Get Vision Care Reimbursement Form - New Jersey Institute Of ... - Njit

Filling out the Vision Care Reimbursement Form is a straightforward process designed to help faculty, staff, and their eligible dependents receive reimbursement for vision care expenses. This guide will provide step-by-step instructions to navigate the form efficiently.

Follow the steps to complete the form correctly.

1. Press the ‘Get Form’ button to access the form and open it in your editor.
2. In the 'Employee’s Name' field, enter your full name as it appears in your records.
3. Fill in your mailing address in the designated section, ensuring all necessary details are provided.
4. Provide your daytime phone number and email address in the respective fields for contact purposes.
5. Indicate the name of the person who received the eye examination by filling in their name and checking the appropriate box (self, spouse, child, domestic partner).
6. Similarly, indicate who received the eyeglasses or contact lenses, filling in their name and checking the corresponding box.
7. Under 'Type of lenses', check the appropriate option: single-vision, bifocals, progressive, or contacts based on what was purchased.
8. Enter the date of purchase in the provided field and specify the cost of the lenses.
9. Sign and date the form where indicated, confirming that the information provided is accurate.
10. Attach the original itemized receipt to the Vision Care Reimbursement Form, as claims will not be processed without it.
11. Once completed, save your changes and choose your preferred option to download, print, or share the form.

Complete your Vision Care Reimbursement Form online today for a seamless claim process.