Forms

Insurance Forms

A consolidated list of insurance forms for member use. 

*Note - Some of these forms are fillable PDF forms and are compatible with Google Chrome or Internet Explorer browsers only.

Life, Disability, Accident & Illness

• Application Form
• AD&D Beneficiary Designation 
• AD&D Insurance Application

Health & Dental

• Application Form (a) -Member Agreement
• Application Form (b) - HBTF Enrollment Form 
• Request for Change 
• Termination of Coverage 
• Dental Claim Form (Great-West Life)
• Health Claims Form (Great-West Life)
• Cost Plus Claim Guide
• Cost Plus Claim Form
• Sole Proprietor HBTF Enrollment Package

Resident Forms

• Resident Life Application without proof of good health
• Resident Transition to Practice Options Form - within 90 days of completing residency/fellowship
• Resident Disability Enrolment Form - No Medicals

Student Forms

• Student Insurance Application
• Student Disability - 4th Year $4,000 Option Form
• Student Transitioning to Resident Form
• 1st Year Student Membership and Insurance Application