Get Over-the-counter Benefit

This guide provides clear and supportive instructions for completing the Over-the-Counter Benefit form online. As a member of Imperial Insurance Company of Texas, you can order eligible items conveniently without a prescription.

Follow the steps to complete your Over-the-Counter Benefit form.

1. Select the ‘Get Form’ button to access the Over-the-Counter Benefit form and open it in your preferred editing tool.
2. Enter your name in the designated field. Ensure that the name matches the name associated with your membership.
3. Input your phone number, allowing for easy communication regarding your order if necessary.
4. Fill in your member ID number, which is essential for verifying your eligibility.
5. Provide your shipping address, including city, state, and ZIP code, for the delivery of the items.
6. Choose the month you wish to have your items delivered, circling one of the months provided on the form. Remember, orders can be placed up to two months in advance.
7. List the products you wish to order by filling in the product codes and quantities in the fields provided on the form. Ensure the total order meets the minimum requirement of $25.
8. Sign in the designated area to validate your order, showing that you agree to the terms.
9. After completing the form, save your changes. You may also download, print, or share the completed form as needed.

Complete your Over-the-Counter Benefit form online today to take advantage of your eligible benefits.