Ww.cirseiu.org HSBP-PEP Claim Form (HHC & WESTCHESTER MEDICAL CENTER) Items covered under PEP: Medical Books Medical Video and Audio MP3s Medical Compact Disks Mobile Electronic Medical Devices Dues and Journals for Medical Specialty Societies Licensure Fees, Board and Licensure Exam Fees Eligibility: All House Staff Officers on HHC & WMC payroll are eligible for PEP reimbursement. Effective July 1, 2011, the maximum benefit payable is $650 per plan year. Any unused funds can be rolled over t.
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How to fill out the CIR SEIU Professional Educational Plan HSBP-PEP Claim Form online
Filling out the CIR SEIU Professional Educational Plan HSBP-PEP claim form online can appear challenging, but with this guide, you will receive step-by-step instructions to simplify the process. This form allows eligible users to request reimbursement for educational and professional expenses related to their residency.
Follow the steps to effectively complete the claim form.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Begin by entering your personal details in the designated fields. This includes your name, social security number, address, phone number, email, hospital, department, and residency year (PGY).
- Indicate your expected residency completion date in the appropriate section.
- List all medical books, audio/video materials, and compact discs. For each item, include the date purchased and the cost in the specified fields.
- Next, record medical equipment and licensure examination fees. Again, provide the date of purchase and associated costs.
- Complete the section for dues and journals for medical societies. Provide necessary details, including the date purchased and amount spent.
- Sum up the costs from the previous sections, entering the grand total at the end of the document.
- If requesting reimbursement for an electronic medical device, fill out that section with the required details. Make sure both you and your chairperson sign and date the application.
- Review all entries for accuracy and completeness before submission.
- Finally, save your changes, download, print, or share the completed form as needed for submission.
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