At t hra claim form 2026

1. Click ‘Get Form’ to open the AT&T HRA claim form in the editor.
2. Begin by filling out your personal information in Section 1, including your Social Security Number or Employee ID, name, and contact details.
3. In Section 2, list each healthcare expense separately. Use a new line for each expense and ensure you include the coverage code from the provided list.
4. Attach supporting documentation for each expense. This includes itemized receipts that show the date of service, type of service, and amount paid.
5. Review all sections for accuracy. Sign and date the form at the bottom of Section 3 to certify that all information is correct.
6. Submit your completed claim form via fax or mail as instructed on the form. Keep copies of everything for your records.

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