Disclosure Authorization

We want you to get the benefits you deserve.

First, we need your authorization to collect information to support the claim. To do so, it's important that you mail a signed Disclosure Authorization Form to us to begin processing your request for benefits.

Simply follow these two easy steps:

1. Print out the Disclosure Authorization Form(s) below.
   
   Disclosure Authorization for Deceased Insured Claim *(PDF 19k)
   
   Disclosure Authorization for Living Insured Claim *(PDF 19k)
   
   
2. Sign, date and mail the Disclosure Authorization Form to the office that manages your claim.

Pittsburgh, PA
CIGNA Group Insurance
P.O. Box 22328
Pittsburgh, PA 15219
Fax: 877-300-6770