When filing your claim, you must attach copies of the receipts. The receipt must show the date and type of service for the expense. Canceled checks, credit card slips, or statements showing only a balance due on your account are not allowable.

Claim Form

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If you mail your claim with receipts, remember to keep a copy of the claim form and supporting documents for your records.

If you fax your claim with receipts, please remember to keep the original claim form and supporting documents for your records.

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