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Direct Reimbursement Claim Form

To file a Direct Claim for reimbursement of prescription drug expenses, you will need to complete and print the Online Claim Form (this requires the free Adobe Acrobat reader). Please follow the instructions listed on the top of the Claim Form carefully. Incomplete or illegible forms will delay your reimbursement.

When you have completed the form, mail it with your attached receipt(s) to:
      NMHC Claims Department
      P.O. Box 1170
      Port Washington, NY 11050

You may also fax completed forms with receipt(s) to: (516) 605-6980.

We suggest you save a copy of all documents for your records.

NOTE:
You can avoid the need for filing a direct claim by presenting your NMHC ID card to the pharmacy when you are having your prescription(s) filled. The NMHC card is accepted at over 97% of pharmacies nationwide. Click here to find a pharmacy near you.