Forms
For Active Members
We understand the ease and importance of accessing your benefit plan, hassle free.
Our claims page provides you with all the items you need to submit and manage your claims for various benefits within your benefit plan.
We are committed to providing you with efficient and timely claims processing so that you can focus on your health and well-being. Explore our claims page to learn more about our claims process and find the necessary forms to submit your claims.
Bereavement & Parental Leave
Details
Member Only
Replace lost wages in an event you missed work due to a death in the family or the birth of your child.
Dental Care
Details
Member, Spouse & Dependents
Claim for all dental care expenses.
Extended Healthcare
Details
Member, Spouse & Dependents
Claim for all heath care expenses which includes prescription drugs.
Jury Duty Application Form
Details
Member Only
Replace lost wages in an event you missed work due to jury duty.
Short Term Disability (STD) Application Package
Details
Member Only
Financial assistance if you are unable to work due to non-occupational injury or illness.
Long Term Disability (LTD) Application Package
Details
Member Only
If you remain totally disabled and have exhausted the Short-Term Disability Benefit.
Vision Care
Details
Member, Spouse & Dependents
Claim for all vision care expenses.
Accidental Death (Basic)
Details
Member, Spouse & Dependents
Loss of Life caused solely by external, violent, and accidental means.
Accidental Death (Occupational)
Details
Member Only
Loss of Life caused solely by external, violent, and accidental means while on the premises of your employer.
Accidental Dismemberment (Basic)
Details
Member, Spouse & Dependents
Accidental Dismemberment caused solely by external, violent, and accidental means.
Accidental Dismemberment (Occupational)
Details
Member Only
Accidental Dismemberment caused solely by external, violent, and accidental means while on the premises of your employer.
Emergency Out of Province Medical
Details
Member, Spouse & Dependents
Claim a medical emergency while travelling.
Hospital Cash Benefit
Details
Member, Spouse & Dependents
Been hospitalized? Claim for a daily cash benefit for the duration of your hospital stay to cover for parking, room amenities, etc.
Life Insurance Claim Form
Details
Member, Spouse & Dependents
Claim in the event of a death.
Nursing Care
Details
Member, Spouse & Dependents
If you require out of hospital home nursing.
Permanent and Total Disability Accident
Details
Member Only
If you become totally and permanently disabled due to an accident.
Critical Illness – Bacterial Meningitis, Benign Brain Tumor, Coma, Stroke
Details
Member & Spouse
Claim for Critical Illness Diagnosis – Bacterial Meningitis, Benign Brain Tumor, Coma or Stroke.
Critical Illness – Cancer
Details
Member & Spouse
Claim for Critical Illness Diagnosis – Cancer.
Critical Illness – Occupational HIV Infection
Details
Member & Spouse
Claim for Critical Illness Diagnosis – Occupational HIV Infection.
Critical Illness – Kidney Failure Major Organ Transplant or Failure on Waiting List Aplastic Anemia
Details
Member & Spouse
Claim for Critical Illness Diagnosis – Kidney Failure Major Organ Transplant or Failure on Waiting List, or Aplastic Anemia.
Critical Illness – Heart Related Conditions
Details
Member & Spouse
Claim for Critical Illness Diagnosis – Heart Related Conditions.
Critical Illness – Additional Dependent Child Critical Illnesses
Details
Dependents only
Claim for Critical Illness Diagnosis for Dependent Child Only – Cerebral Palsy, Congenital Heart Disease, Cystic Fibrosis, Down Syndrome, Muscular Dystrophy, Type 1 Diabetes.
Critical Illness – Loss of Sight, Hearing, Speech, Limbs, Independent Existence, Paralysis, Severe Burn
Details
Member & Spouse
Claim for Critical Illness Diagnosis – Loss of Sight, Hearing, Speech, Limbs, Independent Existence, Paralysis, Severe Burn.
Critical Illness – Neurologic Disorders
Details
Member & Spouse
Claim for Critical Illness Diagnosis – Neurologic Disorders.
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!