Forms

Formsadmin2025-02-21T16:25:12-06:00

Claim Forms

	Dental Accident Claim Form
	Dental Claim Form
	Extended Health Benefits Claim Form
	Direct Deposit of Health and Dental Benefit Payments
	Employee Reimbursement Form for ASSURE Drug Claims
	Health Spending Account Request
	Lifestyle Spending Account Request
	my-benefits eClaims
	Voyage Assistance

Administration Forms

	Appointment of Beneficiary
	Enrolment Application Chief & Council and/or Appointed Official
	Enrolment Application for Group Insurance
	Group Insurance Confirmation of School Attendance
	Group Insurance Employee Change Request
	Notice of Change – Salary, Occupation, Hours
	Notice of Employee Termination, Leave, Reinstatement
	Pre-Authorized Debits (PAD)
	Request for Conversion
	my-benefits Brochure

Winnipeg – Head Office
1051 King Edward Street
Winnipeg, MB
R3H 0R4

Toll Free: 1.800.665.1234
Fax: 1.833.702.4687
contactus@cinup.ca

In the spirit of respect, we honour and acknowledge that Johnston Group is located on Treaty 1 Territory, the ancestral lands of Anishinaabeg, the Dene, the Cree, the Anisininew, the Dakota people, and the homeland of the Red River Métis Nation. We acknowledge that our water is sourced from Shoal Lake 40 First Nation Treaty 3 Territory.

We remember to walk softly on this earth, expressing our utmost respect and appreciation to the traditional caretakers of this land. We respect the spirit and intent of the Treaties and remain committed to working in partnership with First Nations, Inuit and Métis people in the spirit of truth, reconciliation and collaboration.