Toggle navigation
BenefitWallet
Home
My Account(s)
My Tax Forms
My Statements & Activity
My Profile
Change My Password
Create My User ID
My Alerts
My Money
Make an HSA Contribution
Reimburse Myself
Pay a Provider
Health Plan Claims
Filing Cabinet
Investments
My Debit Cards
Order Checks
SimpleeONE
My Completed Contributions
Resource Center
Contact Us
Terry Smith
My Profile
Password
Direct Deposit Information
HSA Alerts
Logout
2
Notifications (2)
Your payment of $200 is due on 22 July, 2015...
Pay now
May 25
Your documentation of claim #73655 has not...
Submit now
May 21
After receiving your enquiry or if you sort them into groups...
Apr 18
Lorem ipsum dolor sit amet, consectetur adipiscing elit...
Apr 16
3
Messages (3)
David M.
Thanks for update on HRA account.
May 25
Eliz Smarter
Hi John, how are you?
May 21
Tanguy Thiran
Hi John, how are you?
Apr 18
John Smith
Don’t forget to update your personal info.
Apr 16
Health Plan Claim Details
Pay a Provider
Reimburse Myself
Claim Amount
$75.00
Service Date
01/02/2017
Received Date
01/27/2017
Provider/Vendor
Dr. Jones
Recipient
Lee Smith
Status
Open
Health Plan Claim ID
BCBSTX-12345
Deductible Amount
$0.00
Co-Payment Amount
$0.00
Co-Insurance Amount
$0.00
Billed Amount
$90.00
Allowed Amount
$90.00
Total Liability Amount
$75.00
Show All Service Details
Notes
No note available
Edit note
The maximum text is 100 characters.
Documentation
Browse
Save
Cancel
Close the Claim
Note
The maximum text is 100 characters.