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  • Application For Claiming Refund Of Medical Expenses

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Treatment taken from an Authorised Medical Attendant / Hospital. (N.B.- SEPARATE FORM SHOULD BE USED FOR EACH PATIENT) 1. NAME and DESIGNATION of the Government servant (in BLOCK letters) : i) Whether Married or Unmarried : ii) If married, the place where wife/ husband is employed : 2. Office /Division in which employed: 3. Pay of the Government Servant as defined : in the Fundamental Rules, and any other emoluments which should be shown separately 4. Place of duty : 5. Actual re.

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You can also order a form online and we'll post it to you. The HC5(W) form cannot be ordered online - call 0300 330 1343 and we'll post the form to you. To claim a prescription refund, ask your pharmacist for a 'FP57' refund receipt when you pay, you cannot get one later.

Who is required to provide health care insurance coverage? All employers with one or more employees, whether full-time or part-time, permanent or temporary, are required to provide Prepaid Health Care Act coverage to their eligible employees in Hawaii unless the employees fall into an excluded category.

Use this form if the employee works at least 20 hours per week and: • Works for 2 or more employers** or. • Claims an exemption or waiver from health care coverage or. • Terminates an exemption or. • Changes principal and/or secondary employer designation**

The 2023 Form HC-5 (Employee Notification to Employer) is available online at the Hawaii Department of Labor and Industrial Relations (DLIR) website. Use this form if the employee works at least 20 hours per week and: Works for 2 or more employers, or. Claims an exemption or waiver for health care coverage, or.

Claim a refund for travel costs to receive NHS treatment: form HC5W(T) Use this form if you are entitled to claim a refund for travel costs for NHS treatment under the care of a consultant.

You can get a form by calling 0300 123 0849 or visiting .nhsbsa.nhs.uk/healthcosts.

If you have not paid any treatment costs You cannot claim a refund if you have not paid for treatment, as you'll need to provide receipts to make a claim. We cannot reimburse the costs for any treatment received at a private facility.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232