General Claim Submission
Complete this form for all general claims. Detailed instructions for eligible expenses are included on the form.
Send the completed form to the appropriate address listed on the form.
Online Claims Submission
Some claims can be submitted online. To find out more, sign in to the Online Group Benefit Solutions service for a full list of eligible expenses.
Note: You can also check your eligibility for some benefits and access pre-populated forms through the Online Group Benefit Solutions service for Plan Members.
Dental Accident Report Form
Send the complete form along with a predetermination or any incurred claims to:
RBC Life Insurance Company
P.O. BOX 1614 Windsor, Ontario N9A 0B9
Please note x-rays are required.
Authorization Form for Prosthetic Appliances and Durable Medical Equipment
Complete this authorization form to request prior approval of claims for prosthetics.
*Please note that the details requested on this form are mandatory and that a claim may be denied without prior authorization.
Mail the completed form to:
RBC Life Insurance Company
Attention: EHS Department
P.O. Box 1610
Windsor, Ontario
N9A 0B7
After reviewing your request, we will send you a response letter outlining your eligibility as soon as possible.
Note: This form is available, pre-filled with your personal details, within our Online Group Benefit Solutions service for Plan Members.
Authorization Form for Post-Cataract Surgery and Prosthetic Eye Wear
Complete this authorization form to request prior approval of claims for post-cataract surgery and prosthetic eye wear.
*Please note that a claim may be denied without prior authorization.
Mail the completed form to:
RBC Life Insurance Company
P.O. Box 1603
Windsor, Ontario
N9A 0B6
Authorization Form for Oxygen Equipment and Supplies
Complete this authorization form to request prior approval of claims for oxygen equipment and supplies.
*Please note that a claim may be denied without prior authorization.
Mail the completed form to:
RBC Life Insurance Company
Attention: EHS Department
P.O. Box 1610
Windsor, Ontario
N9A 0B7
Note: This form is available, pre-filled with your personal details, within our Online Group Benefit Solutions service for Plan Members.
Authorization Form for In-Home Support Services of an RN RNA
NOTE: To open this PDF, you will need to copy the PDF link and paste it into the Open File dialogue box in Adobe.
Complete this authorization form to request prior approval of claims for in-home support services.
*Please note that the details requested on this form are mandatory and that a claim may be denied without prior authorization.
Mail the completed form to:
RBC Life Insurance Company
Attention: EHS Department
P.O. Box 1613
Windsor, Ontario
N9A 0B6
Fax: 1-855-612-3031
Authorization Form for Custom Braces
Complete this authorization form to request prior approval of claims for custom braces.
*Please note that the details requested on this form are mandatory and that a claim may be denied without prior authorization.
Mail the completed form to:
RBC Life Insurance Company
Attention: EHS Department
P.O. Box 1610
Windsor, Ontario
N9A 0B7
After reviewing your request, we will send you a response letter outlining your eligibility as soon as possible.
Note: This form is available, pre-filled with your personal details, within our Online Group Benefit Solutions service for Plan Members.
