Fillable Online VISION CARE CLAIM FORM 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your Member Name and ID Number from your PBC card in the designated fields.
3. Provide your Phone Number, Address, City/Province, and Postal Code to ensure accurate communication.
4. In the EXPENSE INFORMATION section, list the Name of Claimant and Type of Expense. Make sure to include paid receipts as originals will not be returned.
5. Fill in the Date of Purchase/Service and Amount Paid for each expense incurred.
6. Indicate if you or any dependents have other vision care coverage by selecting 'Yes' or 'No'. If applicable, provide details about the other insurance carrier.
7. Review all information for accuracy before signing and dating the form at the bottom.

Start filling out your VISION CARE CLAIM FORM today for free using our platform!