Scheduled Maintenance - Saturday August 24, 2019
The Empire Life websites will be unavailable from 12:00 pm to 7:00 pm ET Saturday 24 August 2019 for scheduled system maintenance. 

Main Content
Please select a group forms category
Favourite Form Name Download
Favourite Accidental Dental Form Download
Favourite GH-0054-EN Attending Physician's Statement - Short Term Disability Claim Download
Favourite G-0058-EN Attending Physician's Statement, Long Term Disability (LTD) Download
Favourite G-0019-EN Claimants Statement For Disability Benefits Download
Favourite GHD-03MD-EN Dental Claim Form Download
Favourite GB-0042-EN Disabled Child Dependant Form Download
Favourite G-0006-EN Extended Health Benefit & Health Care Spending Account Claim Form Download
Favourite GH-05MD-EN Extended Health Claim Form Download
Favourite G-0444-EN Group Application for Optional Benefits Download
Favourite G-0033-EN Group Change Form (Insured Employee) Download
Favourite GB-0005-EN Group Dependant Children Health Information Download
Favourite GB-0004-EN Group Employee Health Information Download
Favourite GLB-0055-EN Group Life and Accidental Death Insurance Claim Form Download
Favourite GRP-1112-EN Group Spouse Health Information Download
Favourite G-0062-EN Maternity/Paternity Leave Temporary Refusal of Benefits Form Download
Favourite Prior Authorization Drug Program List of Special Authorization Drugs Download
Favourite Prior Authorization Request Form Download
Favourite Request for Drug Substitution Download
Favourite Request for Overage Dependant Students Coverage Form Download
Favourite GH-0053-EN Weekly Indemnity (Short Term Disability) Claim Form - Employee's Statement Download
Favourite GH-0052-EN Weekly Indemnity (Short Term Disability) Claim Form - Employer's Statement Download
Favourite Form Name Download
Favourite G-0401-EN Application for Conversion of Group Life Coverage and Highlights Download
Favourite GH-0054-EN Attending Physician's Statement - Short Term Disability Claim Download
Favourite G-0058-EN Attending Physician's Statement, Long Term Disability (LTD) Download
Favourite G-0019-EN Claimants Statement For Disability Benefits Download
Favourite G-0061-EN Cost Plus Benefit Calculation Form Download
Favourite GHD-03MD-EN Dental Claim Form Download
Favourite G-0083-EN Disability Management Services - FAB Download
Favourite G-0082-EN Disability Management Services - Focus on Health Outcomes Download
Favourite GB-0042-EN Disabled Child Dependant Form Download
Favourite GB-0002-EN Employer's Statement - Group Long Term Disability Claim and/or Life Waiver of Premium Claim Download
Favourite GH-05MD-EN Extended Health Claim Form Download
Favourite G-0444-EN Group Application for Optional Benefits Download
Favourite G-0033-EN Group Change Form (Insured Employee) Download
Favourite G-0008-EN Group Change Form Plan Administrator Changes Download
Favourite GB-0005-EN Group Dependant Children Health Information Download
Favourite GB-0004-EN Group Employee Health Information Download
Favourite GB-0040-EN Group Enrolment Form Download
Favourite GLB-0055-EN Group Life and Accidental Death Insurance Claim Form Download
Favourite GRP-1112-EN Group Spouse Health Information Download
Favourite G-0062-EN Maternity/Paternity Leave Temporary Refusal of Benefits Form Download
Favourite G-0032-EN PAD authorization - Pre-Authorized Debit (PAD) Download
Favourite Plan Administrator Website Registration Download
Favourite Prior Authorization Drug Program List of Special Authorization Drugs Download
Favourite Prior Authorization Request Form Download
Favourite Request for Drug Substitution Download
Favourite Request for Overage Dependant Students Coverage Form Download
Favourite GH-0053-EN Weekly Indemnity (Short Term Disability) Claim Form - Employee's Statement Download
Favourite GH-0052-EN Weekly Indemnity (Short Term Disability) Claim Form - Employer's Statement Download
Favourite Form Name Download
Favourite G-0001-EN 20Plus Application For Group Insurance With The Empire Life Insurance Company Download
Favourite Application for AssistNow Employee Assistance Plan (EAP) Download
Favourite G-0401-EN Application for Conversion of Group Life Coverage and Highlights Download
Favourite BEN-0015-EN BeneFit Application For Group Insurance Download
Favourite G-0061-EN Cost Plus Benefit Calculation Form Download
Favourite GHD-03MD-EN Dental Claim Form Download
Favourite B-0002-EN Direct Deposit Request Form Download
Favourite G-0083-EN Disability Management Services - FAB Download
Favourite G-0082-EN Disability Management Services - Focus on Health Outcomes Download
Favourite G-0004-EN Empire Life Pay-Direct Drug Plan Download
Favourite G-0006-EN Extended Health Benefit & Health Care Spending Account Claim Form Download
Favourite GH-05MD-EN Extended Health Claim Form Download
Favourite Group Advisor Information Form Download
Favourite PROD-001-EN Group Advisor Website Registration Download
Favourite G-0444-EN Group Application for Optional Benefits Download
Favourite GB-0005-EN Group Dependant Children Health Information Download
Favourite GB-0004-EN Group Employee Health Information Download
Favourite GB-0040-EN Group Enrolment Form Download
Favourite GRP-1112-EN Group Spouse Health Information Download
Favourite Mobile Solution to Manage your Benefits - Employee Letter Download
Favourite G-0032-EN PAD authorization - Pre-Authorized Debit (PAD) Download
Favourite Plan Administrator Website Registration Download
Favourite Prior Authorization Drug Program List of Special Authorization Drugs Download
Favourite Prior Authorization Request Form Download
Favourite Request for Drug Substitution Download