- Member Reimbursement Form (pdf) – effective 1/1/2020
- MedImpact Reimbursement Form (pdf) (for claims from 2019 and earlier)
- OptumRx Reimbursement Form (pdf) (for claims from 2020)
Prescription Drug Forms:
- Part D (Pharmacy) Coverage Determination Request Form
- Part D Redetermination Request Form
- Medicare Part D Reconsideration Form (pdf)
- OptumRx Home Delivery Prescription Drug Order Form (pdf)
New Member Presentations:
- New Member Presentation Massachusetts
- New Member Presentation Maine
- New Member Presentation New Hampshire
Harvard Pilgrim is an HMO/HMO-POS plan with a Medicare contract. Enrollment in StrideSM (HMO) depends on contract renewal.
Links on this page may take you away from the Harvard Pilgrim Health Care website.
Y0098_21111 Last Update: 02/04/2021