Use this form to enrol a new employee to your plan.
Employee Change Form
Use this form to update a covered employee’s information. Examples: Add new family members, change names, update salary, terminate coverage, etc.
Decline or Apply EHC and/or Dental
Use this form:
- If you were enrolled for EHC and/or Dental, and now want to decline coverage because you’ve acquired coverage through another (e.g. spouse’s) plan
- If you declined coverage for EHC and/or Dental, and now want to enroll because your other coverage terminated
Use this form:
- To designate your beneficiaries for Basic Life/Accidental Death, and/or Optional Life/Optional Accidental Death insurance
- At time of initial enrolment if you want to designate more than 3 primary beneficiaries
- To change your existing beneficiary(ies). The beneficiary(ies) listed here will replace your previous beneficiary designation
Student Declaration Form
To continue coverage on your Extended Health and/or Dental plan beyond age 21 and up to the maximum age on your plan, your child must be:
- Unmarried / not living in a common-law relationship, and-Attending school on a full-time basis, as defined by Canada Revenue Agency, or-Disabled and incapable of sustaining employment – Contact us for instructions.
If your child is about to turn or has recently turned 21, is not married or living in a common-law relationship, and is a full-time student, please complete this Declaration (one per child) and return to us to continue coverage on your plan.
Confirmation of PharmaCare Registration
Complete this form to provide confirmation that you are registered for BC Fair PharmaCare.
Annual Student Declaration for 2018/19 school year.
If you have a child on your plan who is age 21 or more and a full-time student, use this form to continue coverage through to August 31, 2019 (or when they reach the plan's maximum age if earlier).