Get your Group Benefits forms

Below, you’ll find all of our Group Benefits forms organized by product. When selecting the applicable forms for your needs, please ensure you’re downloading all of the necessary forms, noting that some may be for plan members, plan sponsors and treating physicians.

The forms on this page are for administrative and claims purposes, and in most cases, will include requisite instructions and corresponding mailing addresses.

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

Application to Waive Waiting Period

Irrevocable Beneficiary Consent Form

Direct Deposit Application - Health Care/Dental Payments

Direct Deposit Application - Disability Benefit Payments

Flex Benefits Plan Member Change Form

Health Evidence Questionnaire

Optional Accidental Death and Dismemberment Insurance Application

Optional Critical Illness Insurance Application

Optional Group Life Insurance Application

Plan Member Change Form

Plan Member Enrolment Form

Plan Member Enrolment Form - Flex Benefits

Group Policy Change Form

Request for Pre-Authorized Debit (PAD) Plan

Smoking Status Declaration

Student Eligibility Form

Extended Health and Dental Claim forms

Extended Health Claim forms

Extended Health Claim Form

Supplementary Dental Accident Report

Migraine Medication Supplemental Supply Request Form

Request for Brand Name Drug Coverage

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.