To submit the Extended Health Benefits claim form, use the online submission portal for immediate processing. You can also mail your completed form along with original receipts to The Empire Life Insurance Company at Group Health Claims, 259 King St East, Kingston ON K7L 3A8. If preferred, fax submissions can be sent to the designated number provided on your claim form. Contact customer service for assistance in choosing your preferred submission method.

Dates for form submission are consistent each year; ensure you submit your claims within 365 days from the service date. Keep track of coverage termination dates as you will have only 90 days to submit claims after coverage ends. For 2024, ensure compliance with any new policy updates released before the year starts.

The Extended Health Benefits claim form serves the purpose of enabling employees and insured persons to apply for reimbursement of healthcare and dental expenses covered under their group benefits plan. It streamlines the process of submitting claims and ensures that all necessary information is collected for efficient processing. By filling out this form, users can ensure they receive timely reimbursements for eligible expenses incurred.

• 1. Personal Information: This section collects essential personal details such as name, email, and contact information.
• 2. Claim Details: Users must outline the specifics of the claim including service providers and type of expenses.
• 3. Direct Deposit Information: Users can provide banking details to facilitate quicker reimbursements.
• 4. Certification: Insured employees must authorize the release of information and certify that claims are accurate.

Failing to submit this form can result in delayed reimbursements or outright denials of claims. It's essential to check every section for completeness to ensure proper processing.

• Missing Information: Incomplete submissions may lead to requests for additional documents or information.
• Late Submissions: Claims submitted after the specified deadlines will not be accepted.
• Inaccurate Claims: Erroneous entries can significantly delay claim processing and reimbursement.

• 1. Healthcare Claims: To claim reimbursements for services like physiotherapy or chiropractic care.
• 2. Dental Expenses: For claiming dental work costs covered by your insurance.
• 3. Dependents Coverage: When submitting claims for family members covered under your plan.
• 4. Additional Insurance Coordination: For coordinating benefits when having multiple insurance coverages.
• 5. Accident-Related Claims: If seeking reimbursement for medical expenses following an accident.