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Filing a claim for medical expenses can be a straightforward process when you have the right guidance. This guide provides step-by-step instructions for completing the Major Medical Expenses Statement to ensure your claim is submitted correctly and efficiently.

Follow the steps to fill out your claim form with ease.

1. Click ‘Get Form’ button to obtain the form and open it in your selected editor.
2. Enter the plan member's full name in the designated field at the top of the form.
3. Provide the group or employer name associated with your insurance plan.
4. Fill in your personal identification number and group number from your insurance details.
5. Complete your address, including street, apartment number (if applicable), city, province, and postal code.
6. If you are claiming expenses for dependents, complete their information, including their names and dates of birth.
7. Indicate the dependent's relationship to you, utilizing the options provided.
8. List each medical expense you are claiming, along with the date incurred and attach original receipts.
9. Answer whether any health benefits or services were provided under another plan by selecting yes or no.
10. If yes, indicate the member under the other plan, their policy number, and the name of the insuring agency.
11. Provide the recommended physician's name and their contact information if applicable.
12. Read the certification statement carefully, ensuring all details are accurate before signing and dating the form.
13. Finally, save your changes, then download, print, or share the completed form as necessary.

Complete your medical expense claims online today for a hassle-free experience.