Prescription reimbursement form uhs 2026

1. Click ‘Get Form’ to open the prescription reimbursement form uhs in the editor.
2. Begin by entering your name and student ID number in the designated fields. Ensure that your Anthem Blue Cross ID is correctly formatted as U followed by your student ID (e.g., U12345678).
3. Select your plan type by circling either M001 for graduate students, M002 for undergraduate students, or M003 for Filing Fee/Withdrawal/Concurrent Enrollment students.
4. Fill in your date of birth in the specified format (mm/dd/yyyy) and indicate your gender by checking the appropriate box.
5. Once all fields are completed, review your entries for accuracy before saving the document. You can then print it out or save it as a PDF.
6. Submit your completed form along with prescription receipts via fax, email, or mail as outlined in the instructions provided on the form.

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