Get Payflex Fillable Forms

Filling out the Payflex Fillable Forms online can streamline the process of submitting reimbursement claims. This guide will take you through each step of the process, ensuring you understand how to complete the form accurately and efficiently.

Follow the steps to effectively complete the Payflex Fillable Forms online.

1. Click 'Get Form' button to access the Payflex Fillable Form and open it in your chosen editing tool.
2. Begin filling out the form with your employee name and member number, which may include your Social Security Number or an employer-assigned number.
3. Input your employer's name in the designated field. If you need to make any address changes, please reach out to your employer’s HR or Benefits department.
4. For health care claims, include all necessary details under the section for expenses covered by insurance. Attach a copy of the Explanation of Benefits Statement you received from your insurance provider.
5. For expenses not covered by insurance, ensure that you attach an itemized statement from your service provider detailing the provider's name, patient name, service date, description of the service, and amount charged.
6. If claiming for prescription or over-the-counter items, make sure you include the printout of prescriptions if using a pharmacy or that they are identifiable on an itemized receipt.
7. If you opt for automatic monthly reimbursement for orthodontia, check the appropriate box and attach the required documentation.
8. For day care claims, complete the necessary details including the exact dates of service, dependent name, and amount requested. Ensure your provider signs the form or attach an itemized statement, but do not do both.
9. Before signing, review the certification statement confirming the expenses and acknowledging that they have not been reimbursed elsewhere.
10. Finally, save your changes, and you have the option to download, print, or share the completed form as required.

Start filling out your Payflex Fillable Forms online today and experience a hassle-free reimbursement process.