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Ucare eyeglass reimbursement form 2026
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- Click ‘Get Form’ to open the ucare eyeglass reimbursement form in the editor.
- Begin by filling in your Member Information. Enter your Member ID, last name, first name, middle initial, address, city/state/zip code, date of birth, and phone number accurately.
- Provide the service provider's name, address, and phone number. Indicate the total number of receipts attached and whether the eyeglasses are for post-cataract surgery by checking YES or NO.
- Fill in the Date of Purchase in MM/DD/YYYY format and select the Place of Service. Circle all applicable types of service (Eye Glass Frames, Eye Glass Lenses, Contact Lenses) and enter the Amount Paid.
- Sign and date the Certification and Authorization section to confirm that all information is complete and accurate before submitting your form.
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