Finding the Recurring Premium Reimbursement Request Form

Click here for a printable version of this web page.

In mid-November 2015 OneExchange distributed a “Recurring Medicare Part B Reimbursement Form” which didn't cover reimbursement for other medical premiums beyond the Medicare Part B. IBM retirees were supposed to receive a “Recurring Premium Reimbursement Request Form,” which enables reimbursements for other medical expenses beyond Medicare.

It is not clear when OneExchange will distribute the correct reimbursement form. If you want reimbursement for more than Medicare, there is a form is available online at the OneExchange web site, but it is not easy to find. So we wrote up these instructions to help you to locate and access a printable version of the form.

1.) Login to One Exchange

2.) A screen like this will be displayed. Select FUNDS & REIMBURSEMENTS.

3.) Under Contacts and Resources select “Submit a request for reimbursement.”

4.) Press Continue.

5.) Select Resource Center.

6.) Select IBM Recurring Premium Reimbursement Form.

7.) Print the form, fill it in, and send the completed form to OneExchange.

8.) NOTE: On page 2 of the form there is a list of required supporting documentation that must be sent along with the form.