Forms

Formsadmin2024-07-26T11:09:55-05:00

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

	Administration Guide
	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 our head office is on Treaty One territory and the traditional lands of the Anishinaabe, Ininew, Oji-Cree, Dene, Dakota, and the Homeland of the Red River Métis Nation. We are grateful and thankful for our water, which comes from Shoal Lake 40 First Nation Treaty 3 territory, and we understand its significance in light of the many communities who currently do not enjoy the benefit of clean drinking water. We are committed to supporting the interests of Indigenous peoples and communities and we pledge to listen, learn and work together in the spirit of truth and reconciliation.