If you have coverage through your employer or plan sponsor, use our workplace benefits insurance forms. If you have coverage through an advisor, use our personal insurance forms.  

Some prescription drug claims need to be approved before you can apply for reimbursement. To do that, we’ll need information from you and your doctor about your plan, your condition, and what you’re being prescribed. 

 

Step 1: Complete a form.

Download the form and print it, or fill it out in Adobe Reader XI or higher  (not your browser) and save. Complete the plan member section.

Step 2: Ask your doctor to complete the physician information section.

Step 3: Submit your request for approval.

You’ll find instructions on how to submit your request on the form itself.