Mobius Benefit Administrators on behalf of the Regina Civic Employees’ Ltd Plan has retained the services of Manulife as a disability management provider. Each of the following forms must be completed in full and submitted to Mobius in order for the claims process to begin:
Cover Sheet - general information and instructions to provide guidance on the submittion of your claim.
Member Statement - claim form to be completed by the Plan Member applying for LTD benefits.
Employer Statement - claim form to be completed by Member's employer.
Attending Physicians' Statement - claim form to be completed by Member's attending physician (Member must provide authorization in Section 1)
In order to ensure the Plan is able to coordinate your medical documentation, assist with diagnostic testing, assessments, expediting of surgery, if required, and return‐to‐work planning, we ask that you please complete this Authorization & Understanding Form.
Use this form to change the bank account to which your payment is made.
All Canadian residents should use this form to set up personal federal tax credits and deductions.
If you are a Saskatchewan resident, use this form to set up personal federal and provincial tax credits and deductions.
Note: If you do not live in Saskatchewan, please click here to be directed to the Canada Revenue Agency website to obtain provincial TD1 forms for your province of residence.