Forms

REMINDER: any eligible 2023 expenses must be submitted to their appropriate offices by JUNE 30, 2024 no exceptions!!

MEDICAL EXPENSE CLAIM FORM (Click here)
Eligible 2023 expenses due JUNE 30, 2024 – NO EXCEPTIONS.
BY MAIL:  Print, complete and mail WITH receipts to Coughlin & Associates: PO BOX 764, Winnipeg, MB, R3C 2L4.
BY EMAIL:  complete & sign MEDICAL claim form (COUGHLIN)  ==> screenshot or scan completed claim form, attach receipts and email to Coughlin  ==>  [email protected]
BY Coughlin’s APP:  download  ==>    members.coughlin.ca   /      Coughlin & Associates (onlineclaimsaccess.net)

 

DENTAL CLAIM FORM (Click here)
BY MAIL:  Print, complete and mail WITH receipts to Coughlin & Associates: PO BOX 764, Winnipeg, MB, R3C 2L4.
BY EMAIL:  complete & sign DENTAL claim form (COUGHLIN)  ==> screenshot or scan completed claim form, attach receipts and email to Coughlin  ==>  [email protected]
BY Coughlin’s APP:  download  ==>    members.coughlin.ca  /  Coughlin & Associates (onlineclaimsaccess.net)

 

VISIONCARE CLAIM FORM (Click here)
Eligible 2023 expenses due JUNE 30, 2024 – NO EXCEPTIONS.
BY MAIL:  Print, complete and mail WITH original receipts to H&W Plan Office: #203 – 1658 Fosters Way, Delta, BC, V3M 6S6.
BY EMAIL:  complete & sign VISION claim form (WELFARE PLAN)  ==> screenshot or scan completed claim form, attach receipts and email to the H&W Office  ==>  [email protected]


HEALTHCARE SPENDING ACCOUNT (HSA)

For Members eligible for HSA:
HSA general inquiries, call the H&W Office at 604-526-3434  OR more information in Member Booklet.
HSA balance inquiries, call the H&W Office at 604-526-3434
HSA reimbursement how-to, call the H&W Office at 604-526-3434
Current HSA allocation:  July 01, 2023 to June 30, 2024.
An example of what is accepted as HSA reimbursement after submission to Coughlin & Associates (Explanation of Benefits [EOB] statement) == click here ==

 

65+ MEMBERS:  SPECIAL SENIOR MEMBER (SSM) CLAIM FORM (Click here)
Eligible 2023 expenses due JUNE 30, 2024 – NO EXCEPTIONS.
Print & complete form, email WITH receipts to:  [email protected]
OR   Print & complete form, mail WITH original receipts to the H&W Office: #203-1658 Fosters Way, Delta, BC, V3M 6S6.
PREVIOUS BENEFIT:  $35/calendar year maximum for prostate testing + $1,200/calendar year maximum. (Prior to Jan.01/23)
Year 2023 BENEFIT:  $50/calendar year maximum for prostate testing + $1,300/calendar year maximum. (Effective Jan.01/23)
CURRENT BENEFIT:  $50/calendar year maximum for prostate testing + $1,500/calendar year maximum. (Effective Jan.01/24)

 

PRE-AUTHORIZED DEPOSIT FORM – Plumbers Local 170 (for Visioncare, HSA and Special Senior Member claims to be directly deposited)
Print, complete and return form to:  [email protected]   or   [email protected]
OR
   Print, complete and return to the H&W Office: #203-1658 Fosters Way, Delta, BC, V3M 6S6.

 

Medical Services Plan (BC MSP) Premium ELIMINATION January 01, 2020:
Medical Services Plan (MSP) premiums have been eliminated effective January 01, 2020.
For more information, visit the Canadian Government Medical Services Plan website, click here:  https://www2.gov.bc.ca/gov/content/health/health-drug-coverage/msp/bc-residents/msp-premium-elimination-jan-1-2020