Please note: Claims must be received in our office by 4pmMountain Time in order to be processed the same day.Many thanks to our planholders & claimants for your referrals!Scroll down this page for plan details and registration info.
A VOID cheque or approved bank branch validation form must be attached with this agreement
to verify the Planholder bank account information. This form and bank information can be submitted
in advance or at the time of submission of the first health benefit claim. DRAltd will retain the bank
account information in its secure files so that it is only required once.
The undersigned hereby authorizes the execution of the above agreement. The Planholder’s financial
institution is authorized to treat each debit as if a cheque had been issued authorizing such payment