Loading
Get Great West Life Claim Form
How it works
-
Open form follow the instructions
-
Easily sign the form with your finger
-
Send filled & signed form or save
How to fill out the Great West Life Claim Form online
Filling out the Great West Life Claim Form online can streamline your claims process, ensuring that you receive your benefits. This guide will provide clear, step-by-step instructions on how to complete the form accurately and efficiently.
Follow the steps to complete the claim form successfully.
- Click ‘Get Form’ button to obtain the claim form and open it in an editable format.
- In Part 1, provide your employee information. Fill in the plan number, division number, plan name, employee identification number, name, address, date of birth, province, postal code, and phone numbers (home and work). Ensure all details are accurate to avoid any delays.
- Move to Part 2 to enter patient information. Complete the patient’s name, relationship to you, and whether they reside with you. If the patient is a dependent and 18 years or older, indicate whether they are a full-time student and if they are employed. Record their date of birth.
- In Part 3, address the coordination of benefits. Indicate if you or any family member are entitled to benefits under another plan. If yes, provide the name of the family member, their relationship to you, the name of the other insurance company, and the policy number. Also, confirm if another family member is covered as an employee under this plan.
- Complete Part 4, which must be filled out by the provider of materials. Enter the date of service and type of lenses supplied for both eyes, including charges for lenses and frames. Check the reason for purchase, itemizing the costs accordingly.
- Include any additional notes or details for services categorized as 'Other.' Ensure to provide the name and signature of the prescribing optometrist or ophthalmologist along with their address and contact information.
- Finally, review all entered information for completeness and accuracy. Save changes, download, print, or share the completed form as necessary. Confirm the submission method for your claim with Great West Life.
Complete your claims process easily—file your Great West Life Claim Form online today.
Great-West Life was acquired by Canada Life, which is now a part of the Great-West Lifeco Inc. family. This transition ensures that policyholders continue to receive reliable service and support. If you have questions about your Great West Life Claim Form or need assistance with your policy, you can visit the US Legal Forms platform for helpful resources and guidance.
Industry-leading security and compliance
US Legal Forms protects your data by complying with industry-specific security standards.
-
In businnes since 199725+ years providing professional legal documents.
-
Accredited businessGuarantees that a business meets BBB accreditation standards in the US and Canada.
-
Secured by BraintreeValidated Level 1 PCI DSS compliant payment gateway that accepts most major credit and debit card brands from across the globe.