Special markets
solutions forms
Special Markets Solutions Forms
Client Change Forms
- Name and Address Change PDF (120.63 kB)
- Beneficiary Designation Change PDF (146.02 kB)
- Request for Non-Smoker Rates PDF (215.67 kB)
- Request for Pre-Authorized Debit (PAD) Payment PDF (246.88 kB)
- Supplemental Questionnaire for Dependent Child Insurance PDF (165.44 kB)
- Request to Add a Child to Your Existing Plan PDF (121.52 kB)
- Termination of Coverage Request PDF (173.5 kB)
Claims Forms
For each claim form, we have included an information sheet that addresses the most frequently asked questions. If you are looking for a form that is not on this page, please contact our Claims Department toll-free at 1‑800‑266‑5667 for the appropriate form and details on claims procedures.
Accident & Recreation
- Sports Accident Claim Form PDF (195.73 kB)
- Post Secondary Student Accident Claim Form PDF (204.56 kB)
- Camper’s Claim Form PDF (195.49 kB)
Provincial Health Claims
- Provincial Health Replacement Insurance Claim Form PDF (180.33 kB)
- Out Of Country & Province Claim Form PDF (161.8 kB)
- Provincial Health Alternative Student Insurance Claim Form PDF (180.76 kB)
Blanket Student Accident
- Blanket Student Accident Claim Form* PDF (205.26 kB)
*For blanket student accident insurance coverage only. For Kids Plus™ Accident Insurance forms, please visit www.kidsplus.ca
Forms for group plan administrators
Benefits Administrator Forms
- Basic Group Critical Illness Insurance Enrolment Request Form (Employee Only) PDF (135.57 kB)
- Basic Group Critical Illness Insurance Enrolment Request Form (Employee and Dependent Child) PDF (145.93 kB)
- Group Insurance Change Request Form PDF (140.06 kB)
- Late Application for Employee PDF (227.76 kB)
- Late Application for Spouse PDF (225.15 kB)
- Late Application for Dependent PDF (280.74 kB)
Conversion Forms
- Critical Illness Insurance Conversion Request Form PDF (466.86 kB)
- Term Life Insurance Conversion Request Form PDF (134.54 kB)