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EXTENDED HEALTH BENEFITS CLAIM FORM all the fields in this box must be completed. Attach original BILLS, RECEIPTS, STATEMENTS ETC. COPIES WILL BE DENIED AND THE CLAIM WILL BE RETURNED. GROUP NO. DIVISION

How to fill out extended health benefits claim

How to fill out extended health benefits claim:

1. Gather all necessary documents and information - Before starting to fill out the extended health benefits claim, make sure you have all the required documents and information handy. This may include your health insurance policy details, claim form, medical receipts, and any additional supporting documents requested by your insurance provider.
2. Fill out the claim form accurately - The claim form is typically provided by your health insurance provider. Take your time to read the instructions carefully and provide accurate information. This may include your personal details, policy number, the date and nature of the medical service or treatment, and the cost incurred.
3. Attach relevant supporting documents - To support your claim, attach all the necessary supporting documents, such as medical receipts, invoices, referral letters, or any other paperwork required by your insurance provider. Ensure that the documents are legible and organized in a logical order.
4. Double-check the filled-out form and attached documents - Before submitting your claim, thoroughly review the filled-out form and the attached documents to ensure accuracy and completeness. Any mistakes or missing information could cause delays or rejections.
5. Submit the claim - Once you have completed the claim form and attached all the necessary documents, make a copy of everything for your records. Submit the claim to your health insurance provider as instructed, whether it be through mail, fax, email, or an online portal. Pay attention to any deadlines or specific submission instructions provided by your insurance provider.

Who needs extended health benefits claim:

1. Employees with extended health coverage - Many employers offer extended health benefits as part of their employee benefits package. If you are an employee and have access to extended health coverage through your employer, you may need to submit an extended health benefits claim to receive reimbursement for eligible medical expenses.
2. Individuals with private health insurance - If you have private health insurance coverage, either purchased individually or through an insurance broker, you may be eligible to make extended health benefits claims for various medical services not covered by basic health insurance plans.
3. Dependents covered under a policy - Extended health benefits claims can also be made on behalf of dependents covered under a policy. This includes spouses, children, or any other eligible family members specified by the insurance provider.

It is important to review the specific terms and conditions of your extended health benefits policy to determine who is eligible for coverage and how to proceed with the claims process. If you have any doubts or questions, reach out to your insurance provider or their customer service for guidance.

For pdfFiller’s FAQs

What is extended health benefits claim?

Extended health benefits claim refers to the process of submitting a request for reimbursement of medical expenses not covered by basic health insurance.

Who is required to file extended health benefits claim?

Any individual who has extended health benefits coverage through their employer or private insurance provider is required to file a claim for reimbursement of eligible expenses.

How to fill out extended health benefits claim?

To fill out an extended health benefits claim, one must provide details of the medical expenses incurred, including receipts and invoices, and submit the claim form to the insurance provider either online or by mail.

What is the purpose of extended health benefits claim?

The purpose of an extended health benefits claim is to seek reimbursement for medical expenses that are not covered by basic health insurance, such as prescription drugs, dental care, and vision care.

What information must be reported on extended health benefits claim?

The information required on an extended health benefits claim include the date of service, description of the medical expense, cost incurred, and any supporting documentation like receipts and invoices.

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