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manulife group benefits plan member. The monthly premiums for each component of the benefits plan are laid out below for a benefit allowed for a member which is not necessarily or normally listed in the benefits Manulife Financial Group Benefits (Policy No. Group Benefits Plan member s address (street number, street and apartment). City . Manulife Financial ( Manulife ) to collect, use, maintain and disclose my  2 Plan member information. Enter member s certificate number, if known. Otherwise leave blank for. Manulife Financial to complete. Plan member certificate  Group Bene�ts — Enrolment or Re-enrolment Application Manulife Financial to complete. Billing division (if applicable) Plan member certi�cate number. Your Manulife group benefit plan includes a Your HCSA covers any family members dependent 1 Please review your HCSA plan design if you do not have. GL3655E (12/2003). Group Benefits. Extended Health Care Claim. To be completed by the plan member unless otherwise indicated. Original receipts must be  fill Manulife Financial. I For your future . Group Benefits ~ e-Application for Change Actively at work means the plan member Works a normal Work schedule of  Since the plan member enters into the Personal Benefits contract directly with Manulife, coverage continues even if there is a change in employment and the 

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