RWAM Group Insurance & Benefits

Clients are welcome to download and print these forms for their use. Please note:

The guidelines regarding submission of forms (e.g. original signatures and/or receipts) remains in effect. Please see your Administration Manual for details.
RWAM offers products through a variety of carriers. Please refer to the provider page of your Employee Benefits Booklet, contact your Plan Administrator, or call RWAM to determine which carrier's form to use and which Travel Assist Plan applies to you.
Forms which are fillable pdfs may be completed electronically, but cannot be submitted online.

Extended Health Care Claim RC001 (42 KB)
Out-of-Province / Out-of-Canada (OOC) Claim (77 KB)
Dental Claim RC004 (34 KB)
Cost Plus / ARB Claim - ON RC005_a (30 KB)
Cost Plus / ARB Claim — SK AB MB & PE RC005_b (30 KB)
Cost Plus / ARB Claim — NL NB NS & BC RC005_c (30 KB)
Attending Physician’s Statement RC027 (30 KB)
Physician’s Statement - Erectile Dysfunction Drugs RC021 (27 KB)
For Claims to be processed through a Health Spending Account Only.
Health Spending Account Claim RC002 (46 KB)
For Claims to be adjusted through an Extended Health Care Plan first with unpaid portions processed through a Health Spending Account Top-Up Plan.
Extended Health Care & Health Spending Account Claim RC020 (41 KB)

Enrolment Form RA002/RA014 (66 KB)
Electronic Deposit of Group Benefit Payments RA014.0 (34 KB)
Report of Employee Transactions RA028 (273 KB)
Student Eligibility RA042 (77 KB)
Student Studying Abroad RA100 (30 KB)
Change in Status/Beneficiary/Name RA077 (35 KB)
Beneficiary Designation/Change RA086 (68 KB)
Supply Request RA088 (18 KB)
RWAM offers products through a variety of carriers. Please refer to the provider page of your Employee Benefits Booklet, contact your Plan Administrator, or call RWAM to determine which carrier's Health Evidence form to use.
Health Evidence - RBC (452 KB)
Health Evidence - RWAM RU035 (114 KB)

For individuals leaving a company who wish to convert their existing Group Life coverage to an Individual Life Insurance Policy. Please refer to the provider page of your Employee Benefits Booklet, contact your Plan Administrator, or call RWAM to determine which carrier's Group Life Insurance Conversion form applies to you.
Group Life Insurance Conversion - Co-operators Contact RWAM directly for a quote.
Group Life Insurance Conversion - RBC (opens in new window)
Group Life Insurance Conversion - La Capitale Contact RWAM directly for a quote.

Please refer to the Out-of-Province/Canada section of your Employee Benefits Booklet, contact your Plan Administrator, or call RWAM to determine which Travel Assist plan applies to you.
Referral Coverage Plans (824 KB)
Non-Referral Coverage Plans (825 KB)
As of May 1st, 2010, all persons entering CUBA must present proof of medical insurance issued by an approved carrier.
Details on Travel Insurance Requirements for Entry into Cuba
Letter Confirming Mondial Assistance as Recognized Carrier in Cuba