Get Vision Care Plan Claim Form - Rutgers University - Uhr Rutgers

Filling out the VISION CARE PLAN CLAIM FORM is essential for receiving reimbursement for your vision care expenses. This guide provides clear, step-by-step instructions to help you complete the form accurately and efficiently.

Follow the steps to complete your claim form effectively.

1. Press the ‘Get Form’ button to access the claim form and open it in your preferred document editor.
2. Begin filling out the form by entering the employee’s name in the designated field. Ensure that the name matches the records held by the university.
3. Provide the campus department and campus address, including the specific campus extension if applicable, in the respective sections.
4. Input the name of the person receiving the lenses in the appropriate field. This should be the individual for whom the reimbursement is being claimed.
5. Indicate the relationship of the person receiving lenses to the employee by checking the appropriate box (e.g., Self, Spouse, Child, Civil Union/Domestic Partner). If applicable, include the date of birth for dependents.
6. Fill in the lens purchase date and the corresponding lens cost in the designated areas. Ensure that the cost is itemized to exclude other expenses like frames or eye exams.
7. Select the type of lenses by checking the appropriate boxes (Single-Vision, Bifocals, Trifocals, or Contacts). Be sure this matches the itemized receipt.
8. The employee must sign and date the form at the bottom to validate the claim.
9. Review the completed form to ensure all fields are filled in correctly and then save your changes.
10. Lastly, send the entire completed claim form, along with the original itemized receipt, to the appropriate address provided for reimbursement processing.

Submit your claim form online today to ensure you receive your vision care reimbursement promptly.