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Get Your Spending Account Hra Premium Claim Form
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How to fill out the Your Spending Account HRA Premium Claim Form online
Completing the Your Spending Account HRA Premium Claim Form online can be a straightforward process when you know what to do. This guide provides step-by-step instructions to assist you in properly filling out the necessary fields and submitting your claim for reimbursement.
Follow the steps to fill out the Your Spending Account HRA Premium Claim Form online
- Click ‘Get Form’ button to obtain the form and open it for editing.
- Begin by entering the account holder's first name and last name in the designated fields.
- If comfortable, provide the last four digits of the account holder's Social Security Number in the optional section.
- Fill in the account holder's ZIP code.
- For each item listed (starting with Item 1), enter the premium begin/service date using the MM/DD/CCYY format. This date should reflect when your premium payment is effective, rather than when it was paid.
- Indicate the name of the service provider (insurance company) associated with the premium.
- Request the premium amount by filling in the appropriate field, followed by the policy holder's name.
- Repeat steps 5 through 7 for Item 2 if additional entries are necessary.
- In the account holder certification section, provide your signature confirming the authenticity of the information included in the form.
- Complete the date field next to your signature.
- Review the entire form to ensure all information is accurate and complete before submission.
- After verification, save any changes made, then you can download, print, or share the completed form as needed.
Start filling out your forms online now to ensure timely reimbursement of your eligible expenses.
To use your HRA debit card, simply swipe it at the point of sale when purchasing eligible medical services or products. The transaction pulls funds directly from your HRA account, making it easy and convenient. Always keep track of your remaining balance to ensure you maximize the benefits of your Your Spending Account HRA Premium Claim Form.
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