Get Fl Post-deductible Hra Verification Form 2012-2025

Completing the FL Post-Deductible HRA Verification Form online can streamline your reimbursement process for eligible medical expenses. This guide will walk you through each section of the form, ensuring a smooth and accurate submission.

Follow the steps to fill out your HRA verification form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Fill in the enrollee information, which includes last name, first name, primary and secondary phone numbers, People First ID, date of birth, street address, email, city, state, and zip code. If your address has changed, mark the checkbox provided.
3. Attach a copy of an Explanation of Benefits (EOB) from your health insurance plan that confirms your IRS-mandated deductible has been met. Ensure that the EOB includes details such as dates of service, amounts paid by insurance, and the date when the deductible was met.
4. Indicate the coverage level of your health insurance plan by checking either ‘Single’ or ‘Family’. Provide the date range for services covered, including both the start and end dates.
5. Complete the section regarding the deductible amount paid and the date the deductible was met. Ensure all required information is accurate.
6. In the certification section, confirm that all information provided is accurate. You are required to sign and date this section to validate your submission.
7. After completing the form, save your changes. You may then need to print or download the form along with the EOB for submission.
8. Submit the completed form and EOB either via fax or mail to Chard Snyder. Ensure you use the provided fax number (888.245.8452) without a cover page, or mail to the address listed for submissions.

Complete your FL Post-Deductible HRA Verification Form online today to ensure timely reimbursement for your eligible expenses.