Submit a claim

Step 1/3 - Member & claim information

Confirm banking and contact information

Why do we need this information?

Direct Deposit Information:

THE BANK OF NOVA SCOTIA
RICHMOND HILL, Ontario
L4B 3K2

Transit Number:45922
Institution Number:2
Account Number:999999999999

Update

Plan Member Contact Information:

123 MAIN STREET
KITCHENER, Ontario
N2L 4N4
CANADA

Phone Number:(555) 555 - 5555
E-mail Address:test@test.ca

Update

Select a service provider type and patient

Select service provider type

OR Select a spending account

This List represents a typical plan. Your plan may not include all of this coverage. Check your plan details to be sure.

Select a patient

Are you, your spouse or dependants covered under any other plan for the expenses being claimed? Yes No

Student information

Name of accredited school

Coordination of Benefits (COB) - Other Insurance Information

Name of spouse's insurance company

Spouse's plan contract number

Spouse's plan certificate number

Something is wrong here. Provide appropriate validation message.

Spouse's date of birth

Year

Month

Day

Please note! Any unpaid portion of this claim will be processed separately under the secondary policy with Manulife. Please do not submit a separate claim/request for this expense. Allow processing time of 5-7 business days.