Group benefits forms
For a complete list of downloadable forms, sign in to Benefits Now® for Plan Members.
Administration and claims forms
Select the form you want to download:
- Critical Disease Statement
- Critical Illness - Claimant Statement
- Dental Claim
- Direct Deposit Application - Disability Benefit Payments
- Direct Deposit Application - Health Care or Dental Payments
- Dismemberment Statement
- Extended Health Claim
- Rehabilitation Earnings Statement
- Notice of Death - Claimant Statement
- Optional Accidental Death and Dismemberment Insurance Application
- Optional Critical Illness Insurance Application
- Optional Group Life Insurance Application
- Smoking Status Declaration
- Student Eligibility
- Over-Age Dependent Coverage Application
Other documents
- Emergency Out of Country Coverage Booklet
- Health Evidence Questionnaire
- Employer’s Guide to Disability Claims
- Prior Authorization List of Drugs
Physician statement forms
Select the form you want to download:
- Alzheimer's Disease or Dementia
- Aortic Surgery, Coronary Angioplasty, Heart Valve Repair or Replacement
- Aplastic Anemia
- Bacterial Meningitis
- Benign Brain Tumor
- Blindness or Deafness
- Burns
- Coma
- Critical Disease Physician Statement
- Dismemberment Physician Statement
- Kidney Failure (End Stage Renal Disease)
- Life-Threatening Cancer
- Loss of Independent Existence
- Loss of Limbs
- Loss of Speech
- Major Organ Transplant and Major Organ Failure on Waiting List
- Motor Neuron Disease or Multiple Sclerosis
- Myocardial Infarction (Heart Attack)
- Occupational HIV Infection
- Paralysis
- Parkinson's Disease
- Proof of Death
- Stroke or Cerebrovascular Accident (CVA)
Attending physician statements
- Attendance Support Program
- Early Intervention
- Early Intervention for Mental Health Conditions
- Life Waiver of Premium
- Long Term Disability
- Long Term Disability for Mental Health Conditions
- Short Term Disability
- Short Term Disability for Mental Health Conditions
Dependent children covered illness
- Autism
- Cerebral Palsy
- Congenital Heart Disease
- Cystic Fibrosis
- Down Syndrome
- Muscular Dystrophy
- Rett Syndrome
- Type 1 Diabetes Mellitus
Plan member forms
Select the form you want to download:
- Early Intervention
- Life Waiver of Premium
- Living Assistance® Benefit
- Long Term Disability
- Plan Member Enrolment
- Short Term Disability
Plan sponsor forms
Select the form you want to download:
- Critical Illness
- Early Intervention
- Life Waiver of Premium
- Long Term Disability
- Notice of Death
- Short Term Disability
- Return to Work Notice