Plan administration forms
GroupNet for Plan Administration
Staying on top of plan members’ requests while keeping up to date with your day-to-day activities can be a drain on your resources. GroupNet for Plan Administration can help, saving you time and money.
With GroupNet for Plan Administration, you get secure access to experience and claims reporting, enrollment information, billing and much more.
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.
Forms for group benefits plan administrators
Supply services order form M173(D52)
Use this form to submit information needed to enroll new plan members in a group benefits plan.
Use this form to update information about plan members and/or their dependants.
Use this form to have your monthly premium payments automatically withdrawn from your bank account.
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.)
For plans administered by Great-West Life, Winnipeg
For plans administered by Great-West Life, Montreal
For plans administered by Great-West Life, Regina
To find the CANUS adjustments form (M5840 BIL) and other CANUS forms, go to the CANUS page.
Use this form to update the beneficiary information for plan members.
Use this form to designate a trustee for a beneficiary who is a minor or who is legally unable to manage their own affairs.
Use this form to obtain consent for removal of a beneficiary that has been designated irrevocable.
Use this form to designate a beneficiary as irrevocable.
Application for non-smoker rate
For optional critical illness
For optional life
Evidence of insurability
Use this form for all 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.
Group life conversion
For plan members living in Quebec, use this form to convert group life insurance to an individual life insurance policy.
For plan members living outside of Quebec, use this form to convert group life insurance to an individual life insurance policy.
Use this information sheet to provide plan members with details about individual life insurance policy conversion, eligibility and options.
Group disability benefits
Employer’s statement forms