Dental
This form is to be completed when submitting a dental claim for reimbursement. Be sure to include the original receipt along with the completed claim form.
Drug
This form is to be completed when submitting a drug claim for reimbursement. Be sure to include the original receipt along with the completed claim form.
Extended Health Care
This form is to be completed when submitting a major medical claim for reimbursement. Be sure to include the original receipt along with the completed claim form.
Health Service Spending Account (HSSA)
Health Service Spending Account (HSSA)
Wellness
This form is to be completed when submitting a Wellness claim for reimbursement. Be sure to include the original receipt along with the completed claim form.