Financial health claim 2026

1. Click ‘Get Form’ to open the financial health claim in the editor.
2. Begin by filling out your personal information in Section 1. Ensure you provide your contract number, member ID, last name, first name, and contact details clearly.
3. If applicable, complete Section 2 regarding coverage under another plan. Indicate whether your spouse is covered under a different plan and provide necessary details.
4. In Section 3, specify if you have a Health Spending Account (HSA) and how you wish to process your claim. Choose whether to assess through your Extended Health Care benefit or HSA.
5. Section 4 requires listing all individuals for whom you are claiming expenses. Include their names, relationships, and total amounts claimed. Attach original receipts for verification.
6. Finally, complete Section 5 by signing and dating the form to authorize the claims process. Ensure all information is accurate to avoid delays.

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