How to Submit Your HCSA Claim

Get the claim form from the Manulife web site at http://www.manulife.ca/group benefits by
logging in to the Plan Member Secure site. Complete the Extended Health Claim form and
check the HCSA box at the bottom of Section 1. Manulife is not able to release funds unless
you check this box and sign the form. Submit the form with copies of any supporting
receipts/documents.

The reimbursement you receive is based on the funds available in your HCSA and will be
explained on the Explanation of Benefits that Manulife includes with each reimbursement.

Full Issue: No. 323 - November 21, 2008

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