Prescription Drug Claim Form
Use this form if you've paid for a prescription you'd like SCAN to reimburse you for.
- Prescription Drug Claim Form - English Last Modified: 4/9/2024
- Prescription Drug Claim Form - Spanish Last Modified: 4/9/2024
Medical Services Claim Form
Use this form if you paid for healthcare services and want SCAN to reimburse you.
- Medical Services Claim Form - English Last Modified: 4/5/2024
- Medical Services Claim Form – Spanish Last Modified: 4/5/2024
- Medical Services Claim Form - Chinese Last Modified: 4/5/2024
Health Services Provided Outside of the United States Claim Form
Use this form if you’ve received a bill from a foreign healthcare provider that needs to be paid.
- Foreign Provider Reimbursement Request – English Last Modified: 4/5/2024
- Foreign Provider Reimbursement Request – Spanish Last Modified: 4/5/2024
- Foreign Provider Reimbursement Request – Chinese Last Modified: 4/5/2024
