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  • Benecard Prior Authorization Form

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MAIL SERVICE Patient Information and Order Form PO Box 779 Mechanicsburg, PA 170550779 Phone: 18777236005 TDD Phone: 18889070020 Fax: 18889070040 www.benecardpbf.com Complete this form to order new.

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BeneCard PBF is a privately owned PBM that puts patients first, improving healthcare while lowering costs.

When you submit a prescription to your pharmacy, the pharmacist will process it through the BeneCard PBF claims system to see if it's covered by your prescription benefit plan. At the same time, the claims system will look for any safety precautions. If it identifies any concerns, it will alert the pharmacist.

When you receive a prescription from your physician, present it along with your BeneCard PBF member card at the participating pharmacy of your choice. If your prescription is covered, you'll be asked to pay a copayment as required by your plan. Your plan sponsor will pay the remaining cost of your prescription.

Be sure to present your Benecard PBF ID card at a participating network pharmacy to receive a discount off the retail price of medications that may not be covered under the guidelines of your prescription benefit program.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232