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
- BLUE CROSS DENTAL CLAIM FORM
- BLUE CROSS EXTENDED HEALTH CARE CLAIM FORM
- BLUE CROSS MANDATORY GENERIC SUBTITUTION EXCEPTION REQUEST
- NON GENERIC FORM (SIDE EFFECT REPORTING FORM)
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!
- 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)
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
| Attachment | Size |
|---|---|
 Dental-Care-FORM-536E BLUE CROSS.pdf | 583.88 KB |