Claim Form – Medical Expenses (fillable version) (PDF - 115 KB)
To obtain a reimbursement for prescription drugs, paramedical or eye care, or ambulance transportation. Form that can be completed on screen. To know how to submit a medical expense claim.

Claim Form – Dental Care (fillable version) (PDF - 48 KB)
To obtain a reimbursement for dental care. Form that can be completed on screen. To know how do I submit a dental care claim.

Claim Form – Dental Care in case of an accident ( fillable version) (PDF - 48 KB)
For reimbursement of dental care when the expenses are incurred following an accident. This care is reimbursable under the health insurance coverage.

Claim form - Health Spending Account (fillable version) (PDF - 41 KB)
For reimbursement of expenses using your Health Spending Account. Form that can be completed on screen.

Direct Deposit and E-Notification request - F54-069A (PDF - 136 K)
To request the direct deposit of your benefit payments in your bank account and to be notified by email of the status of your medical expense and/or dental claims.

Claim form - Medical Expenses/HSA (fillable version) ()
To obtain a reimbursement for prescription drugs, paramedical or eye care, or ambulance transportation and/or obtain reimbursement of expenses using your Health Spending Account.

Claim Form - Dental Care/HSA (fillable version) (PDF - 302 KB)
To obtain a reimbursement for dental care and/or obtain reimbursement of expenses using your Health Spending Account, see How do I submit a dental care claim and/or a Health Spending Account claim?

Prior Authorization Form for Drug Reimbursement (fillable version) (PDF - 63 KB)
In order for us to evaluate your reimbursement request for a drug that requires prior authorization, please have this form filled out by your doctor. Please note that drugs on the prior authorization list vary by province:
List of drugs for Quebec
List of drugs for other provinces

Prior Authorization Form for Xenical Reimbursement (fillable version) (PDF - 61 KB)
In order for us to evaluate your reimbursement request for Xenical, please have this form filled out by your doctor.

Confirmation of Illness form for H1N1 flu (PDF - 61 KB)
For submitting a Short Term Disability claim if the absence is due to flu like symptoms or a clinical diagnosis of H1N1 during the flu season.

Direct Deposit of disability benefits - F54-072A (PDF - 75 KB)
To request the direct deposit of your disability benefit payments in your bank account.

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