CIGNA Dental Claim Form

UCAR Finance & Administration

Form Title:	CIGNA Dental Claim Form
Last Revised:	2/2012
Purpose:	Use to report expenses incurred during a dental visit
Who Should Use the Form:	Employees with CIGNA dental insurance
Instructions:	Login/Register to myCIGNA.com Click on “Forms Center” link (upper right corner next to “Log Out”) Download Dental PDF Complete the form, sign and submit to the address on your CIGNA Dental ID card: P.O. Box 9013 Sherman, TX 75091-9013
Form Download Information
File Format:	Adobe Acrobat (.pdf)
Form File:	myCIGNA.com
Problems? Contact:	Irena Haimsky, x8706

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