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Forms & Downloads - FNIS Group Insurance Association Plan
FNISLP Group Insurance Extended Health/Vision
& Dental Claim Forms

If applicable, any expenses eligible for coverage through the Non-Insured Health Benefits Program must be put through First Canadian Health.

Standard Group Dental Claim Form
Employee and employee's Dentist must complete this form and submit it to First Nations Insurance
Services Limited Partnership's office for processing. Any orthodontic services require a treatment
plan. For dental services over $300 the member's dentist should provide a dental pre-authorization.
Download Form

Extended Health Benefits Claim Form
Employee must complete this form and submit it for processing along with original
(paid in full) health expense and/or vision expense receipts to First Nations Insurance
Services Limited Partnership's office. Download Form

Out of Province Benefits Claim Form
Employee and employee's Physician and/or Specialist must complete this form and submit
it to First Nations Insurance Services Limited Partnership's office for processing along with
original receipts. Download Form

Blue Cross: Electronic Funds Transfer (EFT) Authorization Group Member
Employee must forward the completed and signed Authorization form and VOIDED
cheque along with their claim and applicable original receipts to First Nations Insurance
Services Limited Partnership's office in order to take advantage of this option. When a claim
is processed, their benefit payment will be deposited to the account provided through Electronic
Funds Transfer. They need only forward the Authorization and Voided cheque the one time, unless
there is a change to their banking information. Download Form

Blue Cross Group Conversion Plan & Pre-authorized Debit (PAD) Agreement
Former employee must complete these forms and submit forms for processing to First Nations
Insurance Services Limited Partnership's office or the Insurer within 31 days of date of
termination. Download Forms

SUMMIT YOUR CLAIM ONLINE
Employees have the option to submit their claim online. The employee must complete the
online form including: Contact Information, Member/Policy Holder Information then upload
scanned copies of his original (Paid in Full) receipts. If the employee is a First Nation
employee he/she must also attach a scanned copy of the rejection from the FNIHB
Non-Insured Health Benefits Plan.

Please contact First Nations Insurance for the rejection if you did not obtain it from
your service provider. Disclaimer: If you submit your claim online you are responsible for
keeping originals on file should Saskatchewan Blue Cross audit you in the future.
Also, you will be responsible for ensuring your claim was received by SK Blue Cross.

 

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