Forms

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

If member wishes to apply or withdraw from the dental clinic

Member Only

Claim 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

Information about your Emergency Out of Province 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

Information about your Hospital Cash Coverage

Member / Spouse / Dependent Children

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 (over the age of 18)

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

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

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

Member Only

Members in Good Standing with LiUNA Local 183 retiring and want to enrol into the Retiree Benefit Plan? Complete the Retiree Benefit Application Package.

Member Only

The Retiree Program Withdraw Notification is for current Retirees that wish to withdraw from the Retiree Benefit Program.

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

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