To Order Forms

Here you will find all the claims forms, administrative forms and return envelopes that you require. You may download them in PDF format or order paper copies.

Formulaires - règlements:
F54-326A Medical and Paramedical Expenses PDF (173.24 kB)
F54-288A Dental Care PDF (165.91 kB)
F54-383A Health Spending Account (HSA) PDF (223.18 kB)
F54-069A Direct Deposit for medical expenses and dental Care PDF (311.62 kB)
F54-381A Disability – Initial Request PDF (299.64 kB)
F54-382A Disability – Extension of disability PDF (880.08 kB)
F54-072A Direct Deposit for disability benefits PDF (62.3 kB)
F54-900A Disability – Authorization for the collection of personal information PDF (91.55 kB)
F54-907A Disability – Policyholder’s Statement PDF (261.72 kB)
No number Disability – Authorization for the collection of personal information PDF (166.58 kB)
No number Travel Insurance PDF (4.39 MB)
F54-361A Life Insurance PDF (67.81 kB)
F54-856A Critical Illness PDF (523.49 kB)
F54-380A Accidental Dismemberment PDF (137.53 kB)
F54-267A Dental Care in case of an accident PDF (136.92 kB)
F54-859A Prior Authorization Drug form PDF (403.59 kB)
F54-860A Prior Authorization Drug form for Xenical PDF (106.04 kB)
F54-898A Nursing Care Questionnaire PDF (146 kB)
F54-896A Home Care Questionnaire PDF (166.53 kB)
Return envelopes
N° de formulaire Nom Commander
F48-182A Disability Claims - Montréal
F48-184A Health and Dental Claims- Montréal
F48-184A-1 Health and Dental Claims- Toronto
F48-184A-2 Disability Claims - Toronto

Formulaires - règlements:
F54-018A Enrolment Request PDF (256.44 kB)
F54-070A Change Request PDF (281.16 kB)
F54-002A Evidence of Insurability PDF (678.72 kB)
F54-863A Policyholder Pre-Authorized Debit Agreement (PAD) PDF (122.56 kB)
No number Notice Of Administrative Changes PDF (303.99 kB)
F54-788A My Client Space Access Request PDF (266.21 kB)
F54-887A Appointment or Change of Beneficiary PDF (114.86 kB)
F54-776A-2 Transit - Individual Health Insurance Application PDF (80.8 kB)
F54-848A Transit - Brochure PDF (312.38 kB)
No number Transit – Rates Table PDF (236.35 kB)
F54-030A Application for Group Life Conversion PDF (163.37 kB)
F54-833A Request for Extension of Benefits PDF (152.75 kB)
F54-020A Notice of Change PDF (122.57 kB)
F54-268A Notice of Return to Work PDF (78.58 kB)
RETURN ENVELOPES
N° de formulaire Nom Commander
F48-182A Administration department - Montréal
F48-182A-1 Administration department - Toronto
F48-184A-3 Accounting department - Toronto

Don't see the form you need in the list above? Please enter the name or number of the form you need in the box below and we'll send it to you.

To expedite processing of your request, please include the complete information required (for example, Manager’s Assistance Program, F54-761A, quantity: 50).

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Back

Consult the Administration Guide to facilitate the administration of your group insurance plan.

Administration Guide (1.08 MB)

Billing Schedule

For 2018 payment deadlines and statement dates, please consult this calendar.