Selectpac plans with 3 to 75 plan members
Find and complete the plan administration form that you're looking for.
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 75 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.
Note: stop handling paper during the COVID-19 situation.
Completing enrolments online is quicker and safer than paper forms during this time of social distancing. Go to GroupNet for plan administrationOpens a new website in a new window to see if you can invite an employee to enrol online using our member self-serve enrolment tool
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
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
During the COVID-19 situation, please email your forms to groupmed@canadalife.com or fax them to 204-946-8558.
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
During the COVID-19 situation, please email your forms to groupmed@canadalife.com or fax them to 204-946-8558.
Evidence of insurability M6129
Group life benefits
During the COVID-19 situation, please email us these forms or fax them. You’ll find this info on the forms.
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
During the COVID-19 situation, please use the online claim submission option by selecting Application for group disability benefits below.
Application for group disability benefits
During the COVID-19 situation, please email or fax us your forms. You’ll find our email address and fax number on the forms.