Claim Forms

Below is a listing of Great West Life forms to be used when making a claim for expenses or request for coverage.

  • LTD Income Benefit Employment Statement document

    To download a copy of the LTD Income Benefit Employment Statement document, click the link below.
    Download
    (235KB)

  • Healthcare Expense Claim form

    To download a copy of the Healthcare Expense Claim form, click the link below.
    Download
    (169KB)

  • Group Coverage Change Form

    To download a copy of the Group Coverage Change form, click the link below.
    Download
    (130KB)

  • Dental Claim form

    To download a copy of the Dental Claim form, click the link below.
    Download
    (100KB)

  • Assure Card Claim form

    To download a copy of the Assure Card claim form, click the link below.
    Download
    (254KB)