Get Emergency Out-of-province Claim Form

Filling out the Emergency Out-of-Province Claim Form online is crucial for obtaining reimbursement for medical expenses incurred outside of your home province. This guide will provide you with clear, step-by-step instructions to ensure that you complete the form accurately and efficiently.

Follow the steps to complete your claim form effectively.

1. Press the ‘Get Form’ button to download the Emergency Out-of-Province Claim Form and open it for editing.
2. Begin by entering your member information in the designated fields. Include the company name, group number, member’s identity number, last name, first name, address, postal code, and daytime phone number.
3. Next, fill out the claimant information. If claims are being made for a dependent, provide their name, dependent number, birth date, and personal health number. Indicate whether the claimant has other insurance coverage.
4. Document the details of the trip, including the country where expenses were incurred, the dates of departure and return from your province, and the reasons for your absence such as vacation or seeking medical treatment.
5. In the member's statement section, confirm that all information provided is true and authorize Pacific Blue Cross to obtain necessary information regarding your claim.
6. Next, complete Section A for patient information, ensuring to provide accurate contact details for the patient and their employer in British Columbia, if applicable.
7. Fill out Section B for claiming doctor's fees. List the reasons for seeking medical attention, diagnosis, treatments, and charges incurred.
8. Complete Section C if you are claiming in-patient hospital charges. Include the name of the hospital, admission and discharge dates, and any required details about the treatment provided.
9. Lastly, review the entire form for completeness. Ensure that all areas are filled in, all required documents such as original receipts are attached, and the form is signed where necessary.
10. Once you have confirmed everything is in order, save your changes and prepare to download, print, or share your completed form.

Complete your Emergency Out-of-Province Claim Form online today for quick and effective processing.