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Insights
Payroll & Bookkeeping
Private Health Services Plans
What is Covered?
PHSP FAQ
Registration Form
Online Claim Submission
Make a Payment
PHSP Forms
Tax Preparation
Business Consulting
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Online Claim Form Submission
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.
Company Name
*
Please enter the name of your company
Covered Employee Name
*
Please enter the name of the covered employee.
First
Last
Claim Date
*
Please enter the date of the claim
MM slash DD slash YYYY
Employee's Email
Please enter the employee's email
Claim Details
*
Please fill out the details of your claim. You can choose from: Dental; Prescription; Optometry; Massage; Chiropractic. You can total up each category and have 1 entry rather than multiple ones. The maximum file size is 10mb per file. If you exceed that, please upload multiple files or a smaller file. Click on the plus icon to add another expense to this claim.
Expense Type
Expense Amount
Receipt Upload
Have you added all of your expenses/receipts?
*
From this form, you can attach multiple expenses/receipts at once by clicking the + icon beside the Receipt Upload field in the above table.
Yes
No
Claim Notes
Any special requests or instructions.
Email
This field is for validation purposes and should be left unchanged.
Δ
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What is Covered?
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Home
Payroll & Bookkeeping
Private Health Services Plans
What is Covered?
PHSP FAQ
Online Claim Submission
Make a Payment
PHSP Forms
Tax Preparation
Business Consulting
Insights
Cart
Checkout
My Account
Website Terms and Conditions
Terms and Conditions of Sale
Privacy Policy
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