Get Claim For Medical Reimbursement - Ok Ngb Army

Filing a Claim For Medical Reimbursement is an essential process for users seeking reimbursement for out-of-pocket medical expenses related to treatment. This guide provides clear and detailed instructions to help users navigate each section of the form with ease.

Follow the steps to complete your claim electronically.

1. Click ‘Get Form’ button to obtain the form and open it in your editor.
2. Start with the personal information section. Fill in your name, including your last name, first name, and middle initial. Remember to include your current address, telephone number, and provide your OWCP file number for reference.
3. Next, move to the provider information section. You will need to enter the name of the doctor’s office, hospital, pharmacy, or medical supply company where the expense was incurred. Describe the charges in detail, such as the type of medical appointment, the name of any prescription drugs, or items purchased.
4. Provide the date of service in the specified format (MM, DD, YY). Indicate the amount you personally paid for the services or items listed. Ensure you have checked 'Yes' or 'No' regarding proof of payment included for each item claimed.
5. Calculate and enter the total reimbursement amount you are requesting based on the documentation attached. This total should reflect all eligible expenses covered by your claim.
6. Read the certification statement carefully. By signing and dating the form, you confirm that the information you provided is correct and that you are aware of the implications of providing false information.
7. Finally, after completing the form, save your changes. You can then proceed to download, print, or share the form as needed for submission.

Complete your claim and ensure you receive the reimbursement you deserve by filing your Claim For Medical Reimbursement online.