Optumr Claim Form

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Web use this form to request reimbursement for covered medications purchased at retail cost. Web use our online form to request reimbursement for covered medications purchased at retail cost. Include the original pharmacy receipt for each. Follow the instructions on the main page. Use this form to submit your claims for reimbursement of eligible dependent care expenses.

Web use this form to request reimbursement for covered medications purchased at retail cost. Filing online is quick, easy, and results in faster response than filing by mail. Use this form to request reimbursement for covered medications purchased at retail cost. Follow the instructions on the main page to enter a new claim.

Include The Original Pharmacy Receipt For Each.

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Web Use This Form To Request Reimbursement For Covered Medications Purchased At Retail Cost.

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