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Use these forms to request reimbursement for expenses covered by your plan, including vision, dental and prescription drugs.
To submit a claim:
- Print the relevant form below and complete it. Some forms may require your doctor to fill out certain sections.
- Attach all of the required documentation, including receipts.
- Return this form to us at the address on the form.
Not the forms you're looking for? Go back to the find a form page.