Employee Benefits Administration Forms

	Application for Group Insurance - Life and Health Program A		Overage Disabled Dependent
	Application for Group Insurance - Life and Health Program B		Refusal of All Coverage
	Evidence of Insurability		Refusal of All Family Coverage
	Application for Change Form		Refusal of Spousal/Common-Law Coverage
	Employee Enrollment Form		Employee Enrollment Form - Flex Plan
	Request for Over-Age Dependent Coverage		Optional Benefits Enrollment Form - Flex Plan

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Please send completed forms to HED Insurance and Risk Services:

In Quebec
HED Courtier en Assurance Inc.
1200 Boul. Chomedey, Bureau 620
Laval, Quebec H7V 3Z3

Rest of Canada
HED Insurance and Risk Services
777 Portage Avenue
Winnipeg, MB R3G 0N3

HED is always looking for new ways to serve our clients better, and we encourage suggestions from our plan members, because we understand that the customer is the most important element of any business