Thank you for choosing ATRIO Health Plans for your health insurance coverage.
Use this form for any reimbursement requests you may have.
For medical claims: If you received services from a contracted medical provider, your claim should be submitted by the provider. You do not need to submit this form unless you know that your claim was not submitted. Please complete a separate form for each member or provider.
For Gym or Flex Card reimbursements: If you were denied access to an approved fitness center or paid out-of-pocket due to an error with your flex card, please complete this form to request a reimbursement.
Approved reimbursement amounts will be deducted from your Flex Card allowance up to the maximum amount. Be sure to include appropriate documentation of proof of payment. Incomplete forms submitted without the necessary information and documentation may result in a delay in your reimbursement or may be returned for additional information. Reimbursement form must be received no later than one year after the date you paid for the service.
If you have questions, please call Member Services at 1-877-672-8620 (TTY 711 ), daily from 8 a.m. to 8 p.m. local time.
