Get Medical Expense Flex & Hra Reimbursement Request Form

Navigating the Medical Expense Flex & HRA Reimbursement Request Form can seem challenging, but this guide offers a clear and supportive approach to help you complete it online. By following the steps outlined below, you can ensure that your request for reimbursement is submitted accurately and efficiently.

Follow the steps to complete the form successfully.

1. Click ‘Get Form’ button to access the Medical Expense Flex & HRA Reimbursement Request Form and open it in the editor.
2. Begin by entering your personal details in the Employee Information section. Provide your full name, Social Security Number, email address, and phone number.
3. Insert one or both codes in the provided fields: 'H' for HRA reimbursement request and 'F' for medical expense/flex reimbursement request.
4. Attach any necessary documentation for claims made at www.cdscpa.com. Ensure that you include the relevant code and the date of service.
5. Fill in details about the person incurring the expense, including their relationship to you, the provider's name, a description of the service received, and the amount requested.
6. Calculate and enter the total amounts for both flex and HRA reimbursements requested.
7. Read the certification statements carefully. By signing, you confirm that you or your eligible dependents have incurred the listed expenses and that they qualify under your employer’s flexible benefits plan and/or HRA.
8. Make sure you have an Explanation of Benefits (EOB) if the expenses were partially covered by insurance, showing that the insurance did not pay due to deductibles or other reasons.
9. Sign and date the form to validate your claim.
10. If your address has changed, check the appropriate box and update your address; if not, leave it unchecked.
11. Finally, save your changes. You may download, print, or share the completed form as needed.

Start filling out your Medical Expense Flex & HRA Reimbursement Request Form online today!