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.