HRA Claims

Submit an HRA Claim

To submit your HRA Claim, click on this HRA Claim Form link. You can then print, complete, and sign the form. Scan and save it and your supporting EOB information into your computer. Then fill out the fields below and upload your claim form and EOB. If you have any questions, please call us at 210-659-8100.

Scan in your completed HRA form and upload it here.
One file only.
100 MB limit.
Allowed types: txt rtf pdf doc docx odt ppt pptx odp xls xlsx ods.
You must upload EOB supporting documentation for each line you filled out in Section 2 of the HRA form. Upload the EOB supporting document if it was not attached to the HRA Form you uploaded above.
One file only.
100 MB limit.
Allowed types: txt rtf pdf doc docx odt ppt pptx odp xls xlsx ods.