Benefit Plan Forms

Whether you are making a claim or changing a beneficiary, these are the forms you need for your CMAW Benefit Plan. Click on the appropriate link to download the form. Then print it, fill it out and send it in according to the instructions on the form.

If you cannot find the form you need, contact us and we will send you a copy.

Green Shield Booklet
Outlines your Extended Health and Dental Benefits in greater detail


Short Term Disability Form
Plan Member Guide And Application For Short Term Disability


Attending Physician Statement Form
Attending Physician’s Statement – Short Term Disability Claim


Bereavement Leave Claim Form
Application for Bereavement Leave


Change of Beneficiary Form
Form to designate or change a beneficiary for the Benefit Plan


Bereavement Leave Claim Form
Application for Wage Compensation


Change of Life Insurance Beneficiary
Update the recipient of your life insurance benefit


Dental, Optical, and Hearing Aid Claim Form
Apply for reimbursement for dental, optical, and hearing aid expenses


Application for El Sickness Hour Bank Credits
Application for Hour Bank Assistance


Group Change Form
Change information on your covered dependents


Green Shield Claim Form
Submit a claim to Green Shield foryour health expenses


Release and Authorization Form
To authorize disclosure of personal information


Travel Assistance Benefit
Application for Reimbursement


Application for WCB Hour Bank Credits
Application for Hour Bank Assistance


Long-term Disability Guide and Application
The Co-operators Guide and Application for Long-term Disability


Long-term Disability Physician Statement Form
The Co-operators Physicians Statement Form for Long-term Disability


Long-term Disability Plan Sponsor Statement Form
The Co-operators Plan Sponsor Statement Form for Long-term Disability