Get Non-status Health Benefit Request & Authorization ... - Fnsds

Filling out the Non-Status Health Benefit Request & Authorization form is essential for individuals seeking assistance with health-related expenses. This guide will provide you with clear, step-by-step instructions to help you complete the form accurately and efficiently.

Follow the steps to successfully complete your request.

1. Press the ‘Get Form’ button to access the form online and open it in an editable format.
2. In Section A, provide the non-status client information as required. This includes the client’s last name, first name, address, postal code, personal health number, current telephone number, date of birth, and the type of income assistance being collected. Ensure that you print clearly.
3. Section B is for the service information. This section must be completed by the health practitioner (dental, optical, pharmacist, etc.). Describe the recommended services or supplies, including the estimated cost, quantity, and fee code. If applicable, note any previous provision of goods/services with dates and amounts.
4. In Section C, which is also to be filled out by a Band Social Development Worker, examine the written request and supporting documents. Approve or deny the request, specifying the client’s eligibility period and amount. Remember to attach all required documentation, such as invoices and prescriptions.
5. Once all sections are completed, save your changes to the form. You may then choose to download, print, or share the completed document as necessary.

Take the next step in managing your health benefits by completing the Non-Status Health Benefit Request online today.