Get Merp Claim Form 2016.doc

Filling out the Medical Expense Reimbursement Plan (MERP) Claim Form 2016.doc online can streamline the process of submitting your medical expense claims. This guide provides clear and detailed instructions to help you successfully complete the form.

Follow the steps to fill out the form accurately and efficiently.

1. Click the ‘Get Form’ button to access the MERP Claim Form 2016.doc and open it in your preferred editing application.
2. Fill in the employer information at the top of the form. Include the employer name, which is Modern Industries, Inc., and ensure the form is sent to J&K Consultants, Inc. at the provided address.
3. Complete the participant information section by entering your name, email address, telephone number, last four digits of your Social Security number, and date of birth.
4. For prescription reimbursement information, enter each drug's name and date. You can list multiple medications as required.
5. In the physician office visits section, record the dates of your visits and corresponding co-pay amounts for each visit.
6. Document your explanation of benefits (EOB) by entering the date of service and the amount owed for each service provided. Record the co-pay amounts as applicable.
7. Read the notes regarding claim submission carefully. All claims must be processed through your health plan and you must provide required documentation.
8. In the employee statement section, review and sign to certify that all information provided is accurate. Include the date of signing.
9. Once all fields are filled out, save your changes to the form and prepare to submit it along with any necessary receipts and documentation.
10. You may download, print, or share the form as needed for submission.

Complete your MERP Claim Form online now for a smoother claims process.