Get your Group Benefits forms

Below, you’ll find our most used Group Benefits forms organized by product. If the form you need does not appear below, you can find it by logging on to Benefits Now®. Please download all the necessary forms to meet your needs and note that some forms are for the plan member, while others are for the plan sponsor or treating physician.

The forms on this page are for administrative and claims purposes, and in most cases will include instructions and the address to send them to.

How to use and submit forms

Save the forms to your computer. In some cases, you can fill them in directly before printing. Otherwise, print them out and complete them by hand before mailing to the address indicated on each form.

Administration forms

Extended Health and Dental Claim forms

Extended Health Claim forms

Drug - Prior Authorization forms

View the list of drugs and access the necessary forms.

If you have been prescribed one of the listed drugs, have your prescribing physician complete the appropriate form and submit to The Co-operators. Any costs incurred for the completion of pre-authorization request forms are the responsibility of the patient/plan member.

Dental Claim forms

Emergency Out of Country

ContinYou GOLDEN - Retiree Product

Disability Claim forms

Early Intervention

Long Term Disabilty

Short Term Disability

Life and AD&D Claim forms

Life Claim forms

Living Assistance

AD&D Claim forms

Life Waiver of Premium

Critical Illness Claim forms

Physician's Statement

Physician's Statement - Dependent Children Covered Illness

If you would like to order more forms, please use the following link: