Get Extended Health Care Claim Form - Amazon S3

Filling out the Extended Health Care Claim Form is an important step in ensuring that your medical expenses are reimbursed efficiently. This guide provides clear, step-by-step instructions to help you complete the form accurately and effortlessly.

Follow the steps to fill out your claim form correctly.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. In the 'Information about you' section, complete all fields. Provide your contract number, member ID number, preferred language of correspondence, full name, address, date of birth, and daytime phone number. Ensure that this information is clear and accurate to prevent processing delays.
3. If you or a partner are covered under another plan, fill out the corresponding section. Indicate if your partner is a member of another benefit plan and provide their information if necessary. Remember to list any expenses not covered under their plan.
4. In the 'Information about your claim' section, list all individuals for whom you are claiming expenses. Add the total amount claimed and ensure each receipt clearly indicates the type of expense. Adhere to submission deadlines for claims, which are 180 days after the end of the calendar year.
5. Complete the 'Authorization and Signature' section by confirming the accuracy of your information. Sign and date the document as required to certify your claims are true and complete.
6. After completing the form, ensure you have attached the original receipts for all claimed expenses. Keep photocopies for your records.
7. Finally, review all sections for completeness. Save your changes, then download, print, or share the completed form as needed.

Complete your Extended Health Care Claim Form online today for efficient claims processing.