EasyHSA policy number
Plan holder's last name
Your email address (in case we have questions)
Your receipt should include: 1.   Description of the service. 2.   Name and license of the provider. 3.   Date service was received. 4.   Name of recipient. 5.   Total amount paid.
We do not want your credit/debit card receipts. IMPORTANT: If you or your spouse have any other health insurance or drug program available to you, it should be used FIRST. Only amounts not covered by that insurance plan or program can then be submitted here. You must include a Statement of Benefits from that provider that shows the amounts not covered (including deductible and co-pay amounts).
Submitted claims totaling less than $5 will not be reimbursed.
Claimant name (you or a dependent)
Claim description (eg. "Eye exam")
Province where service was received ---ABBCMBNBNLNSNTNUONPEQCSKYTOutside of Canada
Date service was received
Total amount you are claiming (Do not include any amount paid by another insurance plan, and attach a Statement of Benefits showing coverage. Do not include tips paid.)
Anything else you'd like to tell us about this claim?
Upload your eligible receipt (do not upload credit/debit receipts).
Do you have another claim to submit? noyes
I understand that I must submit only truthful claims for eligible health services/supplies provided by authorized Medical Practitioners to myself, my spouse, or my eligible dependents. I understand that I must use all other health insurance/programs available to me and my spouse first. I understand that misuse could result in loss of coverage.
Email [email protected] or contact us below.