Health Insurance Reimbursement printable pdf download

Health I nsurance R eimbursement

Flexible S pending A ccounts ( FSA)

Health R eimbursement A ccounts ( HRA)

Health S avings A ccounts ( HSA)

Health I nsurance R eimbursement

Some h ealth i nsurance c ompanies c onsider t he c ost o f t he N utrisystem p rogram t o b e a r eimbursable

expense p rovided c ertain c onditions a re m et. Y ou m ay b e e ligible t o r eceive a f ull o r p artial

reimbursement f or t he c ost o f y our N utrisystem p rogram f rom y our h ealth i nsurance p rovider. T o

determine e ligibility w e r ecommend y ou f ollow t hese s teps:

1. Ask y our d octor t o c omplete t he l etter o f m edical n ecessity a ttached. P lease c omplete o nly o ne

of t he l etters: t he N utrisystem D L etter ( diabetic p rogram o nly) o r t he N utrisystem P rogram

Letter ( any n on-‐diabetic p rogram).

2. Attach a c opy o f e ach N utrisystem p acking s lip. T he p acking s lip c omes i n y our N utrisystem f ood

box a nd s hows b oth t he p rogram t ype ( ex: N utrisystem W omen’s P lan) a nd t he p rice.

3. Submit t he s igned l etter o f m edical n ecessity a long w ith y our p acking s lip(s) t o y our h ealth

insurance p rovider f or r eimbursement.

Flexible S pending A ccount ( FSA) & H ealth R eimbursement A ccount ( HRA)

The c ost o f a w eight l oss p rogram, w hen p rescribed y our p hysician t o t reat a d iagnosed m edical

condition s uch a s o besity, h ypertension o r d iabetes, i s a r eimbursable F SA o r H RA e xpense a ccording t o

the I RS. M any p lan a dministrators c onsider t he N utrisystem w eight l oss p rogram t o b e a q ualified

expense u nder t hese g uidelines. B y f ollowing t he c laim p rocess b elow, y ou c an s ubmit t he c ost o f y our

Nutrisystem p rogram t o y our p lan a dministrator f or r eimbursement.

Claim P rocess f or F SA / H RA

1. Ask y our d octor t o c omplete t he l etter o f m edical n ecessity a ttached. P lease c omplete o nly o ne

of t he l etters: t he N utrisystem D L etter ( diabetic p rogram o nly) o r t he N utrisystem P rogram

Letter ( any n on-‐diabetic p rogram).

2. Fill o ut a F SA / H RA c laim f orm p rovided b y y our p lan a dministrator o r H R d epartment.

3. Attach a c opy o f e ach N utrisystem p acking s lip. T he p acking s lip c omes i n y our N utrisystem f ood

box a nd s hows b oth t he p rogram t ype ( ex: N utrisystem W omen’s P lan) a nd t he p rice.

4. Submit t he s igned l etter o f m edical n ecessity a long w ith t he c laim f orm a nd p acking s lip(s) t o

your F SA / H AS a dministrator f or r eimbursement. E ligibility f or r eimbursement o f t he c ost o f

the N utrisystem p rogram i s a t t he s ole d iscretion o f y our p lan a dministrator.

Please n ote: N utrisystem d oes n ot a ccept F SA d ebit c ards a t t his t ime. P lease f ollow t he c laim

process o utlined a bove t o s ubmit y our N utrisystem p rogram e xpense f or r eimbursement.

Health Insurance Reimbursement