Healthcare Benefit Trust

Healthcare Benefit Trust

These forms are for Healthcare Benefit Trust groups with policy numbers that begin with "91"

• EHC Claim Form
   
  
• HBT Employee Change Form
  For groups with health, dental, and wage indemnity benefits
  
• Application for Group Benefits Program - EHC and Dental
  For groups with health and dental benefits only
  
• Application for Group Benefits Program - EHC, Dental, and WI
  For groups with health, dental, and wage indemnity benefits
  
• Application for Over-Age Dependent Child
  Use to apply for coverage for an overage dependant
  
• Short Term Disability Claim Form
   
  

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