Claim
Claim Form - Medical (FEP)
Federal Employee Program (FEP) members use this form to file a medical claim. ID: 10407
Claim Form - Medical - Reimbursement - Orally Administered Cancer Medication Coverage
Use this form to request reimbursement for cancer medication. ID: 5337
Dental - Patient Encounter Form
This is a Dental claim form used by the dental provider for patient encounters. ID: 2954
Prescription Drug Claim Form
Use this claim form to submit eligible pharmacy expenses for reimbursement. You have to submit one claim form for each person and each prescription. Full instructions can be found on page 2. ID: 3272 NJ 04/23