Out-of-GTA Dental Claim Form Offline
UNITE HERE HEALTH & WELFARE PLAN
Dental Plan Claim Form
Step-1 : Click here to Fill and Download the Offline Form
Soben Management Ltd. is the benefits plan administrator that takes care of the day to day operations of the Plan. ClaimSecure administers your prescription drug cards. The UNITE HERE Wellness and Dental Centre is dedicated to providing excellent, medically necessary care in a pleasant, warm, health oriented environment.
For more information about your benefits plan, please speak with your
Human Resources Department or contact Soben.
Instructions :
Please follow below process for submitting claims and related documents through the portal:
1. Download the PDF template:
- Go to "Step-1" section of the portal and click the "Offline Form" button to download the PDF form.
2. Complete the form:
- Print the downloaded PDF form.
- Fill in all required information accurately.
- If necessary, have your HR department complete the employer section.
- Sign and date the form in the designated areas.
3. Prepare the completed form:
- Scan the filled-in form to get image (jpeg, jpg, png) OR, pdf format.
4. Submit the form:
- Go to the "Step-2 : Upload the Filled Form" section of the portal.
- Upload the scanned form directly through this section along with supported documents.