Get Green Shield Canada Address Form

Filling out the Green Shield Canada Address Form online can streamline your claims process. This guide provides clear and supportive instructions to help you complete the form accurately and efficiently.

Follow the steps to complete the form correctly.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. In Section 1, provide your plan member information, including your Green Shield Canada ID number, email address, surname, first name, phone number, address, company name, city, province, and postal code.
3. Proceed to Section 2, where you must make a mandatory declaration regarding any other group insurance coverage. Indicate whether you have other coverage and, if applicable, provide the insurance company’s name and Green Shield Canada ID number. Confirm whether you wish to coordinate this claim with your other coverage.
4. In Section 3, enter the claim details: the patient's name (only for those with receipts attached), dependent number, date of birth, professional or supplier’s name, date of claim, type of expense, total amount charged per visit/item, and total claimed.
5. For prescription drug claims, ensure you include all required information, such as patient name, original receipts containing necessary details, and breakdowns for injectable medications.
6. In Section 4, provide your authorization by signing and dating the form to confirm that the information provided is complete and accurate.
7. Finally, check the mailing instructions in Section 5 to ensure you submit your claim accurately, along with all required documentation, within the specified timeframe. You may have the option to save changes, download, print, or share the completed form before mailing.

Complete your forms online for a simplified claims process.