FORMS

• Group Insurance Forms
• Pension Plan Forms

Here are copies of the forms most commonly used with the health care plan and the pension plan.
Forms designated “FF” can be completed electronically. Please download these forms to your computer and open the form with Adobe Reader (free download).

Group Insurance Forms

• Group Insurance Application – TRIO Comprehensive Plan FF
  

• Group Insurance Application – TRIO Small Town Plan FF
  Use these forms to enrol new participants in a corresponding existing plan

• Sun Life Statement of Health
  Used to provide evidence of insurability for the following:

• • New Enrolment – Effective Date
  • Increased Coverage
  • Late Applicant (enrolled after 31 days)
  • Re-application (previously declined)
  • Annual Enrolment – effective date

• Extended Health Care Claim Form

• Exception/Special Authorization Application Form
  Use this form to apply for special authorization of a prescription drug not covered by your benefit list

• Dental Claim – If your Dentist does not allow assignment of the benefit, you must pay in full and submit a completed Standard Dental Claim Form (available at your Dentist's office) to Sun Life Financial, PO Box 11010, Stn CV, Montreal, QC, H3C 4T9.

  Group Insurance Notice of Change Form FF
  Use this form to amend personal information already on file

• Voluntary AD&D Application form

• Insurance Options of Plan Members on Termination of Group Coverage

• Salary Report Form

• Confirmation of Attendance at Post-Secondary Institution – Dependents 21 years of age
  Use this form to maintain coverage for student dependents who are over 21 and in FULL-TIME attendance at a post-secondary institution.

Pension Plan Forms

• Use these two forms to enrol a new employee into the pension plan:
  Pension Enrolment Form FF
  Spouse or Cohabiting Partner & Beneficiary Designation Form FF

• Use this form to change a spouse, cohabiting partner, or beneficiary designation:
  Spouse or Cohabiting Partner & Beneficiary Designation Form FF

• Use this form to change any personal information on record:
  Notice of Change in Member Information

• Use this form to notify Mercer of a termination of employment, retirement, or death:
  Notice of Change in Member Status FF

• Use the following form to transfer pension credits between the TRIO Pension Plan and the Newfoundland and Labrador Public Service Pension Plan:
  Pension Transfer Application - Part A

• Use the following form to transfer pension credits between two municipalities, both of which are participating employers in the TRIO pension plan
  Pension Transfer Application (Municipal) – Part A