Benefit Forms
Benefit Forms
| Benefits Forms | ||
| Form Name | Description | Download |
| Medavie Blue Cross Forms | ||
| Medavie Blue Cross Application for Group Benefits (Health & Dental) | Complete if applying for the University’s health and dental plan. Return completed form to Human Resources. | Acrobat .pdf |
| Medavie Blue Cross Direct Deposit Request Form | Complete if you wish to have your health and dental claims reimbursed directly your bank account through direct deposit. Completed form is mailed directly to Blue Cross for processing. | Acrobat .pdf |
| Medavie Blue Cross Dependent Registration Form | Complete the Dependent Registration Card if your dependent child is greater than 20 years of age and less than 26 years of age and is attending University/College on a full-time basis for the upcoming academic year. Completed form is returned to Human Resources. | Acrobat .pdf |
| Medavie Blue Cross Change Form | Complete if requesting change of plan coverage (i.e. add or remove dependants). Form is completed and returned to Human Resources. | Acrobat .pdf |
Contact us
Human Resources
(902) 496-8116
Mailing address:
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McNally South 111
923 Robie Street
Halifax NS B3H 3C3