Application Form to join the Cigna International network of preferred providers

Application Form to join the Cigna International network of preferred providers

Please fill out, submit and we will evaluate your application.

General Information

*Required Field

Physical Address

Billing/Payment Address (only if different from above)

P.O. Box


Number of beds in

Member of Hospital Group

Contacts

General

Admission Desk /Guarantee of Payment

Agreements

Billing/Finance

Payment Details

Price Lists

Remove

Complementary Information

What is the legal entity type of the hospital?*

International Patient Desk

Status doctors

Medical liability insurance

Accreditations:

Is the hospital considered as a centre of excellence for specific diagnoses or treatments?

Does the hospital have agreements with international insurance companies?

Does the hospital have agreements with international companies or organisations?

Does the hospital have agreements with other hospitals on a national/international basis?

Is the hospital member of a national/international hospital federation?

List of specialties

Please add your specialties Add

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Application Form to join the Cigna International network of preferred providers

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