Forms

Loss of Life caused solely by external, violent, and accidental means.

Member / Spouse / Dependent Children

Loss of Life caused solely by external, violent, and accidental means while on the premises of your employer.

Member Only

Accidental Dismemberment caused solely by external, violent, and accidental means.

Member / Spouse / Dependent Children

Accidental Dismemberment caused solely by external, violent, and accidental means while on the premises of your employer.

Member Only

If Member wishes to Authorize an Individual to speak on their behalf.

Member Only

Confidential access to Oncology Nurses to help navigate the healthcare system.

Member / Spouse / Dependent Children

Up to $50,000 per Eligible Dependent Child.

Dependent Children

Information on how to set up eClaims.

Member / Spouse / Dependent Children

Diagnostics Services:
MRI / CT Scans / Ultrasound / Endoscopy / Colonoscopy

Specialists Services:
Dermatologist, Endocrinologist, Gynecologist, Podiatrist, Respirologist, Cardiology, Gastroenterology, General Surgery, Neurosurgery, Ear, nose & throat, Orthopedics, Ophthalmology, Rheumatology, Urology, Neurology

Surgeries Services (MEMBER ONLY):
Orthopedic Surgery – ACL, Elbow, Foot, Ankle, Toe, Hand, Wrist, Hip, Knee & Shoulder
General Surgery – Cataract, Ear, Nose & Throat, Gallbladder & Hernia

Member / Spouse / Dependent Children

Access to tools / information to assist in educating and providing guidance for financial goals and assist in alleviating stress from financial uncertainty.

Member / Spouse / Dependent Children

Information about your Group Legal Plan Coverage

Member / Spouse / Dependent Children

Confidential one-on-one coaching support around healthy eating, diabetes, and heart health.

Member / Spouse / Dependent Children

Access to Nurses to help navigate the healthcare system.

Member / Spouse / Dependent Children

Home delivery for prescription medications.

Member / Spouse / Dependent Children

Intensive outpatient program offered virtually or in-person to address a variety of mental health issues and disorders.

Member / Spouse / Dependent Children

Confidential counselling services to support mental health and wellbeing.

Member / Spouse / Dependent Children

Confidential counselling services to support mental health and wellbeing.

Member / Spouse / Dependent Children

Mental health resources, assessment tool, and confidential counselling services.

Member / Spouse / Dependent Children

Confidential access to virtual or in-person treatment to address opioid use and addiction.

Member / Spouse / Dependent Children

Resources and coaching services to tackle a variety of parenting and caregiving challenges.

Member / Spouse

Online training platform to tackle a variety of lifestyle goals, including smoking cessation, weight loss, sleep, alcohol, stress, diabetes, and more.

Member / Spouse / Dependent Children

Confidential virtual support, coaching, and treatment to address alcohol, opioid, and substance use and addiction.

Members / Spouse / Dependent Children

Information on all substance use and addiction treatment programs.

Member / Spouse / Dependent Children

Information about Tax Services.

Member / Spouse / Dependent Children

Online platform for Non-Emergency Medical Support.

Member / Spouse / Dependent Children

Claim form for Child Disability Benefit.

Dependent Children

Claim for Critical Illness Diagnosis for Dependent Child Only – Cerebral Palsy, Congenital Heart Disease, Cystic Fibrosis, Down Syndrome, Muscular Dystrophy, Type 1 Diabetes.

Dependent Children Only

Claim for Critical Illness Diagnosis – Bacterial Meningitis, Benign Brain Tumor, Coma or Stroke.

Member / Spouse

Claim for Critical Illness Diagnosis – Heart Related Conditions

Member / Spouse

Claim for Critical Illness Diagnosis – Kidney Failure Major Organ Transplant or Failure on Waiting List, or Aplastic Anemia.

Member / Spouse

Claim for Critical Illness Diagnosis – Loss of Sight, Hearing, Speech, Limbs, Independent Existence or Paralysis.

Member / Spouse

Claim for Critical Illness Diagnosis – Muscular Dystrophy

Dependent Children

Claim for Critical Illness Diagnosis – Neurologic Disorders

Member / Spouse

Claim for Critical Illness Diagnosis – Occupational HIV Infection

Member / Spouse

Claim for Critical Illness Diagnosis – Other Conditions

Member / Spouse

Claim for Critical Illness Diagnosis – Cancer

Member / Spouse

If member wishes to apply or withdraw from the dental clinic

Member Only

Claim form for all dental care expenses.

Member / Spouse / Dependent Children

Benefit coverage application for dependents with a disability.

Dependent Children

Complete a direct deposit form to have your claim cheques deposited directly into your bank account.

Member Only

Disabled and unable to work? Complete the Disability Self Pay Extension form to request to self pay for benefit coverage.

Member Only

Claim form to apply for emergency out-of-province medical coverage

Member / Spouse / Dependent Children

Claim for all heath care expenses which includes prescription drugs.

Member / Spouse / Dependent Children

Claim form for legal benefits related to Adoption

Member / Retiree

Claim form for legal benefits related to Change of Name.

Member / Retiree

Claim form for legal benefits related to Child Support

Member / Retiree

Claim form for legal benefits related to Custody

Member / Retiree

Claim form for legal benefits related to Divorce

Member / Retiree

Claim form for legal benefits related to Separation Agreement

Member / Retiree

Been hospitalized? Claim for a daily cash benefit for the duration of your hospital stay to cover for parking, room amenities, etc.

Member / Spouse / Dependent Children

Replace lost wages in an event you missed work due to jury duty.

Member Only

Claim form for legal benefits related to the Highway Traffic Act (HTAO)

Member / Retiree / Spouse

Claim form for legal benefits related to Immigration.

Member / Retiree / Spouse

Claim form for legal benefits related to Wills and Power of Attorney

Member / Retiree / Spouse

Claim in the event of a death.

Member / Spouse / Dependent Children

Claim for Long Term Care Benefits if you or your eligible spouse require support with activities of daily living at home or at long term care facility.

Member / Eligible Spouse

Complete this Prior-Authorization form prior to claiming for medicinal cannabis.

Member / Spouse / Dependent Children

Moving and looking to change your home address? Complete the Member Change of Address Form

Member Only

New Member Enrollment / Application card or to add / change existing dependents and beneficiaries.

Member Only

If you require out of hospital home nursing.

Member / Spouse / Dependent Children

Replace lost wages in an event you missed work due to a death in the family or the birth of your child.

Member Only

If you become totally and permanently disabled due to an accident.

Member Only

Claim form for legal benefits related to Real Estate Discharge

Member / Retiree / Spouse

Claim form for legal benefits related to Real Estate Mortgage

Member / Retiree / Spouse

Claim form for legal benefits related to Real Estate Purchase

Member / Retiree / Spouse

Claim form for legal benefits related to Real Estate Sale

Member / Retiree / Spouse

Claim form for legal benefits related Real Estate Transfer of Title

Member / Retiree / Spouse

If member wants to set up an RESP for child / grandchild

Member Only

Lost / Misplaced your Member Advantage Benefit Card? Complete the Replacement Benefit Card Application to request a new card.

Member Only

Income replacement if you are unable to work due to non-occupational injury or illness.

Member Only

Hospital, Surgeon, Physician Fees

Members / Spouse / Dependent Children
Up to age 70

Claim for member only of $100,000

Member Only

Physician to complete the Speech Therapy Medical Questionnaire for dependent children prior to incurring speech therapy claims. Benefit available to dependent children only.

Dependent Children Only

Advance lump sum of principal life insurance amount paid in advance

Member / Spouse / Dependent Children

Claim a medical emergency while travelling.

Member / Spouse / Dependent Children

Claim for all vision care expenses.

Member / Spouse / Dependent Children

Review and complete if you have need assistance with a new or ongoing WSIB claim.

Members

Approved for W.S.I.B. and unable to work? Complete this Information Form for fund assistance and to request to self pay for benefit coverage.

Member Only