About Saint Mary's

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