Employee Benefit Funds Administration Ltd.
Page updated: Jul 15, 2011
Health and Welfare Claim Forms
Note:
Please make sure that you are eligible for Health and Welfare benefits before incurring any medical expenses or submitting claims to the Fund Office.
Claim Forms
Adobe Acrobat
(.pdf)
Microsoft Word
(.doc)
Dental - Direct Reimbursement Form
Click Here
Click Here
Disability Notice
Click Here
Click Here
Supplementary Health Expense Form
Click Here
Click Here
Supplementary Health Expense Form - Supplies
Click Here
Click Here
Supplementary Health Expense Form - Orthotics
Click Here
Click Here
Prescription Drug - Direct Reimbursement Form
Click Here
Click Here
Private Duty Nursing Form
Click Here
Click Here
Vision - Direct Reimbursement Form
Click Here
Click Here
Dependent Update Form
Click Here
Click Here
Self-Pay Pre-Authorized Debit (PAD) Plan Agreement
Click Here
Click Here
Self-Pay Cancellation Notice of Pre-Authorized Debit (PAD) Plan Agreement
Click Here
Click Here
Download Adobe Acrobat Reader Here
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