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Templates
Government forms
Prescription Reimbursement Claim Form - Aug 2015

Government forms

Prescription Reimbursement Claim Form - Aug 2015

This form is used by Illinois state employees to file a paper claim for benefits.

Originally published by: illinois.gov

Used 85 times

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Frequently asked questions

The Illinois State Employee English Paper Claim Form is used by Illinois state employees to file a paper claim for benefits. The form should be used by those who are unable to file a claim electronically. Once completed, the form should be mailed to the address provided on the form.
Illinois state employees who are unable to file a claim electronically.
The completed form should be mailed to the address provided on the form.

Used 85 times