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Operating Engineers Local 139 Health Benefit Fund N27 W23233 Round Drive Peaked, Wisconsin 530720160 (262) 5499190 or (800) 2427018 www.iuoe139.org Health Reimbursement Account (HRA) Claim Form Participant

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Who needs the 4011132v1 - wfhili-hra form?

The 4011132v1 - wfhili-hra form is typically required by individuals who are participating in a work from home healthcare reimbursement arrangement (HRA). This form helps document and claim reimbursements for eligible healthcare expenses incurred while working from home. Employers may require their employees to fill out this form as part of their HRA program.

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