Benefit Forms

PDF versions of Medical, Dental, Functions Ability Form (FAF) and WI Claim forms are now available to download and print. Mailing addresses are on the bottom of this page.

Plan numbers

As of January 1, 2018, please use the following plan numbers and forms for Blue Cross Dental and Health.

ACTIVE EMPLOYEES - 91389-F

RETIREES - 91392-F

Claim forms

 

PDF versions of Medical, Dental, Functions Ability Form (FAF) and WI Claim forms are now available to download and print. Mailing addresses are on the bottom of this page.

As of January 1, 2017, the Company requires all members with a NEW Weekly Indemity or Long Term Disability Claim, to file their claim with BLUE CROSS. Forms are below.

Please remember to keep a copy of anything that you send to the insurance company. Any problems or rejected claims, please see the union office!

 

Mailing Addresses

Health and Dental Claims     New WI & LTD Claims as of January 1, 2017         

Blue Cross
PO Box 3300
Station B
Montreal, QC
H3B 4Y5  

Blue Cross
PO Box 668
Station B
Montreal, QC
H3B 3K3   

 

Document/file attachments
Attachment Size
Dental Care form583.88 KB 583.88 KB