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!
- Manulife Dental Claim Form
- Manulife Writeable Dental Claim Form
- Manulife Extended Health Care Claim Form
- Manulife Writeable Extended Health Claim Form
- Manulife Weekly Indemnity Claim Form
- NEW - BLUE CROSS* Attending Physician Form -
- Take this form to your Doctor for Weekly Indemity & LTD claims as of January 1, 2017.
- NEW - BLUE CROSS* Employee Claim Form -
- Members are required to fill out this form for Weekly Indemity & LTD claims as of January 1, 2017.
- Functions Ability Form (FAF)
(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