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Owcp-915 Form: What You Should Know

General Information. 2. Applicant's Information 3. Personal Data 4. Form OWCP-915 5. Personal History 6. Medical History 7. Employment Background 8. Financial History 9. Contact Information 10. Additional Information: 11. Information on Workplace Benefits 12. Information about Current Benefits 13. Reimbursement Plan 13.1 The Employer's Payment Plan; 2. The Employer's Payment Plan; Medical Costs — Ontario Ministry of Health and Long-Term Care HRA-905 — Claim of Medical Reimbursement — Ontario Ministry of Health and Long-Term Care Medical expenses, including out-of-pocket expenses, will be paid for as follows: if the claimant is disabled (see section 5.1), the amount of the claim will not exceed 400 per year. For a claimant to be entitled to the benefit, the claimant must indicate whether the claim relates to the claimant's employment by indicating if the claim relates to the claimant's service as: a member of the Royal Canadian Air Force or an employee of the Canadian Forces; a member of the Royal Canadian Air Force as a member of the RCA For the Canadian Forces; or, the claimant is a Canadian Forces Reservist or a civilian employee of the Canadian Forces with a long-term disability as defined in the regulations. Claim of Medical Reimbursement — Ontario Ministry of Health and Long-Term Care For claims relating to the treatment of a serious injury, serious illness or long-term disability: The amount of the claim will not exceed 500 per year. The claimant must agree to have his/her insurance policy paid the entire amount of the claim, as a lump sum in a lump-sum payment, or the entire amount of the claim as an advance payment of future benefits, to enable the insurance company to cover the claim. The insurance company must make such an advance payment in order to cover the claim. To receive the advance payment, the claimant must provide a medical certificate from a licensed physician/hospital in which the claimant certifies that the claimant is incapable of working at the position concerned. The claimant must also provide proof of his/her disability for insurance purposes. The claimant must then provide the insurance company with his/her insurance policy number, name, address and policy number, to ensure payment of his/her insurance policy. An insurance company will pay the full outstanding amount of the claim, in accordance with the applicable contract.

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