Get Lifestyle Coverage/change Form - Unigroup

Navigating the LIFESTYLE COVERAGE/CHANGE FORM is essential for maintaining accurate benefits enrollment. This guide provides clear steps to assist you in completing the form accurately and efficiently.

Follow the steps to fill out your LIFESTYLE COVERAGE/CHANGE FORM effectively.

1. Click ‘Get Form’ button to obtain the form and open it in the document editor.
2. Complete the General Information section, including your employer’s name, policy number, your full name, and the provinces of residence and employment.
3. If applicable, fill out the Reinstatement section by indicating the Date of Return to Work and selecting the reason for your reinstatement.
4. In the Refusal of Benefits section, specify any health, dental, or vision coverage you wish to decline based on having duplicate coverage.
5. If you are applying for the Addition of Benefits due to loss of spousal coverage, complete the Effective Date of Loss of Coverage and the related benefits.
6. In the Dependent Information section, update any details about dependents you are adding or deleting. Make sure to provide effective dates and reasons for changes.
7. For any beneficiaries, complete the Beneficiary Designation Changes, ensuring to provide names, dates of birth, relationship, and allocation percentages.
8. If opting out of all group benefits, specify that decision and provide your effective date by signing.
9. Finally, review all provided information for completeness and accuracy, then save changes. You can also download, print, or share the completed form.

Complete your form online and ensure your benefits are accurately represented.