Forms for coverage through your employer

Drugs from pharmacies, clinics or physicians.

Chiropractors, physiotherapists, massage therapists, psychologists and more.

Medical equipment, appliances and services.

Dental procedures, consultations and laboratory fees.

Eye exams, laser eye surgery, glasses and contact lenses.

Claim expenses through a wellness or lifestyle account.

For plan members who have a Health SolutionsPlus Visa payment card.

For people who have a healthcare spending account.

For people covered under a PlanDirect individual health plan.

For people covered under one of these select plans.

 Use these forms to submit a claim for medical expenses incurred while travelling.

Use this form to request coverage of a brand name drug.

Use this form to request an assessment for nursing care.

Use this form to request the review of a prescribed drug dosage.

Use this form to request an estimate for a Continuous Glucose Monitor.

Use this form to request coverage for a Positive Airway Pressure (PAP) machine.

Use these forms to submit your prescription drug claim for approval before you apply for reimbursement.

If you have coverage through your employer or plan sponsor, use this form to make a medical cannabis claim for approval before you apply for reimbursement.

Use these forms to start a short-term, long-term or early referral services disability claim if an illness or injury is keeping you from working.

Use these forms to make a claim for accidental death, dismemberment or specific loss.

Use these forms to start a critical illness claim.

Use these forms to make a life insurance claim as a beneficiary or estate representative.

Use these forms to apply for a lump sum portion of your life insurance following a terminal diagnosis.

Use this form to request a waiver of life insurance premiums if there’s a disability keeping you from working.

Use this form to apply for coverage for a child who is no longer a minor but is fully dependent on you financially.

Use this form to designate a beneficiary or beneficiaries or appoint a trustee for a beneficiary who is a minor or lacks legal capacity.

Use this form to change from a smoker to a non-smoker rate for optional critical or life insurance benefits.

Set up direct deposit or pre-authorized payments using these forms.

Use these forms to make changes to your trustee or designated beneficiary.

Make changes to your Portable Life and Accidental Death and Dismemberment (AD&D) insurance.

Make a claim on a Portable Benefits life insurance plan.

Make a claim on your Portable Accidental Death and Dismemberment (AD&D) insurance.

Make a claim on your Portable Critical Illness coverage.