New enrollment

To enroll a new member select one of the following options:

Plan coverage
Beneficiary
Employee information
Spouse/
Dependent(s)
Salary
Direct deposit
Coordination of Benefits
Review

Plan coverage

Plan Name

Beneficiary

Beneficiary(ies)

{Employee name} designates the beneficiary(ies) entitled to receive the proceeds arising under this plan to the following person(s) below.
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Employee information

If you are adding a member to a billing group that is specifically for retirees, please indicate their retirement date in the permanent date employed field.

Spouse/Dependent(s)

Spouse

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Dependent(s)

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We require one of the following documents when a dependent with a disability reaches or is over the student age in order for them to remain on or be added to the member plan coverage.

  1. A copy of the Disability Credit Certificate used for Income Tax purposes.
  2. A letter from the dependent’s medical doctor stating the condition and the date the dependent became disabled.
  3. Manitoba Blue Cross Disabled Dependent Declaration form completed by the member and the dependent’s medical doctor.
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Add another dependent

Additional information

Salary

Salary

Direct deposit

Please inform your employee
Once direct deposit is added, statements will be available online only through mybluecross.
Email notification will be sent when a claim is processed informing them a payment will be deposited.
They are eligible to register for mybluecross once their coverage becomes active.
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The employee does not wish to set up direct deposit at this time.

Coordination of benefits

Review

Employee information

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Spouse / Dependent(s)

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Plan coverage

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Beneficiary

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Salary

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Direct deposit

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Coordination of Benefits

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