Submitting benefit expenses or claims is easy. Here’s what you need to know:

Cigna Medical, Mental Health and Behavioral Claim Forms

In most cases when you receive medical care, you’ll be asked to present your insurance card at the time of service. This will enable your healthcare provider to determine what your plan covers and, typically, to submit a claim to your medical plan for you. In the event this doesn’t happen, or you feel you’ve been billed in error, contact your medical plan.

Step-by-step instructions on how to submit a claim by mail or online

Questions about Cigna claims? Contact our Cigna Onsite representative.

Cigna Mental Health Claims

For the Cigna plans, there are no claim forms to complete when you see a Cigna provider. If you see an out-of-network provider, you can submit a claim for out-of-network services [PDF].

Kaiser Claims

Kaiser members can reference this guide [PDF] for more information on paying for care and managing expenses.

Dental Claims

For NVIDIA Dental PPO Plan, there are no claim forms to complete when you see a Delta Dental PPO provider. If you see an out-of-network provider, you can submit a claim for out-of-network services [PDF] by selecting the Delta Dental of California drop down.

You should pay the non-participating dentist for the services you receive at your appointment. Ask the dentist for a detailed receipt or billing statement for the services rendered. It should contain the following:

  • The amount paid
  • A list of all the services and procedures provided, including the teeth treated
  • Name and address of your dentist
  • Date of service

Have a copy of the receipt or billing statement attached to the claim to expedite the processing.

Vision Claims

There are no claim forms to complete when you see a VSP provider. If you see an out-of-network provider, you can submit a claim for reimbursement [PDF].

Spending Account Claims

When you spend money that is eligible for reimbursement from your Health Care Flexible Spending Account or Limited Purpose Flexible Spending Account, the best thing to do is use your Spending Account Card to avoid having to submit receipts. When this isn’t possible, you must submit claims to WageWorks, our FSA administrator, using the appropriate form. (If you can’t find your card, contact WageWorks.) Submit a claim form to get reimbursed for Daycare expenses. 

Health Care FSA Reimbursement Form [PDF]
Day Care Reimbursement Form [PDF]
Limited Purpose FSA Claim Form [PDF] 

Health Savings Account

You can pay for care in any of four ways:

  1. Use your HSA debit card at the point of service.
  2. Set up Fidelity BillPay® for Health Savings Accounts, which allows you to make online payments. If your provider offers electronic billing, you can link them to Fidelity BillPay and receive an email notification when your bill is ready.
  3. The Fidelity HSA checkbook works just like the HSA debit card to pay at the point of service.
  4. Pay out of pocket and reimburse yourself later.