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To request reimbursement for your health care premiums use this form. ①Account Holder Information: The Account Holder is usually the retiree or the surviving spouse. ②Reimbursement Information: Complete this section to indicate the Date of Service; Type of Coverage (e.g. Medigap;) Covered Participant Name and Relationship to the account ...
3 sie 2022 · Learn how to use the Via Benefits Accounts mobile app, website, or Reimbursement Request Form to get reimbursed for your eligible expenses from your reimbursement account. Find out the documentation requirements, submission process, and cancellation options for premium and out-of-pocket reimbursements.
Log in to your account at www.viabenefitsaccounts.com. Submit your claim online and attach the image or scanned copy of your receipt(s) online. Option 1 & 2 are the fastest and most convenient way to complete your claims and send us your documents.
instructions for managing your reimbursement account and explains how to be reimbursed for your eligible expenses. Via Benefits reimbursement accounts are administered by Extend Health, LLC. You will submit your reimbursement requests to Via Benefits and be reimbursed from your available funds. Download the Via Benefits Accounts mobile app to ...
2 lip 2024 · To submit a reimbursement request on the website, complete the following steps: 1. Sign into Via Benefits, and select View Accounts in the Funds and Reimbursements section. 2. Select Visit the Reimbursement Center for the desired account on the Request Reimbursement and Manage Funds tab. 3.
3 sie 2022 · You need to submit reimbursement requests to receive funds from your reimbursement account for your eligible expenses. (You will not receive a debit card.) Use the Via Benefits Accounts mobile app, the website, or a Reimbursement Request Form to submit reimbursement requests.
This form is used to submit reimbursement requests for the Life Planning Account. Parts I–IV are to be completed by an eligible retiree (retired on or before December 31, 2003) or the surviving spouse of an eligible retiree.
