Submit Claim

Online Claim Form

Use this form when submitting a claim online! Your information will be transmitted securely. Your attachments will be purged from our servers once the claim has been submitted. Your information will NOT be stored in our online databases.

Please fill out the details of your claim to the best of your ability. You can choose from: Dental; Prescription; Optometry; Massage; Chiropractic etc. You can submit up to 3 claims at once. The maximum file size is 5mb per claim.