Get Bmi Fsa Claim Form - Wichita Kumc

Filling out the BMI FSA Claim Form is an essential step for users seeking reimbursement for eligible expenses. This guide provides clear instructions to ensure a smooth process while submitting your claims online.

Follow the steps to successfully complete the BMI FSA Claim Form.

1. Press the ‘Get Form’ button to obtain the form and access it in the designated online editor.
2. Enter your general account information, including your last name, first name, middle initial, social security number, state, ZIP code, mailing address, city, and phone number. Ensure all details are accurate to avoid processing delays.
3. Provide the name of your employer in the appropriate section. This identification is necessary for your claim to be linked to the correct benefit plan.
4. Follow the claim filing instructions closely. Be sure to include the completed claim reimbursement form along with any required documentation like an Explanation of Benefits (EOB) from your insurance company and copies of your receipts detailing the service date, amount, and type of service provided.
5. For health care expenses, fill in the date(s) of service, the name of the claimant, the type of service received, and the amount you are requesting for reimbursement.
6. If applicable, complete the dependent care expenses section with the date(s) of service, provider’s signature (if a receipt is unavailable), reimbursement amount, provider tax ID or social security number, provider’s address, and the age of dependents at the time of service.
7. Finalize the form by signing in the employee authorization section, confirming that your statements are complete and true. Include the date of your submission.
8. Once completed, save your changes, then print, download, or share the claim form as needed. Be sure to retain copies of your completed form, supporting documents, and receipts for your records.

Complete your BMI FSA Claim Form online today to ensure swift processing of your claims!