Get Healthscope Forms

Filling out the Healthscope Forms online is a straightforward process that allows users to submit their reimbursement requests efficiently. This guide provides clear, step-by-step instructions to help users navigate through each component of the form with ease.

Follow the steps to successfully complete your reimbursement request.

1. Press the ‘Get Form’ button to acquire and open the form in your selected editor.
2. Begin by entering your employee information. Fill out your name, social security number, phone number, employer name (ABB), email address, and full address including city, state, and zip code. If you have a new address, check the appropriate box.
3. In the reimbursable expenses section, indicate the dates of service by providing the start and end dates in the MM/DD/YY format.
4. Identify the provider of the service. If the service is related to dependent care, you must include the provider's social security number or ID number.
5. Specify the name of the individual for whom the service was provided.
6. Enter the amount you are requesting as reimbursement for each expense. List all relevant expenses under the reimbursement amount requested column.
7. Select the type of expense for each entry. Indicate whether it is health care (M) or dependent care (D).
8. Calculate and enter the total reimbursement amount at the bottom of the expenses section.
9. Read and understand the certification statements carefully. After that, sign and date the form to certify that the information provided is accurate.
10. If applicable, have the provider of dependent care certify the dates and amounts listed, then complete their signature, date, and tax ID.
11. Once you have completed the form, save your changes, and choose to download, print, or share the document as needed.

Complete your Healthscope Forms online today to streamline your reimbursement process.