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Health Benefits —

Enrolment Card

Enrolment Card and Beneficiary Designation

Complete a Group Insurance Enrolment Card to enrol in your Health Benefit Plan, enrol your dependents in the Plan and assign your beneficiary(s).

Once a Member of the Plan, all changes to Member information or dependents should be made by completing a Group Insurance Change Card.

Information Needed to Complete the Form
Your personal Member information is needed to complete the form, including the dates of birth for all eligible dependents, and the policy number of any other group insurance plans that you or your dependents may also be covered under. Please follow the instructions on the form and ensure that you have completed the card in full. You may select a revocable beneficiary of your choice for your Life Insurance benefits.

If you are covered for MSP through your Plan, you must complete a separate MSP Application For Group Enrolment Form for your MSP coverage.

Completed forms should be forwarded to your Human Resources Department

More Information
Questions on completing the form should be directed to the Plan Administrator.

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