file the dental claim form.

How to fill out dental claim form cigna?

To fill out the dental claim form cigna, you need to provide information about the dental services received, the dentist or dental provider, and any other relevant details requested on the form.

What is the purpose of dental claim form cigna?

The purpose of the dental claim form cigna is to request reimbursement for dental expenses covered by Cigna insurance.

What information must be reported on dental claim form cigna?

The dental claim form cigna requires information about the dental services received, the date of service, the cost of the services, and the dental provider's information.