Medical & Dental Forms

SIU Medical Plan Contact Information

Seafarers’ Medical Plan 
200 – 1333 rue St-Jacques
Montreal, Quebec, H3C 4K2

Tel: (514) 931-0550
Fax: (514) 931-3667
Toll-Free: 1 (855) 605-0550

Attention: Lyne Leblanc
Email: medical@seafarers.ca

 

Claiming Care Benefits Form

Form to be completed if claiming for hospital, medical, dental care or vision care benefits. To print or save this form in .PDF format, please click this link below.
Claiming Care Benefits Form

 

Reimbursement Form

Reimbursement of prescribed medication and injections. To print or save this form in .PDF format, please click this link below.
Reimbursement Form

 

Wage Loss Benefits Form

Form for claiming short term wage loss benefits or if you wish to have your disability period counted as a sailing period. To print or save this form in .PDF format, please click this link below.
Wage Loss Benefits Form

 

Dental Claim Form

Standard dental Claim Form: To print or save this form in .PDF format, please click this link below.
Dental Claim Form

 

Death Benefits Form

Standard Death Benefits form: To print or save this form in .PDF format, please click this link below.
Death Benefits Form