This is intended to outline the Plan in everyday language and does not constitute the terms and conditions of any policy of insurance authorized by the Trustees.

Members should be aware the provisions outlined herein are subject to change at any time and this booklet is not intended to be a guarantee of any coverage.  This booklet outlines the eligibility requirements and procedures to be followed when claims arise.

The Dental and Extended Health Plan is carried by Manitoba Blue Cross under group # 7020 (Manitoba Members: # 7021).

The Life Insurance, Accidental Death and Dismemberment, Weekly and Long Term Disability Benefits are insured by Manulife Financial under Group Policy # 31800.

Should you require any information on the operation of the Plan, please contact the Plan’s administration office.

Details of Your Plan Description of Benefits Forms Cabinet

Forms

CategoryNameFile
362HWEnrollment Form
362HWChange of Information
DisabilityDirect Deposit
DisabilityEmployer LTD
DisabilityMember LTD
DisabilityPhysician LTD
DisabilityEmployer LTD Statement
DisabilityPhysician LTD Statement
DisabilityMember LTD Statement
Life-&-Accidental-DeathADD Claim Form
Life-&-Accidental-DeathLife Conversion Form
Life-&-Accidental-DeathLife Forms
MBCAmbulance Medical Transfer Claim Form
MBCDental Claim Form.pdf
MBCHealth Spending Account Claim Form
MBCMISHP EDS Form
MBCTravel Health Claim Form and Statement of Expenses
PTHWPrairie H&W Enrollment
PTHWPTHW Change of Information
RWDSURWDSU Beneficiay Designation
RWDSURWDSU Enrollment
RWDSURWDSU Pension Change of Information
T4PT4P Application to Re-Commence
T4PT4P Application to Suspend
T4PT4P Beneficiay Designation
T4PT4P-Enrollment-Form-fillable.pdf
T4PT4P-Pension-Change-of-Information-fillable.pdf