Get Medical Expense Reimbursement Plan (merp) Claim Form Employee ...

Completing the Medical Expense Reimbursement Plan (MERP) Claim Form online can be a straightforward process. This guide will walk you through each section of the form to ensure that you provide accurate information for your reimbursement request.

Follow the steps to accurately complete the MERP claim form online.

1. Press the ‘Get Form’ button to access the MERP claim form, and open it in the designated editor.
2. In the 'Employee Information' section, fill out your name, Social Security number, address, city/state/zip, daytime phone number, and email address.
3. Next, move to the 'Patient Information' section. Include the patient’s name, date of birth, and their relationship to you. Select 'Yes' or 'No' to indicate if the patient has any other insurance.
4. In the 'Employee Certification for Reimbursement' section, confirm that the expenses being submitted were incurred by you, your partner, or your eligible dependent. Acknowledge that these expenses have not been reimbursed and are not covered by another plan.
5. Sign and date the form to complete your certification.
6. Finally, mail the completed claim form along with the required Explanation of Benefits to Maxor Administrative Services at 320 S Polk St Ste 900, Amarillo, TX 79101.

Start filling out your MERP claim form online today to ensure you receive your reimbursement quickly.