Get Or Msc 5559 2020-2026

This guide provides clear instructions on filling out the OR MSC 5559 form online, ensuring that users understand each component effectively. With simple steps, you can navigate the process with ease.

Follow the steps to complete the OR MSC 5559 form online.

1. Click 'Get Form' button to obtain the form and open it in your designated editor.
2. Fill out Section 1: Employee information. Provide your PEBB benefit number, agency name, last name, first name, middle initial, and contact address. Ensure to check if you have a new address, and include your city, state, ZIP code, gender, and phone number.
3. Review Section 2 with your agency. This section requires verification from an agency representative confirming that you need a CDL for your job duties. They must complete Section 2 and provide their name, phone number, signature, and the date.
4. Once the agency verification is done, take the signed voucher to your appointment with the certified medical examiner. Ensure that the examiner is listed on the National Registry.
5. After the appointment, the examiner will send the billing claim to your medical plan. They must attach a copy of this voucher to that claim.
6. If the examiner requests payment at the time of service, complete your medical plan’s Claim Reimbursement Form. Submit this form along with a copy of your voucher to your medical plan.
7. Keep copies of the completed form and any submitted documents for your records.
8. Finally, ensure that the completed form is submitted to your agency/university payroll office, and after that, forward it to the provider.

Complete your OR MSC 5559 form online today to ensure timely processing of your CDL exam voucher.