Broker Supply Request Form

Broker Supply Request Form
Use the links below to download and print these forms in your office.

Please note - All materials linked below are office printer-friendly. Materials marked with an asterisk(*) can also be ordered directly from Saskatchewan Blue Cross.

Broker Business
- Broker of Record Change Form
- Broker Renewal Notice
Personal Health Plans
- Personal Health Plan Application
- Personal Health Plan Sales Brochure (*Foldable size also available for order from SBC)
- Retiree Plan Sales Brochure (*Foldable size also available for order from SBC)
- Blue Choice Policy Document (*)
- Conversion Policy Document (*)
- Guaranteed Acceptance Policy Document (*)
- Retiree Plan Policy Document (*)
- Pre-Authorized Payment Agreement
- Direct Deposit Agreement
- Extended Health Benefits & Health Spending Account Claim Form (Standard Health Claim)
- Personal Health Plan Rates Charts
Travel Plans
- Travel Plans Sales Brochure (*also available for order from SBC)
- Annual & Individual Travel Plans Policy Brochure
- Top-Up Travel Insurance Policy
- Visitors to Canada Policy Brochure
- Out-of-Province Claims Form (CanAssistance)
Group Benefits
- Blue Essentials Group Benefits Brochure
- Custom Group Benefits Brochure
Student Accident
- Student Accident Claim Form
To request printed materials to be mailed to you:

Click the 'Next' button below to proceed to the request form.

Select your requested documents.
Use the dropdowns below to choose the form you need and indicate your requested quantity. If you need more than one form, use the +Add a Form button to add rows.
Select materials*

Last step! Provide us with your details so we can send out your documents.
Name

First NameLast Name
Broker Number:*
If you don't yet have a broker number, enter N/A.
Name of Brokerage:*
Brokerage Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email Address:*
Should be Empty: