Submitting claims and reimbursement requests is easy.

Medical Claims
HSA Reimbursements
Pharmacy Claims
Flexible Spending Account Claims
Dental Claims
Vision Claims
Weight Loss Program Reimbursement
Smoking-Cessation Program Reimbursement

Medical Claims

When you go to your doctor or hospital, you’ll be asked for your medical insurance card. Your card tells your provider that you have medical coverage and what’s typically covered under your medical plan. It also lets your provider submit claims on your behalf.

In general, after your provider submits a claim, your medical plan will pay the provider directly (based on the type of plan you have and whether you’ve met your deductible or out-of-pocket maximum). Then, you’ll owe the balance. You’ll receive a bill from the provider for the amount you owe. For Kaiser members, it works a bit differently since you pay up front.

Your medical plan may also send you an Explanation of Benefits (EOB)—it’s basically a recap of the provider you saw, the services you had and how much was paid by your insurer. It’s not a bill though, and should say so on the first page.

If you need to submit a claim yourself, use the UHC Claim Form. If you’re a Kaiser member, the plan will handle everything for you. In some cases—like if you need emergency care—you may need to submit the Emergency Care Form. Finally, if you’re traveling, you’ll want to use the International Claim Form.

If you have questions about a medical claim or bill, please contact your medical plan.

HSA Reimbursements

UHC Core HSA and UHC Plus HSA

You have four ways to pay for healthcare using your HSA:

  1. Your Optum Bank HSA Debit Card. If your provider accepts MasterCard, you can use your card to pay a bill after you’ve received it—as long as you have an account balance.
  2. Optum’s online bill pay.
  3. Optum’s paper checks.
  4. Out of pocket. Any time you pay for healthcare yourself—last year, last week or any time going forward—save your receipts to track your qualified expenses. Then, when you’re ready to get reimbursed for them, go to www.optumbank.com, log into your HSA and select “Reimburse Yourself.”

Kaiser HSA

You have four ways to pay for healthcare using your HSA:

  1. WageWorks® Healthcare Card. It’s like a debit card—just swipe and go.
  2. EZ Receipts® Mobile App. Snap a photo of your receipts, then submit them for payment, plus check your HSA balance—all from your mobile device.
  3. Pay My Provider. Access your HSA online and fill out a simple form to pay healthcare providers—no receipts or claim forms needed.
  4. Pay Me Back. Arrange for your HSA funds to be deposited directly into a checking account or as a check to reimburse you for expenses you’ve already paid.

Pharmacy Claims

If you’re a UHC member, use the UHC claim form if:

  • You didn’t have your prescription drug card with you.
  • You requested additional drugs because you were going on vacation.
  • Your claim was rejected by the pharmacy.
  • You’re trying to coordinate coverage with another plan.
  • Your purchase was out-of-network.

Flexible Spending Account Claims

When you spend money on healthcare or dependent care expenses, use your FSA Debit Card to avoid having to submit receipts. When you can’t use your card, use the mobile app, online portal or this form to submit claims to WageWorks, our FSA administrator.

Dental Claims

Guardian PPO

When you visit dentists that accept Guardian insurance, they will file claims with and accept payment from Guardian so you don’t need to do anything. Dentists that don’t accept Guardian may require payment up front; if so, simply file a claim for reimbursement.

Vision Claims

VSP or EyeMed

If you have vision coverage and receive in-network care, there are no claim forms to complete. If you receive care from out-of-network providers, you may need to pay for services up front and then file a claim to get reimbursed.

EyeMed provides vision insurance cards; VSP doesn’t. You’re covered either way, though—just tell your provider that you have VSP coverage, and they will look you up.

Reminder: If you are enrolled in either VSP or EyeMed, you are not eligible for the Hitachi Vantara Vision Reimbursement Plan.

Hitachi Vantara Vision Reimbursement Plan

If you’re enrolled in the Hitachi Vantara Vision Reimbursement Plan, you can get up to $250 each year—for each family member you cover. Getting care and getting reimbursed is easy. Visit the provider of your choice and pay the full bill at the time of your appointment. Then, submit a Vision Reimbursement Expense Report through Oracle iExpense.

Weight Loss Program Reimbursement

Lose weight, gain cash back! Hitachi Vantara will reimburse you 50% of the cost to participate in a qualified weight-loss program, up to $100 each year. To be reimbursed, complete an online expense report through Oracle iExpense, using the “US TE Template”—be sure the “purpose” reads “weight loss reimbursement.”

Smoking-Cessation Program Reimbursement

Here’s an extra incentive to kick the habit: Hitachi Vantara will reimburse you up to $300 each year to participate in a qualified smoking-cessation program. To be reimbursed, complete an online expense report through Oracle iExpense, using the “US TE Template”—be sure the “purpose” reads “smoking cessation.”