Claim Forms

You can now type in your information prior to printing your Dental and Supplementary Claim form:

Claim forms for:

Dental - Active Staff (this is a fillable form & only compatible with Internet Explorer and Firefox; if using Chrome browser, right click on link, choose "save link as," save as Adobe Acrobat Document on your desktop, and then open from desktop) 

Dental - Retired Staff

Supplementary Health & Healthcare Spending Account - Active Staff

Healthcare Spending Account only- Active Staff
(use this form if you have opted out of the Supplementary Health Plan)

Supplementary Health - Retirees

Supplementary Health & Healthcare Spending Account - University Medical Group

Supplementary Health & Healthcare Spending Account - St. John's College

 

Université de Saint-Boniface claim forms:

- Supplementary Health & Healthcare Spending Account (French)

- Supplementary Health & Healthcare Spending Account (English)

- Healthcare Spending Account (French)
    (use this form if you have opted out of the Supplementary Health Plan)

- Healthcare Spending Account (English)
    (use this form if you have opted out of the Supplementary Health Plan)


 

For instructions on submitting your claim
click here

Questions on Group Insurance Benefits?
please e-mail the Staff Benefits Generalists

Employee surnames beginning with:
A to L   phone: 474-8085
M to Z   phone:  474-9771