Describe your reimbursement process. Makeform creates an editable HRA claim form with participant details, expense line items, receipt uploads, attestations, and review routing.
Route reimbursement requests to Google Sheets, Slack, and Zapier.
Sample prompts for the builder
Choose a starting point and tailor it to your plan documents. Examples show form structure, not expense eligibility.
Audience
Employees requesting reimbursement for one expense
Format
Single-expense claim with receipt upload
Prompt size
313 chars
Example form structure
Single-expense claim with receipt upload
Employee and participant details
Service date, provider, and expense category
Amount requested and other reimbursement
Receipt or supporting document
Attestation and signature
Suggested routing tags
Ready for review
More information needed
Processed
Ask for a separate line item for each expense. Service date, provider, category, amount, and receipt stay matched during review.
Step 1
Submit
participant, expense line items, and receipts
Step 2
Review
administrator checks the plan requirements
Step 3
Resolve
request details or record the determination
Step 4
Process
track reimbursement and close the claim
Why use a structured claim form
Email threads separate amounts from receipts and leave benefits teams rebuilding the claim. A structured HRA claim form keeps each requested reimbursement organized from submission through processing.
Match each item's date, provider, category, amount, and document instead of interpreting one combined total.
Place required receipt or proof-of-payment instructions beside the relevant upload field.
Tag claims, flag missing information, assign a reviewer, and preserve the claim ID and status.
Adapt to your plan process
Replace example categories and instructions with your plan materials and administrator process.
Participants enter expenses, attach evidence, and receive confirmation from one public link.
Use a short one-expense form or repeatable line items when participants commonly group several requests.
Show premium periods or proof-of-payment questions only for relevant claim types.
Confirm receipt with a claim ID and route incomplete submissions for follow-up.
Build the workflow
Generate, tailor, test, and publish one intake point for reimbursement requests.
Name the participant fields, categories, documents, attestation, and reviewers.
Use your plan's terminology. The administrator, not the form, determines how a request is handled.
Preview categories, missing-receipt routes, line items, totals, and confirmations.
Route claims, assign IDs, record follow-up, and export processing fields.
Choose an intake method
Collect consistent, review-ready information and update the form as your process changes.
Field guide
Align these six sections with your plan documents and review process.
Participant
Collect only the identifiers needed to locate the participant and arrangement. Clearly distinguish participant IDs from insurance member numbers.
Expense line items
Line items keep dates, providers, categories, amounts, and receipts together. Make the group repeatable for multiple expenses.
Documentation
Place upload guidance beside the expense. State what documents should show and where participants can ask questions.
Other coverage
Ask whether another source paid part of the expense, then reveal amount and explanation fields only when relevant.
Attestation
Place administrator-provided attestation text before confirmation and signature fields, and require active acknowledgment.
Internal review
Keep employee answers separate from internal fields. Use a stable claim ID, controlled statuses, reviewer assignment, and dated notes.
Related tools
Build adjacent enrollment, employee, expense, and reimbursement forms.
FAQ
Practical answers for benefits administrators building a reimbursement intake workflow.
An HRA claim form lets a participant request reimbursement from a health reimbursement arrangement. It collects participant details, expense information, requested amount, documents, and an attestation. Plan documents and administrator review determine how requests are handled.
Include participant and plan identifiers, service date, provider, category, amount incurred, amount requested, other reimbursement, document uploads, and your attestation. Keep claim ID and review status in the internal workflow.
Yes. Use repeatable line items so every expense has its own date, provider, category, amount, and attachment. Calculate the total while preserving each value for review.
Yes. Add an upload beside each line item or one document section for a single expense. State what your process requests, what it should show, and where employees can ask questions.
Ask only for needed information, avoid diagnosis details by default, limit notification recipients, and review sharing, storage, retention, export, and integration settings. Your privacy and benefits teams should choose the configuration.
The form collects and routes facts but should not promise eligibility. Keep status language neutral until the reviewer applies the plan documents and records a determination.
Yes. Makeform includes unlimited free forms and responses. You can generate, edit, publish, and collect submissions without a response cap; the paid tier removes the Makeform badge.
Assign a claim ID, route submissions to a review queue, and use controlled statuses. Keep dated notes and reference the claim ID in follow-up messages.
Replace scattered claim emails with one intake.
