Manulife forms

The purpose of this form is to obtain the medical information required to assess your request for a drug on the Prior Authorization list under your drug plan benefit coverage.

Use this form to submit extended health care claims to the group benefits plan.

Use this form to submit dental claims to the group benefits plan.

Designation of beneficiaries for Basic life and/or Basic accidental Death. Plus Optional Life and/or Accidental Death.

To inform us about the death of someone who has/may have a policy, product or plan with us, complete this digital form.

Enrolment or re-enrollment application to the group benefits plan.

Designation of beneficiaries for Basic life and/or Basic accidental Death. Plus Optional Life and/or Accidental Death.

Form used to decline coverage under the group benefits plan issued or to be issued

Use this form to request or terminate over-age student dependent coverage.

Use this form to submit extended health care claims to the group benefits plan.

Use this form to submit dental claims to the group benefits plan.

The purpose of this form is to obtain the medical information required to assess your request for a drug on the Prior Authorization list under your drug plan benefit coverage.

Use this form to submit claims to the group benefits plan for physician’s fees and hospital services incurred outside of Canada or outside of your home Province.

Use this form to apply for approval of Brand-Name drug pricing above the lowest cost interchangeable drug price.

Beneficiary designation or direction of payment previously made in respect to the proceeds payable. (AF1320E)

Policyholders wanting to make a name, address or payment information change to their inforce insurance coverage should complete this form. (AF1323E)

Affinity Markets - Collateral Assignment Form (AF1446E)

Use this application if you are applying for reinstatement of coverage; reconsideration of exclusion(s) and/or premium ratings; change to non-smoker rates; addition of rider(s) to Life, Critical Illness or Disability insurance plan(s) (AF1554E)

Application for Change to Non-smoker Rates (AF0272E)

Change of Ownership (AF1445E)

This form is to be completed only if the insurance is subject to the laws of the province of Nova Scotia.

Policyholders wanting to make a name, address or payment information change to their inforce insurance coverage should complete this form.

Use this form to change your smoking status to non-smoker.

Complete this form to add family members to a Manulife Affinity Markets Guaranteed Issue Plan. (AF1436E)

This form contains the application for change to enroll additional family members to an underwritten plan. (AF1437E)

Application to Request benefit downgrade

Application for change to reinstate health and dental coverage (AF1439E)

Use for dependant reaching the maximum age limit outlined in your contract (AF1490E)

Policyholders wanting to make a name, address or payment information change to their inforce insurance coverage should complete this form. (AF1323E)

For reimbursement of health care benefits such as prescription drugs, registered specialists or therapist’s visits, you need to complete this form. (CM5000E)

Complete this form to make a dental claim for a Manulife Affinity Markets plan.

For Small Businesses to be able to advise on the form, all policies that they are going to manage the monthly/semi-annual or Annual premiums for.

The purpose of this form is to obtain the medical information required to assess your request for a drug on the preauthorization list under your drug plan benefit coverage.

The purpose of this form is to obtain the medical information required to assess your request for Medical Equipment and Supplies on the Pre Authorization list under your plan benefit coverage.

Request for Approval of Multi-Source Drug – Drug Essentials Formulary – H&D Individual Insurance | Manulife

For reimbursement of health care benefits such as prescription drugs, registered specialists or therapist’s visits, you need to complete this form.

For reimbursement of dental care expenditures have this form completed by your dentist or dental specialist.

Policyholders wanting to make a name, address or payment information change to their inforce insurance coverage should complete this form.