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What is an ASIFlex claim form?

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Quick Answer

ASIFlex plan members can use ASIFlex claim forms to request reimbursements for eligible medical and related expenses from their health care flexible spending accounts or other employer health care reimbursement programs. Eligible expenses may include prescriptions, over-the-counter medications and medical supplies, health care visit costs that insurance does not cover, orthodontia, and work-related child or elder care, according to ASIFlex. Claim forms are for past expenses only, and ASIFlex does not provide members funds for future services.

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Full Answer

Members can file claims for a prior week or for a past month after the end of the month. Members can download a claim form at the organization’s website or submit a paperless claim online, states ASIFlex. When filing claims, individuals should include documentation of the provided services or goods. To reimburse for services, ASIFlex requires documentation stating the service provider, the patient’s name, the date or dates of service, the amount the provider charged, and a description of the provided services. ASIFlex accepts either original documents or legible copies.

For reimbursements for prescription medications, members must submit the pharmacy script, mail order statement, or itemized printout that includes the patient’s name, type of prescription, date and cost, explains ASIFlex. For over-the-counter medications, members should submit a sales receipt that includes the retailer name, date, type of medication and cost.

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