Get Meritain Flex Claim Form - City Of Findlay

Completing the Meritain Flex Claim Form is an essential process for users who wish to seek reimbursement for eligible expenses. This guide will provide clear, step-by-step instructions to help users navigate the form efficiently.

Follow the steps to successfully complete your reimbursement request.

1. Click ‘Get Form’ button to obtain the Meritain Flex Claim Form and open it for editing.
2. Fill in the employer name and your personal details, including employee name, social security number or ID, address, telephone number, city, state, and zip code.
3. Indicate whether this submission is a change of address by checking 'Y' for yes or 'N' for no.
4. Select the account type from which you are requesting reimbursement. You may choose Flexible Spending Account (FSA), Health Reimbursement Arrangement (HRA), or Dependent Care Account (DCA) and fill out all required fields related to your selection.
5. For FSA or HRA, enter the date of service, the provider's name, type of service, and the name of the patient. Document the total amount requested for each expense and indicate if these services were covered by any insurance plan.
6. For DCA, provide the name of the day care provider, the service dates, and the dependent's name and date of birth. Include the total amount requested for dependent care expenses.
7. Ensure all expenses are clearly documented. If you have multiple expenses, list any additional requests on a separate page and combine them in the total amount requested.
8. Sign and date the form, certifying that you have incurred the eligible expenses and that they have not been reimbursed elsewhere.
9. Review the entire form for completeness and accuracy. Once satisfied, save your changes. You can then download, print, or share the form as needed.

Complete your Meritain Flex Claim Form online today to ensure timely processing of your reimbursement request.