Accidental Death Dismemberment (AD&D) is mandatory for all eligible CISVA employees. Accidental Death and Dismemberment (AD&D) coverage provides benefits should you be a victim of an accident that costs your life, limb, sight or hearing. On the occasion of an AD&D claim, please get in touch with the Benefits Administration Office for the form.

• Assure Claim Form – Prescription Drugs Claim ONLY

The Assure Card is an electronic payment system that provides on-the-spot claims submission of prescription drug claims at almost any pharmacy in Canada. It’s a convenient, easy-to-use alternative to submitting claim forms. The pharmacist uses the card to confirm eligibility, drug coverage and remit your eligible drug claim directly to Assure for processing.

• Basic and Voluntary Critical Illness Claimants Statement 

Mandatory for all eligible CISVA employees, Critical illness insurance alleviates some stress due to the financial burden when an insured is diagnosed with a covered condition.  Additional documents (including an Employer claim form) need to accompany this attachment. Therefore, DO NOT forward this claim directly to the Claims Department as indicated on the claim form. Submit the completed form to the Benefits Administration Office.

• Dental Claim Form
• Instructions on how to complete the Dental claim form

The Dental Care plan provides coverage for a wide range of dental services, from your regular check-ups to major procedures such as root canals and crowns. Even if your spouse or dependent children are already enrolled under your spouse plan, you may also enroll in the CISVA plan, providehttps://cisva.bc.ca/wp-admin/post.php?post=5119&action=edit#saved the other plan allows double coverage.

• Short Term Disability Employee Statement
• Short Term Disability Employer Statement
• ATTENDING PHYSICIAN STATEMENT

Fill out this form if the employee is claiming a COVID STD benefit. The employer still needs to complete the Employer Statement.

• Short Term Disability COVID CLAIM
• Short Term Disability Employee Statement
• ATTENDING PHYSICIAN STATEMENT

These benefits are available to eligible employees and provide salary replacement (wage-loss) benefits for a specified period to employees who are disabled due to injury or sickness. Once the applicable documents have been completed in full, please email them to the Benefits Administration Office. The ORIGINAL copy is not required anymore.

NOTE: Please ATTACH a copy of your employee’s JOB DESCRIPTION with the Employer Statement to help Canada Life assess the employee’s ability to return to work.

• Extended Health
• Instructions on how to complete the Extended Health claim form

Extended Health Care covers you for some charges arising from physician-recommended and medically necessary services and supplies beyond the scope of MSP. Even if you or your dependents are enrolled under your spouse’s plan, you may also enrol in the CISVA plan, provided the other insurance allows double coverage. Complete a Group Change Form should you wish to add/remove dependents from your plan.

• Life Claim Brochure
• Life Claim (Beneficiary) Form
• Life Claim Form Employer Statement (To be completed by the Benefits Administration Office)

Mandatory for all eligible CISVA employees, Basic Group Life provides benefits to your designated beneficiary in the event of your death for whatever cause. Spouses and dependent children are not covered under this plan. Please forward this completed document directly to the Benefits Administration Office on the occasion of a Life claim (including an Optional Life claim). There are additional documents that need to accompany this attachment. Therefore, DO NOT forward this claim directly to the Group Life Department as indicated on the claim form.

• Out-of-Country claim
• MSP Out-of-Country claim
• Authorization to provide medical info Schedule B
• Assignment of payment Schedule A
• Instructions on how to complete the Out-of-Country claim form

Submit all out-of-country claims to Canada Life using the Out-of-Country claim form. Canada Life will coordinate the payment of your claim with MSP.

For out-of-province claims, submit the claim to the provincial plan (BC MSP) first, then Canada Life.

• Notice of death claimant’s form in fillable Word format
• Notice of death claimant’s form

If an RCAV Registered Pension Plan member dies, the attached document must be completed by the beneficiary and sent directly to the Benefits Administration Office. There are additional documents that need to accompany this attachment. Therefore, do not forward this claim directly to Canada Life Group Retirement Services as indicated at the top of the claim form. Once this step has been completed, Canada Life Group Retirement Services will contact the beneficiary to summarize available options.

• Welcome Plan Claim Form

The Welcome Plan is a temporary supplementary group plan of insurance that provides essential basic healthcare coverage for temporary, new or returning Canadian residents and their families when they do not qualify for provincial health plan coverage in their province or territory.

Welcome Plan benefits are available if the employee meets all eligibility requirements.

• To be eligible under the Welcome Plan, the employee must be meet the following requirements:
• Covered under the Extended Health plan
• Must legally reside in a Canadian province or territory
• They are not 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.