Get Extended Health Care Standard Claim Form - Uvictory

Filling out the Extended Health Care Standard Claim Form - Uvictory online can streamline your claims process. This guide provides a clear, step-by-step overview to help you complete the form accurately and efficiently.

Follow the steps to successfully complete your claim form.

1. Click 'Get Form' button to obtain the form and open it in the editor.
2. Begin with the member information section. Enter your Member ID number, policy number, and your company name. Ensure your first and last names are correct, and select your employment status (full-time, part-time, or retiree). Provide your daytime phone number and your current address. If you have a new address, check the designated box.
3. In the 'Other Coverage' section, indicate if you or your dependents have additional insurance. If yes, provide the name of the other insurance company, related policy number, ID number, and the name of the member who holds the other insurance. Include their employment status, as well as the effective and cancellation dates.
4. Answer the questions regarding whether the claim is the result of an accident or if it pertains to a WorkSafe BC or ICBC case. If applicable, attach any necessary details.
5. Proceed to the 'Expense Information' section. List the first name of each claimant in dependent and date order, their birthdates, the type of expense or name of medication, and the date of each service or purchase. Record the amount paid and the name of the service provider or prescriber. Optionally, include the nature of the illness or injury.
6. At the bottom of the expense information section, provide the total claim amount, if desired.
7. In the 'Member Consent & Declaration' section, read the statement and provide your signature and the date. If the claimant is under 18 years, the member's signature is necessary.
8. Lastly, review the entire form for completeness. Ensure all sections are filled out and prepare photocopies of any relevant receipts. Make sure to save your changes, and choose to download, print, or share the completed form for submission.

Start filling out your Extended Health Care Standard Claim Form - Uvictory online today to ensure timely processing of your claims.