Here are the available online forms. Use them to simplify the management of your group insurance plan.
Follow the steps below :
- Some forms require Word, while others require Acrobat.
- Fill out the selected form by clicking on each empty field.
- It can take a few seconds for text to appear on the screen, depending on your Internet connection.
- Save and print the form in order to sign it.
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Administrative Forms
Attention! Be sure to always keep a printed and signed copy on hand for your files, and also remember to provide a signed copy to the employee concerned.
If you use the Administrators' Portal, it is not necessary to mail AGA Benefit Solutions an original signed copy.*
Enrolment Form – Optional Dental Care Benefit
Enrolment Form – Evolution, Modular Plan
Reenrolment Form – Evolution, Modular Plan
Insurance Conversion Privilege Form
Notice of Change in Coverage – Optional Dental Benefit
Notice of Change in Coverage – Evolution, Modular Plan
Confirmation of Information – Coordination of Benefits
Administrators' Portal Access Request
Administrators' Portal Access Request – Monthly Billing Only
An original copy of the Evidence of insurability or Declaration of insurability form should be transmitted to AGA Benefit Solutions. Please select the appropriate form.
Assumption Life – Statement of Health
Beneva – Declaration of Insurability
Blue Cross – Evidence of Insurability
Desjardins – Evidence of Insurability
Canada-Vie – Evidence of Insurability (Excess & Optional Benefit)
Canada-Vie – Evidence of Insurability (Late Applicant)
Humania – Declaration of Insurability
Industrial Alliance - Evidence of Insurability
Manulife Financial – Evidence of Insurability
RBC – Evidence of Insurability Form
SSQ – Declaration of Insurability
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Claim Forms
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Insurers’ Contact Details - Disability Insurance
As of January 1st, 2021, following the revision of the disability insurance service offer, you are invited to contact your insurer for any question related to a request for disability benefits, life insurance or serious illness.
- Canada Life
(T) 1 888 878-6059
Email : montreal.dmso@canadalife.com
- Beneva
(T) 1 800 463-4856
To send documents : prest.inv@beneva.ca
For all other inquiries : invalidite.service-client@beneva.ca
- Blue-Cross
(T) 1 877 849-8509
Email : salaire@medavie.croixbleue.ca
- Desjardins Insurance
(T) 1 800 463-7843
Link : Online Form
- Humania Assurance
(T) 1 800 818-7236
Email : prestations@humania.ca
- iA Financial Group (Industrial Alliance)
(T) 1 877 422-6487
Email: invaliditevie@inalco.com
- iA Financial Group AD&D
(T) 1 800 266-5667
Email: specialmarkets-claims@ia.ca
- Manulife
(T) 1 866 236-6313
Email: groupe_invalidite@manuvie.com
- SSQ Insurance
(T) 1888 651-2307
Email : salaire@ssq.ca
- UV Insurance (Union-Vie)
(T) 1 800 567-0988
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Request for Weekly Benefits
We suggest you keep the originals for your records.
Due to the sensitive nature of the information, please send the following documents directly to your insurance provider: the Employee Statement and the Attending Physician’s Statement. Your insurer’s contact information is available on this webpage.
Only the Employer’s Statement must be submitted to us through the Administrators’ Portal, under the Secure File Transfer tab.
If your weekly income replacement benefits are placed with one of the following insurers, please click on the appropriate link to directly access their claim form:
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Long Term Disability Forms
We suggest you keep the originals for your records.
Due to the sensitive nature of the information, please send the following documents directly to your insurance provider: the Employee Statement and the Attending Physician’s Statement. Your insurer’s contact information is available on this webpage.
Only the Employer’s Statement must be submitted to us through the Administrators’ Portal, under the Secure File Transfer tab.
Click on the appropriate link, according to the insurer with which your long term disability coverage is subscribed:
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Critical Illness Forms
We suggest that you keep the originals for your records.
Due to the sensitive nature of the information, please send the following documents directly to your insurance provider: the Employee Statement and the Attending Physician’s Statement. Your insurer’s contact information is available on this webpage.
Only the Employer’s Statement must be submitted to us through the Administrators’ Portal, under the Secure File Transfer tab.
In the event of a diagnosis of critical illness, insurance against serious diseases provides a lump sum payment. To know the eligible health states and eligibility requirements, please consult the contract and/or brochure.
If your critical illness coverage is subscribed with one of the following insurers, please select the link of your insurer:Blue Cross (Employer and Employee)
Industrial Alliance For diagnoses of cancer and heart attack, some additional documents are required. Please refer to the medical declaration for more details and make sure you provide the requested documents in order to obtain optimal service.
Questions? Want to learn more about our products and services? Contact us!
