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Forms and Tools to Manage Your Account

Welcome to the downloadable forms resource page. Below you will find all of the necessary forms and applications you need to process a claim or apply for additional coverages.

Downloads

Welcome to the downloadable forms resource page. Files are available in PDF format to be downloaded, printed and mailed accordingly. Acrobat Reader is a free application that can be downloaded at adobe.com/reader/.

Mail all claim forms to the following address:
AGIA Affiliate Services
Claims Department
P.O. Box 9060
Phoenix, AZ 85068

Form Product Form Type Download
Base EA Plus Member Benefit Guide SAMPLE Emergency Assistance Plus Schedule of Benefits Download
Claim Form Cancer Care CIGNA Cancer Care Insurance Plan Claim Form Download
Claim Form Cancer Care TransAmerica Cancer Care Insurance Plan Claim Form Download
Claim Form Hospital Help CIGNA Hospital Help Plan Claim Form Download
Claim Form Hospital Help TransAmerica Hospital Help Plan Claim Form Download
Emergency Roadside Assistance Application Emergency Roadside Service Enrollment Application Download
No Cost Trio of Security Schedule of Benefits No-Cost Trio of Security Schedule of Benefits Download