Get Hearing Aid Reimbursement Form - Psc-cuny Welfare Fund - Psccunywf

Filling out the Hearing Aid Reimbursement Form for the PSC-CUNY Welfare Fund is a straightforward process that helps users reclaim costs for hearing aids. This guide provides step-by-step instructions to ensure you complete the form accurately and efficiently.

Follow the steps to fill out the Hearing Aid Reimbursement Form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Fill in the member section with your last name, first name, street address, city, state, zip code, and social security number. Be sure to indicate your employer, which should be your college, and select your member status from the given options: Active, Retired, COBRA, Self, Spouse/Domestic Partner, Survivor, or Leave of Absence.
3. If the patient is not the member, complete the patient section. Provide the patient's name and their relationship to the member, selecting from options such as Dependent Child.
4. Complete the other hearing aid coverage section, if applicable. Fill in the name of the employer or union providing the coverage and the relevant contact information.
5. The provider must fill in their details, including name, street address, city, state, zip code, and license number. Specify the type of service provided, such as Testing or Fitting, and indicate the license type.
6. In the charges section, detail the costs associated with the hearing aid, including total charges. Ensure all amounts are accurately calculated.
7. The member must sign and date the form to confirm the information is accurate. The provider must also sign and date the form verifying the services rendered.
8. Finally, review all sections for completeness. You can then save changes, download, print, or share the completed form as needed.

Begin filling out your Hearing Aid Reimbursement Form online today for a smoother reimbursement process.