Oxford

Medical Claims

To file a medical claim with Oxford, print the Oxford Health Insurance Claim Form. Complete the Patient and Insured Information section and have the physician complete the bottom half of the form or attach applicable medical documentation. Sign and date the form. Make a copy of the completed claim form and applicable medical documentation for your records. Send completed form and documents to the address noted on the top of the Oxford Health Insurance Claim Form.

Prescriptions – Medco Health Solutions

New Members: If you are a new member to Oxford and you have a prescription filled prior to receiving your Oxford ID Card(s), you will need complete a Pharmacy Reimbursement Claim Form to be reimbursed for your prescription. Print the Pharmacy Reimbursement Claim Form and complete applicable information and tape your pharmacy receipts to your signed claim form. Send the completed form and receipts to the address noted on the Instructions sheet, page 2 of the claim form.

When Traveling: If you are traveling and need to have a prescription filled with an out-of-network pharmacy, complete a Pharmacy Reimbursement Claim Form to be reimbursed for your prescription. Print the Pharmacy Reimbursement Claim Form and complete applicable information and tape your pharmacy receipts to your signed claim form. Send the completed form and receipts to the address noted on the Instructions sheet, page 2 of the claim form.

Mail Order Prescriptions

First-time Prescription Orders: Obtain a written, 90-day prescription supply with refill Prescriptions from your physician. Complete the Medco by Mail Order Form and either fill out the credit card section of the form or include a check or money order for the required co-payment. Send the completed form along with your prescription(s) and co-payment to the address on the bottom of the claim form.

Ordering Refill Mail Order Prescriptions: To order online: go to www.oxfordhealth.com and have your Oxford Subscriber number and Prescription number ready to order your refill(s).

To order by phone: Call 1-800-473-3455 to use the automated refill system. Have your Oxford Subscriber number and your refill slip(s) with the prescription information ready to make your order.

To order by mail: Complete the Medco by Mail Order Form and include your prescription refill slip(s) with the completed form and your co-payment. Do not complete the Patient Information Section for refills.