Adobe Reader XI or higher is required to fill out and save a completed form. Download Adobe ReaderOpens a new website in a new window.
If you bought coverage through your advisor, use our personal insurance forms instead.
Make a claim
Use this form to make a claim for medical cannabis expenses under your employer or plan sponsor.
Step 1: Complete a claim form.
Download the form and print it, or fill it out in Adobe Reader XI or higherOpens a new website in a new window (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 claim.
You’ll find instructions on how to submit your claim on the form itself.