Download forms
Need a quick form? Find our frequently used forms here.
Did you know?
Your claim may be eligible for online submission. Save time and paper with contactless claiming on our member site today.
Frequently used forms
- Dental claim form
- Disabled dependent declaration
- Health benefits claim form (includes vision)
- Health Spending Account (HSA) claim form
- Pre-authorization request form
Specialty claim forms
- Accidental dental claim form
- Ambulance/medical transfer claim form
- Assisted care nursing recommendation claim form
- Glucose monitoring special authorization request form
- Hospital claim form
- Orthotics, orthopedic shoes and modifications claim form
Bank forms
- Direct deposit application form
- Pre-authorized debit form (for individuals)
- Provider direct deposit form (for providers only)
Travel forms
- For emergency health claims: Travel Insurance claim form
- For trip cancellation claims: Trip Cancellation Insurance claim form
- For baggage claims: Baggage Benefit claim form
To submit an application for disability benefits, an employee’s statement, employer’s statement AND attending physician’s statement are required.
- Employee’s statement
- Employer’s statement (including a Job analysis form or a detailed job description)
- Attending physician’s statement (short-term disability – weekly indemnity OR long-term disability)
- Direct deposit authorization form
Group life forms
Critical illness forms
To submit an application for critical condition benefit, two forms are required:
- Application for critical condition benefit
- Attending physician’s statement
Follow us
Wellness services
Find a plan
Personal plans
Group plans
Travel plans
About us
Customer service
Community WELLNESS
Miscellaneous
®*The Blue Cross symbol and name, Colour of Caring and mybluecross are registered marks of the Canadian Association of Blue Cross Plans, independently licensed by Manitoba Blue Cross. *†Blue Shield is a registered trade-mark of the Blue Cross Blue Shield Association.
