Molina Complete Care has partnered with Veyo to provide our members with another way to get to and from medical appointments – with the help of a friend or family member. Veyo provides compensation to drivers who give MCC members a ride to their eligible healthcare appointments. This is called a “mileage reimbursement.”

Trips are paid at $0.40 per mile. The total amount paid is calculated based on the most direct route from the member’s pickup location to the healthcare facility and back. The route is planned using Veyo’s mapping software. Payments to drivers will be sent electronically, unless the driver specifies otherwise.

Submit the form below to ask for reimbursement for a Molina Complete Care Medallion 4.0 trip. You must be a registered driver with MCC / Veyo to do so.

To register as a driver, please submit the Driver Registration Form before asking for payment for a trip.

If you have trouble viewing the form, please make sure that you are using the latest version of the Google Chrome browser. If you are still having issues, please download a printable version of the form by visiting the Print Forms page.

If you have trouble finding your trip, please make sure that you are using the correct form. If you are a Molina Complete Care CCC Plus member, please use the Molina Complete Care CCC Plus Trip Reimbursement Form.

To view our Mileage Reimbursement Guidelines, please download the guide from our Print Forms page.

Click the button below to download a free PDF reader if you do not have a PDF reader on your computer.