Claim Forms

Life & Accidental Death & Dismemberment

1. Claim for Accidental Dismemberment Benefit & Loss of Use
2. Election of Settlement and Statement of Claim Form
3. Notification of Death
4. Accidental Death & Dismemberment Brochure
5. Optional Life Insurance Application

Disability

1. Filing your disability claim
2. Return to work
3. Long Term Disability
   1. Consent Form
   2. Filing your Disability Claim
   3. Irrevocable Consent to Deduct and Pay an Insurer
   4. Return to Work
   5. Attending Physician Statement Form
   6. Plan Member Employee Statement Form
   7. Plan Sponsor Employee Statement Form
4. Short Term Disability
   1. Return to Work
   2. Attending Physician Statement  Form
   3. Attending Pysician Statement - Update
   4. Job Demands Questionnaire
   5. Plan Member Employee Statement Form
   6. Plan Sponsor Employee Statement Form

Dental Care

1. Dental Claim Form (Policy 50693)
2. Dental Claim Form (Policy 50855)
3. Dental Claim Form (Policy 71180)
4. Dental & Health Spending Account Claim Form (Policy 71180)

Extended Health Care

1. Extended Health Claim (Policy 50855)
2. Extended Health Claim (Policy 50693)
3. Extended Health Claim (Policy 71180)
4. Extended Health Care & Health Spending Account (Policy 71180)

Benefits Services Forms

Enrollment & Change Forms

1. Change Sheet 71180
2. Change Sheet 50693
3. Beneficiary Nomination
4. Beneficiary Nomination with Optional Benefits
5. Conversion Options
6. Disqualification of Partner
7. Enrollment and Change Form
8. Enrollment Form with Optional Life
9. Health Statement
10. Overage/Full Time Student Enrollment Form
11. Qualification of Partner Form
12. Sample Enrollment Change Form

Sun Life

1. click, click...wow! Benefits options online
2. Discover your group benefits
3. Travel Benefit and Medi-Passport

Critical Illness

1. Critical Illness Application
2. Request for Non-Smoker Rates
3. Optional Critical Illness Rates
4. Critical Illness Brochure

Employee Assistance Program

1. Employee Assistance Program brochure
2. Shepell-fgi Manager Resource Guide
3. Wellness Seminar
4. Workshop Catalog (contact us for a no-obligation quotation for full or half day workshops)

Group Accident 

1. Group Accident Beneficiary Form
2. Summary of Policies

Retiree Benefits Plan

1. Municipality Participation Agreement
2. Application Package
   1. Retirees with life insurance
   2. Retirees without life insurance

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