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EXTENDED HEALTH CLAIM FORM Please complete both sides of this form in full and attach photocopies of all receipts. Submit the completed claim form and photocopy of receipts to: 1. By mail Teamsters

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How to fill out extended health claim form

01

Obtain the extended health claim form from your insurance provider or online.

02

Fill out your personal information accurately, including your name, policy number, and contact details.

03

Provide details of the medical service or treatment received, including the date, healthcare provider's name, and cost.

04

Attach any necessary supporting documents, such as receipts or invoices.

05

Review the completed form to ensure all information is correct and legible.

06

Submit the form to your insurance provider through mail or online portal.

Who needs extended health claim form?

01

Individuals who have availed of medical services or treatments covered under their extended health insurance plan.

02

Anyone who wishes to claim reimbursement for out-of-pocket medical expenses covered by their insurance policy.

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What is extended health claim form?

Extended health claim form is a document used to request reimbursement for medical expenses not covered by primary health insurance.

Who is required to file extended health claim form?

Anyone seeking reimbursement for medical expenses not covered by their primary health insurance is required to file an extended health claim form.

How to fill out extended health claim form?

Extended health claim form can be filled out by providing personal information, details of medical expenses, and any supporting documentation required by the insurance provider.

What is the purpose of extended health claim form?

The purpose of extended health claim form is to request reimbursement for eligible medical expenses not covered by primary health insurance.

What information must be reported on extended health claim form?

Information such as personal details, medical expenses incurred, dates of service, and any supporting documentation must be reported on extended health claim form.

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