| Download
Forms
This page provides downloadable forms for
your convenience in filing your benefits claims. To view and print
these forms you will need Acrobat Reader, available as a free
download from Adobe.
As of December 1, 2011
• Register by logging on to www.greatwestlife.com
to view your claims history detail with
the option to sign-up for direct deposit and download personalized
claim forms and submit
claims electronically.
Policy # 164609
Certificate
# No
Change from Manulife, same nine digit number from the front of the
Manulife drug card
HCSA
Policy # 164609
Great West Life Global Medical Assistance # 164609
Submit
claims to:
Great-West
Life
Great-West
Life
Winnipeg
Benefits
Payments
Montreal Benefits Payments
P.O.
Box 3050
Stn. Main
Place
Bonaventure, Suite 5800
Winnipeg, MB R3C
0E6 800
de la Guichetière St. W
Customer Service:
1-800-268-6195 Montreal, QC
H5A 1B9
Customer Service:
1-855-729-1839
For the deaf or hard of
hearing
1-800-990-6654
Police # 164609
Police
CGDS # 164609
Certificat
# Dorénavant,
les mêmes 9 numéros qui étaient auparavant sur la carte Manuvie.
Assistance médicale globale Great-West # 164609
Acheminez
vos demandes de règlement :
Great-West
Life Great-West Compagnie
d’Assurance-vie
Winnipeg
Benefits
Payments
Service des
indemnités
P.O. Box 3050 St. Main
Place
Bonaventure, Suite 5800
Winnipeg, MB R3C
0E6 800 rue De La Gauchetière Ouest
Customer Service: 1-855-729-1839 Montreal, QC H5A 1B9
Service à la clientèle :
1-855-729-1839
Pour les sourds et les malentendants
1-800-990-6654
CLAIM
FORMS all of
these forms are bilingual
For Non-Quebec Residents
Health Claim Form English Non-Quebec Resident
Dental
Claim Form English Non-Quebec Resident For
Quebec Residents
Health Claim Form English Quebec Resident
Dental
Claim Form English Quebec Resident
HEALTH
& WELFARE APPLICATION/ENROLMENT FORM
Health
& Welfare Plan Application/Enrolment English
Health &
Welfare Plan Application/Enrolment French
EMERGENCY
OUT-of-COUNTRY MEDICAL ASSISTANCE
Global Medical Assistance Emergency Medical Travel Assistance English
Global Medical Assistance Emergency
Medical Travel Assistance French
FAMILY SERVICES
Member Assistance Program Brochure
Up to November 30, 2011
MANULIFE
CUSTOMER SERVICE:
1-800-268-6195
The number is the same for both English and French callers. If you
indicate you require French translation, your call will be routed to the
Montreal Customer Service Centre and a French speaking Customer Service
Representative will be available.
|
DENTAL
CLAIMS INFORMATION |
| If you live outside
Quebec: |
Si vous habitez au
Québec: |
| Manulife Financial Group
Benefits Dental Claims |
Assurance Collective
Financière Manuvie Règlements Frais Dentaires |
| P.O. BOX 1654 |
C.P. 5000, Succ. B |
| Waterloo ON N2J 4W2 |
Montréal QC H3B
4B5 |
Dental
Claim Form English
Dental Claim Form French
Part 2: Plan Member Information includes
Health Care Spending Account option if eligible
|
HEALTH
CLAIMS INFORMATION
|
| If you live outside
Quebec: |
Si vous habitez au
Québec: |
| Manulife Financial Group
Benefits Health Claims |
Assurance Collective
Financière Manuvie Règlements Maladie |
| P.O. Box 1653 |
C.P. 2580, Succ. B |
| Waterloo ON N2J
4W1 |
Montréal QC H3B
5C6 |
Health Claim Form English
Health Claim Form French
Part 1: Plan Member
Information includes
Health Care Spending Account option if eligible
HEALTH
& WELFARE APPLICATION/ENROLMENT FORM
Health
& Welfare Plan Application/Enrolment English
Health &
Welfare Plan Application/Enrolment French
EMERGENCY
OUT-of-COUNTRY MEDICAL ASSISTANCE
Mondial
Emergency Medical Travel Assistance English
*See www.manulife.ca/groupbenefits/travel
for additional information and for participating countries.
Mondial Emergency
Medical Travel Assistance French
*Consultez
notre
site Web à
l’adresse www.manuvie.ca/assurancecollective/voyage
pour
obtenir
des
renseignements supplémentaires
et la liste des pays participants.
FAMILY SERVICES
Member Assistance Plan Brochure
Fraud
If
you suspect fraud or the possible abuse of your benefits plan, please refer
to the Manulife Financial bulletin below.
Your Responsibilities When Submitting a Health or Dental Claim.
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