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Manulife Forms

Claim Form Description Download
EHC Claim Form Paper claims for Extended Health Care (EHC) like Prescription Drugs, Vision Care, Paramedical Practitioner’s – Physiotherapist, Chiropractor, Massage Therapist etc. should be completed and submitted to Manulife. Download
Dental Claim Form Paper Claims for Dental Care has to be completed by your dentist and signed by the Plan Member and dentist. This should be submitted to Manulife directly. Download
Manulife Launch Plan Group Application New Group Application to be completed by the Employer (Plan Sponsor) and sent to info@wescaninsurance or, Fax # (866)611-6631. Download
Employee Enrolment Form (Launch Plan) Each Employee participating in the Employer’s Group Benefits Plan has to complete this form and the Plan Administrator (PA) has to send this over to – info@wescaninsurance or, Fax # (866)611-6631. Download
Employee Change Form Any change to the Employee’s – Beneficiary, Dependent Status, Termination, and Salary, should be communicated by completing this form. The completed forms should be sent to Manulife. Download
Refusal Of Benefits An Employee’s consent of Benefits Refusal, should be submitted at the time of Plan Implementation to info@wescaninsurance or, Fax # (866)611-6631 Download
OverAge Disabled Dependent Form This is to be completed for any Disabled Dependent over the Age of 25. The completed form should be sent to Manulife. Download
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