Submitting a Claim

For expenses related to physical therapy, medical expenses, and alternative medicine.

May be required depending on your claim situation and should be submitted with your Medical/Paramedical Claim Form.

For reimbursement of dental expenses when treatment is required as the result of an accident.

For expenses related to vision care (i.e. eye exams, prescription glasses, contact lenses).

For income replacement claims when you are required to withdraw from a current or upcoming contract due to illness or injury. Additional supporting documentation is required.

For income replacement claims, this form must be completed by your physician and submitted with your Income Replacement Benefits Claim Form.