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Group Benefit Services, Inc. P.O. Box 4368 Lukeville, MD 21094 Toll Free: 800.337.4973 Fax: 410.321.8053 FSA×bio.nets PREMIUM REIMBURSEMENT FORM Employee Name:Social Security #:Home Address: Employer
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How to fill out gbs premium reimbursement form

01
Download the GBS premium reimbursement form from the official GBS website.
02
Fill in your personal details in the designated sections, such as your full name, address, and contact information.
03
Provide the policy details, including the policy number, coverage period, and premium amount paid.
04
Attach the necessary supporting documents, such as premium payment receipts and any relevant medical bills or statements.
05
Review the completed form to ensure all information is accurate and complete.
06
Submit the filled-out form along with the required documents to the GBS office or send it by mail as instructed.
07
Wait for the reimbursement process to be completed, which may take a certain amount of time.
08
Upon approval, you will receive the reimbursement amount through the specified method provided during the form submission.

Who needs gbs premium reimbursement form?

01
Anyone who has paid their GBS premium and is eligible for reimbursement as per the terms and conditions of their policy can use the GBS premium reimbursement form.
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The GBS premium reimbursement form is a document used to request reimbursement for premiums paid by an individual or organization for a group benefit plan.
Anyone who has paid premiums for a group benefit plan and wishes to be reimbursed for those expenses is required to file the GBS premium reimbursement form.
To fill out the GBS premium reimbursement form, you will need to provide information about the premiums paid, the group benefit plan, and any other relevant details requested on the form.
The purpose of the GBS premium reimbursement form is to allow individuals or organizations to recoup expenses related to group benefit plan premiums.
The information required on the GBS premium reimbursement form typically includes details about the premiums paid, the group benefit plan, and any supporting documentation.
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