Get Gl3741e Fd Lh Form

Filling out the Gl3741e Fd Lh Form online is essential for submitting your extended health care claim efficiently. This guide provides a step-by-step approach to ensure that you complete the form accurately and effectively.

Follow the steps to successfully fill out your form.

1. Press the ‘Get Form’ button to access the digital version of the form. Make sure to have a stable internet connection for a smooth experience.
2. In the first section, 'Plan member information,' fill in your plan contract number, member certificate number, sponsor details, and your personal information such as name, address, birthdate, and postal code.
3. Answer the questions regarding whether this is a Workplace Safety and Insurance Board case or if your claim is a result of an accident. If applicable, provide a brief description of the relevant circumstances.
4. Determine if you, your partner, or dependants are covered under another plan for the expenses being claimed. If yes, include the necessary details for the secondary carrier, such as your spouse's insurance company and corresponding dates of birth.
5. Move to the 'Patient information' section. Complete details for each patient, including name, date of birth, relationship to you, and if they are a student over 21, indicate their employment details.
6. Attach your prescription drug receipts in the designated area. Ensure that the receipts have the drug identification number, drug name, and quantity; this information does not need to be included on the form itself.
7. For practitioner or paramedical expenses, upload an itemized statement and/or receipt that includes all required details such as the names, dates of service, and charges.
8. If you have expenses related to equipment or appliances, ensure you include a recommendation from your physician and indicate how long the equipment is required.
9. In the 'Claims confirmation' section, sum the total amount of all submitted receipts, ensuring to sign the form conceding the accuracy of the information provided.
10. Finally, follow the mailing instructions for submitting the complete claim form and receipts. Confirm that everything is securely attached before mailing.

Start completing your Gl3741e Fd Lh Form online now to ensure a smooth claims process.