Active Members  |  Forms

Disability Self Pay Extension Form

Coverage Details

Description

Disabled and unable to work? Complete the Disability Self Pay Extension form to request to self pay for benefit coverage.

Applicable for

Member Only

Submit your form online:

Step 1

Download, print and fill out the form.

Download Form
Step 2

Upload the form using our online submission form.

Upload Now

Submit by mail:

LiUNAcare Local 183
200 Labourers Way
Vaughan, ON, L4H 5H9
Suite 2100

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