New Member Reimbursement Form
Posted on December 13, 2013
Effective January 1, 2014, Health New England (HNE) has issued a new Member Reimbursement Claim Form for you to use when you request reimbursement for medical expenses paid out of pocket. The form is on our website in the HNE Member section under Forms:
Member-Reimbursement-Claim-Form.pdf
You can download or print the form from this link.
You must complete and sign this form and submit it to receive reimbursement. Please note the documentation requirements for services received and proof of payment. These changes will allow HNE to process your request quickly and efficiently.
Please use this form to request reimbursements for claims on services incurred after September 1, 2013.
Please follow the instructions on the back of the form.
If you have any questions, please call Member Services:
(Direct line): 413.787.4004
(Toll free): 800.310.2835
TTY/TTD: 800.439.2370
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