Medical & Dental forms

Extended Health Care Form
Use this form for all medical expenses except dental

Medi-Passport (only for members with extended health care coverage)
This is to be used should the employee require medical services when traveling outside British Columbia.

Dental Claim Form
Use this form for dental claims

Disability forms

Short Term, Member Statement Form
Use this form when making a short term disability claim. Must be accompanied by Plan Sponsor and Attending Physician statement forms

Short Term, Physician's Statement Form
Use this form when making a short term disability claim, to be completed by the attending physician and signed by member.

Enrollment & Update forms

Enrollment Card
Use this form to enroll in the group plan

Change Card
Use this form to notify us of any changes or additions to your personal information

Notification of Employee Fair Pharmacare Registration Number
Use this form to notify us of an employee's Fair Pharmacare registration number.
Not registered with Fair Pharmacare? Click Here to go to the Fair Pharmacare web site.

Health Questionnaire
This form to be completed for excess risk long term disability and late entrant employee situations

Beneficiary Designation Form
Use this form to designate or change your beneficiary

Student Confirmation Form
Use this form to identify dependents who are attending post secondary school full time but are still under 25, not married, and supported by you.