Forms and Guides

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Claim Form – Medical Expenses

Claim Form – Dental Care

Direct Deposit and Notification Request – Medical and Dental Care Expenses 

Claim Form – Health Spending Account (HSA)

Claim Form – Disability – Initial Request

Claim Form – Travel Insurance (emergency medical care)

Claim Form – Trip Cancellation

Prior Authorization Drug Form

List of drugs requiring prior authorization

Categories

Wellness Account - Claim Form

Claim Form – Medical Expenses

Claim Form – Dental Care

Claim Form – Health Spending Account (HSA)

Direct Deposit and Notification Request – Medical and Dental Care Expenses 

Claim Form – Disability – Initial Request

Direct Deposit Request – Disability Benefits

Claim Form – Disability – Extension of Benefits

Claim Form – Travel Insurance (emergency medical care)

Claim Form – Trip Cancellation

Prior Authorization Drug Form

List of drugs requiring prior authorization

Claim Form – Life Insurance

Claim Form – Critical Illness Insurance 

Claim Form – Accidental Dismemberment

Claim Form – Dental Care following an accident

Enrolment Request

Enrolment Request – with online beneficiary designation

Change Request

Change Request – with online beneficiary designation

Request for Conversion

Evidence of Insurability

Transit – Individual Health Insurance Application

Transit – Brochure

Transit – Rates Table

E-services Brochure

My Client Space – Plan Member My Client Space Online Registration Guide

Your Health Spending Account

Transit Brochure

Guide to Foot Orthotics

Guide to Orthopedic Shoes

Certificate of insurance – Loan Insurance – Laurentien Bank

Summary of insurance – Line of Credit Insurance – Laurentien Bank

Summary of insurance – Mortgage Loan Insurance – Laurentien Bank

Summary of insurance – Personal Loan Insurance – Laurentien Bank

Certification of insurance product Loan Insurance for Investment Funds

Summary of insurance product Loan Insurance for Investment Funds

Certificate of insurance – Travel insurance – Laurentien Bank Visa

Summary of insurance – Travel insurance – Laurentien Bank Visa

Certificate of insurance – Purchase insurance and extended warranty – Laurentien Bank Visa

Summary of insurance – Purchase insurance and extended warranty – Laurentien Bank Visa

Certificate of insurance – Assur-payment – Laurentien Bank Visa

PLAN ADMINISTRATOR

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