Lineco hra 2025

1. Click ‘Get Form’ to open the lineco hra in the editor.
2. Begin by filling out the Employee Section. Type or print your information for items 1 through 10, ensuring only one patient is listed per request form.
3. In the appropriate sections, enter the total amount for which you are claiming reimbursement. Remember, a minimum of $25 must be accumulated before submission.
4. Attach supporting documentation, such as Explanation of Benefit Statements or itemized bills from healthcare providers, to validate your claim.
5. Retain copies of all supporting documents for your records, as they will not be returned.
6. Once completed, send the claim form and documentation in a confidential envelope to the Administrative Office at the provided address.

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