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Form OWCP-915 can be used to seek reimbursement for expenses in regard to medical treatment, prescription medication and medical supplies. Please submit a separate reimbursement claim for each provider where an out of pocket expense was incurred. Please print clearly and legibly.
Printable Forms. All of the Federal Employees Program's online forms (with the exception of Forms CA-16, CA-26 and CA-27) are available to print and to manually fill and submit. Simply click on the appropriate form and print it using the [Print] button provided near the top of the form.
Fill out and download the OWCP-915 Claim for Medical Reimbursement form online for free. Easily submit your medical expenses for reimbursement using this editable PDF template.
Pharmacy must complete the Universal Drug Claim Form (NCPDP Form 79-1A) or equivalent, which must be attached to this form (CA-915) and must include the following: Pharmacy’s name, address and tax identification number (IRS. No.).
Instructions for use of FORM OWCP-915 Medical Reimbursement • The OWCP-915 is used to seek reimbursement for out-of-pocket medical expenses pertaining to the treatment of an accepted condition including (but not limited to) medical treatments, prescription medications and medical supplies.
1 sie 2024 · Updated versions of the OWCP-915 claimant reimbursement and DEEOIC authorization request forms are now available and have an expiration date of 07/31/2027. Please begin using the updated forms for any claimant reimbursement or DEEOIC authorization requests.
OWCP's DEEOIC has made a variety of forms available online. These forms are only available in PDF format. To view and/or print PDF documents you must have a PDF viewer.
