Get Smart Local 36 Hra Claim Form 2319 Chouteaut Ave - Smw36benefits

Filling out the SMART LOCAL 36 HRA Claim Form is an essential step in managing your healthcare expenses. This guide provides clear, step-by-step instructions to ensure you complete the form accurately and efficiently for online submission.

Follow the steps to successfully complete your claim form online.

1. Press the ‘Get Form’ button to retrieve the SMART LOCAL 36 HRA Claim Form and open it in your preferred online editor.
2. Begin by entering your participant information. This includes your name, date of birth, and Social Security number, followed by your mailing address and phone number.
3. Attach a copy of your Explanation of Benefits (EOB) form along with a proof of payment receipt for all requested reimbursements. Ensure you include any necessary documents for prescription copayment reimbursements.
4. If claiming over-the-counter items, secure a prescription form from a physician, as cash register receipts are not acceptable. Review the back of the form for a list of approved reimbursable expenses.
5. In the qualified healthcare expenses section, list all expenses individually. For each entry, provide the item number, patient name, date of service, name of provider, expense description, and claim amount.
6. Read and acknowledge the certification statements regarding the eligibility of dependents, and that the expenses claimed have not been reimbursed through other means.
7. Sign and date the form to confirm your submission is accurate and complete.
8. Finally, save your completed form and choose to either download, print, or share it for submission to the SMART LOCAL 36 HRA Fund at the provided address.

Complete your claims online to ensure timely reimbursement!