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Claim Forms

​Type of Expense ​Form Name ​Purpose
​Health Care ​Extended Health Care and Health Spending Account Claim Form ​​Use this form when you want to submit a health care claim under your Health Care Plan or Health Spending Account
​Dental Care Dental and Health Spending Account Claim Form Use this form when you want to submit a dental claim under your Dental Care Plan or Health Spending Account

Prior Approval Forms

​Type of Form Form Name ​Purpose
​Brand Name Exception ​Drug Exception Application Form ​Use this form when you want to request approval for coverage
Enhanced Prior Authorization Prior Authorization Form Use this form to request prior approval for coverage under the program for Specialty Drugs
Preauthorized Weight Loss Drug Preauthorized Weight Loss Drug Approval Form ​Use this form to request approval for coverage under the program for Weight Loss Drugs
​Disabled Child Disabled Child Approval Form Use this form to request continuation of coverage for your child, who depends on you for support because of a psychiatric or physical disability and became disabled before age 21

Application and Beneficiary Forms

​Type of Plan ​Form Name ​Purpose
Basic Life Insurance Plan - Beneficiary Designation Basic Life Insurance Plan Naming or Substitution of Beneficiary Use this form to nominate or change a beneficiary for your Life Insurance benefits
​Management Insurance Plan - Application and Beneficiary Designation Management Insurance Plan Application and Naming or Substitution of Beneficiary Use this form to apply for and/or nominate or change a beneficiary for your Management Insurance Plan Benefits
​Health Statement Form Health Statement Form Use this form to provide proof of good health when applying for Critical Illness Insurance (amounts over $50,000) and Management Insurance Plan Benefits
Business Travel AD&D - Beneficiary Designation ​Business Travel AD&D Naming or Substitution of Beneficiary ​Use this form to nominate or change a beneficiary for your Business Travel AD&D benefits

Emergency Travel Forms 

Type of Form​ ​Form Name ​Purpose
​Travel to Cuba Letter providing proof of Travel Insurance Travellers to Cuba are required to provide proof of travel insurance prior to be granted entry into the country
   
 
Published on February 10, 2016