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  • Va Form 21p-8416

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Income. Your out-of-pocket payments for medical, optical and dental expenses may be deductible. This form is used to report any medical expenses that you paid for yourself or for a relative who is a dependent member of your household (spouse, child, grandchild, parent, etc.), for which you were not reimbursed and do not expect to be reimbursed. Below are examples of expenses you may include, if applicable: Hospital expenses Doctor's office fees Dental fees Prescription/non-presc.

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Who can file a reimbursement claim. You can file a reimbursement claim if either of these descriptions is true for you: You paid for an emergency prescription at a pharmacy that's not in our network, or. You paid out of pocket for unauthorized emergency care at a non-VA facility (in-network or out-of-network).

Set up direct deposit. If you haven't already set up direct deposit to receive your reimbursement, you'll need to do that now. ... Sign in to the travel claim entry portal. ... Go to your Beneficiary Travel profile. ... Review your profile and go to your dashboard. ... Create a claim. ... Add your expenses and receipts. ... Submit your claim.

If you're eligible for an MGIB refund, we'll automatically include it in your last monthly housing allowance payment. You don't need to apply for a refund. If you believe you should have received a refund but didn't, contact us in one of these ways: Call us at 888-442-4551.

How to file your claim. Fill out a Claim for Payment of Cost of Unauthorized Medical Services (VA Form 10-583). For prescription claims, include this information on the form: The name and address of the pharmacy.

Medical Care Reimbursement Request A signed written request for reimbursement and receipt of payment must be submitted to your local VA medical facility community care Veterans Experience Officer in a timely manner.

Report unreimbursed medical expenses on VA Form 21P-8416, "Medical Expense Report." If you need a copy of this form, contact the VA at 1-877-294-6380 (Hearing Impaired TDD line 711). You may also download the form at .va.gov/vaforms.

Use VA Form 21p-8416 to report medical or dental expenses that you have paid for yourself or for a family member living in your household. These must be expenses you weren't reimbursed for and don't expect to be reimbursed for.

By phone: Veterans may direct their questions to the national contact center for Veterans, operated by the Health Resource Center, at 1-877-222-VETS (8387), for billing assistance. Contact representatives have full access to Veteran accounts.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232