Get Ohip Out Of Province Claim Submission Form

This guide provides users with clear, step-by-step instructions on how to effectively complete the Ohip Out Of Province Claim Submission Form online. By following these guidelines, users can ensure that their claims are submitted accurately and efficiently.

Follow the steps to successfully complete the form.

1. Press the ‘Get Form’ button to acquire the form and open it for editing.
2. Begin by filling in the patient information. This includes the health number, last name, first name, date of birth, and sex. Additionally, provide your telephone number and residential address along with the mailing address if it differs.
3. Indicate the date of departure from Ontario and the date of return. This will help clarify the user’s time away for any related claim.
4. Answer the question regarding coverage by any travel or supplementary insurance. Provide details if applicable, including the name of the insurance company and policy number.
5. In the treatment information section, specify whether the treatment was necessary due to an acute and unexpected condition that arose outside of Ontario and provide a reason for the visit, diagnosis, type of treatment received, and the place and date of treatment.
6. Fill out the hospital information section with details such as the hospital name, address, admission and discharge dates, and whether the treatment was for inpatient or outpatient services.
7. Ensure that the signature of the patient or guardian is provided along with the date to certify the accuracy of the information submitted.
8. In the authorization and direction section, complete the patient’s name and the name of the hospital or health facility. Sign and date this section to authorize payment by OHIP.
9. Once all fields are accurately filled, users can save changes to the form, download a copy for their records, print it, or share it as needed.

Submit your Ohip Out Of Province Claim Submission Form online to ensure timely processing of your claim.