Administrator Forms

Enrollment Form

Use this form to enrol your employees and their dependents in your company's group benefits plan. To be eligible, an employee must be in an eligible class, work the minimum hours per week, have completed the waiting period (if applicable), and be "actively at work" on the eligibility date.

If an employee enrols in the benefits plan more than 31 days after becoming eligible, he / she will be treated as a late applicant. An employee who is considered a late applicant must provide satisfactory medical evidence of insurability to the insurer and be formally approved prior to becoming eligible for coverage. Some limitations / restrictions will apply.

Change Form

Use the change form to report employee changes, including:

  • change of salary
  • change of position
  • transfer between classes and / or divisions
  • leave of absence for more than 31 days
  • disability
  • termination of employment, including retirement

And changes due to life events, including:

  • addition of spouse and/or dependent child(ren) due to marriage, including common-law, or birth of a child
  • deletion of spouse and/or dependent child(ren) due to legal separation, or divorce
  • death of employee, spouse or dependent child
  • dependent child becoming overage as per your policy
  • spouse gains benefits coverage, or spouse loses benefits coverage
  • home address change

Optional Life Insurance

Additional Life Insurance coverage is available for employee and their spouse, to supplement the amount of insurance provided under the Basic Life insurance plan. Use this form to apply for Optional Life Insurance.

Optional Accidental Death and Disablement Insurance

Employees may wish to add an additional layer of protection to the group benefits package with optional accidental death & dismemberment (AD&D) coverage. Use this form to apply for optional group AD&D insurance.

Evidence of Insurability

Use this form whenever evidence of insurability is requested by your group insurance carrier.

Pre-Authorized Debit

Clients are welcome to set up premium and other payments payable to Johnstone's directly from their financial institution by completing this form.

Tips for
Administrator Forms

Click on the form title to expand the section of the form.

Then, select the listed form name to link to the actual electronic form or the forms directory on the insurer's website.

Each form will have specific instruction on how to complete the  form.

Contact Johnstone's Benefits if you require further information or guidance, if you are unable to access the required form, or if the desired form is not listed.