Transportation and Escort Services (all plans)
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All Fidelis SecureCare plans offer reimbursement for transportation or escort services for up to 12 medically necessary off-site appointments per year. (See your Evidence of Coverage booklet for details.) Use this form to submit your claim for any eligible transport or escort expenses you may have incurred.
Note that your claims submission requires accurate information about the dates and hours of your trips and dated invoices or receipts must accompany your completed form.
If you have any questions about the Transportation and Escort Services benefit or how to submit a claim, please call a Customer Service Representative at 1-877-372-8085, Monday through Friday, 8:00 a.m. to 6:00 p.m.
Incontinence/Vitamin Supplies (Fidelis Secure Independence plan only)
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Your Fidelis Secure Independence plan reimburses you for a set amount per quarter for incontinence and vitamin supplies. These include but are not limited to briefs, under pads, protective underwear, wipes and over-the-counter vitamin supplements. (See your Evidence of Coverage booklet for details.) To receive timely reimbursement for qualifying supplies you have purchased, please complete and submit this form at least quarterly.
Note that you are required to submit dated invoices or receipts with your claim..
If you have any questions about the Incontinence/Vitamin Supplies benefit or how to submit a claim, please call the Fidelis SecureCare Pharmacy Help Line at 1-877-372-7948, Monday through Friday, 8:00 a.m. to 6:00 p.m.
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