• Applications
  • Use the Blue Choice^® Personal Health Plan application if you are applying for a new Personal Health Plan. You may choose any of the optional benefits listed on this form. The Term Life option requires the Application for Term Life Insurance Option below.
    Blue Choice^® Personal Health Plan (141KB PDF)
  • Use the Blue Choice^® Personal Health Plan Options application if you have an existing Personal Health Plan and want to add one or more options. The Term Life option requires the Application for Term Life Insurance Option below.
    Blue Choice^® Personal Health Plan Options (140KB PDF)
  • Use the Blue Choice^® Conversion Plan application if you are transitioning from a Group Plan to a Personal Health Plan.
    Blue Choice^® Conversion Plan (166KB PDF)
  • Use the Blue Choice^® Conversion Plan Options application if you have an existing Conversion Plan and want to add one or more options (except Term Life).
    Blue Choice^® Conversion Plan Options (149KB PDF)
  • Use the Blue Choice^® Dependent Coverage application if you want to add a spouse or dependent child to your Personal Health Plan.
    Blue Choice^® Dependent Coverage (125KB PDF)
  • Use the Blue Choice^®Term Life Insurance application if you are applying for the Term Life Option.
    Blue Choice^® Term Life Insurance (108KB PDF)
• Claims
  • Use the Extended Health Benefits form for expenses incurred in your province of residence.
    Extended Health Benefits (397KB PDF)
  • Use the Out-of-Province Benefits Claim Form for expenses incurred outside your province of residence.
    Out of Province Benefits Claim Form (OOP) (34KB PDF)
  • For all dental expenses, including accidental dental, submit the Standard Dental Claim Form available from and completed by your dental provider. In the event it is not available from your dental provider, use the form below.
    Standard Dental Claim (79KB PDF)
• Pre-authorized Debit (PAD) Agreement
  • Use the Pre-authorized Debit (PAD) Agreement to authorize Saskatchewan Blue Cross to debit monthly premiums directly from your bank account.
    Pre-authorized Debit (PAD) Agreement (35KB PDF)

If you are not sure which claim form to complete, please ask your group administrator or contact us for assistance.

• Claims
  • Standard
    • Use the Extended Health Benefits claim form for expenses incurred in your province of residence. (Please see Specialized section below if submitting an HSA or ASO claim.)
      Extended Health Benefits (397KB PDF)
    • For all dental expenses, including accidental dental, submit the Standard Dental Claim Form available from and completed by your dental provider. In the event it is not available from your dental provider, use the form below.
      Standard Dental Claim (79KB PDF)
  • Specialized
    • Use the Out of Province Benefits Claim Form for expenses incurred outside your province of residence.
      Out of Province Benefits Claim Form (OOP) (34KB PDF)
    • Use the Health Spending Account claim form if your coverage is classified as a Health Spending Account (HSA).
      Health Spending Account (HSA) (83KB PDF)
    • Use the Adminstrative Services Only claim form if your coverage is classified as administrative services only (ASO).
      Administrative Services Only (ASO) (38KB PDF)
  • Disability

    When applying for Disability benefits, five forms are required: the three Employee forms listed below, the Employer Statement, and the Physician Statement that best relates to the reason for the application.

    • Employee Statement - Application for Benefits (23KB PDF)
    • Employee - Education and Work History (16KB PDF)
    • Employee - Job Description (22KB PDF)
    • Employer Statement - Application for Benefits (20KB PDF)
    • Physician Statement - General (24KB PDF)
    • Physician Statement - Cardiac (25KB PDF)
    • Physician Statement - Musculoskeletal (27KB PDF)
    • Physician Statement - Psychiatric (26KB PDF)
    • Physician Statement - Rheumatology (26KB PDF)
• Employee Changes
  • Use the Employee Change form to identify changes that have occurred to the employee and/or their insured dependents.
    Employee Change (44KB PDF)
• Pre-authorized Debit (PAD) Agreement
  • Use the Pre-authorized Debit (PAD) Agreement to authorize Saskatchewan Blue Cross to debit monthly premiums directly from your bank account.
    Pre-authorized Debit (PAD) Agreement (35KB PDF)
• Direct Deposit
  • Use the Direct Deposit Authorization form to authorize Saskatchewan Blue Cross to deposit claims reimbursements directly to your bank account.
    Direct Deposit Authorization (35KB PDF)

More information