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How to use or fill out via benefits reimbursement form 2022

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Click ‘Get Form’ to open it in the editor.
Complete the Account Holder fields: Enter your full name, last four digits of your Social Security number, date of birth (MM/DD/YYYY), address, and employer name.
Under Insurance Premium Expenses, fill in the Name of Covered Individual, select the appropriate Action (New Policy, Premium Change, or End of Policy), and specify the Type of Premium you wish to be reimbursed.
If applicable, provide the Annual Social Security Administration Letter. Enter the Beginning and Ending Dates of Service for your reimbursement period.
Input the Monthly Amount Requested that matches your supporting documentation.
Read through the certification requirements carefully before signing and dating the form.
Mail or fax your completed form along with any necessary supporting documentation to PayFlex as instructed.

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How long does it take to get reimbursed from via Benefits?

Youll want to justify why youre due a reimbursement. Basically, you have to be clear about what you are asking for repayment for any why. Youll also need to prove your expenses by providing all the necessary details and documentation.

How do I get reimbursed from via Benefits?

You need to submit reimbursement requests or, if eligible, turn on Automatic Premium Reimbursement to receive funds from your reimbursement account for your eligible expenses. You will not receive a debit card. Use the Via Benefits Accounts mobile app or website to submit reimbursement requests.

How to submit a reimbursement?

This article applies to you if you have a Via Benefits reimbursement account (sometimes known as a Health Reimbursement Arrangement)*. A reimbursement account is excluded from your taxable income, meaning you dont have to report it as income or pay taxes on it.

How long does it take to get reimbursed from via benefits?

Follow the steps given below to file a reimbursement health insurance claim: Step 1: Inform the Insurance Company. Step 2: Obtain Treatment. Step 3: Pay the Hospital Bill. Step 4: Collect All Your Documents. Step 5: Fill up the Claim Form. Step 6: Submit All Documents to the Insurance Company.

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