Get Hpffa Medical Claim Form 6-2011.xlsx

Filling out the HPFFA Medical Claim Form accurately is essential for the processing of your medical claims. This guide provides step-by-step instructions to help you complete the form online with ease and confidence.

Follow the steps to accurately complete the HPFFA Medical Claim Form online.

1. Press the ‘Get Form’ button to access the HPFFA Medical Claim Form 6-2011.xlsx, and open it in your preferred online editor.
2. Begin by selecting which plan applies to you by checking the appropriate boxes, such as Cigna Kelsey Care or Medicare Retiree Plan.
3. Enter your member information, including your name, birth date, and the last four digits of your social security number.
4. Fill in your address details, including city, state, and zip code. If you have a new address, make sure to check the box provided.
5. List the full name and birth date of any dependents that are included in this claim.
6. Indicate who the claim is for by selecting from the options provided (member, spouse, dependent, stepchild, child, or other).
7. Sign and date the form to certify that the information provided is accurate and true.
8. Attach all original receipts and any necessary documentation required to support your claim to the form.
9. Review all entries for accuracy and completeness. Save, download, print, or share the completed claim form as needed.

Start filling out your claims online today for a faster processing experience.