Prescription Copay Claim Form


Please read the information under the Prescription Copay Information tab prior to submitting for reimbursement.  If you have any questions, please contact the SBF at (716) 881-5462.

 

Supplemental Benefit Fund Prescription Copay Claim Form

For more information regarding the SBF Optical Benefits, please see the Prescription Copay Information Section.

S5 Box

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