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HSA/FSA Reimbursement & Statement of Medical Necessity for Evivo Form

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Evivo is Health Savings Account (HSA) and Flexible Spending Account (FSA) eligible

Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs) are valuable tools that allow you to set aside pre-tax dollars to cover qualified medical expenses. This means that you can use your HSA or FSA funds to purchase Evivo and support your baby’s health.

To make the reimbursement process easier for you, we have created the Evivo Reimbursement Request Form. This form can be downloaded from our website and completed by your healthcare provider. Once completed, you can submit the form to your insurance company to request reimbursement for your Evivo purchase from your insurance provider.