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Claim Form – Medical Expenses (PDF - 115 KB)
To obtain a reimbursement for prescription drugs,
paramedical or eye care, or ambulance transportation, see How do I submit a medical expense
claim? |
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Claim Form – Dental Care (PDF - 48 KB)
To obtain a reimbursement for dental care, see How do I submit a dental care
claim? |
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Claim Form – Dental Care in case of an accident (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. |
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Claim form - Health Spending Account (PDF - 41 KB)
For reimbursement of expenses using your Health Spending
Account. |
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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. |
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Claim form - Medical Expenses/HSA (Health Spending Account) (PDF - 58 KB)
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, see How do I submit a medical
expenses claim and/or a Health Spending Account
claim? |
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Claim Form - Dental Care/HSA (Health Spending Account) (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? |
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Prior Authorization Form for Drug Reimbursement (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 |
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Prior Authorization Form for Xenical Reimbursement (PDF - 61 KB)
In order for us to evaluate your reimbursement request for Xenical, please
have this form filled out by your doctor. |
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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. |
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