Follow the steps to fill out the CHILDCARE CLAIM FORM online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the childcare provider information. Include the Childcare Provider Number, whether the facility is Not-for-Profit or For-Profit, the Childcare Facility Name, Address, Telephone Number, Province, and City.
3. Next, move on to the plan member information. Fill in your name, your child's name, their postal code, employer, child's Green Shield ID number, child's date of birth, and your address.
4. Indicate whether you have any other childcare coverage. If yes, provide details about the other Green Shield Plan or government subsidy. Attach a copy of the payment statement or denial letter from the primary carrier if necessary.
5. Complete the claim information section by providing the claim submission start and end dates, facility rates, number of half days and full days being claimed, and relevant fee details for half days, full days, and weekly/monthly charges.
6. Calculate the total amount charged by the facility for the childcare services indicated and submit any total amount of government or other subsidies for the reported period.
7. Sign and date the form as the employee, parent, or guardian, certifying that the childcare services listed are accurate. Ensure that the facility official signs if applicable, confirming that the charges have been invoiced correctly.
8. Review all information for completeness and accuracy before submitting. You can save changes, download, print, or share the completed form as needed.

Take the next step in managing your childcare claims by completing the form online today.