Forms
Administration
This page provides important information regarding the administration of your benefits package, including eligibility, enrollment, and updates on any changes to your coverage.
You can also find resources to help you understand your benefits and make informed decisions regarding your health and well-being.
Our goal is to ensure that you have access to the best possible benefits and services, so please don’t hesitate to contact us if you have any questions or concerns.
Direct Deposit Form
Details
Member Only
Complete a direct deposit form to have your claim cheques deposited directly into your bank account.
Disability Self Pay Extension Form
Details
Member Only
Disabled and unable to work? Complete the Disability Self Pay Extension form to request to self pay for benefit coverage.
Medical Cannabis Prior Authorization Form
Details
Member, Spouse & Dependents
Complete this Prior-Authorization form prior to claiming for medicinal cannabis.
Member Change of Address Form
Details
Member Only
Moving and looking to change your home address? Complete the Member Change of Address Form.
Member Enrollment/Application Card
Details
Member Only
New Member Enrollment / Application card or to add / change existing dependents and beneficiaries.
Over Age Dependent Coverage
Details
Member, Spouse & Dependents
Benefit coverage application for over-aged dependents that are unable to support themselves.
Replacement Benefit Card Application
Details
Member Only
Lost / Misplaced your Member Advantage Benefit Card? Complete the Replacement Benefit Card Application to request a new card.
Speech Therapy Medical Questionnaire
Details
Dependents Only
Physician to complete the Speech Therapy Medical Questionnaire for dependent children prior to incurring speech therapy claims. Benefit available to dependent children only.
Transfer of Hours
Details
Member Only
Complete this form if you are transferring Locals and are moving your hour bank.
Workplace Safety Insurance Board (WSIB) Information Form
Details
Member Only
Approved for W.S.I.B. and unable to work? Complete this Information Form for fund assistance and to request to self pay for benefit coverage.
Group Legal Enrollment Form
Details
Member Only
Group Legal Plan Enrollment form prior to claiming for all your legal needs.
Get Mobile Access to Your Benefits
LiUNAcare Local 506 mobile apps submit it faster and easier to make claims and get medical assistance – from wherever you are with your smartphone, tablet or desktop.
Check Out Our Mobile Apps
See how easy it is to submit claims and get medical support using our apps – and download them right now!