Get Ucare Eye Glass Reimbursement Form

The Ucare Eye Glass Reimbursement Form is designed to assist users in obtaining reimbursement for their eyewear expenses. By following the steps below, you can easily complete the form online and ensure you provide all necessary information for a successful reimbursement.

Follow the steps to fill out the Ucare Eye Glass Reimbursement Form.

1. Click the ‘Get Form’ button to access the reimbursement form and open it in your preferred editor.
2. Fill in your member information. Include your Member ID number, last name, first name, middle initial, address, city/state/zip code, date of birth, and phone number.
3. Provide the name, address, and phone number of your service provider. Make sure this information is accurate to avoid delays.
4. Indicate the total number of receipts you are attaching to the form. Ensure these receipts are itemized and show the type of service.
5. Specify whether the eyeglasses are for post-cataract surgery by checking 'YES' or 'NO.'
6. Enter the date of purchase in the format MM/DD/YYYY. This is crucial for processing your request.
7. Select the place of service and circle the type of service you received, such as eye glass frames, lenses, or contact lenses.
8. Document the amount you paid for each service listed on the form. Double-check for accuracy.
9. Read and sign the certification and authorization section. Your signature confirms that the information is accurate and has not been submitted elsewhere.
10. After completing the form, save any changes, download or print a copy for your records, and share it as necessary.

Complete your Ucare Eye Glass Reimbursement Form online today to ensure prompt reimbursement for your eyewear expenses.