Sentinel benefits reimbursement claim form 2025

1. Click ‘Get Form’ to open the sentinel benefits reimbursement claim form in the editor.
2. Begin by filling in your employer name and employee information, including your Social Security Number, last name, first name, email address, and phone numbers. Ensure all details are printed clearly.
3. If applicable, check the box for debit card verification receipts. This helps streamline your submission process.
4. Complete the Healthcare Claim Information section by entering the date of service, amount requested, and a brief description of the service provided. Attach any required documentation in order.
5. For Dependent Care Claim Information, provide a statement from your dependent care provider or complete the certification section if no statement is available. Include necessary details such as start and end dates of service.
6. Finally, sign and date the form to certify that all information is accurate before submitting it via fax or mail to the specified address.

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