Insurance forms

Use these forms to submit a health or dental claim

These forms are in PDF format and can be downloaded to and then printed from your computer with Adobe Acrobat Reader. If you do not have this free software installed on your computer, install it now. Once installed, it can be used to read many documents throughout the Web.

Select the name of the form you require and click to open it, print and complete.

Health Claim Forms

Enrolment or Re-enrolment Application

Beneficiary Designation

Over-Age Student Dependant Coverage

Extended Health Care Claim

Refusal of All Coverage

Request for Approval of Brand-Name Drug

Drug Prior Authorization

Dental Claim Forms

Dental Claim

Out of Province/Out of Canada  Health Claim Forms

OOP/OOC Claim

Submit Your Form

Remember to sign the form and attach any necessary receipts. Then submit to your plan administrator, if that's who usually signs your forms. Otherwise, mail your form to the address shown on the form.

Looking for an application form, policy form, or claim form for CoverMeTM products?