How To Get Paper Forms
This article applies to you if you have a Via Benefits reimbursement account (sometimes known as a Health Reimbursement Arrangement)*.
Participants receiving ICHRA benefits can't submit reimbursement requests using a paper form.
Paper forms are available to set up direct deposit or submit reimbursement requests. However, using a paper form isn't the preferred method because it lengthens the processing time of your requests.
Reimbursement Request Form
You may submit a reimbursement request by completing and returning a Reimbursement Request Form. This form is not available online. To request one, call us at 1‑866‑322‑2824 and follow the prompts in our automated voice system or speak directly with a Via Benefits representative. Please allow two to three business days for your request to be processed, plus additional time for the form to arrive by mail.
Once you receive and complete the form, return it to the address printed on the back. Please note that submitting a paper form is less secure and may take up to 10 days longer to process than submitting your request through the website or mobile app. Reimbursement requests submitted online or through the app are typically processed within five business days.
For more information, read Submitting a Reimbursement Request.
Direct Deposit Authorization Form
You may set up direct deposit or update your banking information by completing and returning a Direct Deposit Authorization Form. This form is not available online. To request one, call 1‑866‑322‑2824 and follow the prompts in our automated voice system or speak with a Via Benefits representative. Please allow two to three business days for your request to be processed, plus additional time for the form to arrive by mail.
After you receive and complete the form, return it to the address printed on the back. Please note that it may take up to 15 business days for us to receive and validate your Direct Deposit Authorization Form. Forms received between January 1 and March 31 may take longer to be processed and validated.
If you submit your direct deposit information through the mobile app or website, validation typically takes three to five business days. A voided check is required when you use a paper form, but this is not needed when authorizing direct deposit through the mobile app or website.
For more information, read Setting Up Direct Deposit Using a Paper Form.
*Via Benefits reimbursement accounts are administered by Extend Health, LLC.