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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
Applicable For

Member Only

Description

Replace lost wages in an event you missed work due to a death in the family or the birth of your child.


Method of submission

Dental Care

Details
Applicable For

Member, Spouse & Dependents

Description

Claim for all dental care expenses.


Method of submission

Extended Healthcare

Details
Applicable For

Member, Spouse & Dependents

Description

Claim for all heath care expenses which includes prescription drugs.


Method of submission

Jury Duty Application Form

Details
Applicable For

Member Only

Description

Replace lost wages in an event you missed work due to jury duty.


Method of submission

Short Term Disability (STD) Application Package

Details
Applicable For

Member Only

Description

Financial assistance if you are unable to work due to non-occupational injury or illness.


Method of submission

Long Term Disability (LTD) Application Package

Details
Applicable For

Member Only

Description

If you remain totally disabled and have exhausted the Short-Term Disability Benefit.


Method of submission

Vision Care

Details
Applicable For

Member, Spouse & Dependents

Description

Claim for all vision care expenses.


Method of submission

Accidental Death (Basic)

Details
Applicable For

Member, Spouse & Dependents

Description

Loss of Life caused solely by external, violent, and accidental means.


Method of submission

Accidental Death (Occupational)

Details
Applicable For

Member Only

Description

Loss of Life caused solely by external, violent, and accidental means while on the premises of your employer.


Method of submission

Accidental Dismemberment (Basic)

Details
Applicable For

Member, Spouse & Dependents

Description

Accidental Dismemberment caused solely by external, violent, and accidental means.


Method of submission

Accidental Dismemberment (Occupational)

Details
Applicable For

Member Only

Description

Accidental Dismemberment caused solely by external, violent, and accidental means while on the premises of your employer.


Method of submission

Emergency Out of Province Medical

Details
Applicable For

Member, Spouse & Dependents

Description

Claim a medical emergency while travelling.


Method of submission

Hospital Cash Benefit

Details
Applicable For

Member, Spouse & Dependents

Description

Been hospitalized? Claim for a daily cash benefit for the duration of your hospital stay to cover for parking, room amenities, etc.


Method of submission

Life Insurance Claim Form

Details
Applicable For

Member, Spouse & Dependents

Description

Claim in the event of a death.


Method of submission

Nursing Care

Details
Applicable For

Member, Spouse & Dependents

Description

If you require out of hospital home nursing.


Method of submission

Permanent and Total Disability Accident

Details
Applicable For

Member Only

Description

If you become totally and permanently disabled due to an accident.


Method of submission

Group Legal Claim Form

Details
Applicable For

Member Only

Description

Claim for your legal needs.


Method of submission

Critical Illness – Bacterial Meningitis, Benign Brain Tumor, Coma, Stroke

Details
Applicable For

Member & Spouse

Description

Claim for Critical Illness Diagnosis – Bacterial Meningitis, Benign Brain Tumor, Coma or Stroke.


Method of submission

Critical Illness – Cancer

Details
Applicable For

Member & Spouse

Description

Claim for Critical Illness Diagnosis – Cancer.


Method of submission

Critical Illness – Occupational HIV Infection

Details
Applicable For

Member & Spouse

Description

Claim for Critical Illness Diagnosis – Occupational HIV Infection.


Method of submission

Critical Illness – Kidney Failure Major Organ Transplant or Failure on Waiting List Aplastic Anemia

Details
Applicable For

Member & Spouse

Description

Claim for Critical Illness Diagnosis – Kidney Failure Major Organ Transplant or Failure on Waiting List, or Aplastic Anemia.


Method of submission

Critical Illness – Heart Related Conditions

Details
Applicable For

Member & Spouse

Description

Claim for Critical Illness Diagnosis – Heart Related Conditions.


Method of submission

Critical Illness – Additional Dependent Child Critical Illnesses

Details
Applicable For

Dependents only

Description

Claim for Critical Illness Diagnosis for Dependent Child Only – Cerebral Palsy, Congenital Heart Disease, Cystic Fibrosis, Down Syndrome, Muscular Dystrophy, Type 1 Diabetes.


Method of submission

Critical Illness – Loss of Sight, Hearing, Speech, Limbs, Independent Existence, Paralysis, Severe Burn

Details
Applicable For

Member & Spouse

Description

Claim for Critical Illness Diagnosis – Loss of Sight, Hearing, Speech, Limbs, Independent Existence, Paralysis, Severe Burn.


Method of submission

Critical Illness – Neurologic Disorders

Details
Applicable For

Member & Spouse

Description

Claim for Critical Illness Diagnosis – Neurologic Disorders.


Method of submission

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!