Getting and Submitting a Reimbursement Request Form
This article applies to you if you have a Via Benefits reimbursement account, sometimes called a Health Reimbursement Arrangement.*
If you receive an Individual Health Reimbursement Arrangement (ICHRA) through your employer, reimbursement requests can’t be submitted using a paper form.
You may submit a reimbursement request by completing and returning a Reimbursement Request Form. However, it is less secure and may take up to 10 days longer to process than submitting your request through the website or Via Benefits Accounts mobile app. Reimbursement requests submitted on the website or through the mobile app are typically processed within five business days. For more information, read Submitting a Reimbursement Request.
Getting the Form
The Reimbursement Request Form isn't available online. To request one, call us at 1‑866‑322‑2824 (TTY: 711) and follow the prompts in our automated voice system or speak directly with a Via Benefits representative. Please allow two to three business days for processing, plus additional time for delivery by mail.
Submitting the Form
Once you have received and completed the form, return it to the address printed on the back.
*Via Benefits reimbursement accounts are administered by Extend Health, LLC.