Forms
Immunization Form
The following programs require the submission of the Loyalist College Immunization Record:
Child and Youth Worker, Developmental Services Worker, Early Childhood Education, Esthetics andSpa Management, Fitness and Health Promotion, General Arts and Science, Nursing, Personal Support Worker, Practical Nursing, Recreation and Leisure Services, and Social Service Worker.
Prescription Drugs Benefits
2011-2012 Year
Prescription Drug Claim Form - MANUAL REIMBURSEMENT SYSTEM
Complete all sections of the form that apply to your claim and once you sign it you can send it along with your original receipts directly to:
Deadline & Mailing Information:
General prescription drug claims for the 2010-2011 policy year must be RECEIVED by ClaimSecure no later than November 30, 2011 to be eligible for reimbursement.
ClaimSecure
PO Box 6500, Station A
Sudbury, ON P3A 5N5
Accident Benefits
2011-2012 Year
Deadline & Mailing Information:
Completed claim form must be filed directly to SSQ, Life Insurance Company Inc. within 90 days from the date of the accident, and no later than 1 year.
Mail your Accident Claim form along with your original receipts to:
SSQ, Life Insurance Company Inc.
Claims Department
110 Sheppard Avenue East, Suite 500
Toronto, ON M2N 6Y8
Please Note: The claim form must be signed by an authorized authority at the Loyalist Student Health Centre.
2009-2010 Year
Deadline & Mailing Information:
Completed claim form must be filed directly to Industrial Alliance Pacific Insurance and Financial Services Inc. within 90 days from the date of the accident, and no later than 1 year.
Mail your Accident Claim form along with your original receipts to:
Industrial Alliance Pacific Insurance and Financial Services Inc.
Claims Department
2165 W Broadway
PO Box 5900
Vancouver, BC V6B 5H6
Please Note: The claim form must be signed by an authorized authority at the Loyalist Student Health Centre.