Get (hra) Forms

This guide provides comprehensive instructions on how to fill out the Health Reimbursement Arrangement (HRA) Forms online. By following this user-friendly guide, you will ensure that your reimbursement requests are complete and processed without delay.

Follow the steps to successfully complete your HRA forms

1. Click ‘Get Form’ button to obtain the HRA Form and open it in your preferred online editor.
2. Begin by entering your Member’s Social Security Number or alternate ID in the designated field to identify your account.
3. Fill in the Member’s Name and Address to ensure correspondence is correctly directed.
4. Provide your Phone Number in the specified fields, including your home and work numbers for contact purposes.
5. Indicate the Patient Name and Relationship to ensure clarity about who the expenses are for.
6. In the Type of Service section, specify the medical service being claimed, such as Medical, Dental, Vision, or Prescription.
7. Complete the Providers Name field with the name of the healthcare provider who rendered the service.
8. Enter the Date of Service by filling in the correct day, month, and year in the provided spaces.
9. List the Amount of Claim for each entry. Make sure that each total meets the minimum requirement of $20.00.
10. Check that you have included all required attachments, such as a copy of your Explanation of Benefits (EOB) or detailed invoices as specified for each service type.
11. Sign the form to indicate your understanding of the terms and conditions outlined in the HRA Account document.
12. Finally, save your changes, and choose to download, print, or share the completed form as necessary.

Complete your HRA Forms online today to ensure timely reimbursement for your medical expenses.