Get Retiree Reimbursement Account

This guide provides clear and concise instructions on how to complete the Retiree Reimbursement Account form online. Following these steps will help ensure a smooth and efficient reimbursement process.

Follow the steps to accurately complete your Retiree Reimbursement Account form.

1. Press the ‘Get Form’ button to obtain the Retiree Reimbursement Account form and open it in your digital workspace.
2. Enter your participant information. Fill in the fields for your RRA identification number, last name, first name, middle initial (if applicable), street address, city, state, zip code, and daytime telephone number. Ensure all information is accurate to avoid delays.
3. Provide your employer information. Enter your employer's name and control number, which can be located on your plan documents if not pre-printed.
4. Complete the expense information section. List each family member's name, date(s) of service, relationship to retiree, and the total amount submitted for reimbursement. Be sure to follow your plan's guidelines regarding allowable expenses.
5. Indicate coordination of benefits. If you or any family members are eligible for other medical, dental, or vision coverage, select 'Yes' and include copies of all applicable explanations of benefits (EOBs). If not, select 'No'.
6. Fill out the certification section. Review all the information provided, then sign and date the form to certify that the expenses are valid and have not been reimbursed from another source.
7. After completing the form and attaching the necessary documentation, you may save changes, download, or print the form to send it. Ensure to retain copies for your records before mailing or faxing to Aetna.

Complete your Retiree Reimbursement Account form online today for a smoother reimbursement experience.