Submit Online Claim
Before You Claim - Please Consider...
We deduct $4 from the grand total of your claim each time you file a claim.
You will save money if you accumulate your receipts and claim less often. (Claiming weekly will cost you $208 vs $4 if you claim annually)
All receipts must clearly indicate the date, the amount of purchase including taxes, for whom the purchase was made and what item/service was purchased.
Credit card till receipts by themselves are not sufficient documentation. e.g. We require the actual prescription receipt with drug number, issuing doctor etc or a summary of prescriptions signed by the pharmacist.
Submissions should not have a credit card till receipt covering any information. We would only require the credit card till receipt if the submission did not show payment. Normally the credit card till receipt is not required. See Examples on the right.
| Date of Service/Purchase |
Patient Name | Description of expense (We look at every receipt so don�t worry if unsure) |
Amount Paid Format: 0.00 |
Drag and Drop or Upload File Acceptable File Types: PDF, PNG, JPEG, JPG, DOC, DOCX |
Actions |
|---|---|---|---|---|---|
|
|
|||||
|
Total Claimed: $0.00 |
|||||