One signed form. No more reimbursement chase.

An Assignment of Benefits (AOB) authorizes your insurer to pay FinalMedic directly for covered medical supplies. You sign it once — after that, you stop paying out of pocket and waiting weeks to be reimbursed.

Each insurer handles direct billing differently. Some have a dedicated AOB form, others embed it inside their claim form, and some only allow direct billing through provider portals. We make sense of it for you.

1

Find your insurer

Or use our universal intake form if you're not sure.

2

Fill and sign

Policy number, signature, date. Takes 2 minutes.

3

Send it back

Email a scan or drop the original in the mail. We handle the rest.

Insurer-specific forms

Dedicated AOB form Section of claim form We handle it (portal-only) Use universal intake

Private Insurer National

Sun Life

Fill in policy and member details, sign, return to FinalMedic.

Form: Sun Life AOB

Download form
Private Insurer National

Manulife / Manuvie

Legacy form — universal intake recommended

Legacy 2004 form; we recommend you also sign our universal intake so we can route through TELUS eClaims if needed.

Form: MF.EHP108B (rev.12/04)

Download form Verify on insurer's site →
Private Insurer National

Beneva

SSQ / La Capitale (legacy form code)

Still uses legacy SSQ form number (Beneva = SSQ + La Capitale merger).

Form: SSQ44

Download form Verify on insurer's site →
Private Insurer National

Canada Life

Great-West Life / London Life — routed via TELUS eClaims

Canada Life has no standalone medical AOB. Direct billing runs through TELUS eClaims — sign the TELUS form above. FinalMedic must be enrolled with TELUS.

Form: No standalone AOB — use TELUS eClaims

Download claim form Verify on insurer's site →
Private Insurer National

Desjardins Assurances

Sign Sections H + I of the claim form

Section H assigns benefits to FinalMedic. Section I is your signature. We need both completed.

Form: 19132A (2024-07)

Download claim form Verify on insurer's site →
Private Insurer National

Green Shield Canada

Per-claim — check "Reimburse Provider"

Check the "Reimburse Provider" box and sign. GSC requires a fresh claim form per claim (not a single AOB on file).

Form: GCLMS_GSC_EN / 294

Download claim form Verify on insurer's site →
Private Insurer National

Equitable Life

Sign the assignment portion. Direct billing handled mostly via equitablehealth.ca portal.

Form: Form 466

Download claim form Verify on insurer's site →
Private Insurer National

Empire Life

Limited assignment scope

Empire only allows assignment for dental + hospital. For other supplies, contact us — direct billing typically requires our enrolment in their portal.

Form: G-0006 (EHB / HCSA)

Download claim form Verify on insurer's site →
Third-Party Administrator National

ClaimSecure

Group-plan-dependent

Assignment depends on your group plan settings. Sign the form; we will verify with ClaimSecure on submission.

Form: CL-64 / 2002000-013A

Download claim form Verify on insurer's site →
Third-Party Administrator National

TELUS Health (LifeWorks)

formerly LifeWorks / Morneau Shepell

Same TELUS eClaims form that covers most private insurers.

Form: eClaims Patient Consent

Download form Verify on insurer's site →
Third-Party Administrator National

Johnson Insurance

Routed via Express Scripts Canada

Health claims since March 2018 routed through Express Scripts Canada. Use the TELUS eClaims consent form.

Form: No Johnson AOB — routed via Express Scripts Canada

Download claim form Verify on insurer's site →
Third-Party Administrator National

GroupHEALTH Benefit Solutions

Multi-carrier TPA

BC-based TPA, plans administered with multiple back-end carriers. Use our universal intake form and we will route appropriately.

Form: Portal-dependent

Use universal intake
Third-Party Administrator Ontario

RWAM Insurance Administrators

Underwritten by iA Financial

Ontario TPA underwritten by iA. Use our universal intake form.

Form: Portal-dependent

Use universal intake
Third-Party Administrator National

Chambers Plan

Johnston Group — small business plans

Chambers of Commerce Group Insurance — small-business plans administered by Johnston Group. Use our universal intake form.

Form: Portal-dependent

Use universal intake
Private Insurer National

iA Financial

Industrielle Alliance — call iA group line for case-by-case auth

iA does not provide a public AOB. Direct billing requires FinalMedic to be registered with TELUS eClaims for iA. Sign our universal intake form and we will coordinate.

Contact us
Private Insurer National

Co-operators Life

Co-operators forms live behind their Benefits Now portal. Use our universal intake form.

Form: Benefits Now portal

Contact us
Private Insurer Atlantic / Federal

Medavie Blue Cross

Atlantic Canada + federal programs

Standalone form. Also handles federal programs (VAC, RCMP, CAF).

Form: FORM-109E

Download form Verify on insurer's site →
Private Insurer British Columbia

Pacific Blue Cross

Standalone form. Pacific Blue Cross has a separate provider-side AOP (10-70-260) we file independently.

Form: 10-70-261

Download form Verify on insurer's site →
Private Insurer Alberta

Alberta Blue Cross

Tick assignment box top-right

Sign the assignment box at top-right to direct payment to FinalMedic.

Form: ABC 55063 / 20039 (2020/01)

Download claim form Verify on insurer's site →
Private Insurer Ontario

Ontario Blue Cross

Canassurance backend (shared with QC Croix Bleue)

No standalone AOB — claim-form-embedded. Use our universal intake while we identify your specific plan's form.

Form: Per-claim

Use universal intake
Private Insurer Quebec

Croix Bleue du Québec

Section cession à signer dans le formulaire de réclamation

Signez la section de cession au prestataire. Form 95258 cession-only exists by phone request (1-800-667-4511).

Form: 01QAM0152B (2023-09)

Download claim form Verify on insurer's site →
Private Insurer Saskatchewan

Saskatchewan Blue Cross

Direct billing via SBC Provider Portal real-time EDI. Use our universal intake form.

Form: Provider Portal / EDI

Contact us
Auto Insurance Quebec

SAAQ

Send us your claim # + adjuster name

Just send us your SAAQ claim number and adjuster name. We submit form 4079 30 (signed by your clinician) directly via SAAQclic-Partenaires. No patient signature needed beyond our intake.

Form: 4079 30 (2023-05) — clinician form

Use universal intake Verify on insurer's site →
Workers' Comp Quebec

CNESST

Send us your claim # + agent name

Send us your CNESST claim number ("numéro de dossier") and assigned agent name. We bill directly via the authorized-supplier process. No patient signature needed beyond our intake.

Form: Provider-registered direct billing

Use universal intake
Public Program National

Veterans Affairs Canada

Need: VAC card photo + DOB

Send us a photo of your VAC Health Identification Card and your date of birth. We bill Medavie Blue Cross directly via the VAC provider portal. No patient signature needed beyond our intake.

Form: POC 07 — Medical Supplies (administered by Medavie BC)

Use universal intake
Public Program National

NIHB

Need: Status / N-number + DOB

Send us your Status / N-number and DOB. We bill Express Scripts Canada directly. (Non-Insured Health Benefits, First Nations & Inuit.)

Form: Express Scripts Canada — vendor portal

Use universal intake
Public Program Ontario

ADP Ontario

Per-category application form

ADP has per-category application forms. Ostomy is a reimbursement grant; other categories are 75% vendor-billed. Contact us for the right form for your device category.

Form: 014-1945-67 (ostomy grant)

Download claim form Verify on insurer's site →
Public Program Alberta

AADL (Alberta)

Alberta Aids to Daily Living

Open in browser — the Government of Alberta serves this as a dynamic Adobe form (cannot be downloaded as a static PDF). Fill and save from the official form viewer, then send us the signed copy.

Form: AADL13068 (Rev. 2022-08)

Open official PDF

Assignment of Benefits

An Assignment of Benefits (AOB) is a short form you sign that authorizes your insurance provider to pay FinalMedic directly for covered medical supplies. Instead of paying upfront and waiting for reimbursement, you pay only the portion your plan doesn’t cover — if any.

How It Works at FinalMedic

  1. Request a coverage check on our Insurance Provision page.
  2. We verify what your plan reimburses and send you an AOB form tailored to your insurer.
  3. You sign the AOB and return it to us (email, upload or mail).
  4. We submit the claim and ship your order once the insurer approves direct payment.
  5. You pay only the uncovered portion, such as a deductible or co-insurance.

Who This Is For

  • Patients with Canadian private insurance that permits third-party billing
  • Veterans covered under Veterans Affairs Canada / Medavie Blue Cross
  • First Nations and Inuit clients with NIHB coverage
  • Accident victims with SAAQ, IVAC or provincial workers’ compensation coverage
  • Anyone whose insurer allows the supplier to collect payment directly

Download the Assignment of Benefits Form

Download the bilingual AOB form (PDF)

This is a generic bilingual template. We also send you a pre-filled version once we verify your coverage, so you only have to sign.

What the Form Covers

  • Your name, date of birth, and contact information
  • Your insurer’s name, policy and group numbers
  • The cardholder name (if different from the patient)
  • Authorization for FinalMedic to submit claims and receive payment on your behalf
  • Your signature (and the cardholder’s, if different)

Frequently Asked Questions

Does every insurer accept an AOB?

Most major Canadian insurers do, but some employer plans require you to pay upfront and submit for reimbursement yourself. We’ll tell you which applies to your plan before you place the order.

Is signing an AOB binding forever?

No. The AOB covers the specific order or prescription period you agree to. You can revoke it in writing at any time for future orders.

What if my insurer denies the claim?

We’ll tell you why and, if we can, help you correct missing documentation. If the denial stands, you’re free to pay the balance yourself or cancel the order with no cost to you.

Can I use an AOB for provincial programs like ADP, AADL, NIHB?

These programs use their own authorization forms rather than a standard AOB. Our team handles that paperwork for you as part of the coverage verification.

How long until my order ships after I sign?

For pre-approved private insurance: typically one to three business days. For programs requiring pre-authorization, it can take longer — we’ll keep you updated.

Ready to Get Started?

Start with a free coverage check and we’ll handle the rest, or call 1-800-295-8579.

We'll track it down for you

Use our universal intake form — it captures everything any insurer needs. Or call us and our bilingual team will walk you through it.