Brochures and Information Sheets

Medical Expense Reimbursement Guide
Learn the general guidelines about eligible and ineligible expenses.

Over-the-Counter Drugs Eligible Expense Listing
Find out which over-the-counter drugs are eligible for reimbursement from your VEBA account.

VEBA Mutual Funds List
View a listing of current mutual funds options available to you.

Forms

Medical Expense Reimbursement Account Claim Form
You can now fill out this form online before you print. When entering information into the form, use Tab to move between the fields. To complete your claim submission after printing the completed form, sign, attach supporting documentation and submit to SelectAccount.

Letter of Medical Necessity
In order to determine eligibility for Potentially Eligible Expenses, you will need to obtain a Letter of Medical Necessity from your health care provider.

Member Requested Authorization for Release of Information (ARI)
Complete this form if you want SelectAccount to release information about you to someone else (for example, an agent or a family member).

Appeal Form
Use this to provide additional information to have a denied claim reviewed.

Direct Deposit Form
Sign in to authorize electronic transfer of your reimbursements from your FSA to your bank account.

Medical Crossover Form
For members with an account that includes the crossover feature, sign in to view or update your crossover election.

Dental Crossover Form
For members with an account that includes the crossover feature, sign in to view or update your crossover election.

Account Options Form
Designate whether you would like your VEBA account accessed for any claims processed by SelectAccount.

Reimbursement Return Form
Use this form to return a payment to your account.