Get Uwsa-rcclaim For Extended Health Benefits.doc

This guide provides a clear, step-by-step approach to completing the UWSA-RCClaim for Extended Health Benefits form online. The instructions are designed to assist users of all backgrounds in providing the necessary information accurately and efficiently.

Follow the steps to complete your health benefits claim successfully.

1. Click the ‘Get Form’ button to access the claim form and open it in your browser.
2. Begin by entering your student information in the designated fields, including your name, date of birth, email address, telephone number, and address while at university. Ensure that all entries are complete and legible.
3. In the 'Listing of Expenses Incurred' section, provide details for each expense. Include the claimant’s first and last name, their relationship to the insured, the type of expense incurred (e.g., drugs, vision), the date the expense was incurred, and the total amount charged.
4. Indicate if any claim is due to an accident by selecting 'Yes' or 'No' in the appropriate fields. If the claim relates to a work-related accident or sickness, advise accordingly.
5. Answer questions concerning other group health coverage and employment status of any dependent(s). Provide necessary details related to their employers and coverage providers if applicable.
6. Review the certification statement carefully. Upon ensuring all information is accurate, sign and date the form, confirming the authenticity of the claimed expenses.
7. After completing the form, save your changes. You can then download, print, or share the document as required. If submitting electronically, ensure to follow the instructions for emailing or faxing to the designated claims department.

Complete your UWSA-RCClaim for Extended Health Benefits online today!