Search results with tag "Extended health"
OTIP Health Claims Extended Health Benefits Claim PO Box …
www.otip.comOTIP Health Claims Extended Health Benefits Claim PO Box 280 Waterloo ON N2J 4A7 1.866.783.6847 | www.otip.com INSTRUCTIONS: (Please print all answers.) 1. All sections to be completed by the plan member unless otherwise indicated. 2. Original receipts must be attached for all expenses. (Please attach to the back of this form.) 3.
PEBA EXTENDED HEALTH CARE PLAN EMPLOYEE CLAIM FORM
www.peba.gov.sk.caM635D(PEBA-GE)-12/15 Continued (page 2 of 2) Page 2 of 2 YOU MUST COMPLETE BOTH PAGES Great-West Life Healthcare Expenses Statement PART 9 - Submitting Your Claim
GENERAL CLAIM SUBMISSION FORM - Green Shield Canada
assets.greenshield.caVision Care Itemized receipts showing • patient name • copy of vision prescription • a breakdown of charges for lenses & frames • date eyewear received or paid in full Extended Health - General Itemized receipts showing • patient name • a detailed description of services or supplies • provider's name & address
GENERAL CLAIM SUBMISSION FORM (For Drug and …
onlineservices.greenshield.cageneral claim submission form (for drug and extended health claims) non-union, cupe 79 and cupe 416 employees section 1 - plan member information green shield canada id number email address surname first name phone number company name city of toronto address city province postal code section 2 - mandatory declaration
EMPLOYEE BENEFITS for Partial-Load Academic …
www.local244.caContract No. 50832 and 50090 - Partial-Load Employees Table of Contents Effective January 1, 2015 Section 14 - Expenses out of your province and Your Extended Health
Extended Health Care and Health Spending Account Claim …
www.rbc.comPage . 1. of 2 EHC-HSA-14178-E-09-14 (G4809-E) Extended Health Care and Health. Spending Account Claim Form. If you’re covered under more than one benefits plan, you should consider submitting your claim to the other plan(s) before using your