Claim Forms

Image Authorization for Brand Name Drug Coverage
Image Dental Accident Claim Form
Image Dental Claim Form
Image Extended Health Benefits Claim Form
Image Direct Deposit of Health and Dental Benefit Payments
Image Employee Reimbursement Form for ASSURE Drug Claims
Image Health Spending Account Request
Image Lifestyle Spending Account Request
Image my-benefits eClaims
Image Voyage Assistance

Administration Forms

Image Appointment of Beneficiary
Image Enrolment Application Chief & Council and/or Appointed Official
Image Enrolment Application for Group Insurance
Image Group Insurance Confirmation of School Attendance
Image Group Insurance Employee Change Request
Image Notice of Change – Salary, Occupation, Hours
Image Notice of Employee Termination, Leave, Reinstatement
Image Pre-Authorized Payments (PAP)
Image Request for Conversion
Image my-benefits Brochure