Want to apply for the ACIBP Hour Bank or Office Plan? Click here to contact us and request a quote for your company. Our expert benefits administrators will be touch to get you started on a plan for you and your business.
If you need to enroll or update an employees information, or other declarations, download the appropriate ACIBP form below. If you have any questions or issues with a form, contact benefits@mycibp.ca for more information.
Hour Bank Forms
Use this form to enrol a new employee to your plan.
Use this form to update a covered employee’s information. Examples: Add new family members, change names, update salary, terminate coverage, etc.
Use this form:
- To designate your beneficiaries for Basic Life/Accidental Death, and/or Optional Life/Optional Accidental Death insurance
- At time of initial enrolment if you want to designate more than 3 primary beneficiaries
- To change your existing beneficiary(ies). The beneficiary(ies) listed here will replace your previous beneficiary designation
To continue coverage on your Extended Health and/or Dental plan beyond age 21 and up to the maximum age on your plan, your child must be:
- Unmarried / not living in a common-law relationship, and-Attending school on a full-time basis, as defined by Canada Revenue Agency, or-Disabled and incapable of sustaining employment – Contact us for instructions.
If your child is about to turn or has recently turned 21, is not married or living in a common-law relationship, and is a full-time student, please complete this Declaration (one per child) and return to us to continue coverage on your plan.
Complete this form to add or continue coverage of a dependent with special needs to your Green Shield Canada coverage.
Office Forms
Use this form to enrol a new employee to your plan.
Use this form to update a covered employee’s information. Examples: Add new family members, change names, update salary, terminate coverage, etc.
Use this form:
- To designate your beneficiaries for Basic Life/Accidental Death, and/or Optional Life/Optional Accidental Death insurance
- At time of initial enrolment if you want to designate more than 3 primary beneficiaries
- To change your existing beneficiary(ies). The beneficiary(ies) listed here will replace your previous beneficiary designation
To continue coverage on your Extended Health and/or Dental plan beyond age 21 and up to the maximum age on your plan, your child must be:
- Unmarried / not living in a common-law relationship, and-Attending school on a full-time basis, as defined by Canada Revenue Agency, or-Disabled and incapable of sustaining employment – Contact us for instructions.
If your child is about to turn or has recently turned 21, is not married or living in a common-law relationship, and is a full-time student, please complete this Declaration (one per child) and return to us to continue coverage on your plan.
Complete this form to add or continue coverage of a dependent with special needs to your Green Shield Canada coverage.