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EXTENDED HEALTH CLAIM FORM SUBMIT TO: 1403 Kingston BLVD, Winnipeg MB R3P 2T5 SCAN & EMAIL TO: claims. Inquiries siriusbenefits.ca FAX TO: 204.488.6008 INQUIRIES: 1.800.663.8833 The personal information

How to fill out extended health claim form

How to fill out extended health claim form

1. Obtain the extended health claim form from your insurance provider.
2. Start by filling out your personal information, including your name, address, and contact details.
3. Indicate the policy number and group number associated with your extended health insurance plan.
4. Provide details about the healthcare service or treatment for which you are submitting a claim.
5. Include the name of the healthcare provider, date of service, and a brief description of the treatment received.
6. Attach any necessary supporting documents, such as medical reports, receipts, or invoices.
7. Fill out the section related to the amount claimed, ensuring you provide accurate information.
8. Sign and date the form to certify the accuracy of the information provided.
9. Submit the completed form, along with the supporting documents, to your insurance provider as per their specified instructions.

Who needs extended health claim form?

1. Anyone who has an extended health insurance plan and requires reimbursement for eligible healthcare expenses needs to fill out the extended health claim form.

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What is extended health claim form?

An extended health claim form is a document used by individuals to request reimbursement for eligible healthcare expenses not covered by provincial or territorial health plans.

Who is required to file extended health claim form?

Individuals who have incurred eligible medical expenses that exceed their insurance coverage limits or who have expenses not covered by their health insurance need to file an extended health claim form.

How to fill out extended health claim form?

To fill out an extended health claim form, you need to provide your personal information, details of the healthcare provider, a description of the services rendered, the date of service, and itemized receipts for the expenses.

What is the purpose of extended health claim form?

The purpose of the extended health claim form is to enable individuals to submit their health care expenses for reimbursement from their insurance provider or to track expenses for tax purposes.

What information must be reported on extended health claim form?

The information that must be reported includes the claimant's personal details, provider information, description and date of service, specific expenses incurred, and accompanying receipts.