Forms

The standard versions of the administration and claim submission forms are posted here. Please select the forms you need to download. Most of the forms include instructions, but if you need help with them, send us an email.

For custom forms, plan sponsors should continue to contact their Sun Life group representative. Please do not use the forms below.

Plan members (employees) should contact their company’s group benefits administrator prior to downloading any forms.

Administrative Forms

Form name Purpose Audience File details
Beneficiary nomination
(102G-E / 102G-F)
Use this form to nominate or change a beneficiary for your Life and AD&D benefits Plan member
Plan sponsor
 
[PDF 2 pages, 72 KB]
Beneficiary nomination with Optional benefits
(102G-OPT-E / 102G-OPT-F)
Use this form to nominate or change a beneficiary for your optional benefits Plan member
Plan sponsor
[PDF, 2 pages, 76 KB]
Consent by beneficiary
(102C-E / 102C-F)
Use this form if you need to add, change, or update your irrevocable beneficiary Plan member
Plan sponsor
[PDF, 1 page, 125 KB]
Disqualification of partner
(942-2785 / 942-2786)
Use this form to disqualify you partner as your spouse Plan member
Plan sponsor
[PDF, 1 page, 139 KB]
Enrolment form
(942-2755-BI / 942-2756-BI)
Use this form when enrolling for group benefits Plan member
Plan sponsor
[PDF, 3 pages, 137 KB]
Enrolment/change form - PA clients
(945-0735 / 945-0736)
Use this form to enroll or make changes to your group benefits for PA clients Plan member
Plan sponsor
[PDF, 3 pages, 446 KB]
Enrolment form for plans with optional life
(4197-OPT-CI-BI-E/ 4197-OPT-CI-BI-F)
Use this form when enrolling for group benefits if your plan offers optional benefits Plan member Plan member
Plan sponsor
[PDF, 3 pages, 156 KB]
Health Statement
(3484-Basic-Opt-CI-MSD-E/F)
Use this form if your plan requires proof of good health for any benefits Plan member
Plan sponsor
[PDF, 4 pages, 943 KB]
Health Statement (Optional life & Critical Illness only)
(3484-Basic-Opt-CI-MS-E/F)

Use this form if your plan only requires proof of good health for any of these two benefits:

  • Optional Life
  • Critical Illness
Plan member
Plan sponsor
[PDF, 4 pages, 943 KB]
Insurance options for plan members on termination of group benefits
(4262-E / 4262-F)
Use this form if you are losing coverage under the group plan and want information about continuing your benefits. Plan member
Plan sponsor
 
[PDF, 1 page, 85KB]
Request to continue group coverage
(2685-E / 2685-F)
Use this form to continue coverage beyond the terms outlined in your contract. Plan sponsor
 
[PDF, 3 pages, 336 KB]
Qualification of partner
(942-2700 / 942-2701)
Use this form to qualify you partner as your spouse Plan member
Plan sponsor
 
[PDF, 1 page, 117 KB]
Travel Benefit and Medi-Passport Brochure and Card
(GB00200-E / GB00200-F)
Provide your plan member with this brochure if your group benefits plan offers Travel Assistance Plan member
Plan sponsor
 
[PDF, 2 pages, 133 KB]


Approval Forms

Form name Purpose Audience File details
Prior Authorization Forms Includes forms required for the approval of prior authorization drugs. Plan member
Plan sponsor
 


Claim Forms

Dental

Form name Purpose Audience File details
Dental claim – standard
(DENT- E / DENT - F)
Use this form when you want to make a standard dental claim Plan member
Plan sponsor
[PDF, 2 pages, 608KB]
Dental with health spending account claim form
(DENT-HSA-E / DENT HSA-F)
Use this form when you want to submit a dental claim under your health spending account Plan member
Plan sponsor
[PDF, 2 pages, 348 KB]


Disability

Form name Purpose Audience File details
Disability – Long Term – Plan Member package Includes forms required for the submission of a LTD claim Plan member [PDF, 20 pages, 912 KB]
Disability - Long Term - Plan Sponsor package Includes forms required for the submission of a LTD claim Plan sponsor [PDF, 8 pages, 668 KB]
Disability - Short Term - Plan Member package Includes forms required for the submission of a STD claim Plan member [PDF, 15 pages, 864 KB]
Disability - Short Term - Plan Sponsor package Includes forms required for the submission of a STD claim Plan sponsor [PDF, 7 pages, 561 KB]
Salary Continuance - Plan Sponsor Package Includes forms required to submit a request for Salary Continuance Services. Plan sponsor [PDF, 5 pages, 435 KB]
Salary Continuance - Plan Member Package Includes forms required to report an absence under Salary Continuance Services. Plan member [PDF, 11 pages. 796 KB]


Extended Health Care

Form name Purpose Audience File details
Extended health care - Standard claim form
(EHC-E / EHC-F)
Use this form for all medical expenses and services claims Plan member
Plan sponsor
[PDF, 2 pages, 341 KB]
Extended health care - Health spending account claim form
(EHC-HSA-E / EHC-HSA-F)
Use this form for all medical expenses and services to be claimed under your health spending account Plan member
Plan sponsor
[PDF, 2 pages, 342 KB]


Life

Form name Purpose Audience File details
Notification of death
(020-3252)
Use this form when submitting a death notification. Plan sponsor [PDF, 2 pages, 257 KB]
Election of method of settlement & statement of claim
(490-CS-E / 490-CS-F)
Use this form when submitting a life claim as a designated beneficiary. Plan member [PDF, 2 pages, 77 KB]
Election of method of settlement and statement of claim: Physician statement
(490-PS-E / 490-PS-F)
A completed Physician Statement is acceptable in lieu of an original or certified copy of a provincial death certificate.

A completed Physician Statement is required if death occurs within two years of coverage being approved or, if the benefit is more than $250,000 and coverage has been in effect for less than five years. This is in addition to an official death certificate.
Plan member [PDF, 1 page, 148 KB]
Waiver of Premium Claim – Employers statement
(4205-E / 4205-F)
Use this form when submitting a waiver of premium claim notification. Plan sponsor [PDF, 1 page, 293 KB]
Waiver of Premium Claim – Claimant’s statement
(4203-E / 4203-F)
Use this form when submitting a waiver of premium claim by the plan member. Plan member [PDF, 6 pages, 212 KB]
Waiver of Premium Claim – Physician
(4202-E/4202-F)
Use this form to support a claim for waiver of premium. Plan member [PDF, 5 pages, 237 KB]

Request forms and supplies
Forms, including others not listed above, and supplies for plan administrators are available to be sent to you. Just complete the order form and submit it to us with a click of your mouse.

 

The above files are in Adobe Acrobat format. If you don't already have Adobe Acrobat Reader, you can download it here:

 

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