Claim Forms

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

Claim forms for:

Dental - Active Staff

Dental - Retired Staff

Supplementary Health - 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 - University Medical Group

Supplementary Health - 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)

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