Get Tri Star Advocate Health Hfa Claim Form

Filling out the Tri Star Advocate Health Hfa Claim Form is an essential step toward securing your health reimbursement. This guide will provide you with clear, step-by-step instructions on how to navigate the online form efficiently.

Follow the steps to complete your claim form online.

1. Click the ‘Get Form’ button to access the Tri Star Advocate Health Hfa Claim Form online.
2. Begin by filling out Part 1, which is required for all claims. Input your Social Security Number, last name, first name, middle name or initial, date of birth, and date of hire. Ensure all entries are accurate.
3. Complete your address by providing your street or P.O. Box, city, state code, zip code, and phone number. Update your email address only if it has changed recently.
4. Indicate the specific HRA claim you are submitting. Choose between HMO/Copayment & Coinsurance Reimbursement Account or Healthe Futures Account by checking the appropriate box. Remember to attach the corresponding provider statements as required.
5. In Part 2, provide the reimbursement request details. Enter the patient’s name, service dates, description of service, provider name, and claimed amount. Sum up the total claims requested at the end of this section.
6. Proceed to Part 3. Read the acknowledgements carefully, and then provide your signature and the date. This section confirms that all information submitted is accurate and that no prior reimbursements will conflict with this claim.
7. Finally, ensure to attach all necessary supporting documentation, as claims without these cannot be processed. Save your changes, and you can download, print, or share your completed form as needed.

Complete your Tri Star Advocate Health Hfa Claim Form online today to ensure timely reimbursement.