Certificate of Coverage Request Tool

Welcome to the Certificate of Coverage request tool. Please follow the instructions below to request your certificate. Once you complete all the required information and submit your request, you should receive your letters within two business days.

Synopsys Travel Medical coverage extends to all employees who are traveling on business or leisure. Dependents are covered only when traveling with the employee. Per the policies rules, dependents are:

  • Your lawful Spouse / Domestic Partner
  • Any child born to you or legally adopted by you of yours who is up to 19 years old, or up to 25 if a full-time student who is chiefly dependent on the employee for support. Also includes step child.

Travel to any location sanctioned by the United States Office of Foreign Assets Control (OFAC), or other applicable government or enforcement authority, must be authorized by OFAC or otherwise permissible under applicable law. Contact us at benefitsadmin@richterintl.com for more information.

Traveler Information
Total travel days cannot exceed 180.
Dependent Information
Please enter your dependents' information below:

 

 

Additional Information

Please review the information before submitting. You cannot make changes after submission.

"By submitting this request I hereby certify that any statements made by me are true and correct to the best of my knowledge, information and belief. I understand that any false statements may disqualify me for benefits. I understand that a Certificate of Coverage is not a guarantee of payment and that Cigna will review all claims for coverage under my plan."