Get Healthstuff Over The Counter Items Reimbursement Form

This guide provides clear and supportive instructions on how to complete the Healthstuff Over The Counter Items Reimbursement Form online. By following these steps, you can ensure that your reimbursement request is submitted accurately and efficiently.

Follow the steps to successfully complete your reimbursement form.

1. Click ‘Get Form’ button to obtain the form and open it for editing.
2. Fill in your member's name and member ID in the designated fields. Ensure that the information is accurate to avoid delays.
3. If there is a new address, check the box provided and enter your updated address, including the city, state, and ZIP code.
4. Enter your telephone number. This may be necessary for any follow-up questions regarding your submission.
5. In the receipts section, list the purchase details. For each item, write the date purchased, the name of the retailer, a description of the item, the item amount (A), and any applicable tax amount (B).
6. Calculate the total claim amount by adding the item amounts and tax amounts for each entry. Ensure the grand total is correct.
7. Sign and date the form at the bottom to confirm that your request is for eligible items and not covered by any other plan.
8. Review the completed form to ensure all information is correct and that you have included the necessary receipts.
9. Save any changes made to the form, then proceed to print, download, or share it as needed.

Complete your reimbursement document online now to ensure a smooth process.