Reimbursement Request

If you received a bill for medical services or if you paid for medications that should be covered by the plan, you can request that we pay for the invoice or request a reimbursement.

Send us your request for payment, along with your bill and/or documentation of any payment you have made. Even if it is not a requirement, we suggest you fill out our claim form to make your request for payment. This form, which you can find below, will help us process the information faster, with all the information we need to make a decision. It’s also a good idea to make a copy of your bill and receipts for your personal records.

Important details

You must submit your claim within a period of 12 months from the date when you received the service, item, or medication. When the request arrives to the plan, it must be processed within 14 calendar days. If the plan’s decision is favorable to you, the plan must make the payment within a period of 14 calendar days after receiving the request.

For more details on how to submit a claim in writing, you can refer to the Claims Process that is explained in Chapter 7 of the Evidence of Coverage of your plan.

For more information or help in submitting your request, you can contact Member Services.