Reimbursement Forms

General Reimbursement Form

Use our general reimbursement form to get paid back for Wellness Bucks purchases, myFlex plan purchases, and covered medical services you paid for.

Note for Flex plan members. If you're using this form for a myFlex purchase, get paid back faster by logging into your myFlex account and making a payment request.

Get the Form

Prescription Drug Reimbursement Form

Use our prescription drug reimbursement form to get paid back for covered medications you paid for.

Get the Prescription Drug Form