Once you complete a form, check the instructions on that specific form. Most forms will have a mailing address printed directly on them, such as the Chattanooga, TN address for medical claims or the Ashburn, VA address for privacy requests. Always send your forms to the address listed, or follow the submission method provided—some forms allow fax or electronic submission.

If you paid out of pocket at a non-network pharmacy, or for short-term needs, complete the Short-Term Prescription Claim Form and include your detailed pharmacy receipt. If you have Medicare Part D, use the SilverScript Prescription Claim Form.

Yes. To give another person permission—such as a spouse, caregiver, or family member—submit the Authorized Representative Form under the HIPAA Privacy section. Once approved, that person will be able to speak with the Plan about your benefits, claims, and coverage on your behalf.

If you have upcoming travel, complete the Vacation Prescription Request Form. This form allows you to receive an early refill so you don’t miss doses while you’re away.