Ready for some easy money?

Please tell us who you are:

EasyHSA policy number

Plan holder's last name

Your email address (in case we have questions)

Please submit eligible receipts

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.

For your first claim:

Claimant name (you or a dependent)

First

Last

Claim description (eg. "Eye exam")

Province where service was received

Medical Practitioner who provided the health service, medicine or supply received. If there is more than one on your receipt select the primary practitioner. For drug and medicine prescriptions select "Pharmacist".

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?

For your second claim:

Claimant name (you or a dependent)

First

Last

Claim description (eg. "Eye exam")

Province where service was received

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?

For your third claim:

Claimant name (you or a dependent)

First

Last

Claim description (eg. "Eye exam")

Province where service was received

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?

For your fourth claim:

Claimant name (you or a dependent)

First

Last

Claim description (eg. "Eye exam")

Province where service was received

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?

For your fifth claim:

Claimant name (you or a dependent)

First

Last

Claim description (eg. "Eye exam")

Province where service was received

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?

If you have additional claims please submit these batch first and then refresh this page to submit another batch. This helps us ensure that all of your attachments will be uploaded without errors.

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.

Ready for some easy money?

Please tell us who you are:

Please submit eligible receipts

For your first claim:

For your second claim:

For your third claim:

For your fourth claim:

For your fifth claim:

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