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How To Submit A Claim ( note: reimbursement rate is contracted rate less applicable copayment) : Online: Go To: Under Information Center Select Forms Click Online Claim Form Click "File a form online" Paper Form: Download OptumRx Claim Form (pdf) Complete, sign/date, include documents and make copies for your records Mail to: OptumRx, PO Box 650334, Dallas TX 75265-0334 2025 Prescription Drug Plan Co-Pays Tier One: Covered generic drugs Tier Two: Covered preferred brand-name drugs Tier Three: Covered brand-name drugs** Aetna HDHP with HSA Plan applies deductible, then copay (except preventive meds) * Using home delivery saves one month's copayment for specialty and long-term maintenance medications **Some medications are excluded and alternative medications are available, check with your physician Contraceptive Coverage for 2025 ***If a prescription is not a generic or single source brand, refer to the above OptumRx tier schedule for the 2nd or 3rd tier copays

Whole fish protein was measured by Kjeltec TM 8200 (FOSS, Sweden)

Prevalence of glp1 use is 2.5 times higher in those with #eatingdisorders than the general population

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