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STATE OF CALIFORNIA DEPARTMENT OF INSURANCE Dave Jones, Insurance Commissioner CLAIMS SERVICES BUREAU 300 SOUTH SPRING STREET, SOUTH TOWER LOS ANGELES, CA 90013 www.insurance.ca.gov CCB-025 P Eff.:
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What is hprfa form?
The hprfa form refers to the Health Premium Reimbursement Flexible Account form. It is a form used by employees to request reimbursement for eligible health expenses.
Who is required to file hprfa form?
Employees who have a Health Premium Reimbursement Flexible Account are required to file the hprfa form to request reimbursement for eligible health expenses.
How to fill out hprfa form?
To fill out the hprfa form, employees need to provide their personal information, details of the health expenses incurred, and any supporting documentation. They should follow the instructions provided on the form.
What is the purpose of hprfa form?
The purpose of the hprfa form is to enable employees to request reimbursement for eligible health expenses through their Health Premium Reimbursement Flexible Account.
What information must be reported on hprfa form?
The hprfa form requires employees to report their personal information such as name and employee ID, details of the health expenses incurred, including the date, description, and amount, and any supporting documentation.
When is the deadline to file hprfa form in 2023?
The deadline to file the hprfa form in 2023 is not provided. Please check the specific guidelines or deadline provided by your employer or health insurance provider.
What is the penalty for the late filing of hprfa form?
The penalty for the late filing of the hprfa form may vary depending on the employer or health insurance provider. Please refer to the guidelines or terms and conditions provided by your employer or health insurance provider to determine the specific penalty.
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