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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.
FAMILY MEMBERS MAY SUBMIT A COMBINED CLAIM. • PLEASE ATTACH ITEMIZED RECEIPTS/INVOICES AND PRESCRIPTIONS/REFERRALS (IF REQUIRED). A COPY OF A VALID PRESCRIPTION IS REQUIRED FOR VISION CLAIMS. • RECEIPTS WILL NOT BE RETURNED.
Download applicable claim form (s) and once completed and signed: Mail to Manitoba Blue Cross at PO Box 1046 Stn Main, Winnipeg, Manitoba R3C 2X7. Drop it into the secure 24-hour claim box outside our building at 599 Empress Street, Winnipeg, Manitoba. Fax to 204.772.1231.
Frequently used forms. Accidental dental claim form. Dental claim form. Health Spending Account (HSA) claim form. Health benefits claim form (includes vision)
HEALTH SPENDING ACCOUNT CLAIM FORM. CANADA REVENUE AGENCY REQUIRES YOU TO CLAIM ALL MEDICAL EXPENSES THROUGH YOUR PROVINCIAL AND GROUP INSURANCE PLANS BEFORE PAYMENT CAN BE MADE FROM A HEALTH SPENDING ACCOUNT. MEMBER INFORMATION. SERVICE RECIPIENT (PATIENT) INFORMATION. For additional service recipients, please use another claim form.
Download forms. Find commonly used forms to access your benefits and submit claims. View forms list.
You must claim all medical expenses through your provincial and group insurance plans before payment can be made from a HealthFDUH Spending Account. Only medical expenses recognized by Canada Revenue Agency are eligible, and payments will only be issued to the member. AUTHORIZATION AND CONSENT.
Manitoba Blue Cross offers a wide range of plans, including health and dental benefits for individuals and groups, travel coverage & life insurance.
Sign up for direct deposit to receive claim payments directly into your bank account. Check benefit eligibility and find out what you need to submit a claim. Check the status of a claim and view claim history. Submit supporting claim documents. View updates, announcements and correspondence.
HOSPITAL CLAIM FORM. P.O. BOX 1046, WINNIPEG, MANITOBA R3C 2X7 PHONE 775-0151 OR TOLL FREE WITHIN MANITOBA 1-800-USE-BLUE (1-800-873-2583) The Blue Cross symbol and name are registered trademarks of the Canadian Association of Blue Cross Plans, an association of independent Blue Cross plans, used under license by Manitoba Blue Cross.
