Follow the steps to complete the form successfully.

1. Press the ‘Get Form’ button to obtain the form and open it for editing.
2. Complete the 'Information about you' section. Enter your contract number, member ID number, employer's name, preferred language of correspondence, last name, first name, date of birth, address, daytime phone number, province, and postal code.
3. In the 'Payment under the Health Spending Account' section, attach original receipts or the original Explanation of Benefits if you have previously submitted the claim to another plan. Fill in the details for each expense, including the year of expenses, description, names and dates of birth of the persons for whom you are making claims, their relationship to you, gender, and the amount claimed.
4. Ensure that the total amount claimed is calculated accurately. If applicable, submit your claim to another plan before completing this form.
5. Complete the 'Authorization and Signature' section. Certify that all information is true and complete, and that you are authorized to disclose information regarding your spouse or dependents.
6. Sign and date the form to validate your claim.
7. After completing the form, save changes, download a copy for your records, and print or share the form as needed. Mail it to the claims office nearest you.

Complete your Health Spending Account claims online today for a smooth and efficient process.