NOTE: ALL FORMS MUST BE SIGNED BEFORE SUBMITTING TO THE BENEFITS ADMINISTRATION OFFICE
Employees with a one-year contract, working 20 hours/week must be enrolled on the Benefits.

It is not by the employee’s choice whether they want to join or not.

• Group Benefits only APPLICATION FOR GROUP COVERAGE

• Group Benefits and Pension APPLICATION FOR GROUP COVERAGE  and APPLICATION FOR MEMBERSHIP IN A REGISTERED PENSION PLAN 35169

NOTE: For legal purposes, Canada Life requires the member to sign the form in ink. A digital signature is only accepted if the member has physically scribbled their signature – typing the signature with the cursive font is not accepted.

• Guaranteed Approval Voluntary Critical Illness (must be completed within 60 days upon benefits eligibility date) http://www.solutionsinsurance.com/cisva
• Optional Life Insurance
• Voluntary RRSP
• Tax-Free Savings Account.

NOTE: ALL FORMS MUST BE SIGNED BEFORE SUBMITTING TO THE BENEFITS ADMINISTRATION OFFICE

Reminder: ALL updates must be reported within 31 days from the date of the change NO EXCEPTION!

• To update information (name, contact details, add/remove dependent, waive extended health and dental coverage, LIFE insurance beneficiary) for the GROUP benefits:

• GROUP COVERAGE CHANGE FORM

• To increase pension contribution from 3% TO 7% OR to add, update, remove voluntary pension:

• GROUP COVERAGE CHANGE FORM

• To update information (name, address, contact details) for the PENSION benefits – forms must be signed in INK:

•  CHANGE OF MEMBER INFORMATION

• Changing pension beneficiary/contingent beneficiary and appointing a trustee:

• DESIGNATION OF REVOCABLE BENEFICIARY-TRUSTEE APPOINTMENT

• To increase pension contribution from 3% or 7% to 8% (15th year of service) or 9% (20th year of service):

• APPLICATION FOR INCREASE TO PENSION CONTRIBUTION
• VERIFICATION OF PREVIOUS TEACHING EXPERIENCE(for teachers/principals ONLY)

• Updating dependent children’s student status (dependent is turning 22 years old and attending full-time in-class post-secondary school):

• STUDENT RECERTIFICATION FORM

• For employees who had a disabled dependent, please have them to complete the: 

• OVERAGE DEPENDENT COVERAGE M6943

Employees who had previously waive their extended health and/or dental coverage who would like to have dual coverage (not losing the spousal coverage) will be considered as a late applicant and will have to be subjected to the approval of CANADA LIFE ASSURANCE CO.

NOTE:

Dental coverage for an approved late applicant will be limited.

• Once approved, the employee and dependents have limited coverage of $250 for the first 12 months after the approval date.

Extended health for an approved late applicant is effective immediately after the approval date.

• Approval for extended health coverage is not guaranteed.
• Canada Life will approve the application based on the employee and the dependents medical insurability.

Please refer to our booklet for coverage information. DO NOT SEND THE FORMS TO CANADA LIFE DIRECTLY. SUBMIT THE COMPLETED FORM to the BENEFITS ADMINISTRATOR.

Late applicants must complete the following forms:

• GROUP COVERAGE CHANGE FORM and 
• LATE APPLICANT FORM

NOTE: ALL FORMS MUST BE SIGNED BEFORE SUBMITTING TO THE BENEFITS ADMINISTRATION OFFICE

• To remove a member under your account (transfer of employment, retirement, or termination of employment), complete the:

• GROUP COVERAGE CHANGE FORM 

• To convert group life insurance to a private policy, complete the:
• Life Insurance Conversion when Leaving employment

Employees who are away from work due to illness or injury for 7 consecutive days (including weekends and holidays) MUST apply for disability benefits. The employee must fill out the EMPLOYEE STATEMENT and have their doctor to complete the PHYSICIAN STATEMENT

• EMPLOYEE STATEMENT
• ATTENDING PHYSICIAN STATEMENT

The employee has the option of submitting their completed form directly to CANADA LIFE, or to our office.

• The employer must complete the STD EMPLOYER STATEMENT and attach a copy of the employee’s JOB DESCRIPTION Please note that once you had submitted the scanned copy of the STD form(s), there’s no need to mail the original form(s).
• You as the employer must provide us with the employee’s actual gross salary from the first of the month, until the last day that they had been paid.

NOTE: Once the employee’s back to work full-time, you must provide us with the exact date that they came back to work and the gross salary that they will earn from the first day of their return to work to the last day of the month. The Benefits Administration Office will not ask for the information. YOU ARE RESPONSIBLE TO GIVE IT TO OUR OFFICE. For any specific questions or concerns regarding a disability claim, please contact our office.

All women in our system are entitled to the STD Maternity Benefit once they gave birth. You must give the employee the following forms: 

• EMPLOYEE and ATTENDING PHYSICIAN STATEMENT can be submitted directly to CANADA LIFE or to our office.
• For Teachers and Principal, you must give them the EMPLOYEE and PHYSICIAN STATEMENT and the MATERNITY MEDICAL REPORT – the medical report is for the school’s use only; do not send this form to GWL or to our office.

You must complete the STD EMPLOYER STATEMENT  and attach a copy of the employee’s JOB DESCRIPTION – MUST be submitted to the Benefits Administration Office. Please note that once you had submitted the scanned copy of the STD form(s), there’s no need to mail the original form(s).

TOP-UP CALCULATOR:

• REGULAR Maternity Leave Calculator
• Teacher-Principal on Disability BEFORE Maternity Leave

All maternity leaves are different. If you have specific questions or concerns regarding maternity leave or top-up benefits, please contact our office. YOU MUST ALSO PROVIDE A COPY OF THE MATERNITY LEAVE REQUEST FORM TO THE BENEFITS ADMINISTRATION OFFICE.

NOTE: ALL FORMS MUST BE SIGNED BEFORE SUBMITTING TO THE BENEFITS ADMINISTRATION OFFICE

GROUP COVERAGE CHANGE FORM must be submitted to our office to change their benefit class and to indicate if extended health and dental will be kept while they are on leave.

GROUP COVERAGE CHANGE FORM when they return to work and to re-instate their benefit class and benefits.

If the return to work is not the first day of the month, make sure that the gross salary from the first day that they return to work until the last day of that month is indicated on the form (this is for employees who have a pension).

Retirement/Leaving Employment – Retiree Form

• Benefit Class 5 – Retiree Members
• Retirement Benefit Overview
• Retirement Enrollment Form (2020-2021)
• Pre-authorized Debit Form
• Life Insurance Conversion when Leaving employment
• Medical Services Plan Information

The Welcome Plan is a temporary supplementary group plan of insurance that provides essential basic healthcare coverage for newcomers, returning Canadian residents and their families, or employees who had an expired Provincial Health Plan. Welcome Plan benefits are available as long as the employee meets all eligibility requirements. To be eligible under the Welcome Plan, the employee must be covered under the Extended Health plan; they must legally reside in a Canadian province or territory. They must not be eligible for coverage under a federal or provincial government health plan (i.e., MSP) because they do not satisfy the residency requirement in their province or territory of residence. 

• WELCOME PLAN APPLICATION