Get Po Box 277

Filling out the Po Box 277 form effectively is crucial for ensuring your emergency medical expense claims are addressed promptly. This guide will provide you with a comprehensive, step-by-step approach to navigate through each part of the form.

Follow the steps to complete your claim form accurately.

1. Press the ‘Get Form’ button to access the Po Box 277 online form.
2. Begin by entering the patient information. Input the patient's full name and case number in their respective fields. Complete the address fields, including city, province, and postal code. Don’t forget to include the patient's date of birth in the specified format.
3. Indicate the patient's gender by selecting either 'Male' or 'Female'. Specify the patient's relationship to the policyholder by writing it in the designated area.
4. Fill out the insurer's information section. Enter the policyholder's name, date of birth, and their associated Mondial Assistance Group number and Green Shield I.D. number.
5. Provide travel details. Indicate if this was the first trip outside the home province this year, and if not, specify the number of stays. Enter the departure date, anticipated return date, and actual return date along with the nature of travel.
6. If applicable, fill in the other insurance information by including details about other coverages and employer information related to the policyholder and spouse.
7. Document any other insurers that may cover the medical expenses. Include their name, phone number, address, policy number, and certificate number if applicable. Signature of policyholder is required for verification.
8. Include additional documentation as required, such as itemized medical bills and health card photocopy. Mark any additional documentation needed if you have experienced an accident.
9. Complete the medical information section if medical assistance was sought. Include a description of the situation, hospital details, and any previous conditions related to your medical claim.
10. Once all sections are complete, review the entire form for accuracy. You can then save the changes made to the form, download it for your records, print it out for submission, or share it as necessary.

Complete your Po Box 277 form online today to ensure your emergency claims are processed swiftly.