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Health Reimbursement Account (HRA)
Reimbursed Medical Claim Form
INSTRUCTIONS: Please type or print the required information. Remember to attach the appropriate Explanation of
Benefit (EOB) statements,
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03
Open the downloaded form using a compatible document editor.
04
Read the instructions and guidelines provided on the form carefully.
05
Fill in your personal details accurately, including your name, address, contact information, etc.
06
Provide the necessary information regarding your healthcare expenses, such as the date, type of service, provider name, and cost.
07
If applicable, attach the supporting documents, such as receipts or invoices, as mentioned in the instructions.
08
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Who needs integrabms hra claim formdoc?
01
Integabms hra claim formdoc is needed by individuals who have a Health Reimbursement Arrangement (HRA) through Integabms.
02
This form is used to claim reimbursement for eligible healthcare expenses incurred by the individual and covered under their HRA.
03
Those who are enrolled in an HRA plan provided by Integabms should use this form to request reimbursement for their qualifying medical expenses.
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