Forms & Documents

The following forms are available in Adobe Acrobat format. To download this free software, visit the Adobe Website. 

Health Association Forms must be printed duplex (back-to-back) and on the paper size specified. We have noted the paper size to be used in brackets after the title of each form. 

Your compliance is required to ensure that plan member forms are accurate and complete, and meet specifications for electronic document management. 

Forms received that do not meet these specifications may result in processing delays, and if necessary, may result in us having to return forms to you. 

For more information please click here

 

Application and change forms

Application for Excess Amounts-LTD (Form 50 - Letter)

Application Form - Group Insurance Benefits (Form 1 - Legal) 

Benefit Change/Cancellation Form - Group Insurance Benefits (Form 7 - Legal)

Employer Change Form - Group Insurance Benefits (Form 8 - Letter)

Personal Information Change Form - Group Insurance Benefits (Form 61 - Legal)

Beneficiary Designation Form - Group Insurance Benefits (Form 62 - Legal)

EASE Notification of 21 Consecutive Calendar Days of Absence (Form 38 - Letter)

Application for Continuation of Group Benefits During an Approved Unpaid Leave of Absence (Form 12 - Legal)

Application for Continuation of Group Benefits During an Unpaid Leave of Absence Due to an Injury or Sickness (Form 48 - Legal)

Application for Continuation of Group Benefits - Retired Members (Form 17 - Letter)

LTD Approval - Benefits Election Form (Form 65 - Letter)

LTD Insurance Plan Monthly Remittance Form (Form 44 - Complete form & mail copies as instructed on form)

Overage Dependent Form (Form 56 - Letter)

Manulife Evidence of Insurability Form - Health (statement of health) (Form B1 - Letter)

Manulife Application for Over-Age Disabled Dependent Coverage (Form 55 - Letter)

Manulife Direct Deposit Form (Form 66 - Letter)

Manulife Evidence of Insurability Form - Critical Illness (Form 57 - Letter)

Retiree Change Form - Group Insurance Benefits (Letter) 

Plan Sponsor Request to Continue Group Coverage (Form 69 - Letter)

Sun Life Financial Statement of Health (Form 5 - Letter)

Sun Life Financial Disabled Child Coverage (Form 68 - Letter)

SSQ Emergency Travel Card (Letter)

 

Claim forms  

SSQ Emergency Medical Claim Report - Out of Province or Out of Country and Consent to Collect Form (Form 45 – Letter)

Critical Illness Notification Form (Form 49 - Legal)

Manulife Group Benefits Extended Health Care Claim Form (Form 67 - Letter)

Manulife Group Benefits Dental Claim Form (Form 42 - Letter)

Manulife Group Benefits Vision Claim Form (Form 51 - Letter)

Manulife Clinical Measurements Claim Form (Form 53 - Letter)

Optional Accidental Death & Dismemberment Claim Form (Form 39 - Legal)  

Sun Life Financial Notice of Conversion Privilege on Group Life Benefit (Form 13 - Letter) 

Sun Life Financial Application for Living Benefits Loan (Form 60 - Letter)


Sun Life Death Claim

Sun Life Financial Election of Method of Settlement and Statement of Claim(Form 20A - Letter)

Sun Life Financial Notification of Death (Form 20B - Letter)
 

Waiver Applications for Employees Not Covered Under the NSAHO LTD Plan

Sun Life Financial Waiver of Premium Claim - Employers Statement (Form 63 - Letter) 

Sun Life Financial Waiver of Premium Claim - Claimant's Statement (Form 64 - Letter)

Sun Life Financial Waiver of Premium Claim - Attending Physician's Statement of Disability (Form 65 - Letter)

CI - Manulife Waiver of Premium Member Statement (Form 71 - Letter)

CI – Manulife Waiver of premium APS (Attending Physician's Statement) (Form 72 – Letter)

CI – Manulife waiver of premium plan sponsor statement (employer) (Form 73 – Letter)


Long Term Disability Claim

LTD Application Package - Disabled After October 1, 2010 (Letter)