- Fill out and sign the form
- Gather original supporting documents
- Send everything to the address indicated on the form
Keep copies of all correspondence for at least 12 months.
- Originals will not be returned.
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.
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.
This form is used for dental care only. Use
form 20009A (PDF, 1.5 MB) Opens in a new window. for all other applications for enrolment.