Following is the claim form and instructions for getting reimbursed for the COVID-19 at-home test kit(s) you purchased. For faster processing, you are instructed to mail in the completed reimbursement form directly to our pharmacy benefit partner, MedImpact. See complete instructions and mailing address on the form.
CCHP COVID-19 Test Kit Reimbursement
(Please Read First)
A few important points to remember:
- Have your CCHP Member ID card ready
- Complete only one claim form per member
- Per member reimbursements are for 8 tests per month, costing up to $12 per test
- When submitting for multiple members with original receipt(s), enclose multiple forms that go with the receipt(s)
- Purchases that cover more than one month supply will not be honored
For any future test kits or testing needs, consider the options we have provided for your convenience. These options require no upfront out-of-pocket costs – you just need to show your CCHP Member ID card. Click Here to See Options.
Thank you for being a CCHP Member.
Download Claim Form Here