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.

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.

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 and Dental Claims                                                   New WI & LTD Claims as of January 1, 2017          

Blue Cross                                                                                    Blue Cross

PO Box 3300                                                                                 PO Box 668

Station B                                                                                        Station B

Montreal, QC                                                                                 Montreal, QC

H3B 4Y5                                                                                        H3B 3K3

 

                                                           

                                                                                                 

                                                                                                          

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