Forms

Health & Dental Claims

• Pacific Blue Cross Extended Health Care Standard Claim Form (PDF)
• Pacific Blue Cross Dental Claim Form (PDF)
• Pacific Blue Cross Out-of-Province Claim Form (PDF)
• Pacific Blue Cross Medi-Assist brochure (PDF)
• Nexus National Claim Form (PDF)
• MTB Claim Form (PDF)
• Authorization for Payment of Excontractual Claims (PDF)

Life/AD&D Claims

• IAP Proofs of Death - Physician's Statement (AD&D and Voluntary AD&D) (PDF)
• IAP Certificate of Employer (AD&D and Voluntary AD&D) (PDF)
• IAP Proofs of Death - Claimant's Statement (AD&D and Voluntary AD&D) (PDF)
• Group Life Claim Report (PDF)
• Attending Physician's Certificate of Death (PDF)