CoverMe Knowledge Centre: Forms Library, manulife claim forms.#Manulife #claim #forms


Forms Library

Flexcare is a unique, flexible supplemental health and dental insurance plan that protects you against healthcare costs not covered by your provincial health plan.

Flexcare Application Form for residents of Canada, not including those from Quebec

Please print, complete and send to Manulife, P.O. Box 670, Stn Waterloo, Waterloo, ON N2J 4B8, along with a cheque to cover two months of premiums.

Flexcare Application Form for residents of Quebec

Please print, complete and send to Manulife, P.O. Box 670, Stn Waterloo, Waterloo, ON N2J 4B8, along with a cheque to cover two months of premiums.

FollowMe Health is a supplemental health plan designed for individuals leaving a group plan. Completion of a medical questionnaire is not required when you apply within 60 days of the loss of your group health benefits.

FollowMe Health Application Form for residents of Canada

Please print, complete and send to Manulife, P.O. Box 670, Stn Waterloo, Waterloo, ON N2J 4B8, along with a cheque to cover two months premiums.

Critical Illness Insurance

The CoverMe Critical Illness insurance plan protects you by minimizing financial worries in the event you are diagnosed with a covered critical illness.

CoverMe Critical Illness Application Form for residents of Canada

Please print, complete and send to Manulife, P.O. Box 670, Stn Waterloo, Waterloo, ON N2J 4B8, along with a cheque to cover your initial premium payment.

Life Insurance

CoverMe Term Life

CoverMe Term Life insurance offers affordable term life coverage that will fit your lifestyle – today and in years to come.

CoverMe Term Life Application Form for residents of Canada

Please print, complete and send to Manulife, P.O. Box 670, Stn Waterloo, Waterloo, ON N2J 4B8, along with a cheque to cover your initial premium payment.

FollowMe Life insurance is specially designed to start when your group life insurance stops.

FollowMe Life Application Forms for residents of Canada

Please print, complete and send to Manulife, P.O. Box 670, Stn Waterloo, Waterloo, ON N2J 4B8, along with a cheque to cover your initial premium payment.

CoverMe Guaranteed Issue Life

Life offers you few guarantees. The CoverMe Guaranteed Issue Life plan offers many.

CoverMe Guaranteed Issue Life Application Form for residents of Canada

Please print, complete and send to Manulife, P.O. Box 670, Stn Waterloo, Waterloo, ON N2J 4B8, along with a cheque to cover your initial premium payment.

CoverMe Easy Issue Life

CoverMe Easy Issue Life insurance is quick and easy to understand, easy to apply for, and easy to get.

CoverMe Easy Issue Life Application Form for residents of Canada

Please print, complete and send to Manulife, P.O. Box 670, Stn Waterloo, Waterloo, ON N2J 4B8, along with a cheque to cover your initial premium payment.

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 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 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.

Change of Information Form

Policyholders wanting to make a name, address or payment information change to their inforce insurance coverage should complete this form. This form can also be used to set-up or make any changes to your pre-authorized payment method.



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