Benefit Claim Forms

Form Name Description
Assure Card Claim Form
Submit this form for prescription drug claims.
Healthcare Expenses Statement This form is used for extended health claims (including eye exams) covered under your plan.
Dental Claim Form Submit this form for dental claims.
Visioncare Claim Form Submit this form to claim the costs of purchasing glasses or contacts.
Out of Country Claim Form Submit this and the out of country authorization and release form (below) to claim out-of-country medical expenses.
Out of Country Authorization and Release Form Submit this and the out of country claim form (above) to claim out-of-country medical expenses.

Benefit Application and Change Forms

Form Name Description
Beneficiary Nomination Form Change your beneficiaries for Group Life Insurance. Return to the Benefits Coordinator when complete.
Evidence of Insurability This form is used in addition to the Group Coverage Change form when you are a late applicant for health, dental or optional life insurance, or when you want to increase your optional life insurance.
Group Coverage Change Form Enrol in or change benefits information – includes health & dental, reinstatement or refusal of benefits, optional life insurance, beneficiary changes and name changes. Return to the Benefits Coordinator when complete.
Optional Life Insurance – Trustee Appointment Form Assign a trustee for optional life insurance when your beneficiary is a minor or lacks legal capacity. Return to the Benefits Coordinator when complete.
Pension Beneficiary Form Change your Pension Beneficiaries.  Contact the Pension Officer if you require assistance.

Tuition Benefits

Form Name Description
Free Tuition Application Submit this form to apply for free tuition. See your benefits package for eligibility.
Contract Instructor Tuition Waiver Application to waiver tuition fees for contract instructors.

Career Development Forms

Form Name Description
Career Development Fund Application Form The Career Development Fund is available to assist employees who wish to pursue training associated with career development objectives.