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VEBA/HRA/HSA Plans

Work with SCSC and BCBS/Select Account to implement a VEBA (Voluntary Employees’ Beneficiary Association) account, HRA (Health Reimbursement Account), or HSA (Health Savings Account) to help manage your costs. You can contribute pre-tax dollars for your employees and retirees to a fund that can be used for current and future medical expenses. Many deductible or coinsurance options are available, and all plans offer preventive care benefits including physical exam provisions.

Contact

Larry IntVeld, 651-226-4365
Les Martisko, Ph.D., 507-389-1881

Reimbursement Account Claim Form (PDF)
Submit a claim to SelectAccount.

Letter of Medical Necessity (PDF)
In order to determine eligibility for Potentially Eligible Expenses, you will need to obtain a Letter of Medical Necessity from your healthcare provider.

Direct Deposit Form (PDF)
Authorize an electronic transfer of your reimbursements from your reimbursement account to your checking or savings account. Note: this form can also be completed online.

Medical Crossover Form (PDF)
Have your medical claims automatically submitted from your health plan to SelectAccount and avoid paperwork. Note: this form can also be completed online.

Account Access Form (PDF)
Designate whether you would like your VEBA account accessed for any claims processed by SelectAccount.

Account Option Form (PDF)

Member Requested Authorization for Release of Information (PDF)
Complete this form if you want SelectAccount to release information about you to someone else (for example: an agent or family member).

Appeal Form (PDF)
Use this to provide additional information to have a denied claim reviewed.