In and Out-of-network Reimbursement Process

The drug reimbursement request form can be used in cases where you have had to pay for your covered drugs.  The reimbursement form must be submitted within 180 days of purchase. The Original Receipts must be included with the form. The plan must make a coverage determination within 72 hours after request was received. If reimbursement applies, payment must be made within a 30 calendar days from receipt of request.

For more information you can call our Customer Service Department at 1-888-767-7717 Monday thru Friday from 8:00 am to 8:00 pm. TTY /TDD users should call 1-877-672-4242.

Click Here for PPO Reimbursement Formulary

Click Here for HMO Reimbursement Formulary

Click Here for PDP Reimbursement Formulary