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Please Fill Out The Form(s) Completely.
FORMS
HRA Reimbursement Receipt Validation Process
Step one: Click below to begin your reimbursement request
Step two: Complete the form, attach valid receipts of your qualified expenses or copies of your premium payments for the month you are requesting reimbursement. Please submit the form for processing*
Step Three: Once your request is received, Smart Choices Health will validate it per the IRS requirements. A validation email will be sent to your employer on a monthly basis to initiate payment.
Note: Only one month per reimbursement request is allowed however you can submit multiple requests.
*If this is your first reimbursement of the plan year please complete the Initial MEC Attestation Form
Initial MEC Attestation Form
- Submit legible receipts that include dates of service or payment
- Include the amount requested to avoid processing delays
- Remember to only submit one month at a time per submission
- Make sure the name of the employee is on the submission
- Be sure to upload documents correctly so they are easy to read
Reimbursement Form
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