Follow the steps to accurately complete your Horace Mann Health Hub reimbursement claim.

1. Press the ‘Get Form’ button to obtain the form and open it in your preferred editing program.
2. Begin by filling in your employee name and member number. This may be your Social Security Number or an employer-assigned number.
3. Input your employer name in the designated field. If you need to change your address, please contact your employer's HR or benefits department, as direct address changes cannot be accepted.
4. For health care claims related to you or your dependents, ensure you have submitted expenses to your insurance provider first. Include a copy of the Explanation of Benefits Statement (EOB) from your insurance company with your completed claim form.
5. If claiming expenses not covered by insurance, prepare an itemized statement from your healthcare provider. This statement must include the provider's name, address, patient's name, date of service, a description of the service, and the amount charged.
6. For orthodontia claims, include an itemized statement or payment receipt, along with any relevant agreements or payment coupons.
7. Record the date of service, type of service (e.g., prescription, vision, dental), and amount requested in the appropriate fields on the form.
8. For day care provider claims, complete the form and have your day care provider sign it or attach their itemized statement, but do not do both.
9. Fill in the exact dates of service, the age of the dependent, and the amount requested for day care services.
10. Make sure to sign and date the form certifying that all provided information is accurate and that you will not seek reimbursement elsewhere.
11. Once you have completed the form, you may save changes, download, print, or share the document as necessary.

Start your reimbursement process now by completing the Horace Mann Health Hub form online.