Get Medical Expense Claim Form For Flynn Members

Filling out the Medical Expense Claim Form for Flynn Members online is an important step to ensure you receive reimbursement for eligible medical expenses. This guide will provide you with clear and concise instructions to help you complete the form with ease.

Follow the steps to successfully complete your claim form.

1. Click ‘Get Form’ button to access the Medical Expense Claim Form for Flynn Members. Once you have obtained the form, open it in your preferred editor.
2. Begin by entering your plan member information in the designated fields. Provide your member ID/PIN, last name, first name, mailing address, email address, and phone numbers. Make sure to select your preferred language of correspondence.
3. In the 'Coordination of Benefits' section, indicate if any expenses are related to a work-related incident or covered by another plan. If applicable, provide the necessary details about the other plan, including member information.
4. Fill out the 'Claim Information' section. Specify the type of expenses by checking the corresponding boxes for drugs and vision care. For each expense, include the patient’s name, relationship to the plan member, and the amount being claimed.
5. If submitting a vision care expense, complete the additional questions regarding the prescription status and select relevant options if applicable.
6. Attach original receipts for each claimed expense to the form. Retain copies for your records, as original receipts will not be returned.
7. Sign and date the form in the 'Authorization & Declaration' section. Ensure that you print the form and then sign it.
8. Finally, save your changes, download or print the completed form, and return it to Coughlin & Associates Ltd. for processing through the appropriate mailing address or fax.

Complete your Medical Expense Claim Form online today for a seamless reimbursement experience.