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Forms

Forms

Types Form Names
Plan Descriptions

EFAP Brochure

Employee Benefits Program

EFAP website

Enrolment & Changes

Group Benefits Plan Member Enrolment Form

Group Benefits Plan Member Change Form

Optional Life Insurance Application Form - Employee & Spouse

Policy Change Form

Payment by Monthly Pre-Authorized Chequing Form

Health Evidence Form

Group Benefits Student Eligibility Form

Request to Waive Waiting Period

Notice of Return to Work Claim for Group Disability Benefits

Life Claims

Notice of Death – Claimant Statement

Notice of Death – Plan Sponsor Statement

Proof of Death – Physician's Statement

Disability Claims

Early Intervention – Attending Physician Statement

Early Intervention – Plan member guide and application

Early Intervention – Plan Sponsor Statement

Employer Guide to Disability claims

Living Assistance Benefit – Plan member agreement and application

Long Term Disability – Attending Physician's Statement

Long Term Disability – Plan member guide and application

Long Term Disability – Plan Sponsor Statement

Short Term Disability – Attending Physician's Statement

Short Term Disability – Plan member guide and application

Short Term Disability – Plan Sponsor Statement

Health & Dental Claims

Standard Dental Claim Form

Claim Form for Extended Health Benefits

Request for Brand Name Drug Coverage

AD&D Claims

Dismemberment – Physician Statement

Dismemberment Statement

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