If you are a new employee with at least a ONE-YEAR contract and working 20 hours/week, you must be enrolled on the Benefits.

ALL eligible employees MUST be enrolled on Group Benefits.

• Group Benefits ONLY – APPLICATION FOR GROUP COVERAGE
• Group Benefits AND Pension:
• APPLICATION FOR GROUP COVERAGE
• APPLICATION FOR MEMBERSHIP IN A REGISTERED PENSION PLAN 35169 – open the file as read-only, and enter the required information.

NOTES:

1. The certificate number is assigned by the Benefits Administration Office – please leave blank.
2. Division/subgroup is always 01 – DO NOT enter your local division number 

• Guaranteed Approval Voluntary Critical Illness (must be completed within 60 days upon benefits eligibility date)
• Optional Life Insurance
• Voluntary RRSP
• Tax-Free Savings Account

Do you need to change any of the following:

• Contact Information (Address, Phone number, email address)
• Legal Name

Complete the following form(s):

• GROUP COVERAGE CHANGE FORM
• CHANGE OF MEMBER INFORMATION (ONLY if you have PENSION)

Do you need to:

• Add the extended health and dental coverage (loss the spousal insurance coverage)
• Add your spouse (newly married – within 31 days from the date of marriage
• Add/Remove dependent

Complete the following form:

• GROUP COVERAGE CHANGE FORM

FOR LIFE INSURANCE BENEFICIARY/CONTINGENT BENEFICIARY:

• GROUP COVERAGE CHANGE FORM

FOR PENSION BENEFICIARY/CONTINGENT BENEFICIARY:

• PENSION BENEFICIARY FORM

• GROUP COVERAGE CHANGE FORM

To change/update RPP level from 3% to 7% or vice versa, add/update/remove voluntary pension contribution, please complete complete the form below:

• GROUP COVERAGE CHANGE FORM

Are you eligible to increase your pension contribution 8% (15th year of service) or 9% (20th year of service)?

Fill out the following form(s):

• APPLICATION FOR INCREASE TO PENSION CONTRIBUTION – (must be signed by the EMPLOYEE and PRINCIPAL/PASTOR/ADMINISTRATOR ONLY); and
• VERIFICATION OF PREVIOUS TEACHING EXPERIENCE – (for teachers/principals ONLY)

1. EMPLOYEE STATEMENT and your doctor must complete the ATTENDING PHYSICIAN STATEMENT
2. For Teachers and Principals, you must complete the EMPLOYEE STATEMENT and have your doctor complete the PHYSICIAN STATEMENT and the MATERNITY MEDICAL REPORT – the maternity medical report form is for the school’s use only; do not send this form to Canada Life or our office. 

Options on how to submit your claim:

• Email your employee and attending physician statements directly to Canada Life via email at langley.dmso@canadalife.com.ca

• Email your employee and attending physician statements to your school to be submitted to the Benefits Administration Office (only if you are comfortable doing so)     

• Email your employee and attending physician statements to the Benefits Administration Office; or                                                     

NOTE: 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).

IF YOU ARE THE EMPLOYER OR REPRESENTING THE EMPLOYER, PLEASE GO ON THE BENEFIT REPS CORNER TO ACCESS THE EMPLOYER STATEMENT.

Things to remember:

1. Decide if you want to take 12 months or 18 months leave (there are no choices in between)
2. Decide if you want to keep or waive your *Group Benefits and Pension (as per Federal Law, employees can now waive their Group Benefits and/or **disability benefits while on Maternity. Employees can also choose to continue contributing to the match pension while on Maternity Leave)
3. Arrange the Maternity leave agreement with your employer/PEC
4. Request for your Record of Employment (ROE)
5. Apply for Employment Insurance (EI) Maternity and Parental Benefits***
6. Apply for Maternity STD Benefit**
7. If you are a teacher/principal, provide the Maternity Medical report to your school for top-up calculation.
8. Add your baby under your plan (the latest date that you can provide this information is 31 days after your child is born)
9. Prepare post-dated cheques to cover your Group Benefits and Pension employee contribution (if you are keeping your benefits and pension)

*You can keep your Life Insurance, AD&D, STD, LTD, and Critical Illness and choose to waive the extended health and dental

**You will not be eligible for the Maternity STD benefits if you choose to waive your Disability Benefits.

***You can start receiving maternity benefits as early as 12 weeks before your due date or the date you give birth. You cannot receive these benefits more than 17 weeks after your due date or the date you gave birth, whichever is later.

Employment Insurance – Maternity/Parental Benefits
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If you are away from work due to illness or injury for seven consecutive days (including weekends and statutory holidays), you must apply for the disability benefits. You must complete the EMPLOYEE STATEMENT and have your doctor complete the PHYSICIAN STATEMENT.

• EMPLOYEE STATEMENT
• ATTENDING PHYSICIAN STATEMENT

If you are claiming for a COVID-19 STD benefit, please fill out this form. Please inform your employer that you are applying for a COVID-19 related STD as the employer will have to provide our office with the employer statement.

• Short Term Disability COVID-19 CLAIM

Options on how to submit your claim: 

• Email your employee and attending physician statements directly to Canada Life via email at langley.dmso@canadalife.com
• Email it to your school to be submitted to the Benefits Administration Office (only if you are comfortable doing so); or
• Email your forms to the Benefits Administration Office

NOTE: While you are on disability, your match pension contribution will be suspended. It will be re-instated on the day that you return to work full-time (pre-disability regular hours and duties).

IF YOU ARE THE EMPLOYER OR REPRESENTING THE EMPLOYER, PLEASE GO ON THE BENEFIT REPS PAGE TO ACCESS THE EMPLOYER STATEMENT.

Did you:

• Previously waived your extended health or dental coverage and now would like to have dual coverage (not losing the spousal coverage)?
• Or did you missed the 31 days grace period and had not added your spouse or child under your plan?

Canada Life will now consider you a late applicant and have to be subjected to their coverage approval.

As a Late Applicant, you must complete the following forms:

• GROUP COVERAGE CHANGE FORM
• LATE APPLICANT FORM

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, BUT:

• 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.

FAILURE TO FOLLOW WILL CAUSE DELAY THE PROCESSING OF YOUR APPLICATION.

Is your dependent child turning 22 years old and attending full-time in-class post-secondary school?

• STUDENT RECERTIFICATION FORM

Do you need coverage for your dependent child over age 22 who had a disability, please complete the:

• OVERAGE DEPENDENT COVERAGE M6943

FILL-UP the following forms as follows :

• GROUP COVERAGE CHANGE FORM
• RETIREE ENROLLMENT FORM*** 2020-2021 Retiree form AVAILABLE NOW ***
• PRE-AUTHORIZED DEBIT FORM
• LIFE INSURANCE COVERAGE WHEN LEAVING EMPLOYMENT

• BENEFIT CLASS 5 – RETIREE MEMBERS
• NEW RETIREMENT INCOME BROCHURE
• MEDICAL SERVICES PLAN INFORMATION
• RETIREMENT BENEFIT OVERVIEW

How to request a new card(s)? Who should we contact?

1. Please contact your Benefits Representative first if you need a replacement card.
2. Your Benefit Representative will send a request to mphan@cisva.bc.ca
3. Once we receive the request, we will order your new cards.
4. <Please allow 10 to 20 working days to receive a new card(s).

NOTE: Due to the current situation, it might take longer for you to receive your cards; we highly recommend that you register online and download your electronic cards.