Claim Reminders BE SURE TO USE YOUR MEMBER ID AND ACCOUNT/GROUP NUMBER WHEN YOU FILE CLAIM FORMS, OR WHEN YOU CALL OUR CLAIM OFFICE. • YOUR MEMBER ID IS THE ID SHOWN ON YOUR BENEFIT IDENTIFICATION CARD. • YOUR ACCOUNT/GROUP NUMBER IS SHOWN ON YOUR BENEFIT IDENTIFICATION CARD. BE SURE TO FOLLOW THE INSTRUCTIONS LISTED ON THE BACK OF THE CLAIM FORM CAREFULLY WHEN SUBMITTING A CLAIM TO US. Timely Filing of Claims We will consider claims for coverage under Your plan when proof of loss (a claim) is submitted to Us within: • 12 months for In-Network claims • 12 months for Out-of-Network claims after services are rendered. If services are rendered on consecutive days, the limit will be counted from the last date of service. If claims are not submitted to Us within the timeframe shown above, the claim will not be considered valid and will be denied. Failure to give notice within such time shall not invalidate nor reduce any claim if it shall be shown not to have been reasonably possible to give such notice and that notice was given as soon as was reasonably possible. NOTE : We consider one month to equal 30 days regardless of the number of days within a calendar month. WARNING: Any person who knowingly and with intent to defraud any insurance company or other person: files an application for insurance or statement of claim containing any materially false information; or conceals for the purpose of misleading, information concerning any material fact thereto, may be guilty of committing a fraudulent insurance act determined by a court of law.
How to Find a Cigna Vision Provider and File a Claim Cigna Vision Providers To find a Cigna Vision Provider, or to get a claim form, You should visit myCigna.com and use the link on the vision coverage page, or You may call Customer Service using the toll-free number on Your identification card. How to File a Claim Reimbursement/Filing a Claim When You have an exam or purchase Vision Materials from a Cigna Vision Provider You pay any applicable Copayment, Coinsurance or Deductible shown in The Schedule at the time of purchase. You do not need to file a claim form. There is no paperwork to submit for Covered Vision Services received from a Participating Provider. If You have an exam or purchase Vision Materials from a provider who is not a Cigna Vision Provider, You pay the full cost at the time of purchase. You must submit a claim form to be reimbursed or the claim can be submitted by the provider if the provider is able and willing to file on Your behalf. If Your plan provides coverage when care is received only from a Participating Provider, You may still have claims for services received from a Non-Participating Provider. For example, when Emergency Services are received from a Non- Participating Provider, You should follow the claim submission instructions for those claims. Claims can be submitted by the provider if the provider is able and willing to file on Your behalf. If the provider is not submitting on Your behalf, You must send Your completed claim form and itemized bills to the claims address listed below. Send a completed Cigna Vision claim form and itemized receipt to: Cigna Vision, Claims Dept. c/o FAA PO Box 8504 Mason, OH 45040-7111 Cigna Vision will pay for covered expenses within ten business days of receiving the completed claim form and itemized receipt. You may get the required claim forms from the website listed on Your identification card, if You received one, or by calling Customer Services using the toll-free number listed below. Cigna’s Toll Free Number(s): 1-(800) CIGNA 24 (1-800-244-6224) or 1-(888)-353-2653
HCVIS-CLM0
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myCigna.com
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