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Use a separate form for each covered individual. Submit completed form to claims hraveba.org Fax 206 577-3020 HRA VEBA Plan PO Box 80587 Seattle WA 98108 PARTICIPANT ACCOUNT and CONTACT INFORMATION If you have more than one claims-eligible account enter the participant account number of the account from which you want to be reimbursed. Otherwise your claim will be reimbursed from the account with the earliest claims-eligibility date. Claim Formhraveba*org and submit your expenses and...
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