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Document Category: Health & Dental

Claim Form for Vision Care Services

Complete this form to submit a claim for vision care expenses such as eye glasses and contact lenses. One form should be used per practitioner, per patient.

Send the completed form, along with itemized receipts that include the information below, to RBC Insurance.

  • Patient name
  • Copy of vision prescription
  • A breakdown of charges for lenses and frames
  • Date glasses were picked up

Note: There is no need to attach receipts if this form is completed in full by your provider.

Online Claims Submission
You can also check your eligibility for vision care benefits and submit vision care claims through the Online Group Benefit Solutions service for Plan Members.

Mailing Instructions
If mailing the form, please send to:
RBC Life Insurance Company
Attention: Vision Department
P.O. Box 1603
Windsor, Ontario
N9A 0B6

Wellness Spending Account (WSA) Claim Submission Form

Complete this form to submit a claim for reimbursement under your Wellness Spending Account for eligible expenses.

Send the completed form, along with your original, fully paid receipt and an explanation of the benefit received, to the appropriate address listed on the form.

Be sure to keep a copy of your receipt for your records.

Claim Form for Related Health Professional Services

Complete this form to submit a paramedical claim for services provided by a massage therapist, naturopath, chiropractor, etc.

When completing the form, be sure to include the following information:

  • Patient name
  • Type of service ie. Chiropractor, massage therapy, etc.
  • Individual date and nature of treatment
  • Charge for each service

Mail the completed form, along with itemized receipts, to:
RBC Life Insurance Company
Attention: EHS Department
P.O. Box 1603
Windsor, Ontario
N9A 0B6

Online Claims Submission

You may be able to submit this type of claim online. To find out more, sign in to the Online Group Benefit Solutions service for a list of eligible expenses.

Note: You can also check your eligibility for select practitioners and access pre-populated forms through the Online Group Benefit Solutions service for Plan Members.

Claim Form for Medical Devices

Complete this form to submit a claim for a medical device. One form should be used per practitioner, per patient.

For custom-made foot orthotics or custom footwear, please use the Claim Form for Custom Foot Orthotics

Mail the completed form to:
RBC Life Insurance Company
Attention: EHS Department
P.O. Box 1613
Windsor, Ontario
N9A 0B8

Note: This form is available, pre-filled with your personal details, within our Online Group Benefit Solutions service for Plan Members


Health Spending Account (HSA) Claim Submission Form

For assistance with filling out the form, please click here.

Complete this form to submit a claim for reimbursement under your Health Spending Account for eligible expenses that are not covered (or not covered in full) by your Health or Dental plan.

For a list of eligible expenses, please visit the Canada Revenue Agency website.

Send the completed form, along with your original, fully paid receipt and an explanation of the benefit received, to the appropriate address listed on the form.

Be sure to keep a copy of your receipt for your records.

Hearing Aid Claim Form

Complete this form to submit a claim for hearing aids. Please note that this form must be filled out for all pay plan member claims.

Send the completed form, along with itemized receipts that include the information below, to RBC Insurance.

  • Patient name
  • Services and dates
  • Audiologist name and address
  • Breakdown of charges (i.e. acquisition cost, fee, mold)

Note: This form is available, pre-filled with your personal details, within our Online Group Benefit Solutions service for Plan Members.

Mail the completed form to:
RBC Life Insurance Company
Attention: EHS Department
P.O. Box 1610
Windsor, Ontario
N9A 0B7