Loading
Get Keystone Otc Store
How it works
-
Open form follow the instructions
-
Easily sign the form with your finger
-
Send filled & signed form or save
How to fill out the Keystone Otc Store online
This guide provides step-by-step instructions on how to complete the Keystone Otc Store Order Form online, ensuring a smooth and efficient experience for users. With your OTC benefit, you can easily access a variety of health-related products at no cost to you.
Follow the steps to successfully complete your order form.
- Press the ‘Get Form’ button to access the Keystone Otc Store Order Form and open it in your preferred editor.
- Fill in your personal information, including your date of birth, member ID number (located on your health ID card), last name, first name, middle initial, street name, street number, apartment or suite number, city, state, ZIP code, email, and daytime phone number. If this is a new address, check the box provided.
- Select the OTC products you wish to order by entering the item number, product name, quantity, and price for each item. Ensure that your total order amount does not exceed your quarterly benefit allowance.
- Review your completed order form carefully to confirm that all information is accurate and that you have included only the products you need.
- Once satisfied with your order, you can save the changes to your document, download it for your records, or choose to print it out.
- Mail your completed order form to the OTC Servicing Center at the specified address or, if you prefer, place your order via phone.
Start filling out your order form online today for quick and easy access to your OTC benefits.
Related links form
Visit a participating pharmacy or retailer to buy eligible OTC items with your available funds. Participating retailers and OTC categories can be found under the Over-the-Counter Benefit Section of the online portal at KeystoneFlexCard.com. Your benefit amount of $315 is offered at the beginning of each quarter.
Industry-leading security and compliance
US Legal Forms protects your data by complying with industry-specific security standards.
-
In businnes since 199725+ years providing professional legal documents.
-
Accredited businessGuarantees that a business meets BBB accreditation standards in the US and Canada.
-
Secured by BraintreeValidated Level 1 PCI DSS compliant payment gateway that accepts most major credit and debit card brands from across the globe.