Get Submit Claims To

Filing a claim can be a critical step in receiving the benefits you are entitled to. This guide will walk you through the process of filling out the Submit Claims To form, ensuring that you provide all necessary information accurately.

Follow the steps to successfully complete your claim form.

1. Press the ‘Get Form’ button to access the form and load it into your online editor.
2. Begin with Section A: Claimant Information. Provide your first name, last name, date of birth, and policy number. Fill in your address in Canada, telephone number, email, and country of origin, along with the date of your arrival in Canada.
3. In Section A, you will also need to list your family physician's details both in your country of origin and in Canada, including their names, addresses, and contact numbers.
4. Indicate whether you have any other insurance coverage, including through your spouse. If applicable, provide the name and address of any other insurance provider.
5. Proceed to Section B: Medical Information. Here, provide a brief description of your sickness or injury along with the relevant dates for when symptoms first appeared and when you consulted a physician.
6. If you have a history of treatment for this condition, list the relevant dates and medications taken before the current policy took effect.
7. Next, fill out Section C: Expenses Claimed. List each provider, their diagnosis, date of service, amount billed, and amount paid in the provided fields.
8. Move on to Section D: Authorization and Certification. Read the authorization text carefully before signing. Fill in the date, print your full name, and sign the form. If applicable, also include the signature of the policyholder from Section A.
9. Lastly, complete Section E: Attending Physician/Dentist Statement. Ensure the physician completes all the required information regarding the patient’s diagnosis, treatment, and other relevant medical history.
10. Once all sections are completed, save your changes to the form. You may then download, print, or share the completed document as needed.

Take action now and complete your Submit Claims To form online.