Employee Benefit Plans
EBP Documents and Forms
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Use the table below to find the form you need. You can sort alphabetically by name, by plan type, by plan category, or you can simply search for what you need in the search field below.
| Name | Annotation | Plan Type | Plan Document Type Label | Plan Category. | Plan Category Label | Release date | Audience | Weighting | |
|---|---|---|---|---|---|---|---|---|---|
| Employee Benefits Dependent Change Form | This form is used to update information about your spouse and dependent children with 3sHealth Employee Benefits. If you wish to change your beneficiary for Group Life Insurance please call a 3sHealth Benefit Services Officer at 1-866-278-2301. | Form | 2021-04-04 | Administrator,Employee | 100 | ||||
| Health Care Claim Form | The Health Care Claim Form allows members to submit health care related expenses to Great-West Life for the Extended Health Care Plan. This form can be completed online and then printed, signed and mailed to Great-West Life for processing. |
Form | Extended Health Care (in-scope), Extended Health Care (out-of-scope) | 2020-07-07 | Employee | 90 | |||
| Standard Dental Claim Form | The Great-West Life Standard Dental Claim form allows members to submit dental claim expenses to Great-West Life for the Core Dental and Enhanced Dental Plans. This form can be completed online and then printed, signed and mailed to Great-West Life for processing. | Form | Core Dental | 2020-07-07 | Employee | 80 | |||
| Out-of-Scope Lifestyles Spending Account Claim Form | The Lifestyles Spending Account (LSA) Claim Form can be used by eligible employees to submit their eligible expenses to 3sHealth for adjudication. | Form | Flexible Spending Account | 2021-02-24 | Administrator,Employee | 70 | |||
| Out-of-Scope Plan Member Health Care Expenses Claim Form | The Out-of-Scope Plan Member Health Care Expenses Claim Form is used by Out-of-Scope employees to submit health care spending account expenses to Canada Life. This form can be completed online and then printed, signed and mailed to Canada Life for processing. | Form | Flexible Spending Account | 2020-07-07 | Employee | 60 | |||
| Out-of-Scope Healthcare Spending Account Claim Form Standard Dental Expenses | Out-of-Scope Standard Dental Expenses Healthcare Spending Account Claim Form M445D (335663HC) | Form | Flexible Spending Account | 2020-07-07 | Administrator,Employee | 50 | |||
| About the Dental Plans | Information on 3sHealth Core Dental Plan and Enhanced Dental Plan for both in-scope and out-of-scope employees. For more specific information, refer to either the Core Dental Plan Commentary or the Enhanced Dental Plan Commentary or contact your employer. | Overview | Core Dental, Enhanced Dental | 2012-11-09 | Administrator,Employee | 0 | |||
| About the Disability Income Plans | Information on the four separate disability income plans that 3sHealth administers for CUPE, SEIU, SUN and the General Plan. The plans provide wage-loss insurance due to a disability. Specific information on each plan can be found on this web site or in hard copy from your employer. | Overview | Disability Income Plan | 2018-11-21 | Administrator,Employee | 0 | |||
| About the Extended Health Care Plans | Information on the Extended Health Care Plan for eligible in-scope (unionized) and out-of-scope health care employees of participating employers. The plans provide medical, hospital and vision coverage. To obtain specific information, contact your employer. | Overview | Extended Health Care (in-scope), Extended Health Care (out-of-scope) | 2012-11-09 | Administrator,Employee | 0 | |||
| About the Group Life Plan | This page provides general information on 3sHealth's Group Life Plan. The plan offers four types of insurance: Basic Life, Basic Accidental Death Dismemberment Insurance and Dependent Life Insurance; Optional Life Insurance; and Voluntary Accidental Death & Dismemberment Insurance. More information on the plan can be found online in the plan commentary. A commentary can also be obtained from your employer. | Overview | Group Life | 2021-04-07 | Administrator,Employee | 0 | |||
| About the Health and Dental Plan for Retirees | This document contains information about the Health and Dental Plan for Retirees with Group Medical Services (GMS). For more information visit the GMS website. |
Other | Core Dental, Extended Health Care (in-scope), Extended Health Care (out-of-scope), Retiree Plan | 2021-06-29 | Administrator,Employee | 0 | |||
| About the Saskatchewan Drug Plan | This overview provides information about the Saskatchewan health services Special Support Program and eligibility changes to the Seniors' Drug Plan. |
Overview | Extended Health Care (in-scope), Extended Health Care (out-of-scope), Other | 2018-11-22 | Employee | 0 | |||
| About the Shepell EFAP Care Access Centre | Information sheet providing an overview of the Care Access Centre services provided by Shepell, Employee Family Assistance Program provider. | Overview | Employee Family Assistance Program | 2015-10-01 | Employee | 0 | |||
| Banking Information Form | The Great-West Life Banking Information Form can be used by employees who wish to have their claim reimbursements direct deposited to their bank accounts. | Form | Core Dental, Enhanced Dental, Extended Health Care (in-scope), Extended Health Care (out-of-scope) | 2012-08-16 | Employee | 0 | |||
| Benefits Bulletin: New GroupNet Mobile App | Great-West Life has launched their new GroupNet mobile app. | Bulletin | Core Dental, Enhanced Dental, Extended Health Care (in-scope), Extended Health Care (out-of-scope) | 2019-06-26 | Administrator,Employee | 0 | |||
| Core Dental Survivor Benefits Commentary | 3sHealth Core Dental Plan Survivor Benefits Commentary. | Commentary | Core Dental | 2019-06-03 | Administrator,Employee | 0 | |||
| CUPE Long-term Disability Plan Commentary | This Commentary provides members who are affiliated with the Canadian Union of Public Employees (CUPE) with information related to the 3sHealth CUPE Disability Income Plan. | Commentary | Disability Income Plan | 2020-06-15 | Administrator,Employee | 0 | |||
| Dependent Verification Form |
The Dependent Verification Form can be used to make changes to your dependent child information. |
Core Dental, Disability Income Plan, Enhanced Dental, Extended Health Care (in-scope), Extended Health Care (out-of-scope), Flexible Spending Account, Group Life | 2018-11-22 | Administrator,Employee | 0 | ||||
| Disability Income Plan Application at a Glance | This brochure is designed to provide detailed information to help you complete an initial application for Disability Income Plan benefits. | Form | Disability Income Plan | 2020-04-24 | Employee | 0 | |||
| Attending Physician's Initial Statement Form | The Initial Application Attending Physicians Form is designed for physicians so that they can provide 3sHealth with information regarding an employee's medical condition. This is required when reviewing a claim. Employees must complete the section titled "Patient Authorization" which authorizes the physician and medical practitioners to release health information to 3sHealth. | Form | Disability Income Plan | 2020-06-25 | Administrator,Employee | 0 | |||
| Employee's Initial Application Form | This is the Initial Application Form members can use to apply for Disability Income Plan benefits. | Form | Disability Income Plan | 2019-12-06 | Employee | 0 | |||
| Disability Income Plan Frequently Asked Questions | The brochure provides information about the Disability Income Plan claims process including some frequently asked questions. More information can be found here. | Other | Disability Income Plan | 2018-11-22 | Employee | 0 | |||
| Disability Income Plan Opting Out Information | The Disability Income Plan Opting Out Pamphlet/Information Sheet can be provided to employees who are eligible to opt-out of the CUPE, SEIU, SUN or General Disability Income Plans. The Pamphlet/Information Sheet provides details that can assist the employee in making their decision on whether to opt-out or not. | Disability Income Plan | 2013-01-03 | Administrator,Employee | 0 | ||||
| Disability Income Plan Opting Out of Disability Income Plan Form | The 3sHealth Disability Income Plan Opting Out form can be used by CUPE, SEIU, SUN and General members who have retired and were rehired and wish to take advantage of the one-time opportunity to relinquish claims to coverage and benefits under the 3sHealth Disability Income Plan. Other plan provisions may apply. | Form | Disability Income Plan | 2017-01-17 | Administrator,Employee | 0 | |||
| Disability Income Plan Your Right to a Review Pamphlet | The 3sHealth Disability Income Plan Your Right to Review Pamphlet provides members with information regarding the appeal process for terminated or denied disability claims. | Other | Disability Income Plan | 2012-08-09 | Administrator,Employee | 0 | |||
| Extended Health Care Plans and Prescription Drugs Frequently Asked Questions | Information regarding the types of prescription drugs covered and the procedure for submitting claims. |
Other | Other | 2015-08-31 | Administrator,Employee | 0 | |||
| Extended Health Out-of-Country and Province Form | The Out of Country/Province and Authorization form can be used by employees to submit expenses that were incurred while they were out of the country or province for a duration of time. | Form | Enhanced Dental, Extended Health Care (out-of-scope) | 2012-08-16 | Employee | 0 | |||
| General Long-term Disability Plan Commentary | This Commentary provides employees affiliated with the General Plan with information related to the 3sHealth General Disability Income Plan. | Commentary | Disability Income Plan | 2020-06-15 | Administrator,Employee | 0 | |||
| GMS Retiree Benefits Plan Booklet | The purpose of this booklet is to summarize the main provisions of the Group Medical Services (GMS) master group policy for Retirees of the 3sHealth Dental and Health Plans. | Commentary | Retiree Plan | 2021-06-24 | Employee | 0 | |||
| GMS Retiree Benefits Plan Brochure | The purpose of the Group Medical Services (GMS) Retiree Benefits Program Brochure is to provide Retirees of the 3sHealth Dental and Health policies with general information on the GMS Retiree Plan.
|
Form | Retiree Plan | 2019-07-16 | Administrator,Employee | 0 | |||
| Group Life Beneficiary Designation Form |
The Beneficiary Designation Form allows members to update their Beneficiary Designation for the 3sHealth Group Life Plan. |
Group Life | 2018-07-19 | Administrator,Employee | 0 | ||||
| Group Life Conversion Member Fact Sheet | The Great-West Life Conversion Fact Sheet provides employees with information regarding converting their existing Group Life insurance. | Form | Group Life | 2016-12-06 | Administrator,Employee | 0 | |||
| Group Life Conversion Privilege Notification Form | The Group Life Conversion Privilege Notification Form allows employees/retirees the option to convert their Group Life Plan to an individual life insurance policy. | Form | Group Life | 2019-07-16 | Administrator,Employee | 0 | |||
| Group Life Designating a Beneficiary Brochure | Commonly asked questions regarding beneficiary designations in your Group Life Plan.
|
Form | Group Life | 2016-07-14 | Administrator,Employee | 0 | |||
| Group Life Insurance Plan Commentary | 3sHealth Group Life Plan Commentary | Commentary | Group Life | 2021-02-22 | Administrator,Employee | 0 | |||
| Group Life Options Upon Termination or Retirement Frequently Asked Questions | Questions and answers regarding Group Life insurance options upon termination or retirement. | Other | Group Life | 2016-06-23 | Employee | 0 | |||
| GroupLife Waiver basic information form for non-3sHealth plans | The Group Life Waiver Basic Information Form for non-3sHealth LTD Plans form is used by employers submitting application for Group Life Waiver for their plan members. |
Form | Disability Income Plan | 2019-03-19 | Employee | 0 | |||
| In-Scope Extended Health Care and Enhanced Dental Plan Commentary | Commentary | Enhanced Dental, Extended Health Care (in-scope) | 2020-02-28 | Administrator,Employee | 0 | ||||
| In-Scope Extended Health Care and Enhanced Dental Plan Survivor Benefits Commentary | 3sHealth In-Scope Extended Health Care and Enhanced Dental Plan Survivor Benefits Commentary. | Commentary | Enhanced Dental, Extended Health Care (in-scope) | 2020-11-13 | Administrator,Employee | 0 | |||
| Leave of Absence Maintaining DIP and Optional Group Life Coverage Form | The 3sHealth Leave of Absence form is designed for members who are taking a leave of absence of greater than 30 days. It allows members to elect
whether or not they will continue their Disability Income Plan and/or Group Llife coverage while on an approved leave of absence (subject to the provisions
of the applicable plans).
|
Form | Disability Income Plan, Group Life | 2018-11-22 | Employee | 0 | |||
| Leaves of Absence Frequently Asked Questions | Questions and answers regarding leaves of absences. | Other | Disability Income Plan, Extended Health Care (in-scope), Extended Health Care (out-of-scope), Group Life, Other | 2012-11-27 | Employee | 0 | |||
| Maximum Reimbursement Schedule Core Dental Plan - 2021 | The Core Dental Maximum Reimbursement Schedule lists all the codes and the maximum fee amount payable for each eligible procedures. | Schedule | Core Dental | 2020-01-14 | Administrator,Employee | 0 | |||
| Maximum Reimbursement Schedule Enhanced Dental Plan - 2021 | The Enhanced Dental Maximum Reimbursement Schedule lists all the codes and the maximum fee amount payable for each eligible procedures. |
Schedule | Enhanced Dental | 2020-01-14 | Administrator,Employee | 0 | |||
| NPO Employee Changing Information Form | The Employee Changing Information Form is used by employees of non-payroll organizations who need to make changes to their spouse, dependents, name, group life options and beneficiary designations. | Form | Core Dental, Disability Income Plan, Enhanced Dental, Extended Health Care (in-scope), Extended Health Care (out-of-scope), Group Life | 2018-09-05 | Administrator,Employee | 0 | |||
| Out-of-Scope Flexible Spending Plan Account Selection Form | The Flexible Spending Account, Initial Account Selection Form is used by employees who are newly eligible for the Flexible Spending Account to allocate their credits for the first time. | Form | Flexible Spending Account | 2018-05-14 | Administrator,Employee | 0 | |||
| Out-of-Scope Flexible Spending Plan Commentary 2021 | 3sHealth Out-of-Scope Flexible Spending Plan Commentary January 2021 | Commentary | Flexible Spending Account | 2020-12-31 | Employee | 0 | |||
| Out-of-Scope Lifestyles Spending Account Eligible and Ineligible Expenses | The Lifestyles Spending Account Eligible and Ineligible Expenses Pamphlet lists some examples of the types of expenses under the LSA Plan that are eligible or ineligible. The eligible and ineligible expenses listed are examples only. All claims will be adjudicated and 3sHealth reserves the right to determine the eligibility of any claims submitted. | Other | Flexible Spending Account | 2018-02-09 | Employee | 0 | |||
| Out-of-Scope Extended Health Care and Enhanced Dental Plan Commentary | The Out-of-Scope Extended Health Care and Enhanced Dental Plan Commentary provides plan eligibility rules, information regarding covered items and how
to submit claims.
|
Commentary | Enhanced Dental, Extended Health Care (out-of-scope) | 2020-02-28 | Administrator,Employee | 0 | |||
| Out-of-Scope Extended Health Care and Enhanced Dental Plan Survivor Benefits Commentary | 3sHealth Out-of-Scope Extended Health Care and Enhanced Dental Plan Survivor Benefits Commentary. | Commentary | Enhanced Dental, Extended Health Care (out-of-scope) | 2020-11-13 | Administrator,Employee | 0 | |||
| Q-A for Employees group life waiver of premium benefit for non3shealth LTD claimants | The 3sHealth Disability Income Plan Q&A for employees - Group Life Waiver of Premium Benefit for Non-3sHealth LTD Claimants provides plan members with information regarding the Group Life Waiver process |
Other | Disability Income Plan | 2019-03-19 | Administrator,Employee | 0 | |||
| SEIU-West Long-term Disability Plan Commentary | This Commentary provides members who are affiliated with the Service Employees International Union (SEIU) with information related to the 3sHealth SEIU Disability Income Plan. | Commentary | Disability Income Plan | 2020-06-15 | Administrator,Employee | 0 | |||
| Shepell Confidentiality Fact Sheet | Information sheet on confidentiality practices at Shepell, Employee Family Assistance Program provider. | Other | EFAP | Employee Family Assistance Program | 2015-10-01 | Employee | 0 | ||
| Shepell E-Counselling Fact Sheet | Information sheet on e-counselling services provided by Shepell, Employee Family Assistance Program provider. | Other | EFAP | Employee Family Assistance Program | 2015-10-01 | Employee | 0 | ||
| Shepell EFAP Brochure | General brochure on services provided by Shepell, Employee Family Assistance Program provider. |
Overview | Employee Family Assistance Program | 2015-10-01 | Employee | 0 | |||
| Shepell EFAP FAQ | Frequently asked questions about services provided by Shepell, Employee Family Assistance Program provider. | Other | EFAP | Employee Family Assistance Program | 2015-10-01 | Employee | 0 | ||
| Shepell Family Support Services Fact Sheet | Information sheet on family support services provided by Shepell, Employee Family Assistance Program provider. | Other | Employee Family Assistance Program | 2015-10-01 | Employee | 0 | |||
| Shepell Financial Support Fact Sheet | Information sheet on financial support services provided by Shepell, Employee Family Assistance Program provider. | Other | Employee Family Assistance Program | 2015-10-01 | Employee | 0 | |||
| Shepell First Chat Fact Sheet | Information sheet on First Chat services provided by Shepell, Employee Family Assistance Program provider. | Other | Employee Family Assistance Program | 2015-10-01 | Employee | 0 | |||
| Shepell Health Coaching Fact Sheet | Information sheet on health coaching services provided by Shepell, Employee Family Assistance Program provider. | Other | Employee Family Assistance Program | 2015-10-01 | Employee | 0 | |||
| Shepell Legal Services Fact Sheet | Information sheet on legal services provided by Shepell, Employee Family Assistance Program provider. | Other | Employee Family Assistance Program | 2015-10-01 | Employee | 0 | |||
| Shepell My EAP App Fact Sheet | Information sheet on how to access the MyEFAP app provided by Shepell, Employee Family Assistance Program provider. | Other | Employee Family Assistance Program | 2015-10-01 | Employee | 0 | |||
| Shepell Nutrition Support Services Fact Sheet | Information sheet on nutrition services provided by Shepell, Employee Family Assistance Program provider. | Other | Employee Family Assistance Program | 2015-10-01 | Employee | 0 | |||
| Shepell On-Line Programs Fact Sheet | Information sheet on on-line programs provided by Shepell, Employee Family Assistance Program provider. | Other | Employee Family Assistance Program | 2015-10-01 | Employee | 0 | |||
| Shepell Registering On-line Fact Sheet | Information sheet on on-line registration for services provided by Shepell, Employee Family Assistance Program provider. | Other | Employee Family Assistance Program | 2015-10-01 | Employee | 0 | |||
| Shepell Self-Directed Support Fact Sheet | Information sheet on self-directed support services provided by Shepell, Employee Family Assistance Program provider. | Other | Employee Family Assistance Program | 2015-10-01 | Employee | 0 | |||
| Shepell Video Counselling Fact Sheet | Information sheet on video counseling services provided by Shepell, Employee Family Assistance Program provider.
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Other | Employee Family Assistance Program | 2015-10-01 | Employee | 0 | |||
| Shepell workhealthlife Website Fact Sheet | Information sheet on the workhealthlife website provided by Shepell, Employee Family Assistance Program provider. |
Other | Employee Family Assistance Program | 2015-10-01 | Employee | 0 | |||
| SUN Long-term Disability Plan Commentary | This Commentary provides members who are affiliated with the Saskatchewan Union of Nurses (SUN) with information related to the 3sHealth SUN Disability Income Plan. | Commentary | Disability Income Plan | 2020-06-15 | Administrator,Employee | 0 | |||
| Travel Assist Booklet | TravelAssist provides support worldwide to travellers in emergency medical situations and obtains Great-West’s approval for covered medical expenses. | Other | Core Dental, Disability Income Plan, Enhanced Dental, Extended Health Care (in-scope), Extended Health Care (out-of-scope), Group Life, Other | 2016-02-01 | Administrator,Employee | 0 | |||
| Name | Annotation | Plan Type | Plan Document Type Label | Plan Category | Plan Category Label | Release date | Audience | Weighting |
