This is your monthly reminder that in order to receive your health insurance reimbursement benefit you need to send confirmation that coverage remains in effect or a copy of a receipt showing payment has been made.

To make this process as easy as possible please use the following link: 

To complete the form:

1. Employee Name…use the dropdown menu to select your name.
2. Provider Name…enter the name of your health insurance coverage provider.
3. Coverage Through Date…enter the date that your coverage is paid through e.g., if you are paying for coverage for the month of December enter the last day of coverage; December 31^st.
4. Amount Paid…enter the amount that you paid for the coverage period.
5. Comment…please add a note if anything has changed since your last submission or need to communicate anything about health insurance reimbursement.
6. Attach a Copy of Your Provider's Statement or Receipt…attach a copy of your insurance company documentation showing that payment has been made…drag and drop or browse. For your initial submission if you have not yet paid for coverage you may include your Insurance Company Quote for the coverage you have chosen…subsequently you will need to submit a paid statement or receipt before the 15^th of the month. 

Reimbursements will be paid in the first pay period of each month. However, should proof of payment (each month) not be received by the 15^th of the month, the amount advanced will be deducted from the first pay period of the following month.