Benefit Plan

Benefits

ALL ORIGINAL SIGNED FORMS MUST BE SUBMITTED TO THE BENEFITS OFFICE.
Group Benefit Forms
Application for Group Coverage (re: NEW employees to the benefit plan)

PLEASE WRITE LEGIBLY IN BLACK OR BLUE INK. 

This document should be completed by those employees who (1) are new employees with the CISVA or (2) have exceeded the reinstatement period and must complete a new application form. PLEASE PRINT DOUBLE SIDED IF POSSIBLE

Group Coverage Change form (re: CURRENT participants of the benefits plan)

This document should be completed by those employees who want to make a change to their current and active benefits enrollment status. PLEASE PRINT DOUBLE SIDED IF POSSIBLE

Late Applicant Enrollment Form

This document should be completed by those employees who have exceeded the time requirement (31 days) from the eligibility period to enroll for benefits. Benefits will not become available/active until approved by the insurance carriers. PLEASE PRINT DOUBLE SIDED IF POSSIBLE

Student Recertification Form

Great-West Life’s (GWL) claims examiners carefully assess the dependent information reported on a claim and will verify if the dependent student is still eligible for benefits. To help ensure that claims are paid accurately and efficiently, the CISVA must notify GWL if there are any dependents listed that are no longer attending school and should have their coverage terminated. For audit purposes, the Student Recertification form must be completed in full to support maintenance of benefits eligibility. 

NOTE: Student coverage is extended for 6 months after the student’s last day in regular full-time school attendance. (i.e. last day in school is June 25th, dependent will be covered from June 25th – December 25th).

Welcome Plan Application (for employees who do not have the MSP coverage)

The Welcome Plan is a temporary supplementary group plan of insurance which provides essential basic healthcare coverage for temporary, new and returning Canadian residents and their family when they do not qualify for provincial health plan coverage in their province or territory. 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, and must not be eligible for coverage under a federal or provincial government health plan (ie: MSP) because they do not satisfy the residency requirement in their province or territory of residence. PLEASE PRINT DOUBLE SIDED IF POSSIBLE

GWL Direct Deposit Form
Optional/Voluntary Benefits
Optional Life Insurance Application Form

CISVAs optional insurance plan provides supplementary life insurance coverage for CISVA employees only. For further information regarding Optional Life rates, please refer to the Optional Life Brochure within our CISVA Benefit Plan Overview section.

New Employee Guaranteed Acceptance Voluntary Critical Illness
New Employee Guaranteed Acceptance Voluntary Critical Illness

Note: available to eligible employees and dependent spouses who are enrolled in Benefit Class 1, 2 and 4. As an employee of CISVA you are automatically covered for $10,000 of Basic Critical Illness Insurance. If you or your spouse require more than the Basic Insurance amount, you can each apply for $25,000 to $300,000 of medically underwritten Critical Illness Insurance coverage under the CISVA Voluntary Critical Illness Insurance plan. For new employees to the benefits plan, within the first 60 days of employment only, you have an opportunity to apply for the first $25,000 of Optional Critical Illness insurance without having to supply medical evidence. You are guaranteed approval for this voluntary coverage, regardless of your medical history (regardless of your pre-existing conditions). Please be cognizant of this strict timeline as after the 60-day window, you are subject to medical evidence! Industrial Alliance Pacific (IAP) has updated their website to allow for direct, online applications as well. Please feel free to visit their site for additional information on this benefit narrative, rates, application process, etc.: http://www.solutionsinsurance.com/cisva

Additional Voluntary Critical Illness

Taxes & Other Forms
TD1 (Federal)

TD1 Federal Personal Tax Credits Return

TD1BC (Province of British Columbia)

TD1BC British Columbia Personal Tax Credits Return

Fair PharmaCare Application

Fair Pharmacare indexes your provincial deductible for prescriptions to your income. Registering ensures that the Fair Pharmacare plan, and not the CISVA Benefits plan, pays for drug costs after your new deductible has been reached, making each benefits dollar go farther. Send this form directly to Fair PharmaCare for processing. All B.C. residents who have a CareCard from MSP should be registered for Fair PharmaCare. Please note that effective January 1, 2008, PharmaCare will no longer reimburse prescription or medical supply costs that were incurred before the date a family register for Fair PharmaCare. To register or obtain further information regarding Fair PharmaCare, please visit their website at www.health.gov.bc.ca/pharme/.

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