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.

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.

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.

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.

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.

SUBMIT 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.

Download the Mobile Application

https://www.youtube.com/watch?v=cnN2-z3rhkU

• Sign up for Login to the secure site right on the app
• Submit a claim
• Sign up for Direct Deposit
• Access and share a mobile ID card by text or email
• Search benefit details to determine eligibility and annual maximums
• View benefit usage
• Search for health professionals
• Check prescription drug coverage
• View and sort past claims
• Update your profile and banking information… and more!

• First Nation Members/Claimants must include an NIHB Rejection with the receipts they are submitting

Call our FNIS Extended Health Department and they can email it to you.
• Must RETAIN ORIGINAL DOCUMENTS for (12) MONTHS after submitting
claim in case of investigation/audit
As an alternative to submitting your claim online, please email your claim to [email protected] and our EH/D/V department will look after ensuring your claim is submitted on your behalf.