Forms (Public)

The following Group Benefits Plan forms are available only here, in the Members’ Area of the website. Additional forms are available in the Group Benefits Plan section of the main public area of the website. If you can’t find the forms you are looking for, please call the Group Benefits Plan office.

Medical & Dental Forms

Extended Health Care Form
Complete this form when submitting any eligible medical expenses. Attach the original receipts to your claim form, along with referrals, if necessary. Make sure to keep photo copies of all original receipts.

Drug Exception Application Form
Complete this form to request a drug not commonly covered, not fully covered or that requires more frequent dispensing than eligible under your plan.

Notification of Member Fair Pharmacare Registration Number
This form is used to notify us of a Fair Pharmacare registration number. For complete details or to register for Fair Pharmacare, go to their website

Medi-Passport (only for members with extended health care coverage)
Download this form and card for use should the employee or their eligible dependents require emergency medical services when traveling outside British Columbia.

Dental Claim Form
Most dental claim forms are produced by the dental office. Any standard Dental Claim form would be accepted. This form is used for dental claims, especially for claiming orthodontic expenses, if your plan includes ortho.

Disability Forms

Short Term, Sponsor Statement
This form is to be completed by the employer to notify us of a member’s absence from work due to a disability. Please send this form to the ARA office as we must include the a claims certificate produced by our admin system to confirm the plan details to the insurance company.

Short Term, Member Statement Form
This form is completed by the employee when making a short term disability claim. This form must be accompanied by the Attending Physician statement.

Short Term, Physician’s Statement Form
This form is to be completed by the attending physician and signed by member after the employee is off work due to disability.

Short Term, Job Description
Complete this form when a member is expected to be absent for four weeks or more.

Short Term, Return To Work
Use this form to advise us a member has returned to work.

Notice of Long Term Claim Form
Employers complete this form when there is reason to believe the member will qualify for long-term disability benefits and there is no short term disability coverage in place.

Administration Forms

Enrollment Form (Rev. February 2016)
To enroll or reinstate a employee in the group plan. To add your logo to this form, please contact the ARA Group Plan office.

Change Card
Use this form to notify us of change to your members’ personal information. Marital Status changes, address changes, to add new or remove dependents, beneficiary designation changes, etc.

Earnings Change Card
Use this form to report an update in a member’s earnings.

Termination Notice Form
Use this form to advise when a member’s employment is termination.
Note: If you are on the ARA Plan there may be options for you upon termination or retirement. Click here for details.

Health Questionnaire
To be completed for excess risk long term disability and late entrant member and/or late entrant dependent situations.

Employee Refusal Card
Use this form if you have an employee you wish to remove from your plan.

Beneficiary Designation Form
Use this form when a member wants to designate or change their beneficiary.

Student Verification Form
Use this form to identify dependents who are attending post secondary school full time but are still under 25, not married, and supported by you.

Disabled/Handicapped Child Form
This form is to be used when a member’s handicapped child reaches age 21, is wholly dependent on the member and is not married.

Insurance (EI) Premiums
If you are an employer who provides your employees with disability coverage for short-term illness or injury, you may be eligible for a reduction in your EI premium rate. Click Here