NALC HBP Postal High Option Forms | Claims, Privacy & More

Postal

Manage Your Health Plan with Confidence

Managing health benefits comes with some paperwork, but for Postal employees, you can quickly find and submit every form you need for your NALC High Option Plan coverage right here.

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Forms

Caremark Forms

Use these forms to manage your prescription needs with CVS Caremark®.

Mail Order Prescription Form

Submit this form with your prescriptions and payment to receive medications by mail.

Download Mail Order Prescription Form

Short-Term Prescription Form

Submit this form for the reimbursement of short-term prescriptions received at non-network or retail pharmacies. Receipts are required.

Download Short-Term Prescription Form

Compound Prescription Reimbursement Form

Submit this form for the reimbursement of compound drugs. Include a full ingredient list and itemized printout.

Download Compound Prescription Reimbursement Form

Claim Forms

These forms are for submitting covered medical and accident-related expenses.

Member Medical Claim Form

If you currently have Medicare coverage or are submitting a foreign claim, please submit to the following address:  NALC Health Benefit Plan, 20547 Waverly Court, Ashburn, VA 20149

All other completed Member Medical Claim Forms should be sent to NALC Health Benefit Plan, Cigna Payor 62308, PO Box 188004, Chattanooga, TN 37422-8004

Download Member Medical Claim Form

Form 41 - Important Questionnaire (Coordination of Benefits)

Submit this form when you or a dependent has other insurance coverage (health, auto, or Medicare).

Download Important Questionnaire (Coordination of Benefits)

Form J400 – Dental Accident Claims

Submit this form for dental services and expenses that were received within 72 hours of an accident.

Download Dental Claim Form

Photo Release PDF

Grant us permission to use your photo for NALC Health Benefit Plan materials.

Download Photo Release Form

Privacy Forms

Manage your privacy and how your health info is shared.

HIPAA Privacy Notice

Understand how your protected health information (PHI) is handled.

Get HIPAA Privacy Notice

Authorized Representative Form

Let someone speak to NALC HBP on your behalf. Complete this form to grant access.

Get Authorized Representative Form

Request for Access to PHI

Request a copy of your personal health records from the NALC HBP.

Request Access to PHI

Request for Alternate Address

Safeguard your information by requesting mail at a different address.

Request for Alternate Address

Authorization for Release of Information

Authorize us to share your PHI with a third party (e.g., an insurer or new provider).

Get Authorization for Release Information

Mail all completed forms to: Privacy Officer – NALC Health Benefit Plan 20547 Waverly Court – Ashburn, VA 20149

SilverScript® Prescription Drug Program Forms

Manage enrollment or submit prescription claims for Medicare-eligible members using SilverScript®.

Mail Order Prescription Form

Submit this form along with your prescriptions and payment for mail-order medications through SilverScript

Get Mail Order Prescription Form

Prescription Drug Claim Form

Submit this form to request reimbursement for eligible Medicare Part D prescriptions.

Get Prescription Drug Claim Form

Travel Prescription Request Form

Traveling soon? Ensure you’re covered.

Submit this form to request an early refill of your regular prescriptions before you travel. Submissions must be received prior to departure.

Download Travel Prescription Request Form

2025 Massachusetts Schedule HC

Massachusetts residents must verify health coverage when filing state taxes.

Schedule HC Form + Instructions NALC HBP qualifies as Minimum Creditable Coverage. Use this form when submitting your MA tax return.

Get Schedule HC Form

Get Instructions

We're Here to Help - Contact and Support

Your questions matter. Reach out for help with your NALC High Option Plan forms or coverage.

NALC HBP Member Services

For general plan questions, our team is ready to assist you

Go to Contact Page

Download Your Plan Brochure

For all the detailed information on your benefits—including exclusions and limitations—please download your official Plan Brochure.

Download Plan Brochure

Frequently Asked Questions (FAQs) — Quick Answers for You

We’ve gathered answers to common questions—to provide immediate clarity.

Once you have completed a form, they should be mailed to the address listed or submitted in the manner the form suggests.

Yes. Submit the HIPAA Authorized Representative Form to grant permission.

It gives NALC HBP permission to use your photos in communications or testimonials.

Only submit forms when needed—such as when filing claims, updating privacy info, or requesting coverage changes.

View All FAQs

Manage Your Health Plan with Confidence

Download Forms

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Forms

Forms

Most Popular

Caremark Forms

Claim Forms

Photo Release PDF

Privacy Forms

HIPAA Privacy Notice

Authorized Representative Form

Request for Access to PHI

Request for Alternate Address

Authorization for Release of Information

SilverScript® Prescription Drug Program Forms

Travel Prescription Request Form

2025 Massachusetts Schedule HC

We're Here to Help - Contact and Support

NALC HBP Member Services

Download Your Plan Brochure

Frequently Asked Questions (FAQs) — Quick Answers for You