Ready for some easy money?

    Please tell us who you are:

    Please submit eligible receipts

    Your receipt should include:
    1.   Description of the service.
    2.   Name and license of the provider.
    3.   Date service was received.
    4.   Name of recipient.
    5.   Total amount paid.

    We do not want your credit/debit card receipts.

    IMPORTANT: If you or your spouse have any other health insurance or drug program available to you, it should be used FIRST. Only amounts not covered by that insurance plan or program can then be submitted here. You must include a Statement of Benefits from that provider that shows the amounts not covered (including deductible and co-pay amounts).

    Submitted claims totaling less than $5 will not be reimbursed.

    For your first claim:

    For your second claim:

    For your third claim:

    For your fourth claim:

    For your fifth claim:

    If you have additional claims please submit these batch first and then refresh this page to submit another batch. This helps us ensure that all of your attachments will be uploaded without errors.