Benefits forms and resources

Benefit plan resources

MyCHOICE plan

• MyCHOICE Benefits Handbook (PDF, 1.4 MB)
• Benefit Partner Statutory Declaration (PDF, 51 KB)
• Enrolment/Change form (PDF, 471 KB)
• Premium Rates (PDF, 215 KB)
• Statutory Declaration (PDF, 124 KB)

1stchoice plan

• 1stchoice Benefits Handbook​ (PDF, 672 KB)
• Benefit Partner Statutory Declaration (PDF, 51 KB)
• Enrolment/Change form​ (PDF, 406 KB)
• Premium Rates (PDF, 631 KB)
• Statutory Declaration (PDF, 124 KB)

Group Life Insurance Plan

MyCHOICE plan

• Group Life Insurance Plan Handbook (PDF, 382 KB)
• Application and Declaration for Non-Smoker Rates​​​ (PDF, 278 KB)
• Application for Advance Payment of Group Life Insurance (PDF, 165 KB)
• Application for Conversion (PDF, 317 KB) (for payroll use only)
• Application for Paid up Life Insurance (PDF, 537 KB) (for payroll use only)
• Attending Physician's Statement (PDF, 148 KB)
• Certificate of Attending Physician Dismemberment of Loss (PDF, 111 KB)
• Claim for Accidental Dismemberment or Loss (PDF, 114 KB)
• Designation of Beneficiary (PDF, 410 KB)
• Evidence of Insurability (PDF, 503 KB)
• Group Life Claimant Statement​ (PDF, 68 KB)
• Group Life Plan Sponsor Statement (PDF, 66 KB)

1stchoice plan

• Group Life Insurance Plan Handbook (PDF, 459 KB)
• Application and Declaration for Non-Smoker Rate​​ (PDF, 258 KB)
• Application for Advance Payment of Group Life Insurance (PDF, 165 KB)
• Application for Conversion (PDF, 2.0 MB) (for payroll use only)
• Application for Paid up Life Insurance (PDF, 375 KB) (for payroll use only)
• Attending Physician's Statement (PDF, 148 KB)
• Certificate of Attending Physician Dismemberment of Loss (PDF, 111 KB)
• Claim for Accidental Dismemberment or Loss (PDF, 134 KB)
• Designation of Beneficiary (PDF, 672 KB)
• Evidence of Insurability (PDF, 498 KB)
• Group Life Claimant Statement (PDF, 68 KB)
• Group Life Plan Sponsor Statement​ (PDF, 66 KB)

Dental Plan

MyCHOICE plan

• Dental Plan Handbook (PDF, 310 KB)
• Alberta Blue Cross Dental Claim form​ (PDF, 221 KB)

1stchoice plan

• Dental Plan Handbook (PDF, 512 KB)
• Alberta Blue Cross Dental Claim form (PDF, 221 KB)

Extended Medical Benefits Plan

MyCHOICE plan

• Extended Medical Benefits Plan Handbook (PDF, 405 KB)
• Alberta Blue Cross Health Services claim form (PDF, 159 KB)
• Alberta Blue Cross Emergency Out of Province / Country claim form (PDF, 903 KB)

1stchoice plan

• Extended Medical Benefits Plan Handbook (PDF, 203 KB)
• Alberta Blue Cross Health Services claim form (PDF, 159 KB)
• Alberta Blue Cross Emergency Out of Province / Country claim form (PDF, 903 KB)

Prescription Drug Plan

MyCHOICE plan

• Prescription Drug Plan Handbook (PDF, 258 KB)
• Alberta Blue Cross Health Services claim form (PDF, 159 KB)

1stchoice plan

• Prescription Drug Plan Handbook (PDF, 458 KB)
• Alberta Blue Cross Health Services claim form (PDF, 159 KB)

Long Term Disability Income Continuance (LTDI) Plan

MyCHOICE plan

• Long Term Disability Income Continuance Plan Handbook (PDF, 310 KB)
• Employee's Statement​ (DOC, 338 KB)
• Employer's Statement (DOC, 241 KB)
• Long Term Disability Income Continuance plan brochure (PDF, 496 KB)
• Long Term Disability (LTD) Contacts
• LTD Appeal Process: A hands-on guide and reference (PDF, 140 KB)
• Notice of Appeal​ ​(DOC, 115 KB)

1stchoice plan

• Long Term Disability Income Continuance Plan Handbook (PDF, 277 KB)
• Employee's Statement​​ (DOC, 338 KB)
• Employer's Statement (DOC, 241 KB)
• Long Term Disability Income Continuance plan brochure (PDF, 496 KB)
• Long Term Disability (LTD) Contacts
• LTD Appeal Process: A hands-on guide and reference (PDF, 140 KB)
• Notice of Appeal​​ (DOC, 115 KB)

Special Accidental Death and Dismemberment Insurance

• Appointment of Beneficiary form (PDF, 468 KB)