Get Sexsb

Filling out the Sexsb form online is a straightforward process that allows users to request reimbursement for covered medical expenses. By following the steps outlined in this guide, you can efficiently complete the form to ensure timely processing of your reimbursement requests.

Follow the steps to complete your reimbursement request.

1. Click the ‘Get Form’ button to obtain the form and access it in the online editor.
2. Select the type of reimbursement you are requesting by checking the appropriate box: Medical, Pharmacy, or Both.
3. Provide information about yourself, including your first name, last name, address, city, state, zip code, member ID number, and member group number as found on your ID card.
4. Indicate whether you have other insurance coverage by checking 'Yes' or 'No' and listing the name and policy number of the insurance. Remember to include any relevant documentation.
5. If applicable, provide details regarding any injuries or illnesses due to a car accident and include necessary documentation from your auto insurance provider.
6. In the section regarding where you received the services or items, check all applicable options and provide the provider's name and address.
7. Detail your medical care or supplies by entering the date of service, diagnosis or treatment, CPT code, number of items or visits, and the amount paid. Ensure to attach copies of supporting documents as needed.
8. Provide a description of how the items relate to your illness or injury in the provided space.
9. Sign and date the form to confirm that the information provided is accurate. If signing as an authorized representative, include legal documentation verifying your authority.
10. After completing the form, review all information, then save your changes. You can download, print, or share the form as needed.

Ready to submit your reimbursement request? Complete the Sexsb form online today!