Get Extended Health Claim Form - Sirius Benefits

This guide provides a detailed walkthrough on completing the EXTENDED HEALTH CLAIM FORM by Sirius Benefits online. Whether you are familiar with digital forms or new to the process, these instructions are designed to support you in efficiently submitting your health claims.

Follow the steps to successfully complete your claim form.

1. Click ‘Get Form’ button to obtain the form and open it for editing.
2. In the 'Plan member information' section, fill in your group number, firm number, certification number, last name, first name, mailing address, city, phone number, province, and postal code accurately.
3. Move to the 'Plan member questions' section. Indicate whether you or your dependants are entitled to benefits under any other plan by selecting 'Yes' or 'No'. If 'Yes', provide the necessary details including your partner’s name, date of birth, and the insuring company's name.
4. Answer the following questions regarding whether any claimed services were required due to an accident, and if you are seeking damages from a third party. Select 'Yes' or 'No' accordingly.
5. In the 'Claimed expenses' section, enter each patient's name and date of birth along with the service dates, types of service provided, relationship to the plan member, and the amount charged.
6. In the 'Plan member statement' section, review the certification statement, ensuring that all information provided is true and complete to your knowledge. Sign the form and provide the date signed.
7. Once you have completed all sections, save your changes. You can then download, print, or share the form as necessary. Ensure all original receipts are either retained or included when submitting a paper claim.

Start filling out your EXTENDED HEALTH CLAIM FORM online today for a smooth claims experience.