In order to submit a claim, please fill out the appropriate claim form on-line, print, sign, attach your receipts and submit to:
Attn: FlexSave Division
Suite 1001, 3700 Steeles Avenue West
Woodbridge, Ontario L4L 8M9
Claim Forms - for Mac users click here.
Claim Form (British Columbia only)
Claim Form (Alberta, Saskatchewan, Manitoba)
Claim Form (Ontario only)
Claim Form (Quebéc only)
Claim Form (Atlantic Canada)
Stop Loss / Travel Medical - In-province Claim Form
Stop Loss / Travel Medical - Claim Consent Form
Out of country - Stop Loss / Travel Medical Claim Form
In order to apply for a FlexSave™ plan, the following forms need to be completed in full and submitted to the following address:
Attn: FlexSave Division
Suite 1001, 3700 Steeles Avenue West
Woodbridge, Ontario L4L 8M9
Set up Forms
REQUIRED
1a. FlexSave Trust Application Form - Self Employed / Unincorporated Applicants
1b. FlexSave Trust Application Form - Corporate Applicants
1c. Credit Card Payment Form (To accompany Trust Application if paying Set Up Fee by credit card)
2. Employee Enrollment Form
- each employee must complete which includes the business owner/sole proprietor
3. Stop-Loss/Travel Medical Form (requirement for unincorporated business)
- each applicable employee must complete along with business owner
OPTIONAL
4. Pre-authorized debit
- for companies that wish to pre-fund their FlexSave plan on a monthly basis
5. Pre-authorized debit for STOP/LOSS monthly premium
- for companies that wish to pay stop/loss insurance on a monthly basis
6. Request for Direct Deposit (EFT)
Administration Forms
1. Employee Termination
- Complete this form to remove an employee from the FlexSave plan
2. Address Changes
- Complete this form to change the address for the company or an individual employee