Examples of Reimbursement Request Form in a sentence
This Account-Based Offerings Administrative Services Agreement will be considered accepted and binding by the parties when you sign your Group Setup Form or, when applicable, your Claim Reimbursement Request Form, or you pay your first month’s service fees for Account-Based Offerings.
Blue Cross and Blue Shield will administer these services in accordance with the terms and conditions of this Account-Based Offerings Administrative Services Agreement, your Group Setup Form and Fee Schedule or, when applicable, your Claim Reimbursement Request Form and Fee Schedule, and the Business Associate Agreement which is included as Attachment 3 to the Premium Account Agreement.
When you elect to have Blue Cross and Blue Shield work with your designated vendor for your Account-Based Offerings, Blue Cross and Blue Shield will provide services as described in this Account-Based Offerings Administrative Services Agreement and in your Claim Reimbursement Request Form.
When you elect to have your designated vendor administer your Account-Based Offerings, Blue Cross and Blue Shield will provide services in accordance with the Claim Reimbursement Request Form you provide to Blue Cross and Blue Shield for services under this Account-Based Offerings Administrative Services Agreement.
When you elect to have Blue Cross and Blue Shield work with your designated vendor for your Account-Based Offerings, you will provide Blue Cross and Blue Shield with a completed Claim Reimbursement Request Form that designates certain aspects of the Account-Based Offerings that you will make available to your eligible employees.
Part G Reimbursement Request Form To be furnished, completed, and submitted via an excel template provided to the Subrecipent upon execution of this Agreement.
The employee must complete the Tuition Reimbursement Request Form and secure approval from the Health Officer and Human Resources Director PRIOR to taking a course.
Documentation must be submitted with a completed Grant Funding Assistance Reimbursement Request Form.
Such requests shall be submitted on a Tuition Reimbursement Request Form.
Each invoice shall be submitted by the Grantee using Grantor’s system with a signed copy sent by mail or other means as specified in Article 17 (NOTICES) herein, and the Reimbursement Request Form found in Exhibit E.