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All About PHSPs and HSAs
How does it work?
What's covered?
Is a PHSP for me?
What does it cost?
Info for Accountants
Why DR Associates?
1. Register Your Plan
2. Fund Your Plan
3. Submit Your Claims
Forms
FAQs
Claim Form for PAY-AS-YOU-GO PLAN
Date
Business or Company Name
Name of Covered Employee
Employee Email Address
Employee Phone Number
Patient Information
Patient Name
Service Date
Description of Service
Amount
Remove
Add Patient Information
Total Claim (A)
0
Administration Fee (B)
0
A x 5%
GST on Administration Fee Only (C)
0
B x 5%
Total Planholder Payment Enclosed (D)
0
A + B + C
Employee hereby certifies that all health services were purchased by or for an eligible member of their household.
I have read and confirmed that all the information provided above is accurate and complete.
Submit