Health Reimbursement Arrangement Claim Form. The forms can be filled in on the computer.You need to fill out claim form CMS-1500 if you have private health insurance. If you have Medicare or Medicaid, you need to fill out claim form CMS-1490S. Travel Expense Reimbursement Form. This form is used when seeking reimbursement for non-participating providers. HEAP helps low-income households meet the cost of heating their homes. Learn more about the Essential Plan for New York. Check eligibility, explore benefits, and enroll today. This exemption only applies to OTPs whose states concur with the exercise of this exemption and its conditions within their states.