Employee Benefit Funds Administration Ltd

Employee Benefit Funds Administration Ltd.


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Page updated: May 31, 2016

 

EBFA 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.

 
  EBFA 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 - Orthopedic Boots  Click Here Click Here
 Supplementary Health Expense Form - Orthotics Inserts  Click Here Click Here
 Prescription Drug - Direct Reimbursement Form Click Here Click Here
 Private Duty Nursing Form Click Here Click Here
 Physician's Medical Referral 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
 Co-ordination of Benefits Statement Form Click Here Click Here
 Registration and Declaration of Beneficiary Form Click Here
 Form 5 Click Here
 Form 9 Click Here


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