Manulife Financial CoverMe

Forms Library

Application Forms

Health Insurance

Flexcare®

Flexcare is a unique, flexible supplemental health and dental insurance plan that protects you against healthcare costs not covered by your provincial health plan.

Flexcare® Application Form for residents of Canada, not including those from Quebec

Please print, complete and send to Manulife Financial, P.O. Box 670, Stn Waterloo, Waterloo, ON N2J 4B8, along with a cheque to cover two months of premiums.

Flexcare® Application Form for residents of Quebec

Please print, complete and send to Manulife Financial, P.O. Box 670, Stn Waterloo, Waterloo, ON N2J 4B8, along with a cheque to cover two months of premiums.

FollowMe™ Health

FollowMe Health is a supplemental health plan designed for individuals leaving a group plan. Completion of a medical questionnaire is not required when you apply within 60 days of the loss of your group health benefits.

FollowMe Health Application Form for residents of Canada

Please print, complete and send to Manulife Financial, P.O. Box 670, Stn Waterloo, Waterloo, ON N2J 4B8, along with a cheque to cover two months premiums.

Critical Illness Insurance

The CoverMe Critical Illness insurance plan protects you by minimizing financial worries in the event you are diagnosed with a covered critical illness.

CoverMe™ Critical Illness Application Form for residents of Canada

Please print, complete and send to Manulife Financial, P.O. Box 670, Stn Waterloo, Waterloo, ON N2J 4B8, along with a cheque to cover your initial premium payment.

Life Insurance

CoverMe™ Term Life

CoverMe Term Life insurance offers affordable term life coverage that will fit your lifestyle - today and in years to come.

CoverMe™ Term Life Application Form for residents of Canada

Please print, complete and send to Manulife Financial, P.O. Box 670, Stn Waterloo, Waterloo, ON N2J 4B8, along with a cheque to cover your initial premium payment.

FollowMe™ Life

FollowMe™ Life insurance is specially designed to start when your group life insurance stops.

FollowMe™ Life Application Forms for residents of Canada

Please print, complete and send to Manulife Financial, P.O. Box 670, Stn Waterloo, Waterloo, ON N2J 4B8, along with a cheque to cover your initial premium payment.

CoverMe™ Guaranteed Issue Life

Life offers you few guarantees. The CoverMe Guaranteed Issue Life plan offers many.

CoverMe Guaranteed Issue Life Application Form for residents of Canada

Please print, complete and send to Manulife Financial, P.O. Box 670, Stn Waterloo, Waterloo, ON N2J 4B8, along with a cheque to cover your initial premium payment.

CoverMe™ Easy Issue Life

CoverMe™ Easy Issue Life is quick and easy to understand, easy to apply for, and easy to get.

CoverMe Easy Issue Life Application Form for residents of Canada

Please print, complete and send to Manulife Financial, P.O. Box 670, Stn Waterloo, Waterloo, ON N2J 4B8, along with a cheque to cover your initial premium payment.

Claim Forms

Standard Dental Claim Form

Claimants requiring reimbursement for dental care expenditures must have this form completed by their dentist or dental specialist. Original receipts and applicable supporting documentation must accompany all claim submissions.

See form for mailing address.

Health Benefit Claim Form

Claimants requiring reimbursement for health care benefits such as prescription drugs, or registered specialists or therapists visits, should complete this form and submit along with original receipts and applicable supporting documentation.

See form for mailing address.

Assignment of Benefits Form

By completing this form, the policyholder authorizes Manulife Financial to pay the service provider directly for the eligible costs associated with a claim. Please note that fees for services not covered under a benefit plan, and fees in excess of the coverage provided under a benefit plan, will be the financial responsibility of the policyholder.

See form for mailing address.

Prescription Drug Special Reimbursement Form

Certain medications and drug therapies require pre-authorization by Manulife Financial prior to the commencement of treatment. The claimant's attending physician must complete this form describing the claimant's underlying medical condition, previous treatment history outcomes and medical criteria for the treatment request.

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    We've got you covered with 24-hour-a-day, seven-day a week access to relevant, reliable and secure benefit plan information at your fingertips. By logging onto Health and Dental: SecureServe®, our automated claims information site, you can:

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    in the last 12 months

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