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- Administrative Forms
- Approval Forms
- Claim Forms
Help! Why won't my forms open?
Fillable web forms may not work in certain internet browsers such as Google Chrome. If this occurs, you can try right-clicking on the form and select “Save link as” to your desktop. The saved PDF on your desktop should open.
| Form name | Purpose | Audience | File details |
|---|---|---|---|
| Beneficiary nomination (102G-ALL-E / 102G-ALL-F) |
Use this form to name the same beneficiary for all benefits. | Plan member Plan sponsor |
[PDF, 2 pages, 857 KB] |
| Beneficiary for Optional spouse life benefits (102G-SPOUSE-E / 102G-SPOUSE-F) | Use this form to name a beneficiary for Optional spouse life benefits. | Plan member Plan sponsor |
[PDF, 2 pages, 728.99 KB] |
| Beneficiary nomination with Optional benefits (102G-OPT-E / 102G-OPT-F) |
Use this form to name different beneficiaries for your life benefits. | Plan member Plan sponsor |
[PDF, 3 pages, 752 KB] |
| Consent authorization (4362-E/4362-F) |
Use this form if you want someone to call the Customer Care Centre on your behalf. This form authorizes the Sun Life Customer Care Centre to provide your personal information to a specific person (s). | Plan member | [PDF, 2 pages, 859 KB] |
| Consent authorization (4362-SD-E/4362-SD-F) |
Use this form if you want someone to call the Customer Care Centre on your behalf. This form authorizes the Sun Life Customer Care Centre to provide your personal information to a specific person (s). | Spouse or Dependent Child Age 16 and over | [PDF, 3 pages, 863 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, 1.13 MB] |
| Disabled Child Coverage (3381-E / 3381-F) |
This form should be used for a member’s disabled child who exceeds the age of “child” specified in the group contract. | Plan member Plan sponsor |
[PDF, 5 pages, 753 KB] |
| Disqualification of partner (942-2785 / 942-2786) |
Use this form to disqualify your partner as your spouse | Plan member Plan sponsor |
[PDF, 1 page, 139 KB] |
| Enrolment form (942-2755/ 942-2756) |
Use this form when enrolling for group benefits | Plan member Plan sponsor |
[PDF, 4 pages, 714 KB] |
| Enrolment forms / Modular plans (942-2755-BI-MOD/942-2756-BI-MOD) |
Use this form when enrolling for group benefits with Modular plans | Plan member Plan sponsor |
[PDF, 4 pages, 714 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, 4 pages, 714 KB] |
Enrolment form for plans with Optional Life and/or Critical Ilness (4197-OPT-CI-E / 4197-OPT-CI-F) |
Use this form when enrolling for group benefits if your plan offers optional benefits and/or Critical Illness | Plan member Plan sponsor |
[PDF, 6 pages, 726 KB] |
| Group benefits enrolment form for First Nations Groups (4197-FN-E (G2711-E) / 4197-FN-F (G2711-F)) |
Use this form when enrolling for group benefits for First Nations | Plan member Plan sponsor |
[PDF, 5 pages, 718 KB] |
| Group benefits enrolment/change form for First Nations Groups (4197-FN-CHG-E / 4197-FN-CHG-F) |
Use this form to enroll or make changes to your group benefits for First Nations | Plan member Plan sponsor |
[PDF, 5 pages, 719 KB] |
| Health Statement (3484-Basic-Opt-CI-MSD-E/3484-Basic-Opt-CI-MSD-F) |
Use this form if your plan requires proof of good health for any benefits, for member, spouse or dependents | Plan member Plan sponsor |
[PDF, 4 pages, 172 KB] |
| Health Statement (Optional life & Critical Illness only) (3484-Opt-CI-MS-E/F) |
Use this form if your plan only requires proof of good health for member and/or spouse for any of these two benefits. - Optional life - Critical illness |
Plan member Plan sponsor |
[PDF, 4 pages, 943 KB] |
| Plan Sponsor Services - Group Benefits Administration Guide for ME Tool (DS-9872 11-23 lj-cd) |
For plans that have access to the Member Enrolment tool A quick reference guide to accessing the administrative functions available with the Member Enrolment tool. |
Plan sponsor | [PDF, 12 pages, 250 KB] |
| Non-smoking declaration (940-3300) |
Form used by members to update smoking status | Plan member Plan sponsor |
[PDF, 1 page, 63 KB] |
| Notice of Conversion Privilege 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, 2 pages, 732 KB] |
| Notice of Conversion Privilege Insurance options for plan members on termination of group benefits with CI (4262-CI-E / 4262-CI-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, 2 pages, 735 KB] |
| Medical and Dental Cost Plus benefit coverage (042-0825 / 042-0826) |
Use this form when submitting a request for cost plus payment. | Plan sponsor |
[PDF, 4 pages, 788 KB] |
| Qualification of partner (942-2700 / 942-2701) |
Use in conjunction with an enrolment form or member change form | 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, 726 KB] |
Help! Why won't my forms open?
Fillable web forms may not work in certain internet browsers such as Google Chrome. If this occurs, you can try right-clicking on the form and select “Save link as” to your desktop. The saved PDF on your desktop should open.
| Form name | Purpose | Audience | File details |
|---|---|---|---|
| Prior Authorization Forms | Includes forms required for the approval of prior authorization drugs. | Plan member Plan sponsor |
Help! Why won't my forms open?
Fillable web forms may not work in certain internet browsers such as Google Chrome. If this occurs, you can try right-clicking on the form and select “Save link as” to your desktop. The saved PDF on your desktop should open.
| 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, 337 KB] |
| 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, 356 KB] |
Disability
| Form name | Purpose | Audience | File details |
|---|---|---|---|
| Disability Insurance - Important information | A quick reference document to help you understand your disability coverage | Plan member | [PDF, 2 pages, 573 KB] |
| Rehabilitation Earnings Statement (4630-E_AF) |
Form required for reporting a plan member’s earnings during a rehabilitation program | Plan sponsor | [PDF, 2 pages, 69.3 KB] |
| Rehabilitation Earnings Statement-ASO Deduction Support (4630-ASO-E_AF) |
Form required for reporting a plan member’s earnings during a rehabilitation program | Plan sponsor | [PDF, 2 pages, 71.3 KB] |
| Disability – Long Term – Plan Member package | Includes forms required for the submission of a LTD claim | Plan member | [PDF, 35 pages, 2.59 KB] |
| Disability – Long Term – Plan Sponsor Form (045-1405_AF) |
Form required for the submission of a LTD claim | Plan sponsor | [PDF, 8 pages, 668 KB] |
| Attending Physician’s Statement – LTD (General) (045-1355-GEN_AF) |
Medical form required for the submission of a LTD claim | Plan member | [PDF, 7 pages, 410 KB] |
| Attending Physician’s Statement – LTD (Mental Health) (045-1355-MHC_AF) |
Medical form required for the submission of a LTD claim | Plan member | [PDF, 7 pages, 515 KB] |
| Attending Physician’s Statement – LTD (Musculoskeletal) (045-1355-MSK_AF) |
Medical form required for the submission of a LTD claim | Plan member | [PDF, 7 pages, 530 KB] |
Disability - Short Term - Plan Member package (Package-Standard-PM-STD-LTD-E) |
Includes forms required for the submission of a STD claim | Plan member | [PDF, 16 pages, 1170 KB] |
Disability - Short Term - Plan Sponsor package (Package-Standard-PS-STD-LTD-E) |
Includes forms required for the submission of a STD claim | Plan sponsor | [PDF, 8 pages, 659 KB] |
Disability Job Demands Questionnaire (020-3475) |
Form required with the submission of a STD claim | Plan sponsor | [PDF, 3 pages, 356 KB] |
Attending Physician's Statement Disability Claim (020-3485-STD-LTD) |
Medical form required for the submission of a STD claim | Plan member | [PDF, 3 pages, 201KB] |
| Salary Continuance - Plan Member Package | Includes forms required to report an absence under Salary Continuance Services. | Plan member | [PDF, 11 pages. 478 KB] |
Salary Continuance Services – Plan Sponsor Package (Package-Standard-SCS-PS-E) |
Includes forms required for the submission of an absence under Salary Continuance Services | Plan sponsor | [PDF, 4 pages, 714 KB] |
| COVID – 19 (CLHIA Form) (490SL-M-COVID19-COI-E_AF) |
Confirmation of Illness form. | Plan member Plan sponsor |
[PDF, 4 pages, 131 KB] |
| Accommodation Services – Plan Sponsor Referral Form (490SC-ER-AS-S-E) |
Form required for Accommodation Services |
Plan sponsor |
[PDF, 4 pages, 410 KB] |
| Accommodation Services – Plan Member Statement (5134-E_AF) |
Form required for Accommodation Services |
Plan member |
[PDF, 2 pages, 91 KB] |
| Accommodation Services - Attending Physician Statement (490SC-AS-HH-P-E_AF) |
Medical form required for Accommodation Services (plan member will submit directly to Homewood Health) |
Plan member |
[PDF, 5 pages, 320 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] |
Health Spending Account Claim Form
| Form name | Purpose | Audience | File details |
|---|---|---|---|
| Health Spending Account Claim Form (HSA-E) |
Use this form for all medical & dental expenses to be claimed through your health spending account only. |
Plan member Plan sponsor |
(PDF, 2 pages, 743.53 KB) |
Life
| Form name | Purpose | Audience | File details |
|---|---|---|---|
| Notification of death (020-3252) / (020-3253) |
Use this form when submitting a death notification. | Plan sponsor | [PDF, 2 pages, 740 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, 2 pages, 738 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, 2 pages, 783 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.
