In order to be reimbursed, you will need to submit a claim for the amount that’s being deducted from you or your spouse’s pay. Here is the step-by-step guide.

  1. Select 'Submit Claims' on the blue navigation bar at the top of your screen
  2. Select 'Health Insurance Premium' for the claim type
  3. Choose whether you’re submitting a new claim or whether you’re looking to replace an existing claim (due to premium increase or other)
  4. If choosing ‘Replace an existing premium,’ select which premium it will replace before continuing
  5. Click the box for Source of Policy and select Employer Sponsored Group with the corresponding tax status (Pre-Tax or Post-Tax)
  6. Fill out the rest of the policy, premium and reimbursement information 
  7. Attach your supporting documentation, a copy of your insurance card, the signed Tax Acknowledgement Form, and a copy of the pay stub for the period you’re requesting reimbursement for.
  8. If you’ll be faxing your documents, scroll down and select ‘Yes’ for ‘Are you going to fax your documentation?
  9. Click ‘Submit for Review’

Acknowledgement of Tax Responsibilities for Payroll Contributions to Employer-Sponsored Premiums

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