Get Lh1ondemand

This guide provides detailed instructions for effectively completing the Lh1ondemand Benefit Plan Claim Form online. Following these steps will ensure that your claims are submitted accurately and efficiently.

Follow the steps to complete your claim form successfully.

1. Click ‘Get Form’ button to obtain the Benefit Plan Claim Form and open it in your online system.
2. Fill out the member information section completely. Provide your first name, middle initial, last name, social security number, employer name, and email address. Ensure every field is filled out without omissions, as incomplete forms will delay processing.
3. List each eligible expense separately. For each expense, include the amount, type of service, and the plan under which the service should be filed. Specify the service dates (not the date paid) and the service provider's name along with their tax ID or social security number if applicable.
4. If you have dependent care expenses, complete the dependent care provider certification section to verify that services were rendered. Provide the provider's name, federal ID number or social security number, and ensure that the provider signs and dates the form.
5. Read and acknowledge the certification section carefully. By signing, you confirm that the expenses were incurred by you or your eligible dependents, and that you have not received reimbursement from other sources.
6. Sign and date the form. Remember, unsigned forms will not be processed, which is crucial for timely reimbursement.
7. Choose your submission method: fax the completed form to 952.666.7454, email it to claims@flytehcm.com, or mail it to Flyte HCM, PO Box 3260, Burnsville, MN 55337. Retain copies of your claim form and all supporting documentation for your personal records.

Complete your documents online today for faster processing of your claims.