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Section 125 Medical Reimbursement Request Form Section 1 This section must be completed fully for all claims. (PLEASE PRINT) EMPLOYER NAME: EMPLOYEE NAME: ADDRESS: Check if this is a NEW address EMPLOYEE
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What is section 125 medical reimbursement?
Section 125 medical reimbursement allows employees to set aside a portion of their salary on a pre-tax basis to pay for eligible medical expenses.
Who is required to file section 125 medical reimbursement?
Employees who want to participate in a section 125 medical reimbursement plan must file to enroll in the plan.
How to fill out section 125 medical reimbursement?
Employees must complete the necessary enrollment forms provided by their employer to participate in a section 125 medical reimbursement plan.
What is the purpose of section 125 medical reimbursement?
The purpose of section 125 medical reimbursement is to help employees save money on eligible medical expenses by using pre-tax dollars.
What information must be reported on section 125 medical reimbursement?
Employees must report their eligible medical expenses and the amount they wish to set aside from their salary for reimbursement.
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