Health Care Reimbursement Account Claim Form
Please use this form to request reimbursement for: eligible expenses not covered by any insurance plan, or the unpaid balance of a health, dental, or vision care claim submitted under an employees group plan.
Questions about a claim? Please contact HealthEquity at 877-924-3967.
| Form Name | Format |
|---|---|
| Health Care Reimbursement Account Claim Form (can be filled in electronically) |
Categories
Benefits - Health Care Reimbursement Account, Benefits - Reimbursement Accounts