Forms
Claim Forms
Standard Dental Claim Form
Claimants requiring reimbursement for dental care expenditures must have this form completed by their dentist or dental specialist. Original receipts and applicable supporting documentation must accompany all claim submissions.
See form for mailing address.
Health Benefit Claim Form Claimants requiring reimbursement for health care benefits such as prescription drugs, or registered specialists or therapists visits, should complete this form and submit along with original receipts and applicable supporting documentation.
See form for mailing address.
Assignment of Benefits Form By completing this form, the policyholder authorizes Manulife Financial to pay the service provider directly for the eligible costs associated with a claim. Please note that fees for services not covered under a benefit plan, and fees in excess of the coverage provided under a benefit plan, will be the financial responsibility of the policyholder.
See form for mailing address.
Prescription Drug Special Reimbursement Form Certain medications and drug therapies require pre-authorization by Manulife Financial prior to the commencement of treatment. The claimant's attending physician must complete this form describing the claimant's underlying medical condition, previous treatment history outcomes and medical criteria for the treatment request.
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See form for mailing address.
Health Benefit Claim Form Claimants requiring reimbursement for health care benefits such as prescription drugs, or registered specialists or therapists visits, should complete this form and submit along with original receipts and applicable supporting documentation.
See form for mailing address.
Assignment of Benefits Form By completing this form, the policyholder authorizes Manulife Financial to pay the service provider directly for the eligible costs associated with a claim. Please note that fees for services not covered under a benefit plan, and fees in excess of the coverage provided under a benefit plan, will be the financial responsibility of the policyholder.
See form for mailing address.
Prescription Drug Special Reimbursement Form Certain medications and drug therapies require pre-authorization by Manulife Financial prior to the commencement of treatment. The claimant's attending physician must complete this form describing the claimant's underlying medical condition, previous treatment history outcomes and medical criteria for the treatment request.
Back To Top
