Follow the steps to complete the main claim form successfully.

1. Press the ‘Get Form’ button to access the main claim form and open it in the editor.
2. Input your name and either the last four digits of your social security number or your six-digit member ID from your medical insurance card in the member’s information section.
3. Detail all health expenses incurred, specifying dates of service, names of patients or individuals who incurred expenses, and provide your out-of-pocket expenses for each item individually. Do not total receipts on one line; every receipt must be listed separately.
4. Attach necessary documentation: for expenses covered by other insurance plans, include a copy of the Explanation of Benefits. For expenses not covered, ensure you attach a paid receipt with a full explanation.
5. If applicable, check the box requesting a one-time disbursement of any pending claim amounts up to your contribution balance. Make sure you understand that this will not apply if you are already set for automatic disbursements.
6. Review the certification statement regarding tax deductions and reimbursement claims. It is crucial to ensure compliance with The Plan's requirements.
7. Provide your signature and the date at the bottom of the form to validate your request.
8. Finalize the process by selecting how you wish to submit the form: via fax, email, or mail it to the specified Toledo Electrical Welfare Fund address. Make sure to keep a copy for your records.

Complete your claims online to ensure timely reimbursement for eligible health expenses.