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Wageworks hra retiree 2026
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- Click ‘Get Form’ to open the wageworks hra retiree claim form in the editor.
- Begin by filling out the Account Holder Information section. Enter your last name, first name, and the last four digits of your Social Security Number (SSN). Include your birth date and email address if it’s new.
- In the Certification and Authorization section, ensure you sign and date the form. This certifies that all information provided is accurate.
- Proceed to Section 1 for SSA Deducted Premiums. Fill in the service start and end dates, along with the annual out-of-pocket cost for Medicare premiums.
- If applicable, complete Section 2 for Health Care Premiums not deducted from your Social Security Check. Provide necessary documentation like insurance statements.
- For other expenses, fill out Section 3 with details of any additional eligible costs incurred. Attach receipts as proof of payment.
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| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 2010 | 4.9 Satisfied (40 Votes) |
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