Get Ibew 115

The Ibew 115 form is essential for filing health care expenses accurately and efficiently. This guide will help you navigate each section of the form online, ensuring that you provide all necessary information for a smooth claims process.

Follow the steps to successfully complete the Ibew 115 online form.

1. Press the ‘Get Form’ button to access the Ibew 115 form and open it in your preferred editor.
2. Fill in your member information accurately. Provide your name, date of birth, and current address. If you have a new address, please ensure to check the related box.
3. Enter your city, province, and postal code along with your policy number (110301) accurately.
4. For the Express Scripts ID number, include the information exactly as shown on your drug card.
5. If applicable, complete the coordination of benefits section if you have additional coverage through a partner. Fill in the insured’s name, policy number, ID number, and name of the insurance company.
6. For dental care expenses, note that you should not complete this form. Instead, sign and submit the 'Standard Dental Claim Form' provided by your dentist.
7. For prescription drug expenses, ensure that drugs are claimed through Express Scripts using your drug card. If the card was not utilized, attach detailed original receipts and provide an explanation.
8. In the vision care expenses section, attach original detailed receipts that confirm the services provided for prescription eyewear and exams.
9. For miscellaneous expenses, attach original detailed receipts confirming the type of service, the person for whom the service was rendered, the cost, and the date incurred.
10. If you are submitting for coordination of benefits as a second payer, ensure to attach photocopies of original claim forms along with the coordination of benefits statement from the first payer insurance.
11. Complete the declaration section, confirming that the information provided is complete and true. Authorize access to the administrator for any particulars pertaining to your claim.
12. Insert the date and provide your signature to finalize the form.
13. After filling out the form, save your changes. You can then choose to download, print, or share the completed form as needed.

Start competing your Ibew 115 document online today!