ENROLLMENT FORMS

ENROLLMENT FORMS

WHAT FORMS NEED TO BE COMPLETED?

All of the forms required to enroll in the Health Care Providers group benefits program are available from the table below. It is not necessary for every enrollee to complete all of the forms. Please refer to each form’s description to determine if your enrollment requires that form.

You can fill in the forms online however we do require original signatures therefore each form must then be printed, signed and dated, and sent in to us by mail. (Click here for mailing addresses)

Already a plan member but looking to make changes?

No problem. You’ll find the change forms at the bottom of the table below.

Making Extended Health Care Benefit Claims

All claims are processed by Greenshield Canada and should be sent directly to their offices. Claim forms can be found here:
Claim forms for do-it-yourself claim submission

All claim and claim form inquiries should be directed to Greenshield Canada directly by calling 1-888-711-1119.

Any enrollee required to show evidence that they are enrolling within 60 days of hire, retirement, full-time transfer etc. must complete this form

ALL enrollees must complete this form.

Any enrollee wishing to be considered for our Optimum health plan must submit Form 2 with their enrollment.

Signature or Supreme Enrollees ONLY

Any enrollee to whom ONE OR MORE of the following applies

  • You do not work at an endorsing hospital
  • You are not applying in a 60-day open window
  • You have chosen to apply for any optional or additional life insurance or long term disability


Signature or Supreme Enrollees ONLY

Any enrollee who chooses to apply for optional life insurance and/or excess long term disability must complete this worksheet.

Signature or Supreme Enrollees ONLY

Any enrollee who chooses to apply for spousal life insurance.

Signature or Supreme Enrollees ONLY

Any enrollee who chooses to apply for child life insurance.

Any plan member formerly covered under the HCP plan as a dependent and wishing to continue with coverage of his/her own

Any covered dependent attending a post-secondary educational institution and wishing to retain his/her coverage

Any current plan member looking to make changes to his/her contact information or dependent/spousal coverage options

Any current plan member looking to make changes to his/her package or plan coverage options

Signature or Supreme Plan Members ONLY 

Any plan current plan member looking to make changes to his/her beneficiary

*Other forms of documentation are accepted as evidence of a 60 day window are: hire letter from the hospital, confirmation of loss of benefits from the hospital as a result of retirement or transfer from full time to part time.

Are you prepared for the unexpected?

You never know what the future holds, but with HCP, you will have peace of mind knowing that you and your family are well protected.

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