Get Valucare Reimbursement

Completing the Valucare Reimbursement form is essential for receiving reimbursement for eligible lifestyle benefits. This guide provides clear, step-by-step instructions to help users effectively fill out the form online.

Follow the steps to successfully complete the Valucare Reimbursement form.

1. Click the ‘Get Form’ button to obtain the Valucare Reimbursement form and open it in your preferred editor.
2. Enter your Subscriber ID Number in the designated field. This number is unique to your account and helps identify your submissions.
3. Provide the Subscriber's full name. Make sure to input the name as it appears on your identification card.
4. Fill in the employer's name. It is important to note the company you are associated with for benefit verification.
5. Input your address, including your city, state, and zip code. Ensure this information is current; if there are changes, follow the instructions on the form to notify customer service.
6. Include your telephone number for any necessary follow-ups regarding your submission.
7. In the Lifestyle Benefits section, indicate the specific benefit you are claiming for, such as a health club membership.
8. For each service, fill out the fields for Patient Name, relationship to subscriber, date(s) of service, description of the service, and the amount charged.
9. Indicate whether the patient has insurance coverage for this service by marking 'Yes' or 'No'.
10. Enter the provider's name who delivered the service.
11. Sign the form in the designated signature field, confirming that the information provided is accurate. Unsigned forms will be returned.
12. Finally, save your changes, and then download, print, or share the completed form, as needed.

Complete and submit your Valucare Reimbursement form online for a quick processing of your benefits.