Get Money Back
How to get reimbursed for your out-of-pocket expenses
Perhaps you paid money out of your own pocket for emergency care you received while traveling outside the Tufts Health Plan service area. Or perhaps a covered dependent paid for urgent treatment at a clinic in another part of the country.
Payments for health care:
If you have paid out of pocket for covered health care services and you want to ask for reimbursement for expenses that exceed your applicable copayment, coinsurance, and/or deductible, fill out our Member Reimbursement Medical Claim Form and send it to us. We will pay you back for the out-of-pocket costs you paid that are covered under your plan, except for any copayments, coinsurance, and/or deductible you are responsible for.
Download the Member Reimbursement Medical Claim Form
Prescription drug costs:
If you’re covered by the Tufts Health Plan prescription drug benefit and have paid for covered drugs, fill out and send the CVS Caremark claim form to the address listed on the form.
Download the Prescription Reimbursement Standard Claim Form
If you have other prescription drug coverage, please check with the person in your company who manages health care benefits.
You can also get medical and pharmacy reimbursement forms by calling a member service representative at the number on your member ID card.
Three things you should know:
- There are deadlines for asking for your money back, so check your SBC, speak with the benefits manager where you work, or call a Tufts Health Plan member service representative at the number on your member ID card.
- If you paid for covered services you received from a doctor in our network, we will pay the doctor and ask the doctor to pay you.
- We pay out-of-network provider bills at what is called the “reasonable charge.” If the amount you paid is more than the “reasonable charge”—not including any copayments, coinsurance, and deductible you paid—you are responsible for paying the amount over the “reasonable charge” unless the services were for emergency care.