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Forms & Downloads - FNIS Group Insurance Association Plan
FNIS Group Mandatory Critical Conditions Insurance

FNIS Group Mandatory Critical Conditions Insurance for Your Employees
An employer wishing to add this coverage to their current plan must submit their request
in writing including plan identification and date they wish coverage to take effect. Once elected
their coverage becomes mandatory for all eligible employees.

Application for Critical Condition Benefit
Written notice of a claim must be given to the company no later than one year from the
date on which a claim arises on account of diagnosis or surgery. The Plan Sponsor complete,
sign and date the "Employer Statement" section on this form and the Plan Member/Claimant
must complete, sign and date the "Claimant's Statement" of this form, in full and provide
a copy to First Nations Insurance Services Limited Partnership.
Download Form

Attending Physician's Statement Critical Condition Benefit
The Plan Member/Claimant must have this form completed by the doctor who is providing
treatment upon diagnosis of an insured critical condition. Please note that FNISLP and
the underwriter are not responsible for any expenses that may be charged by medical
authorities for providing medical information. In most cases, the form will be given
back to the Plan Member/Claimant by the doctor; however, there may be cases in
which the doctor wishes the report to be treated confidentially and would therefore,
send it directly to FNISLP, or the underwriter.
Download Form

 

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