Get Extended Health Care Claim Form - Western University - Uwo

Filling out the Extended Health Care Claim Form is an essential step for users to receive reimbursement for medical expenses and services. This guide provides clear, step-by-step instructions for completing the form online, ensuring that all necessary information is accurately captured.

Follow the steps to complete the form appropriately.

1. Press the ‘Get Form’ button to access the Extended Health Care Claim Form and open it in your editing platform.
2. In the 'Information about you' section, clearly print your contract number, member ID number, plan sponsor or employer, last name, first name, date of birth, and your complete address. Select your preferred language for correspondence and provide your daytime phone number.
3. If you or your spouse are covered under another plan, fill out the appropriate sections regarding additional coverage. Indicate whether you are claiming expenses that are not covered by the other plan and provide relevant details.
4. In the 'Information about your claim' section, list all persons for whom you are making claims, including their relationship to you and their date of birth. Ensure that you accumulate all receipts and insert the total amount claimed.
5. Indicate if you are attaching receipts for out-of-Canada expenses and provide the date of departure from your home province. Make sure the currency and amount are clearly marked on each receipt.
6. Complete the 'Authorization and Signature' section by certifying that the information provided is true and complete. Sign and date the form as required.
7. Once all sections are filled out correctly, save your changes. You can then download, print, or share the completed form as necessary.

Begin completing your Extended Health Care Claim Form online today for a smooth submission process.