Forms

IATSE 891 Health Benefits Enrollment and Change Forms

• Group Benefits Enrolment Form (Extended Health and Dental) (PDF)
  Complete this form to enroll in the benefits plan.
• Group Change Form (Extended Health and Dental) (PDF)
  Report changes, including addition or deletion of a family member, if you are enrolled under the group plan.
• Over-Age Dependant Form (PDF)
  Complete this form to enroll a dependant disabled child over the age of 21. (PDF)
• Common-Law Declaration (PDF)
  Complete this form to add a common-law partner to your health benefits plan. To be used in
  conjunction with J&D Benefits and/or MSP forms.
• Disabled Rate Application Form (PDF)
  Use this form to apply for reduced shortage rate payments.
• 60+ Health Plan Opt-In Form (PDF)
  Complete this form to enroll in the Benefits of Film 60+ Plan

Basic Life Insurance

• Life Insurance – Beneficiary Designation Information and Form (PDF)
  To add a beneficiary to your life insurance.
• Optional Life Insurance
  Optional Life Insurance Application (PDF)
  

Extended Health and Dental

• Healthcare Expenses Statement With Healthcare Spending Account (PDF)
  Reimbursement of health care expenses, i.e. physio, massage therapy, chiropractor etc. (Active Group Number 58197, Retiree Group Number 58198)
• Dentalcare Expenses Statement With Healthcare Spending Account (PDF)
  Reimbursement of dental expenses. (Active Group Number 58197, Retiree Group Number 58198)
• Statement of Claim - Out of Country Expenses Form (PDF)
  Reimbursement of eligible out of country medical expenses.

Short Term Disability

• Application for Short Term Disability (Homewood Health) (PDF)
• Application for Short Term Disability due to COVID-19 (Homewood Health) (PDF)

Brochure on Short Term Disability When Ill or Diagnosed With COVID-19. (PDF)

Critical Illness

• Critical Illness Summary (PDF)
• Critical Illness Benefit Claim Statement (PDF)
• Critical Illness Attending Physician Statement (PDF)
• Critical Illness Authorization to Obtain Information (PDF)