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Forms

Enrollment

Apply for enrollment in the Medical Expense Reimbursement Plan.

Download Form
Direct Deposit

Direct Deposit

Authorize direct deposit of reimbursement funds into your personal bank account.

Download Form

Claims

Submit a claim for a medical expense or premium reimbursement.

Download Form
Portfolio

Portfolio

Make your investment portfolio selection during open enrollment.

Download Form

Need More Information?

Contact Us at (877) 808-5994

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Contact

Phone: (877) 808-5994
Fax: (866) 676-1530
Email: PORAC@vimly.com

Mail Claims To

PORAC Retiree Medical Trust
c/o Vimly Benefit Solutions
P.O. Box 6
Mukilteo, WA 98275

Quick Links

  • Enrollment Application
  • Direct Deposit Form
  • Claim Form
  • Portfolio Selection Form

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