Get Employer Must Complete This Area - Carpenters Union Local 2222 ... - Local2222

Filling out the Employer Must Complete This Area - Carpenters Union Local 2222 form is essential for submitting health claims efficiently. This guide will walk you through each section of the form, ensuring that you provide all necessary information accurately and clearly.

Follow the steps to complete the form correctly.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by printing the member's name clearly in the designated area. Ensure to include the union number and the member’s address along with the city, postal code, and province.
3. Provide the member’s date of birth by filling in the day, month, and year. This information is crucial for the processing of the claim.
4. If the claim is for a dependent, input their name, date of birth, and relationship to the member (e.g., spouse, child). Also, indicate whether the dependent is currently working or in school.
5. Answer the question regarding whether group health benefits are payable from any other source. If 'yes', provide the relevant details.
6. Indicate if any expenses are due to sickness or injury related to the employment of the member or dependent. Include details and the employer name if applicable.
7. Check whether the claim is for Workers Compensation Board (WCB) benefits by selecting 'yes' or 'no'.
8. List the name and address of prescribing physician(s) who provided medical care.
9. Attach original receipts related to the medical treatment for the claimed individuals. This step is mandatory for claim processing.
10. In the total amount claim section, write the total dollar amount you are claiming.
11. Review the certification statement carefully, affirming that the information provided is true and complete. Sign and date the form at the end.
12. Submit the completed claim form and original receipts to the designated address: Manion, Wilkins & Associates Ltd, 626 - 21 Four Seasons Place, Etobicoke, ON, M9B 0A6.

Complete your claim form online today to ensure timely processing of your health benefits.