Get Extended Bhealth Benefits Claimb Form 1 0 - Cinup

Completing the Extended Bhealth Benefits Claimb Form 1 0 - Cinup online is a straightforward process that ensures your claims for health benefits are submitted correctly. This guide provides clear, step-by-step instructions to help you fill out the form efficiently.

Follow the steps to complete your claim form online.

1. Click the ‘Get Form’ button to access the Extended Bhealth Benefits Claimb Form 1 0 - Cinup and open it in your preferred editor.
2. Begin by entering your Policy Certificate Number in the designated field at the top of the form.
3. Next, fill out your name as the employee, along with your address including city, town, and postal code.
4. Indicate any injuries related to workplace treatment or a motor vehicle accident by selecting 'Yes' or 'No' for each question.
5. If the claimant is a dependent child over 18, provide their age, marital status, and employment status, if applicable.
6. List any other insurance plans covering the expenses claimed by providing the policy holder’s details and other relevant information.
7. Fill out the details for each claimed benefit, including the amount for each service, ensuring itemized receipts are enclosed.
8. State whether payment should be made directly to the service provider; include their name, address, and provider number.
9. Review the certification section, confirming your understanding and agreement with the terms stated. Sign and date the form at the bottom.
10. Finally, save any changes made to the form. You may download, print, or share the completed form as necessary.

Complete your Extended Bhealth Benefits Claimb Form 1 0 - Cinup online today to ensure prompt processing of your health benefits claims.