Follow the steps to successfully complete your HRA account form.

1. Click ‘Get Form’ button to obtain the form and open it.
2. Begin by typing or printing your information in the Employee Section. This includes your name, social security number, mailing address, local union, telephone number, email address, and confirmation of insurance coverage with the Line Construction Benefit Fund.
3. Enter the patient's name and relationship to you, noting that only one patient can be listed on a request form. Ensure accuracy in the details provided.
4. In the section labeled ‘UN-REIMBURSED HEALTH CARE EXPENSES,’ list the dates of service for each expense. Provide the amount to be reimbursed for each category, including deductibles, co-insurance, co-payments, prescriptions, and any expenses not covered by your insurance plan.
5. As you fill in these amounts, make sure that the total does not fall below the minimum of $25 to submit a claim. This total should also be clearly mentioned in the ‘Total’ section.
6. Attach all required supporting documentation. This may include Explanation of Benefit statements or itemized bills from healthcare providers. Retain copies of the documentation for your records as the originals will not be returned.
7. Once the form is completed and verified, sign and date the certification section, confirming the accuracy of the claimed expenses.
8. Finally, send the completed form along with your supporting documentation in a personal and confidential envelope to the administrative office at the address provided.

Complete your Lineco HRA Account form online today for a hassle-free reimbursement experience.