Get Flex Claim Reimbursement Form - Tristar Benefit Administrators

Filling out the Flex Claim Reimbursement Form correctly is crucial to ensure timely reimbursement for eligible expenses. This guide provides step-by-step instructions to help you navigate through the form effortlessly in an online environment.

Follow the steps to complete your reimbursement form accurately.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Complete the employee information section by entering your employer’s name, your last name, first name, initial, home address, social security number, email address, city, state, zip, and daytime phone number. Ensure that you check the box if you have a new address.
3. In the health care section, provide an itemized statement that includes the date of service, type of service, and total charge. Depending on your situation, select one of the checkboxes indicating whether the charges are covered or not by your insurance. Attach any necessary explanations of benefits or receipts as indicated.
4. For dependent care claims, fill in the required information for the dependent receiving care, including their relationship to you, date of birth, date(s) of care, and the name and taxpayer identification number of the daycare provider. Attach the required receipt or have the provider sign the verification section.
5. Complete the employee certification section by signing and dating the form. By signing, you affirm that the information is correct and that the expenses being claimed have not been reimbursed under another plan.
6. Once all sections are completed, save your changes, and consider downloading or printing the form for your records. You can now submit the completed claim along with the necessary documentation to TRISTAR Benefit Administrators at the provided address or via fax or email.

Start completing your Flex Claim Reimbursement Form online today to ensure you receive your benefits promptly.