Forms for Group Benefits Plan Administrators
For group plans with more than 35 plan members
The following forms are for Plan Administrator use only. If you’re a group plan member looking for claim forms, go to the Group Plan Members > Forms page.
These documents are in PDF format. To view and print them, you need Adobe Acrobat Reader Version 4.0 or higher, which you can download, at no cost, from the Adobe website.
Note: Many of the forms can be completed on-screen, by clicking in the space provided for writing and typing in your information. After printing the completed form, you will need to add any required signatures and dates by hand before you submit the form.
- Group Insurance Adjustments
Use this form to summarize new or updated information about plan members and/or dependants. This form may require the Application for Group Coverage or Group Coverage Change forms to be attached. (Types of changes that apply are listed in the "Reason Codes" section on the form.)
- Adjustments Form M5726 BIL - for plans administered by Great-West Life, Winnipeg
- Adjustments Form M5733 BIL - for plans administered by Great-West Life, Montreal
- Adjustments Form M5726(REGINA) BIL - for plans administered by Great-West Life, Regina
- Application for Non-Smoker Rate
Use the designated form to apply for a change from a smoker rate to a non-smoker rate.
- Evidence of Insurability
Use the appropriate form to submit the plan member information needed to apply for group benefits that require medical underwriting, such as Optional Life, Excess Life and LTD, Supplemental Life, Late Applicants and Critical Illness.
- Evidence of Insurability - Critical Illness M5995(CI)
Use this form for Group Critical Illness coverage.
- Evidence of Insurability M5995(CHOLIFE)
Use this form for Child Optional Life if your plan includes Child Optional Life.
- Evidence of Insurability M5995
Use this form for all other benefits if you maintain plan member eligibility information for Great-West.
Note: Winnipeg, Regina and Montreal Member Administration forms M5995(W), M5995(R) and M5995(M) are no longer available. Please use M5995 instead of these forms.