
3350 East Paris Ave. SE
Grand Rapids, MI 49512
p. 877.274.8796
f. 616.301.2149

Obtain the claim form from the Manulife web site at http://www.manulife.ca. Select Group Benefits and log 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 accompanying Explanation of Benefits from Manulife.