Benefit Forms

As of January 1, 2018, please use the following plan numbers and forms for Blue Cross Dental and Health 

ACTIVE EMPLOYEES - 91389-F

RETIREES - 91392-F

 

PDF versions of Medical, Dental, Functions Ability Form (FAF)and WI Claim forms are now available to download and print. Mailing addresses are on the bottom of this page.

Medical Plan # 85020 for active members, Division # 73. Use these numbers for all Manulife and Blue Cross Health Claims.

As of January 1, 2017, the Company requires all members with a NEW Weekly Indemity or Long Term Disability Claim, to file their claim with BLUE CROSS. Forms are below.

Dental Plan #85021 for active members, Division # 73

Medical Plan #85080 for Retired members

 

Click on the link below to download and print. The files are in Acrobat PDF format.

Also there are Dental & Health writeable PDF versions  available.

Please remember to keep a copy of anything that you send to the insurance company. Any problems or rejected claims, please see the union office!

 

 

 

Mailing addresses

(Health claims):                             (Dental claims):                                    New WI & LTD claims as of January 1, 2017 :

Manulife Financial                        Manulife Financial                                 Blue Cross

Group Health Claims                      Group Dental Claims                               Weekly Indemity & LTD Claims

PO Box 1653                                  PO Box 1654                                            PO Box 668, Station B

Waterloo, Ontario                          Waterloo, Ontario                                       Montreal, Quebec

N2J 4W1                                          N2J 4W2                                                  H3B 3K3

File Attachments: 
AttachmentSize
PDF icon Dental-Care-FORM-536E BLUE CROSS.pdf583.88 KB