Western Life Group Enrollment & Administration Forms
Western Life Forms
- Application for Excess Group Insurance (WLA-1393)
- BeneShield Request for Quote (WLAG2000)
- BeneShield New Group Application (WLAG2100)
- Enrollment or Change Form (WLA-1240)
- Enrollment or Change Form - CWEDA (WLA-1240 CWEDA)
- Evidence of Insurability for Group Health (WLA-1202)
- Group – Monthly Payment Option Form
Green Shield Canada Forms
The following forms can be obtained from the Green Shield Canada web site.
http://www.greenshield.ca/English/PlanMembers/Forms/
- Drug Claim Submission
- Extended Health Services (EHS) Claim Submission Form
- General Claim Submission Form
- Dental Claim Submission Form
- Audio Claim Form
- Authorization Form for Custom Braces
- Authorization Form for Post-Cataract Surgery and Prosthetic
- Eyewear
- Authorization Form for Prosthetic/Orthotic Devices/MedicalEquipment/Oxygen
- Claim Form for Medical Devices
- Claim Form for the Services of an R.N., R.N.A., R.P.N., P.N.A., or L.P.N., Personal Support Worker
- Custom Foot Orthotics Claim Form
- Vision Claim Form