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SIU Medical Plan Forms

200 – 3131 Pitfield Blvd.
Saint-Laurent, QC H4S 1N3
Tel: (514) 931-7859 Ext 227

Attention Catherine Hand
E medical@seafarers.ca

IMPORTANT:

To help ensure your claim is processed without delay, please use the correct form:

  • Dental Claim Form: for dental treatments and services

  • Prescription Drug Claim Form: for prescription medications only

  • Medical Claim Form: for doctor visits, medical services, and other eligible health expenses

Submitting the correct form helps avoid delays and ensures your claim is processed as quickly as possible.

Prescription Drug Reimbursement Form

Reimbursement of prescribed medication and injections.

Open

Dental Claim Form

Standard dental Claim Form.

Open

Medical Claim Form

Form to be completed if claiming for hospital, medical or vision care benefits.

Open

Death Benefits Form

Standard Death Benefits form.

Open

Wage Loss Benefits Form

Form for claiming short term wage loss benefits or if you wish to have your disability period counted as a sailing period.

Download