Forms

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

Member Only

Information about Cancer Assistance.

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

Online platform for Non-Emergency Medical Support.

Member / Spouse / Dependent Child

Claim form for Dependent Child Disability Benefit.

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.

Dependent Child

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

Member Only

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 Dependent 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

Information about your Hospital Cash Coverage

Member / Spouse / Dependent Child

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

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

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

Member / Spouse / Dependent Child (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 Dependent Child and beneficiaries

Member Only

If you require out of hospital home nursing.

Member / Spouse / Dependent Child

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

For Members in Good Standing with CCWUcare that are 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 Member that wish to withdraw from the Retiree Benefit Program.

Member Only

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

Dependent Child

Claim a medical emergency while travelling.

Member / Spouse / Dependent Child

Claim for all vision care expenses.

Member / Spouse / Dependent Child