Get Extended Health Claim Form - Td Benefits

This guide provides a clear and comprehensive approach to completing the Extended Health Claim Form - TD Benefits online. By following these instructions, you will ensure that your submission is accurate and received without delays.

Follow the steps to fill out your Extended Health Claim Form efficiently.

1. Press the ‘Get Form’ button to access the Extended Health Claim Form and open it in your online editor.
2. Begin with Section 1, where you will input your plan member information. Clearly print your surname, identification number, address, city, home telephone number, province, postal code, and email address.
3. In Section 2, provide your work telephone number and repeat the patient information. List the first name, last name, dependent number, and date of birth for each patient associated with the claims.
4. Section 3 contains a mandatory declaration. Indicate whether any of the expenses are covered by another group insurance plan. If applicable, provide the other member's name and ID number.
5. In Section 4, specify the patient's name once more and include their dependent number. For Section 5, provide the professional's or supplier's name along with their provider number, if known, the date of the claim, type of expense, and total amount charged per visit or item.
6. Finalizing the form involves the authorization section. Sign the claim form, affirming that the information is complete and accurate. Also, provide the date for your signature.
7. Once completed, ensure that you attach all required documents, such as original paid receipts and any prescriptions. You can now save your changes, download, print, or share the form as needed.

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