D.A. Townley.  -  Plan Administrators      
 

health
benefits

        
 
 
 
 
 
 
 
 
 
   
   
   
 
 
 
 
   
 

Prescription Drug Card

Use
Under normal circumstances, when you use your pay-direct drug card to purchase prescription medicines, you pay only the Member's share at time of purchase and no claim form is needed. Rarely, you may find that the pharmacy is not able to process your prescription using your pay-direct drug card due to technical difficulties with the pay-direct computer system or the fact that the pharmacy doesn't participate in the drug card program. In these rare cases you may have to pay the full amount for your prescription and file a claim for reimbursement. 

Use the Extended Health Benefits Claim Form form if you've paid for prescription drug purchases that would normally be covered when using your pay-direct drug card and you wish to be reimbursed.


Information Needed to Complete the Form
Your personal Member information and the Group Plan number (9000) is needed to complete the form. in addition:
  • original receipts,
  • the name of the insured person(s),
  • the relationship of the employee,
  • birth date(s),
  • information about other insurance plans that you may be eligible to claim from,
  • If you are coordinating claim's payment with your spouse's health plan, you should include the primary carrier's payment statement.

  • Please follow the instructions on the form.


Notes
Questions on completing the form should be directed to the Plan Administrator.

Completed forms should be forwarded directly to DA Townley.


Plan Administrator
Millworkers Health & Welfare Plan (Unifor) Administrator
c/o D.A. Townley
160 – 4400 Dominion Street
Burnaby, BC V5G 4G3

Phone: 604-299-7482 or 1-800-663-1356
Fax: 604-299-8136

Email: Health
 

Form Link
 
Extended Health Benefits Claim Form (English)
Extended Health Benefits Claim Form (French)
 
 
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