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Health Reimbursement Arrangement (HRA) / Retiree Reimbursement Arrangement (ERA) Recurring Premium Reimbursement Claim Form Member Identification Number (Employer/Member assigned number or W ID)Mail
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To fill out the arrangement RRA recurring premium, follow these steps:
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Start by opening the RRA recurring premium form.
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Enter your personal information such as your name, address, and contact details.
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Provide the details of the policy or agreement for which you are setting up the recurring premium.
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Specify the frequency and amount of the recurring premium. This could be monthly, quarterly, annually, etc., and the corresponding premium amount to be deducted.
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Attach any necessary documents or supporting evidence related to the agreement.
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Review the completed form to ensure all the information is accurate and complete.
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Submit the filled-out form to the designated department or the concerned authority.

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Arrangement RRA Recurring Premium refers to a type of premium payment that is made on a regular basis for a specific arrangement or agreement.
The entity or individual who has entered into the arrangement or agreement which requires recurring premium payments is required to file arrangement RRA recurring premium.
Arrangement RRA recurring premium can be filled out by providing all the necessary information related to the arrangement, premium payments, and any other required details on the designated form.
The purpose of arrangement RRA recurring premium is to ensure that the premium payments for a specific arrangement or agreement are made in a timely manner and in accordance with the terms of the agreement.
The information that must be reported on arrangement RRA recurring premium includes details of the arrangement, premium payment amounts, payment schedule, and any other relevant information.
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