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NORTH CENTRAL STATES REGIONAL COUNCIL OF CARPENTERS HEALTH FUND P.O. BOX 4002, EAU CLAIRE, WI 54702 PHONE: 8004243405Health Reimbursement Account (HRA) Request for Reimbursement Nonparticipant Information
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To fill out the HRA claims form, follow these steps:
02
Start by entering your personal information such as your name, address, and contact details.
03
Next, provide details about the healthcare expenses you want to claim. This may include medical bills, pharmacy receipts, or any other eligible expenses.
04
Make sure to fill in the correct dates and amounts for each expense.
05
If you have multiple expenses, list them separately on the form.
06
Attach all the required supporting documentation, such as receipts or statements, to validate your claims.
07
Double-check all the information you have entered to ensure accuracy.
08
Finally, sign and date the form.
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That's it! You have successfully filled out the HRA claims form.

Who needs hra claims form-updated 9-28-19?

01
Anyone who has incurred eligible healthcare expenses and wants to claim reimbursement through an HRA (Health Reimbursement Arrangement) needs to fill out the HRA claims form. This form is typically required by employers or healthcare providers who offer HRAs as part of their benefits package. It allows individuals to request reimbursement for eligible medical expenses, such as doctor visits, prescriptions, or diagnostics.
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The HRA claims form updated on 9-28-19 is a document used to request reimbursement for eligible healthcare expenses.
Employees who have incurred eligible healthcare expenses and are seeking reimbursement from their HRA account are required to file the updated form.
The form can be filled out by providing the necessary personal information, details of the healthcare expenses incurred, and any supporting documentation required.
The purpose of the updated form is to facilitate the reimbursement process for eligible healthcare expenses incurred by employees.
The form requires information such as the employee's name, HRA account details, description of healthcare expenses, and any relevant receipts or invoices.
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