The drug claim form is available to you in a variety of ways. You can print the Prescription Reimbursement Claim Form online. You can also request copies by mail or in person.

To print the claim form:

• Log onto My Account.
• Hover over Drugs and click Order drugs online. You’ll be directed to HMSA’s pharmacy benefit manager’s web-page.
• Click Plans & Benefits and choose Print Plan Forms and select the appropriate link under Paper Claims Reimbursement Forms.

To request that the claim form be mailed to you:

• Call HMSA’s Customer Relations department and select the drug option to speak with a representative.

To request the claim form in person:

• Visit an HMSA office to pick up claim forms.