Medical and Prescription Forms
- CIGNA Medical Claim Form
- CIGNA Mail Order Form for Prescriptions (Choice Fund Plan participants only)
- CIGNA Claim Form for Prescriptions (Choice Fund Plan participants only)
- Express Scripts/Medco Mail Order Form for Prescriptions (Incentive and Co-Pay Plan participants only)
- Express Scripts/Medco Claim Form for Prescriptions (Incentive and Co-Pay Plan participants only)
Flexible Spending Account (FSA) Forms
- Dependent Care FSA Claim Form from PayFlex (for 2012 and 2013 expenses)
- Health Care FSA Claim Form from PayFlex (for 2012 and 2013 expenses)
- Limited-Purpose FSA Claim Form from CIGNA (for 2012 expenses) (only for Choice Fund plan participants)
- Limited-Purpose FSA Claim Form from PayFlex (for 2013 expenses) (only for Choice Fund plan participants)
Retirement Forms
- How to Enroll in Voluntary Retirement Savings (formerly Tax-Deferred Annuities)
- Waiver for Three-Year Waiting Period of Purdue’s 10% contribution 403(b) Defined Contribution Retirement plan
Other Benefit Forms and Information
Information on which medical procedures or tests require pre-certification through CIGNA can be found by accessing CIGNA Pre-Certification (PDF).
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