Forms and guides that will help employers administer their insurance policy.
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Basic AD&D Insurance Monthly Premium Statement
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On a monthly basis, the plan administrator will need to complete a statement for self-administered plans detailing the activity on the group.
Form Number: 20101 |
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Beneficiary Designation Card
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Employees purchasing life insurance are required to provide RBC Insurance with a beneficiary designation card to keep on file with the insurance plan. This is only necessary if you have not completed an Enrollment Card.
Form Number: 13049 |
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Calculating an Employee's Monthly LTD Premium Amount
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Follow the instructions on this worksheet to calculate an employee's monthly volume and premium for long term disability insurance with a flat percentage.
Form Number: 13010 |
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Calculating an Employee's Monthly LTD Split Premium Amount
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Follow the instructions on this worksheet to calculate an employee's monthly split volume and premium for long term disability insurance.
Form Number: 13012 |
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Confirmation of Appointment of Third Party Administrator (TPA)
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As a policyholder, if you are appointing a TPA you must fill out this form with the TPA's name, policy number, and other relevant information.
Form Number: 13033B |
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Election of Portability Coverage - Voluntary Group Term Life Insurance
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If an employee has recently been terminated, they may be eligible to apply for conversion and become insured under the Group Voluntary Life Portability Policy. Learn about this benefit and how to apply.
Form Number: 13094 |
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Employee Data Listing
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A grid that plan administrators can use to submit employee information at time of issue or renewal
Form Number: 13082 |
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Evidence of Insurability Form
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Both the employee and the plan administrator must fill out this approval form for reasons specified within the insurance contract(s).
Form Number: 13074 |
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Group Enrollment Card
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To enrol in group insurance, the employee and employer must fill out this card and return it to RBC Insurance.
Form Number: 13006 |
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Group LTD Conversion Facts
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If your plan has a conversion option and an employee who has been covered for long term disability benefits under a group long term disability plan for at least 12 months, has recently terminated employment, that employee may be eligible to apply for conversion and become insured under the Group LTD Conversion Policy. Learn about its benefits and how to apply.
Form Number: 13079-1 |
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Group Request for Change
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Both the employer and the employee must complete this form if the employee's name has changed, they wish to change their beneficiary information, or the number of dependents has changed. If adding a dependent through marriage or birth, we must receive this form within 31 days of the event.
Form Number: 13017 |
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Life Conversion Application
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If an employee has recently been terminated or their life coverage was reduced, they may be eligible to apply for conversion and become insured under the Group Life Conversion Policy. Learn about its benefits and how to apply.
Form Number: 13086 |
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Monthly Group Premium Statement
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On a monthly basis, the plan administrator will need to complete a statement for self-administered plans detailing the activity on the group.
Form Number: 13092 |
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Plan Administrator Guide to the Guarantee Standard
Issue® (GSI®)
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Download this guide if your company has purchased GSI and, as the plan administrator, you wish to learn more about the administration of the plan.
Form Number: 83556 |
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Plan Administrator's Guide Integrated
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Download this guide if your company has purchased a combination of group insurance and GSI and, as the plan administrator, you wish to learn more about the administration of the plan.
Form Number: 83588 |
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Plan Administrator's Guide List Bill
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Download this guide if your company has purchased Group Insurance and, as the plan administrator, you wish to learn more about the administration of your list billed plan.
Form Number: 83572 |
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Plan Administrator's Guide Self-Administered
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Download this guide if your company has purchased group insurance and, as the plan administrator, you wish to learn more about the administration of your self-administered plan.
Form Number: 83592 |
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Plan Administration Made Easy: Key Points
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A list of key points and key contact numbers for plan administrators when enrolling employees or making member changes.
Form Number: 13081B |
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Refusal of Coverage Form
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Both the employer and employee must complete this form if the employee does not wish to enrol in short and/or long term disability coverage offered under their employer's non-mandatory plan.
Form Number: 13026 |
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Request for Group Insurance Supplies
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As plan administrator, complete and forward this form to your local RBC Insurance® regional office to order application forms for group insurance, You'll need to know the application form numbers and quantities needed.
Form Number: 13008 |
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Social Insurance Number Authorization Card
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If the employer chooses to use social insurance numbers for identification purposes, employees must provide us with authorization to use their social insurance number and keep it on file as part of the insurance plan.
Form Number: 13066 |
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Status Change Form
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Employers must complete this form to report a change in status of an employee. Changes include termination, salary increase/decrease, insurance class, and account number/billing division.
Form Number: 13015B |
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Trustee Designation Card
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Employees must fill out and sign this card in order to appoint a trustee for a minor beneficiary.
Form Number: 13090B |
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Voluntary Accident Insurance Enrollment Form
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To enrol in group voluntary AD&D insurance, the employee and employer must complete this card and return it to RBC Insurance.
Form Number: 20103 |
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Voluntary AD&D Insurance Monthly Premium Statement
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On a monthly basis, the plan administrator will need to complete a statement for self-administered plans detailing the activity on the group.
Form Number: 20105 |
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