EasyHSA policy number
Your last name
Your email address (in case we have questions)
"Eligible" means that your receipt should include:
1.   A description of the health service/supply (ex. "physiotherapy"). 2.   The date the service/supply was received. 3.   Full name of the recipient (you, your spouse or dependent). 4.   The 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 deductibles and co-pay amounts).
Submitted claims totaling less than $5 will not be reimbursed.
Claimant name (you, your spouse, or a dependent)
Claim description (eg. Physiotherapy)
Province where the health service, medicine or supply was received ---ABBCMBNBNLNSNTNUONPEQCSKYTOutside of Canada
Date service or supply was received
Total amount you are claiming on this receipt (Do not include any amount that was paid by your other health insurance plan or program. A "Statement of Benefits" from this insurer is required.)
Anything else you'd like to tell us about this claim?
Upload your eligible receipt (please do not upload credit/debit card receipts).
Do you have another receipt to include? noyes
Claim description ( eg. Physiotherapy )
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 firstname.lastname@example.org or contact us below.