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Coverage Change Form
Includes adding/deleting a dependent child or a spouse. Changes may be made at the start of any month
Trustee Appointment for Life Insurance
Beneficiaries under the age of 18 are not legally eligible to receive money from Life Insurance. They must a trustee appointed for them who will receive and administer these funds on their behalf. If you have questions concerning a trustee appointment, you should consult a lawyer before making any designation.
Beneficiary change forms
These changes, to be legally binding, require an original form with a pen signature. Electronic copies are not considered legally valid and can be disputed in a court of law.
Medical and Dental Forms
Dental Claim Form
Claims through the dental plan and the Health Spending Plan Visa account.
Health Care Expenses Claim form
Claims for Drug Expenses as well as Health Care Expense Claims through the plan and under the Health Spending Plan Visa account – such as : Chiropractor, Physiotherapy, Massage Therapy, Ambulance etc. Vision Care Claims if you are using your health spending account.
The Plan name is : IATSE LOCAL 873 Health and Welfare Trust.
Plan Number is 055342. Your plan ID can be found on your member profile when you log into the IATSE873 website.
Health Spending Plan Visa Account Claim Form
Claims that should be applied to your health spending Visa account ONLY. i.e. use this form if you need to submit a claim for the 20% you had to pay.
Use this form to apply for a pre-care assessment for nursing care. You’ll need the doctor and case coordinator/manager to fill in some sections.
Use this form to request an increase to a drug dosage outside of Health Canada’s recommended guidelines. You’ll need your doctor to fill out some sections.
Other Requested Forms
Out of Country Claims and OHIP reimbursement forms
Claims for any emergency care while traveling where expenses were not paid directly by Global Medical Assistance.
All claim forms along with Original Receipts should be mailed to:
Winnipeg health and Dental Claim Centre
Canada Life
BOX 3050
Winnipeg, MB R3C 0E6