Benefit forms

This page contains forms for the public service group insurance benefit plans: the Public Service Health Care Plan (PSHCP), the Public Service Dental Care Plan (PSDCP), the Pensioners’ Dental Service Plan (PDSP), the Public Service Management Insurance Plan (PSMIP) and the Disability Insurance Plan (DI).

PSHCP

The Public Service Health Care Plan forms are found on the PSHCP Member Services website

List of forms available:

  • Application form for active and retired members
  • Prior Authorization form
  • Claim forms (regular and out-of-country)
  • Veterans Affairs Canada Application and Amendments forms

The PSHCP Relief Provision application form is found on the Public Services and Procurement Canada website.

PSDCP

Here you can access forms for the Public Service Dental Care Plan (PSDCP).

PDSP

Here you can access forms for the Pensioners’ Dental Services Plan (PDSP).

Note: If you are about to retire, you can obtain the Pensioners’ Dental Services Plan (PDSP) form (used to enrol, amend or terminate PDSP coverage) from the Government of Canada Pension Centre. If you are already retired or become entitled to a survivor benefit, you can obtain the PDSP form from the Pension Centre.

PSMIP

Here you can access forms for the Public Service Management Insurance Plan (PSMIP).

DI

The Disability Insurance Plan claim forms below can be found on the Sun Life DI webpage: www.sunlife.ca/DI.

  • Employee’s Statement (490L-M-12500-E)
  • Attending Physician’s Questionnaire (490L-P-12500-GEN-E, 490L-P-12500-MHC-E, or 490L-P-12500-MSK-E)
  • Employer’s Statement (Immediate Supervisor or Manager)(4841-E)
  • Employer’s Statement (Compensation Advisor)(4811-E)

Page details

Date modified: