Member Vaccine Reimbursement

HMO member reimbursement form for vaccines: Flu, Shingles, and Tda​​p/Td

Medicare Members

Hill Physicians is not responsible for reimbursement for Tdap/Td​ shot (Boostrix®, Adacel®, Tenivac®, TDVAX®) or shingles shots (Zostavax®, Shingrix®). Please call your Medicare Part D insurance company to see if they will pay for you to get the vaccine at a pharmacy, or if they only pay for the vaccine in your doctor’s office.​ Hill Physicians will reimburse up to $90 for the flu vaccine.​

HMO Members (non-Medicare)

Hill Physicians will reimburse your vaccine cost up to $90 for the flu vaccine, up to $80 for the Tdap/Td shot​ (Boostrix®, Adacel®, Tenivac®, TDVAX®), and up to $275 for each dose of shingles shot (Zostavax®, Shingrix®​).​​

Reimbursement Steps

  1. Fill out the form below.
  2. ​Attach 2 receipts (original pharmacy receipt and a copy of the cash register receipt). You must attach both receipts to receive reimbursement.
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Max. file size: 100 MB.
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