Get Hill Physicians Members

This guide provides clear instructions on completing the Hill Physicians Members reimbursement form for flu vaccinations received at a retail location. By following these steps, you can ensure you fill out the form correctly and submit it for reimbursement effectively.

Follow the steps to successfully complete the form and obtain your reimbursement.

1. Press the ‘Get Form’ button to access the reimbursement form, opening it in your digital editor.
2. Begin by filling out the Doctor’s Name, which is required to identify your healthcare provider.
3. Next, enter the Health Plan Name associated with your Hill Physicians membership.
4. Provide your Subscriber ID Number, which can be found on your insurance card.
5. Fill in your First and Last Name accurately as it appears in your membership record.
6. Input your Street Address, ensuring it’s accurate for future correspondence.
7. In the City field, enter the name of the city you reside in.
8. The State will automatically be set as California (CA), which is required for proper mailing.
9. For the Zip code, ensure that you enter the correct postal code for your area.
10. Document the Date of Birth of the individual receiving the vaccination.
11. Input your Phone Number, including the area code, for any follow-up inquiries.
12. Specify Where Service Was Performed, detailing the retail location of your flu shot.
13. Attach the original receipts, ensuring you have both the pharmacy receipt and the cash register receipt for reimbursement processing.
14. Remember to allow four weeks for the reimbursement check to be processed after submission.
15. Mail the completed form and receipts to the specified address for the Flu Vaccine Reimbursement Program.

Complete your Hill Physicians Members reimbursement form online today for your flu vaccination.