Get Gl3585e 052007 Cll Form

The Gl3585e 052007 Cll Form is designed for plan members to submit claims for extended health care expenses. This guide will provide a clear, step-by-step approach to filling out the form online, ensuring you can submit your claims efficiently and accurately.

Follow the steps to complete your Gl3585e 052007 Cll Form online.

1. Click ‘Get Form’ button to access the form and open it in your preferred online editor.
2. Begin by entering your plan member information, including your plan contract number, your certificate number, and your name. Also, include your birthdate and address details.
3. Indicate if the expenses are eligible for coverage under any type of workers' compensation board by selecting 'Yes' or 'No'. Additionally, indicate if you, your partner, or dependants are covered under another plan for the expenses being claimed.
4. If applicable, provide your partner's date of birth and indicate if you would like to sign up for direct deposit and electronic claim statements.
5. Complete the patient information section by entering the patient's name, date of birth, and relationship to the plan member. If necessary, indicate the school and city, and hours worked per week if the person is employed.
6. Document all prescription drug expenses by attaching receipts to the back of the form. Ensure that all receipts include the drug identification number and the name of the prescription drug.
7. For practitioner or paramedical expenses, attach an itemized statement or receipt containing required details such as patient name, practitioner name, type of practitioner, charge for treatment, and more.
8. For equipment and appliance expenses, provide a written recommendation from your prescribing physician, including the diagnosis and activities requiring the use of the item.
9. Enter vision care expenses by enclosing itemized receipts that detail the costs associated with contact lenses, glasses, or other vision services.
10. Complete the claims confirmation section by signing and dating the form, certifying that all information provided is accurate.
11. Finally, follow the mailing instructions to send your completed claim form and receipts to the appropriate address based on your location.

Start filling out your Gl3585e 052007 Cll Form online today for a streamlined claims process.