Get the free Prescription Drug Reimbursement Claim Form - Harvard Pilgrim
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Member Reimbursement Request Nonprescription Drugs
InstructionsSubmit1.×You must submit your reimbursement request within 180
days of the date you purchased the prescription drug.
Reimbursement for
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How to fill out prescription drug reimbursement claim
How to fill out prescription drug reimbursement claim
01
To fill out a prescription drug reimbursement claim, follow these steps:
1. Obtain a prescription drug reimbursement claim form from your insurance provider.
02
Fill in your personal information including your name, address, and policy number.
03
Provide details about the prescription drug you are seeking reimbursement for, such as the name of the medication, dosage, and quantity.
04
Attach the original pharmacy receipt or invoice for the prescription.
05
If applicable, include any additional supporting documents such as a doctor's prescription or a letter of medical necessity.
06
Double-check all the information you have provided to ensure accuracy.
07
Submit the completed claim form along with the supporting documents to your insurance provider either by mail or electronically.
08
Keep a copy of the completed claim form and supporting documents for your records.
09
Follow up with your insurance provider to track the progress of your reimbursement claim.
Who needs prescription drug reimbursement claim?
01
Anyone who has a prescription drug expense and has insurance coverage for prescription drug reimbursement needs to fill out a prescription drug reimbursement claim. This includes individuals who have purchased prescription drugs out-of-pocket and need to be reimbursed by their insurance provider.
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