If you have coverage through your employer or plan sponsor, use our workplace benefits insurance forms. If you have coverage through an advisor, use our personal insurance forms.
Use this form to request reimbursement for non-emergency medical expenses incurred while travelling, such as massage treatments or prescription refills. You'll find instructions on how to return the completed form on the form itself.
Download the form and print it, or fill it out in Adobe Reader XI or higher (not your browser) and save.