Submit a claim

We have received your claim

Your confirmation number is 1234567

Your claim has been randomly selected for audit.

You must submit your receipts now or lose online claiming privileges.

Your claim has been submitted and will be processed within five business days. However, your claim has been randomly selected for audit. You must submit your receipts and supporting documentation within 40 days from the date of this request. Failure to comply will result in the removal of your online claiming privileges and repayment of any money paid to you for this claim will be required.

1. Print the online claims statement for this claim.
2. Attach your receipts and all other supporting documentation.
3. Send the online claims statement and supporting documentation by fax or mail to:
Fax: 1-877-MANUCLM (626-8256) or 1-855-837-3971 if you reside in Quebec.
Mail: Manulife Financial On-line Claims Verification Services PO Box 250 Waterloo ON N2J 4A5
Do not use any other mailing address (including the one on your claim form) to ensure that this claim is dealt with properly.

Questions? Contact us at 1-800-268-6195, 8:00am to 8:00pm EST, Monday to Friday.

If you are unable to print these documents now, they can be accessed later from our full site by selecting 'Online claim status' from the Claims menu.

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Consent Authorization

Sign and date, and include with your claim statement, receipt and supporting documentation

I certify that I, my spouse and/or my dependants of minor or majorage (Dependants), have received all goods or services claimed and that the informationprovided for this online claim session is true and complete. I authorize Manulife Financial (Manulife) to collect, use, maintain and disclose personalinformation relevant to this online claim (Information) for the purposes of GroupBenefits plan administration, audit and the assessment, investigation and managementof this online claim (Purposes). I am authorized by myDependants to disclose and receive their Information, for the Purposes. I authorize any person or organization with Information, including any medical and health professionals,facilities or providers, professional regulatory bodies, any employer, group planadministrator, insurer, investigative agency, and any administrators of other benefitsprograms to collect, use, maintain and exchange this Information with each otherand with Manulife, its reinsurers and/or its service providers, for the Purposes. I agree that both my online claim and my coverage may bedenied or terminated as a result of my providing false, incomplete, or misleadingInformation. I agree to refund any monies or overpayments that I may owe to Manulife in accordance with the provisions of the Group Benefitsplan with Manulife, and I authorize Manulife to deduct suchmonies from my future claims. I authorize the use of my SocialInsurance Number (SIN) for the purposes of identification and administration,if my SIN is used as my plan member certificate number. I agree a photocopy, facsimile or electronic version of this authorization shall be as validas the original. I understand that Manulifes Privacy Policyand Privacy Information Package are available at www.manulife.ca/groupbenefits , or from my Plan Sponsor.

Signature of plan member:

Date Signed :

Any Information provided to or collected by Manulife in accordance with this online authorization, will be kept in a Group Benefits health file. Access to your Information will be limited to:

Manulife employees, representatives, reinsurers, and service providers in the performance of their jobs;

Persons to whom you have granted access; and

Persons authorized by law.

You have the right to request access to the personal information in your file, and, where appropriate, to have any inaccurate information corrected.

Submit a claim

We have received your claim

Your confirmation number is 1234567

Your claim has been randomly selected for audit.

You are leaving the plan member e-Service

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