Form and Paperwork Requirements

 

 

Stop Loss / Travel Medical - In-Province Claim Form

Stop Loss / Travel Medical - Claim Consent Form

Out of Country - Stop Loss / Travel Medical Claim Form

 

 

In order to apply for a FlexSave™ plan, the following forms need to be completed in full and submitted to the following address:

Attn: FlexSave™ Division
3700 Steeles Avenue West, 10th Floor
Woodbridge, Ontario L4L 8M9

 

Set up Forms


REQUIRED

 

1. FlexSave™ Trust Application Form 

1b. Credit Card Payment Form (To accompany Trust Application if paying Set Up Fee by credit card)
 
2.
Employee Enrollment Form 
- each employee must complete which includes the business owner/sole proprietor

 

OPTIONAL

3. Pre-authorized debit 
- for companies that wish to pre-fund their FlexSave™ plan on a monthly basis

 

4. Stop-Loss/Travel Medical Form
- each applicable employee must complete along with business owner

5. Pre-authorized debit for Stop Loss monthly premium 
- for companies that wish to pay stop/loss insurance on a monthly basis

6. Request for Direct Deposit (EFT) 

 

Administration Forms

 

1. Employee Termination 
- Complete this form to remove an employee from the FlexSave™ plan

2. Employee/Company Changes 
- Complete this form to make any changes to the company or an individual employee

3. Wellness Plan Application
- For existing FlexSave™ clients to add a Wellness Plan to their account.
 


In order to submit a claim, please fill out the appropriate claim form on-line, print, sign, attach your receipts and submit to:


 

Attn: FlexSave™ Division
3700 Steeles Avenue West, 10th Floor
Woodbridge, Ontario L4L 8M9


 

Claim Form (British Columbia only)

Claim Form (Alberta, Saskatchewan, Manitoba)

Claim Form (Ontario only)

Claim Form (Quebec only)

Claim Form (Atlantic Canada)