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  • Veba Automatic Premium Reimbursement Form - Wwcc

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Auto Premium Reimbursement Skip this form! Log in at veba.org and submit your request online. Important reminders and information on reverse. Submit completed form to: claims veba.org Fax: (206) 5773020.

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Automatic premium reimbursements can be set up online (recommended) after logging in. If you prefer, you can submit a paper Automatic Premium Reimbursement form via e-mail, regular mail, or fax as indicated on the form. Instructions are contained on the backside of the form.

A VEBA is a tax-free health reimbursement account which can continue year over year (unlike a Flexible Spending Account). A VEBA can be used by you and your eligible dependents to reimburse for qualified health expenses after your retirement (with the exception of Group Two (UW Police Officers below).

If you are still working and you elect "limited" VEBA Plan coverage, Medicare will provide benefits without requiring that you use up your HRA first. To elect "limited" HRA coverage, submit a Limited HRA Coverage Election form. Forms are available after logging in or upon request from our customer care center.

A voluntary employee beneficiary account (VEBA) is a unique, tax-free health care savings plan funded entirely by your employer. It can pay for qualified medical expenses now or in the future, plus it can be used to pay health insurance premiums when you retire.

You can file claims at any time after you become claims-eligible. You will become eligible to file claims for qualified expenses incurred on or after your retirement date, provided the VEBA MEP has received both your completed Enrollment form (or online enrollment) and a contribution from your employer.

Eligible expenses include qualified medical, dental, and vision expenses not covered by your insurance plans, or medical, dental, vision, Medicare Part B and Part D, Medicare supplement, and tax-qualified long-term care insurance premiums.

You can use these tax free funds to reimburse eligible out-of-pocket healthcare costs and premiums for yourself, your spouse, and your qualified children and dependents. The HRA VEBA plan is available to public employees in the Northwest.

To activate your Benefits Card, click the Activate Now button or call 1-877-907-7505 from your main telephone number. Then, begin using your card to instantly pay for qualified medical care items and services directly from your health reimbursement arrangement (HRA). No filing claims and waiting to get reimbursed.

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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