Cigna Beneficiary Designation Form PDF Details

A Cigna beneficiary designation form is a document that designates a specific individual or organization to receive the proceeds of an insurance policy in the event of the policyholder's death. This form can be used to name a beneficiary for life insurance, disability insurance, and other types of policies. It is important to designate a beneficiary, especially if you do not have any heirs or if you have a complex estate plan. Naming a beneficiary can ensure that your loved ones receive the benefits from your insurance policy after your death.

QuestionAnswer
Form NameCigna Beneficiary Designation Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namescigna beneficiary, life insurance company of north america cigna beneficiary, 2016 ak cr765 order form search, cigna group life insurance beneficiary form

Form Preview Example

BENEFICIARY DESIGNATION FORM

CIGNA Life Insurance Company of New York

 

New York, NY

Group Insurance

 

Employer Name ___________________________________

Life Accident Disability

Employee Name_____________________________________________ Employee Social Security #_________________

Current Address__________________________________________ City__________________State______ Zip _______

Home Phone____________________Work Phone____________________ please enter all dates in mm//dd/yyyy format.

Primary and Contingent Beneficiaries – Unless you designate a percentage, proceeds are paid to primary surviving beneficiaries in equal shares. Proceeds are paid to contingent beneficiaries only when there are no surviving primary beneficiaries. If you designate contingent beneficiaries and do not designate percentages, proceeds are paid to the surviv- ing contingent beneficiaries in equal shares. Unless otherwise provided, the share of a beneficiary who dies before the insured will be divided proportionately among the surviving beneficiaries in the respective category (primary or contingent).

Basic Term Life Insurance, CIGNA Life Insurance Company of New York - Policy No. __________

Employee’s Primary Beneficiary(ies):

Relationship to Employee

Social Security Number

Date

of Birth

%(total must equal 100%)

Employee’s Contingent Beneficiary(ies):

Relationship to Employee

Social Security Number

Date

of Birth

%(total must equal 100%)

Voluntary Term Life Insurance, CIGNA Life Insurance Company of New York - Policy No. __________

Employee’s Primary Beneficiary(ies):

Relationship to Employee

Social Security Number

Date

of Birth

%(total must equal 100%)

Employee’s Contingent Beneficiary(ies):

Relationship to Employee

Social Security Number

Date

of Birth

%(total must equal 100%)

Basic Accident Insurance, CIGNA Life Insurance Company of New York - Policy No. __________

Employee’s Primary Beneficiary(ies):

Relationship to Employee

Social Security Number

Date

of Birth

%(total must equal 100%)

Employee’s Contingent Beneficiary(ies):

Relationship to Employee

Social Security Number

Date

of Birth

%(total must equal 100%)

Voluntary Accident Insurance, CIGNA Life Insurance Company of New York - Policy No. __________

Employee’s Primary Beneficiary(ies):

Relationship to Employee

Social Security Number

Date

of Birth

%(total must equal 100%)

Employee’s Contingent Beneficiary(ies):

Relationship to Employee

Social Security Number

Date

of Birth

%(total must equal 100%)

Note: This form is not complete without your signature. Please sign the form on page 2 where indicated.

Community Property Laws - If you are married, reside in a community property state (Arizona, California, Idaho, Louisiana, Nevada, New Mexico, Texas, Washington or Wisconsin), and name someone other than your spouse as beneficiary, it is possible that payment of benefits may be delayed or disputed unless your spouse also signs the beneficiary designation.

Spouse Signature________________________________________________________________Date____/____/____

Owner Signature___________________________________________________________________Date____/____/____

If you need additional space, using the above format, attach a separate piece of paper with the appropriate policy number, the date, and your signature.

GUIDELINES FOR DESIGNATION OF BENEFICIARIES

General - Please be sure to include the beneficiary’s full name, social security number and relationship to you. Providing this information can help expedite the claim process by making it easier to locate and verify beneficiaries.

Minors - While you may designate minors as beneficiaries, please note that claim payments may be delayed due to special issues raised by these designations. In the event of a claim and the beneficiary is a minor child, the insurance proceeds will not be released to the minor child. The insurance proceeds may be paid to a duly appointed guardian of the child’s estate. You may want to obtain the assistance of an attorney in drafting your beneficiary designation.

Trust as Beneficiary - You may designate a trust as beneficiary, using the following form: “To [name of trustee], trustee of the [name of trust], under a trust agreement dated [date of trust].”

If you wish to designate a testamentary trust as beneficiary (i.e., one created by will), you should recognize the possibility that your will which was intended to create this trust may not be admitted to probate (because it is lost, contested, or super- seded by a later will). Claim payment delays can result if the beneficiary designation doesn’t provide for this situation.

Life Status Changes - We recommend that you review your beneficiary designation when significant life status events occur, such as marriage, divorce, or birth of a child.

See an Attorney! The above guidelines are general and are not intended to be relied on as legal advice. Unless your designation is a simple one, we recommend that you obtain the assistance of an attorney in drafting your beneficiary designation. A qualified attorney can help assure that your beneficiary designation correctly reflects your intentions, is clear and unambiguous, and meets legal requirements.

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Be mindful while filling in this pdf. Ensure that each and every blank is completed accurately.

1. The cigna beneficiary form needs specific details to be typed in. Be sure that the next fields are finalized:

Part no. 1 in submitting dearborn life insurance beneficiary form

2. Once your current task is complete, take the next step – fill out all of these fields - Employees Contingent Beneficiaryies, Relationship to Employee, Social Security Number, Date, of Birth, total must equal, Basic Accident Insurance CIGNA, Employees Primary Beneficiaryies, Relationship to Employee, Social Security Number, Employees Contingent Beneficiaryies, Relationship to Employee, Social Security Number, Date, and of Birth with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

The way to prepare dearborn life insurance beneficiary form stage 2

3. The following section is mostly about Community Property Laws If you, Spouse SignatureDate, Owner SignatureDate, If you need additional space using, GUIDELINES FOR DESIGNATION OF, General Please be sure to include, Minors While you may designate, Trust as Beneficiary You may, If you wish to designate a, Life Status Changes We recommend, and See an Attorney The above - complete each one of these blanks.

Completing segment 3 of dearborn life insurance beneficiary form

It is easy to make errors while filling out the Spouse SignatureDate, hence be sure to go through it again prior to deciding to submit it.

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