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 AdministrationOpens a new website in a new window, you get secure access to experience and claims reporting, enrollment information, billing and much more.
Selectpac plans with 3 to 35 plan members
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.
Supply services order form
Business pre-authorized debit (PAD) agreement
Application for group coverage
Use this form to submit information needed to enroll new plan members in a group benefits plan.
Application form M6191
Employee change form
Use this form to update information about plan members and/or their dependants.
Change form M6190
Group insurance adjustments
Group insurance adjustments M266(SEL) BIL
Use this form to summarize new or updated information about plan members and/or dependants, and may require the Application for Group Coverage or Employee Change forms above to be attached. (Types of changes that apply are listed in the "Reason Codes" section on the form.) - 110 kbpdf Opens in a new window
Beneficiary designation M6463
Trustee appointment M6242 BIL
Consent to change of irrevocable beneficiary M6320 BIL
Irrevocable beneficiary designation M6348 BIL
Application for non-smoker rate
Use the designated form to apply for a change from a smoker rate to a non-smoker rate.
Application form M7064
Application form M4672
Evidence of insurability
Evidence of insurability M6129
Group life benefits
Group life conversion
Group life conversion privilege notification M5725 (Quebec)
Group life conversion privilege notification M5725
Group life conversion fact sheet M6236
Group life conversion fact sheet M6236 (Quebec)
Group disability benefits