Forms

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

Member / Spouse / Dependent Child

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 Child

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

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

Member Only

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

Member / Spouse / Dependent Child

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 Child

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

Member / Spouse / Dependent Child

Access to Nurses to help navigate the healthcare system.

Member / Spouse / Dependent Child

Confidential counselling services to support mental health and wellbeing.

Member / Spouse / Dependent Child

Confidential counselling services to support mental health and wellbeing.

Member / Spouse / Dependent Child

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

Member / Spouse / Dependent Child

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

Member / Spouse / Dependent Child

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

Member / Spouse / Dependent Child

Claim form for Child Disability Benefit.

Dependent Child

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

Dependent Child

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

Member / Spouse / Dependent Child

Claim for Critical Illness Diagnosis – Cancer.

Member / Spouse / Dependent Child

Claim for Critical Illness Diagnosis – Heart Related Conditions.

Member / Spouse / Dependent Child

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

Member / Spouse / Dependent Child

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

Member / Spouse / Dependent Child

Claim for Critical Illness Diagnosis – Muscular Dystrophy

Member / Spouse / Dependent Child

Claim for Critical Illness Diagnosis – Neurologic Disorders

Member / Spouse / Dependent Child

Claim for Critical Illness Diagnosis – Occupational HIV Infection.

Member / Spouse / Dependent Child

If member wishes to apply or withdraw from the dental clinic

Member Only

Claim for all dental care expenses.

Member / Spouse / Dependent Child

Benefit coverage application for Dependent Child with a disability.

Member / Spouse / Dependent Child

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 a medical emergency while travelling.

Member / Spouse / Dependent Child

Claim for all heath care expenses which includes prescription drugs.

Member / Spouse / Dependent Child

Claim form for legal benefits related to Adoption

Member Only

Claim form for legal benefits related to Change of Name.

Member Only

Claim form for legal benefits related to Child Support

Member Only

Claim form for legal benefits related to Custody

Member Only

Claim form for legal benefits related to Divorce

Member Only

Claim form for legal benefits related to Separation Agreement

Member Only

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 Child

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 / Spouse

Claim form for legal benefits related to Immigration.

Member / Spouse

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

Member / Spouse

Advance lump sum of principal life insurance amount paid in advance

Member / Spouse / Dependent Child

Claim in the event of a death.

Member / Spouse / Dependent Child

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

Member / Spouse

If you remain totally disabled and have exhausted the Short-Term Disability Benefit.

Member Only

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

Member / Spouse / Dependent Child

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 Dependent Child and beneficiaries.

Member Only

If you require out of hospital home nursing.

Member / Spouse / Dependent Child

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

Member Only

Claim form for legal benefits related to Real Estate Discharge

Member / Spouse

Claim form for legal benefits related to Real Estate Mortgage

Member / Spouse

Claim form for legal benefits related to Real Estate Purchase

Member / Spouse

Claim form for legal benefits related to Real Estate Sale

Member / Spouse

Claim form for legal benefits related Real Estate Transfer of Title

Member / Spouse

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

Member Only

Financial assistance if you are unable to work due to non-occupational injury or illness.

Member Only

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 Child

Complete this form if you are transferring Locals and are moving your hour bank.

Member Only

Claim a medical emergency while travelling.

Member / Spouse / Dependent Child

Claim for all vision care expenses.

Member / Spouse / Dependent Child

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