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sbsStarbridge Select - Coverage for day-to-day medical expenses.

Starbridge Select>Member Resources>Important Forms

Claim Identification Form

1. Complete the Claim Identification Form

Note: claim forms may be photocopied

2. Attach original bills (bills must be originals, not photocopies).

3. Attach copy of "Certificate of Creditable Coverage" from your prior
insurer, if applicable.

4. Mail (Facsimile documents can not be accepted) to:

      Connecticut General Life Insurance Company
      Starbridge Select
      P.O. Box 55270
      Phoenix, AZ 85078-5270
      Toll Free: (800) 308-5948
      Phone: (602) 484-9633

IMPORTANT: Please submit your claim within 90 days of the date of service.

Dental Claim Form
Complete and include this form when submitting a dental claim to Starbridge Select .

Dependent Verification Form

Complete and include this form when submitting a claim to Starbridge Select for a dependent.

Authorization From Individuals Form

This form is required under the Health Insurance Portability and Accountability Act of 1996 (HIPAA Privacy Act).  The form confirms the authorization from an individual from Starbridge Select to use or disclose protected health information for a particular purpose.  The form can also be used to appoint an individual to personally represent an insured person.

Beneficiary Designation Notification Form

Completing and returning this form will allow Starbridge Select to pay a chosen beneficiary upon the insured person's death.

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CIGNA HealthCare’s Claims Department is staffed with Customer Service Representatives ready to provide assistance from Monday through Friday 5 a.m. to 6 p.m., MST at 1-800-308-5948. Spanish speaking representatives are available.

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CIGNA HealthCare
“CIGNA” and “CIGNA HealthCare” refer to various operating subsidiaries of CIGNA Corporation. Products and services are provided by these operating subsidiaries and not by CIGNA Corporation. These operating subsidiaries include Connecticut General Life Insurance Company, Tel-Drug, Inc. and its affiliates, CIGNA Behavioral Health, Inc., Intracorp, and HMO or service company subsidiaries of CIGNA Health Corporation and CIGNA Dental Health, Inc.