Fill Out Your Shps Reimbursement Form

What is the SHPS Reimbursement form used for?

The SHPS Reimbursement form is designed to request reimbursement for qualified health and dependent care expenses incurred by employees and their eligible dependents. It allows employees to claim amounts not fully covered by other insurance or expenses that are not reimbursable through any other plans.

How do I complete the Employee Information section?

To complete the Employee Information section, fill in your control number, name, date of birth, social security number, email address, daytime telephone number, and address. Make sure that all information is accurate and clearly printed. If your address changes, contact your Health Insurance Section, unless the change is temporary and indicated on the form.

What types of services can I claim in Part II?

Part II allows you to request reimbursement for various types of health care services, including medical, vision, prescription, dental, and orthodontics. You must specify the dates of service and include any Explanation of Benefits (EOB) provided by your insurance plan. Claims under this section will pend if the total requested amount is less than $25.

What is required for reimbursement of dependent care expenses?

To claim dependent care expenses, complete Part III, which includes the dependent's full name, date of birth, and service dates. Attach supporting documentation, such as bills or signed receipts, and ensure that the provider's Tax ID number is included. Claims will not be processed without the necessary Tax ID.

What are the guidelines for documentation?

Documentation is essential for both health and dependent care expenses. For health care claims, include an EOB for partially covered expenses or receipts for expenses not covered by insurance. For dependent care, provide a signed receipt or bill, along with the provider's Tax ID number. Proper documentation is necessary to process your claims efficiently.

How do I submit the completed reimbursement form?

You can submit the completed form via fax or mail. For fax submissions, ensure that you send only one claim per transmission to expedite processing. If mailing, include all required documentation and send it to the SHPS Processing Center. The fax number is 502-267-2233, and the mailing address is PO Box 34700, Louisville, Kentucky 40232-4700.

What does the Employee Certification for Reimbursement entail?

Before signing, carefully read the Employee Certification for Reimbursement statement. By signing, you certify that the information provided is accurate, that the expenses are for you or your eligible dependents, and that you have not previously received reimbursement for these expenses from any other plans. You also authorize SHPS to obtain necessary information from relevant parties to process your claims.

What limitations are there for dependent care reimbursement?

Dependent care expenses may not exceed specific limits based on your income or the amount of money you have contributed to your Flexible Spending Account. The total for dependent care claims cannot exceed $5,000 per year, or $2,500 if filing separately, and claims must be for services that allow you and your spouse to work or attend school full time.

Whom do I contact if I have questions about the form?

If you have questions or require assistance regarding the SHPS Reimbursement form, you can contact the SHPS Customer Service Center at 1-800-678-6684 for support.

Filling out the SHPS Reimbursement form can seem straightforward, but many individuals make common mistakes that could potentially delay their claims. Understanding these pitfalls is crucial for ensuring a smooth reimbursement process.

One major mistake is incomplete information. It is essential to fill in all required sections, especially in Part I, which includes your name, Social Security number, and date of birth. Omitting any of these details can result in your claim being rejected outright. It’s easy to overlook something when you're in a hurry, but double-checking your entries can make a big difference.

Another frequent error involves incorrect documentation. Many people forget to include necessary supporting documents, such as the Explanation of Benefits (EOB) or receipts. It is crucial to attach these items when claiming for healthcare expenses. If you don’t provide adequate proof of your expenses, SHPS may pend your claim, leading to further delays.

People often misinterpret the minimum reimbursement requirement. Claims for both health care and dependent care must be at least $25. If your claims do not meet this threshold, SHPS will not process them. This can catch you off guard if you expect smaller amounts to be reimbursed.

Not understanding the rules surrounding dependent care expenses can also lead to mistakes. For instance, claiming expenses for children over the age of 13 or for services when you or your spouse aren’t working may result in immediate denials. It’s imperative to be aware of eligibility to ensure your claims hold up under review.

Another area where people slip up is the formatting of dates. The form specifically requests that dates be entered in MMDDYYYY format. Failure to adhere to this format could lead to confusion and delay in processing your claim. Consistency and attention to detail can help mitigate this issue.

Many claimants neglect the employee certification section. All claims must be certified by the employee, confirming that the information is accurate and that no other reimbursements have been received for the same expenses. Without a signature, the form is considered incomplete and will not be processed.

It’s also common for individuals to submit multiple claims in one transmission when faxing their forms. This not only complicates the processing but can also lead to confusion and significant delays. It's best practice to send one claim per fax to expedite the reimbursement process.

Finally, ignoring the contact information provided for assistance can be a mistake. If questions arise while filling out the form, reaching out to SHPS Customer Service is helpful. They can clarify any doubts and guide you through the process, preventing unnecessary mistakes that could hinder your claim.

The SHPS Reimbursement form is typically used in conjunction with other documents to ensure a smooth claims process. Below is a list of common forms and documents that may accompany the SHPS Reimbursement form, each designed to provide essential information regarding your claim.

• Explanation of Benefits (EOB): This document details the services provided and the amount covered by your insurance plan. It must accompany claims for expenses that were partially covered.
• Provider Receipt: A receipt from your doctor or care provider that includes the date of service, type of service, and the amount charged. This is crucial for reimbursement of expenses not covered by insurance.
• Dependent Care Provider Tax ID: A form that captures the Tax ID number of the dependent care provider. This is required for submitting claims for child or elder care expenses.
• Provider Signature Form: A document that captures the signature of the dependent care provider, confirming the services rendered in accordance with the claimed amounts.
• Employee Certification Form: A separate certification statement confirming that the information submitted is accurate and that the claimed expenses meet eligibility requirements.
• Claim Submission Cover Sheet: A cover sheet that outlines the contents of the submission. This can help organize the documents and ensure nothing is overlooked.
• Payroll Documentation: This includes pay stubs or W-2 forms as proof of income for determining eligibility for dependent care expense claims.
• Bank Account Information Form: If you prefer electronic payment, this form is used to provide your banking details for direct deposit of reimbursements.

These forms work together to streamline the reimbursement process. Having them ready can significantly reduce delays and improve the chances of a successful claim submission.

• Flexible Spending Account (FSA) Claim Form: This document also requests reimbursement for eligible medical and dependent care expenses. It requires similar employee information and supporting documentation, ensuring that expenses align with FSA guidelines.
• Health Reimbursement Arrangement (HRA) Claim Form: Like the SHPS form, the HRA form is used to claim reimbursement for health-related expenses that are not fully paid by insurance. Both forms ask for similar details about the expenses incurred.
• Dependent Care Tax Credit Form: This form helps individuals claim a tax credit for dependent care expenses. Similar to the SHPS Reimbursement form, it requires information about the provider and the nature of the expenses, but focuses on tax credit filing rather than reimbursement.
• Out-of-Pocket Expense Claim Form: Used for claiming refunds for expenses incurred outside insurance coverage, this form shares features with the SHPS Reimbursement form, including detailed expense tracking and provider information.
• Medical Expense Deduction Worksheet: Taxpayers use this worksheet to prepare for potential deductions on their income tax returns. It resembles the SHPS form in that it requires thorough documentation of each expense, but is aimed at tax preparation rather than reimbursement.
• Employee Benefits Enrollment Form: While primarily used for enrolling in benefits, this form shares similarities with the SHPS Reimbursement form in gathering essential employee information and outlining specific benefits covered.
• Claim for Payment of Medical Services: This form is used to request direct payment from an insurer for medical services rendered. The process for documenting expenses and need for provider verification mirrors that of the SHPS Reimbursement form.
• Tax Form 2441 – Child and Dependent Care Expenses: This IRS form is utilized for claiming child and dependent care expenses. It requires the same basic information regarding care provider and expenses, paralleling the SHPS form’s requirements.

Here are seven important tips for filling out the SHPS Reimbursement form, including what to do and what to avoid:

• Do complete all sections of Part I thoroughly, including your full name and contact information.
• Do attach all necessary supporting documentation, such as the Explanation of Benefits (EOB), receipts, or signed statements from providers.
• Do double-check that all expenses are eligible for reimbursement, and ensure they are not covered by other insurances first.
• Do check your total requested amount; claims for less than $25 will not be processed.
• Don’t forget to sign and date the form in the Employee Certification section to avoid delays.
• Don’t submit multiple claims in one fax transmission, as this can impact processing times.
• Don’t include this instruction page when faxing your completed claim form.

Here are some common misconceptions about the SHPS Reimbursement form, along with clarifications for each:

1. Claim submission is automatic. Many believe their claim will be processed without any additional steps. However, you must complete the form correctly and provide all necessary documentation.
2. Multiple claims can be faxed together. Some think they can save time by sending multiple claims in one transmission. This is not advised. Each claim should be sent separately to ensure proper processing.
3. Only medical expenses are eligible. There's a belief that only health care expenses qualify. In reality, both health care and dependent care expenses can be reimbursed under this form.
4. Reimbursement guarantees tax-free payment. Many assume that any reimbursement received is tax-free. It’s important to understand that reimbursement does not guarantee that the payment won't be taxable.
5. All dependent care expenses are covered. Some expect all childcare costs to be reimbursed. Eligible expenses must meet specific criteria, such as being necessary for work or school.
6. Previous reimbursements affect current claims. There's a misconception that receiving reimbursement once invalidates future claims. Each submission is evaluated independently based on current eligibility.
7. Providing a canceled check is sufficient documentation. It's a common misunderstanding that a canceled check meets documentation requirements. Acceptable evidence must include specific detailed receipts.
8. Only services from licensed providers are accepted. While it’s vital to choose qualified providers, there’s a belief that unlicensed services can never be claimed. Not all services require licensing; they just need to be legitimate and meet criteria.
9. Dependent care providers do not need a Tax ID number. Many think a Tax ID number is optional for providers. In fact, it is required to process dependent care claims.

Understanding these misconceptions can help ensure smoother processing of your reimbursement claims. If you have any questions about the form or the process, don't hesitate to reach out for assistance.

Filling out and using the SHPS Reimbursement form effectively can streamline the reimbursement process for health and dependent care expenses. Here are five key takeaways to consider:

• Complete All Required Sections: Ensure that every section of the form is filled out accurately. This includes your personal information, details on health care expenses, and dependent care affidavit, if applicable.
• Provide Supporting Documentation: Attach necessary documentation, such as the Explanation of Benefits (EOB) for health care expenses or signed receipts for dependent care services. Without these attachments, claims may be delayed or denied.
• Understand the Minimum Requirements: Claims for both health care and dependent care expenses must exceed $25 to be processed. Claims below this amount will be pending until the minimum is achieved.
• Choose Your Submission Method Wisely: You can submit your claim via fax or mail. Faxing is generally quicker; however, ensure that you send only one claim per transmission to avoid processing issues.
• Register for Electronic Payments: Consider enrolling in electronic reimbursements for faster payments. You may also access account history and services via the mySHPS online platform.