With my-benefits® you have quick and secure online access to your group benefit coverage.
my-benefits is your online self-service portal. This is where you can find everything you need to manage your benefits plan. Sign up for my-benefits, today!
PDF Form Downloads
Everything you need to manage your benefits is right here. These forms are available for you to download. Complete the form and submit it to us. We’ll take it from there.
Viewing forms may require Adobe Acrobat Reader. You can download this free program by clicking here. (http://get.adobe.com/reader/)
Authorization For Direct Deposit
Brand Name Drug Request
Dental Accident Claim
Employee Reimbursement Form For Assure Drug Claims
Health Spending Account Request
Lifestyle Spending Account Request
Travel Health Summary
Enrolment and Administration Forms
Application For Over-Age Disabled Dependent Coverage
Employee Change Request
Employee Statement of Dependent's Health
Employee Statement of Health
Request For Over-Age Dependent Coverage
Find a local healthcare provider who can submit claims on your behalf.
Viewing forms may require Adobe Acrobat Reader. You can download this free program by clicking here.
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