Get Meritain Health Travel Verification Form 2018-2025

Completing the Meritain Health Travel Verification Form online is a vital step for users seeking reimbursement for travel expenses related to medical care. This guide will walk you through each section of the form, ensuring that you provide all necessary information accurately.

Follow the steps to complete the Meritain Health Travel Verification Form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling out the Employee Information section. Provide your name, sex, home address, identification number, city, state, zip code, employer name, work telephone number, birthdate, and group number.
3. Next, complete the Home Telephone field with your personal contact number.
4. Proceed to the Patient Information section. Indicate the relationship of the patient to the employee by selecting from the available options: ‘The Employee’, ‘Employee’s Spouse’, or ‘Employee’s Child’. Enter the patient’s name, sex, and birthdate.
5. If applicable, provide the name of the escort, ensuring that this is relevant to the guardian of a dependent child or incapacitated adult.
6. Move to the Referring Physician section. Here, the referring physician must enter the condition being treated and answer specific questions regarding the treatment's relation to transgender services, transplant procedures, cancer treatment, and if this treatment was due to an accident or medical emergency.
7. Determine if the treatment can be performed locally and provide an explanation if not. The referring physician must then sign and date this section.
8. Finally, the employee must affirm payment for travel services and sign the document, including the date.
9. After ensuring that all information is complete and accurate, save your changes. You can then choose to download, print, or share the form as required.

Complete your Meritain Health Travel Verification Form online now to ensure timely reimbursement for your medical travel expenses.