The amount you claim and include in medical expenses is the amount that you paid for and were not reimbursed. In this case, you will claim $15 which is the amount you paid for.
Note: If a weekly/monthly amount is being deducted from your work pay/income, this payment which you are paying for, can be used as a medical deduction. Verify your pay stubs to see if an amount is deducted for Great-West Life and such as it would be beneficial to include it with your medical expenses.
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