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Member Register

First time filing a claim?

Instructions are included on the form

Unsure which claim form to use?

Please use the Marin Benefits Claim Form

Prefer not to use a form?

Submit through our Member Portal

Member Forms

HRA Claim Forms

Marin Benefits Claim Form

ICHRA Premium Claim Form

ICHRA Medical Expense Claim Form

QSEHRA Claim Form

Other Forms

Direct Deposit Form

Privacy Authorization Form

Letter of Medical Necessity Form

If you have a fertility, adoption, or surrogacy benefit please contact Marin Benefits for assistance.
If your employer has a custom claim form you can access it online inside your Member Portal

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