Forms

pdf Authorization For Direct Deposit

Complete this authorization, identifying the bank account you want to use to receive benefit payments directly from Maximum Benefit. This account must have chequing privileges. Send the completed form to Maximum Benefit along with a sample cheque marked "VOID".

pdf Beneficiary Update

This form should be used when you wish to make a change to your Beneficiary designation for your life insurance benefits. Please DO NOT use whiteout and initial any corrections you make on this form. Send the completed form to the Fund Office located at 17804 118 Avenue NW, Edmonton, Alberta T5S 2W3.

pdf Dental Claims

Your dentist may be able to submit your dental claim electronically. You will need to provide your dentist with your Division Firm #, your Certificate ID # and the CDA Net: Carrier #627223.

pdf Employee Change Request

This form should be used when adding or removing dependents and when changing your address. The completed form must be returned to the Fund Office located at 17804 118 Avenue NW, Edmonton, Alberta T5S 2W3.

pdf Employee Reimbursement Form for Drug Claims

Direct Bill: Show your Telus Assure Pay-Direct Drug Card along with the prescription and your pharmacist will submit the claim electronically for payment. You will be required to pay for any portion not covered by the Plan. Reimbursement: Prescription drugs may also be paid for directly at the pharmacy and then claimed for reimbursement on a Telus Drug Reimbursement Claim Form. Remember to include your original receipts when submitting the form to Telus at the address indicated on the form.

pdf Enrolment Application

To register in the Health & Welfare Plan, you must complete an Enrolment Application. Please ensure you complete BOTH sides of the Enrolment Application. The Authorization for Direct Deposit is required to allow Maximum Benefit to make direct deposit benefit payments to your account. A "Void" cheque must be attached. Please DO NOT use whiteout in the Beneficiary Designation section of this form and initial any corrections you need to make.

pdf Extended Health Care Direct Billing Authorization

Complete this authorization if the provider issues you an invoice for an Extended Health Care eligible expense. This authorization form must be submitted along with the invoice and the completed Extended Health Claim Form.

pdf Extended Health Claims

You must submit original receipts with a completed Extended Health Claim Form for claims such as vision, physiotherapy or ambulance to Maximum Benefit at the address indicated on the form.

pdf Vision Care Direct Billing Authorization

Complete this authorization if the provider issues you an invoice for a Vision Care eligible expense. This authorization form must be submitted along with the invoice and the completed Extended Health Claim Form.

Questions regarding claim submissions should be directed to Debbie Rasmussen at (780) 484-8645 Ext 227, Toll Free in Alberta at 1-800-661-6786 or by Email at This email address is being protected from spambots. You need JavaScript enabled to view it..

Questions regarding the status of your claim must be directed to Maximum Benefit at 1-800-893-7587. Please provide your Firm/Division # and Certificate ID # when you call.