Use this form to explain your company's medical reimbursement plan if you choose to reimburse employees directly. Detail which medical expenses the company will cover and who is entitled to reimbursement.

THIS FORM:

• provides a sample from a corporation that insures its own workers
• demonstrates the ways in which such a plan can be explained simply and concisely so that all employees fully understand what kind of coverage they have and the procedure for making claims against that coverage