Get Group Benefits E-application For Change

Filling out the Group Benefits E-Application For Change online can be a straightforward process when guided step by step. This guide aims to provide you with clear instructions on how to complete each section of the form efficiently.

Follow the steps to successfully complete your application.

1. Click 'Get Form' button to access the application form and open it in the online editor.
2. Provide the general information by entering your plan contract number, plan member certificate number, and the full name of the plan sponsor, which in this case is Uber Canada Inc. Make sure to include the plan administrator's name and phone number, along with your own name as it appears on your certificate.
3. If you are applying for a name change, enter your new name, including your last name, first name, and middle initial.
4. Fill out your address details: include the street number, street name, apartment number (if applicable), city, province, and postal code.
5. Review your benefits. If you wish to add Extended Health Care or Dental Care, select the appropriate option for yourself and any dependants. Indicate the reason for additions, such as marriage or common-law relationship, and provide the effective date.
6. Indicate if evidence of insurability is required and denote any refusals of benefits for Extended Health Care or Dental Care. Record the date of refusal if applicable.
7. For termination of dependant coverage, specify whether you want to terminate coverage for specific dependants or all dependants, and provide the effective date of termination and the reason.
8. If applicable, complete the sections regarding coordination of benefits if you reside in Quebec and provide the necessary details about your spouse's health and dental coverage.
9. If you need to make changes pertaining to dependants, enter their names, date of birth, sex, relationship to you, and whether they are full-time students. Use the designated codes for change type.
10. If you wish to change your beneficiary designation, complete and submit the necessary GL1435E form.
11. If you would like direct deposit for claim payments, fill out the financial institution details including name, address, transit number, and account number.
12. Complete your email address section if you wish to receive online services, and confirm your understanding of the information provided in this application.
13. After filling out all sections, review your entries for accuracy. You may choose to save changes, download, print, or share your completed form.

Start filling out your Group Benefits E-Application For Change online today!