If you have coverage through your employer or plan sponsor, use our workplace benefitsOpens in a new window insurance forms instead.

Make a claim

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 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.