Claim Documentation FAQ

What type of documentation should I include with my eligible medical expense reimbursements?

You can substantiate your claim with one of the following:

  • The Explanation of Benefits (EOB) statement returned to you from the insurance carrier indicating the amount you are responsible for
  • Copay receipts if you are covered under a managed care or prescription drug plan
  • If there is no insurance for the health care expenses, submit an itemized bill with the following:
    • Name of the provider and patient
    • Service cost, date, and description
    • Notation when there is no coverage

What type of documentation should I include with my premium reimbursement?*

You can substantiate your claim with a Premium Notice, such as a bill or acceptance letter from the insurance company, which includes the following:

  • The premium amount
  • The effective date of coverage
  • Name of the person insured – this will be you, your spouse or a qualifying dependent

Good Documentation vs. Bad

Good documentation includes:

  • A breakdown of each service and/or medical expense
  • The date each service and/or medical expense was incurred
  • Your name (or your spouse / eligible dependent’s name, if the expense is for them)
  • We suggest an EOB, Itemized Statement, or Copay Receipts because these forms of documentation will always include the information we need to quickly process your reimbursement.
  • See left for an example of an Itemized Receipt.

 

 

 

 

 

 

 

Bad documentation examples:

  • A late notice that only includes the total amount owed and does not include a description of the services incurred
  • A credit card receipt that only includes the total amount paid
  • See left for an example of bad documentation.

 

 

 

 

 

 

 

 

If you have questions on reimbursement documentation, please email us at claims@myMidAmerica.com.

*Flexible Spending Accounts do not reimburse premiums. This applies to Health Reimbursement Arrangements.

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