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FORM 4 ? Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT

How to fill out cigna group 4 received

How to fill out cigna group form 4

1. To fill out Cigna Group Form 4, follow the steps below:
2. Start by entering the required information on the top part of the form. This includes the group number, effective date, employer information, and policyholder's name.
3. Next, provide the employee's personal details, such as full name, address, social security number, and date of birth.
4. Fill in the section related to the employee's dependents, if applicable. Include their names, dates of birth, and relationship to the employee.
5. Complete the coverage details section, indicating the type of coverage (medical, dental, vision, etc.) and the desired coverage levels for the employee and dependents.
6. If there are any additional remarks or special instructions, provide them in the designated area.
7. Review the completed form to ensure all information is accurate and legible.
8. Sign and date the form, along with any required signatures from the policyholder or employer representative.
9. Finally, submit the filled out form to the appropriate Cigna representative or follow the instructions provided for submission.

Who needs cigna group form 4?

1. Cigna Group Form 4 is typically needed by employers or policyholders who offer group insurance coverage through Cigna to their employees. Employees may also need to complete this form if they are enrolling in or making changes to their coverage.

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What is cigna group form 4?

Cigna Group Form 4 is a specific form used by Cigna's group health plans for reporting information regarding health insurance policies and services provided to plan members.

Who is required to file cigna group form 4?

Entities that sponsor Cigna group health plans, including employers and benefits administrators, are required to file Cigna Group Form 4.

How to fill out cigna group form 4?

To fill out Cigna Group Form 4, gather the necessary information about the group plan members, services provided, and follow the instructions provided by Cigna for completing the form accurately.

What is the purpose of cigna group form 4?

The purpose of Cigna Group Form 4 is to ensure compliance with regulatory requirements and to provide necessary data for accurate record-keeping and reporting on health insurance coverage.

What information must be reported on cigna group form 4?

Cigna Group Form 4 must report information such as the number of covered lives, types of health services utilized, and any other relevant data pertaining to the group health plan.