Employee Benefit Funds Administration Ltd

Employee Benefit Funds Administration Ltd.


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Page updated: June 12, 2019

 

EBFA Forms

  Note: Please make sure that you are eligible for Health and Welfare benefits before incurring any medical expenses or submitting claims to the Fund Office.

 
  EBFA Forms Adobe Acrobat(.pdf)
 Dental - Direct Reimbursement Form Click Here
 Disability Notice Click Here
 Supplementary Health Expense Form Click Here
 Supplementary Health Expense Form - Supplies Click Here
 Supplementary Health Expense Form - Orthopedic Boots  Click Here
 Supplementary Health Expense Form - Orthotics Inserts  Click Here
 Prescription Drug - Direct Reimbursement Form Click Here
 Physician's Medical Referral Click Here
 Vision - Direct Reimbursement Form Click Here
 Dependent Update Form Click Here
 Self-Pay Pre-Authorized Debit (PAD) Plan Agreement Click Here
 Self-Pay Bank Change Form Click Here
 Self-Pay Cancellation Notice of Pre-Authorized Debit (PAD) Plan Agreement Click Here
 Registration and Declaration of Beneficiary Form Click Here
 Form 5 Click Here
 Form 9 Click Here


Download Adobe Acrobat Reader Here