Get Prescription Drug Claim Form For Yale Health Members Use This Claim Form To Request Reimbursement

Filling out the Prescription Drug Claim Form is an essential step for Yale Health members seeking reimbursement for their prescription drug purchases. This guide will provide you with comprehensive, step-by-step instructions to help you complete the form accurately and efficiently.

Follow the steps to successfully complete your prescription drug claim form.

1. Click ‘Get Form’ button to access the claim form and open it in your preferred document editor.
2. Complete the top portion of the form in full, ensuring all fields are filled out accurately. Incomplete forms will be returned, so double-check your information.
3. Enter the subscriber’s full name, mailing address, date of birth, and the patient’s name (if different from the subscriber). Make sure to include the patient’s member ID number.
4. Indicate the patient’s status by checking the appropriate box (faculty/staff/associate or student). Also, provide the patient’s date of birth.
5. If the medication is covered under any other insurance plan, provide the name of the employer and insurance company.
6. Attach copies of the prescription receipts. Ensure they clearly show the following information: pharmacy name, address & phone number, patient name, prescription number, prescription fill date, drug name, strength, NDC code, drug quantity, day supply, drug cost, and amount paid.
7. Certify that all information provided is correct and that the person is eligible for benefits by signing the form.
8. Once completed, save your changes to the form. You can then download, print, or share the form, along with the attached receipts.
9. Mail the completed form and receipts to Catamaran at the provided address. Ensure that postage is affixed, and consider using a trackable mailing option.

Take the first step towards reimbursement by completing your prescription drug claim form online today.