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Medical Claim Forms
Medical Claim form for Out-of-Network Provider or Massage Therapy
Directions on Submitting Medical Claim form to HNAS
Phone: 800-220-2600
Website: www.myhnas.com
Email: claims.hnas@hnas.com
Group: U44
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Massage Therapy Reimbursement
If you are enrolled in HMC medical plan, the plan offers massage therapy benefit and does not require referral from a physician. The only requirement is that your massage therapist is licensed in the state of service.
Click Here for directions on how to file claim for reimbursement.
$700.00 benefit per Calendar year. Applies to both employee and spouse in the HMC medical plan.
o $25 Copay for Standard PPO and EPO plan.
o $35 Copay for Choice and HSA PPO plan.
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Dental Claim Form
The Dental Claim form applies to the Dental PPO plan Only. If your dentist is an out-of-network provider and does not submit your service to the insurance company, please complete form to receive your dental benefit.
Directions on Filing Dental Claim Form
Phone: 800-765-6003
Website: deltadentalins.com
PPO Group number: 00511
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Vision VSP Claim Form
Submit a claim with VSP if you visit an Out-of-Network provider.
Directions to filing a VSP claim
Phone: 800-877-7195
Website: www.vsp.com
Group number: 30058404
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FSA Tax Spending Claim Form
If you did not use your FSA debit card or if HNAS requires documentation for the debit card you used, please submit documentation or claim to the FSA website.
Directions on Setting up an Account with HNAS FSA
Filing medical or dependent care claim.
FSA Customer Service Number: 800-518-8332
Email: hnasfsaclaims@hnas.com
Website: HNAS.wealthcareportal.com
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