Dental care

Instructions

  1. Fill out and sign the form
  2. Gather original supporting documents
  3. Send everything to the address indicated on the form

Important

  • Keep copies of all correspondence for at least 12 months.
  • Originals will not be returned.

Forms

Claim for Dental Care Expenses – Plan member – 19110A (PDF, 1.6 MB) Opens in a new window.

This form is used to submit claims for dental care expenses.

Important:

You can also use the claim form that your dentist's office gives you. Be sure to clearly indicate your contract and certificate numbers.

Evidence of Insurability – Dental Care – Plan administrator – 20021A (PDF, 410 KB) Opens in a new window.

This form is used to apply for enrolment in the dental care insurance plan, based on the contract provisions.

Important:

This form is used for dental care only. Use form 20009A (PDF, 420 KB) Opens in a new window. for all other applications for enrolment.