Plan Member Forms

Use this form to claim for medical, vision and extended health expenses and services.
Use this form for direct billing. Submit a completed and signed form along with receipts.
Use this form to request a change in your address, coverage, name, dependants or spouse.
Use this form to authorize payment for claims directly to your bank account via electronic fund transfer.
Use this form to apply to extend a dependant’s coverage for age 21 and older. Provide a proof of enrollment at an accredited post-secondary institution.
Use this form to apply for coverage for a disabled dependant once they reach age 21.
Use this form to register a change in your beneficiary.

Healthcare Provider Forms

Use this form to set up an electronic fund transfers for claim payments (for providers only).
Use this form for direct billing. Submit a completed and signed form along with receipts.
Fill out, sign and submit this Agreement to apply for online claims submission. This Agreement does not apply to pharmacists or dentists.

Plan Admin Forms

Use this form to enrol a new Plan Member. A scan of completed forms must be submitted to your plan advisor.
Use this form to designate a beneficiary.