COA Member Reimbursement Request Form

The COA Member Reimbursement Request Form is designed for members to submit requests for reimbursement of out-of-pocket medical expenses. It requires detailed member information and a description of the services or products that incurred the costs. Members must provide itemized receipts to ensure the request is processed without delays. The form must be mailed to Colorado Access, and additional support is available via phone. This document is also accessible in various formats upon request.