FORMS
File for a hassle-free claim reimbursement online
Use our online form to request reimbursement for covered medications purchased at retail cost. Filing online is quick, easy, and results in faster response than filing by mail.
If you would prefer not to file online, download your claim form as a PDF (descargue su formulario de reclamo como PDF)
HIPAA and your rights
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Rule gives you rights over your protected health information (PHI), including the right to obtain, change, share and monitor the information. These rights are collectively known as “Individual Rights.”
Authorizing releaseof your health information
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Rule gives you rights over your protected health information (PHI), including the right to obtain, change, share and monitor the information. These rights are collectively known as “Individual Rights.”
PersonalRepresentative information
By submitting a Personal Representative form, you can legally appoint or designate someone to act on your behalf.
