You are using an outdated browser. Please upgrade your browser to improve your experience and security.

Employee Benefit Plans

EBP Documents and Forms

Find the form you need here

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 Canada Life for the Extended Health Care Plan. This form can be completed online and then printed, signed and mailed to Canada 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 Canada Life Standard Dental Claim form allows members to submit dental claim expenses to Canada Life for the Core Dental and Enhanced Dental Plans. This form can be completed online and then printed, signed and mailed to Canada 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 Plan (out-of-scope) 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 Plan (out-of-scope) 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 Plan (out-of-scope) 2020-07-07 Administrator,Employee 50
 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 2022-04-12 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 2021-11-08 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
 Benefits at a Glance Form Core Dental, Disability Income Plan, Enhanced Dental, Extended Health Care (in-scope), Extended Health Care (out-of-scope) 2021-11-18 Employee 0
 Core Dental Plan Commentary The Core Dental Commentary provides plan eligibility rules, information regarding covered items and how to submit claims. Commentary Core Dental 2021-11-08 Administrator,Employee 0
 Core Dental Survivor Benefits Commentary 3sHealth Core Dental Plan Survivor Benefits Commentary. Commentary Core Dental 2021-11-08 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
 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 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-West, 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-West, 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 2022-03-02 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
 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. Form Group Life 2021-11-04 Administrator,Employee 0
 Group Life Conversion Member Fact Sheet The Canada 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 2021-11-04 Administrator,Employee 0
 Group Life Designating a Beneficiary Brochure Commonly asked questions regarding beneficiary designations in your Group Life Plan. Form 2016-07-14 Administrator,Employee 0
 Group Life Insurance Plan Commentary 3sHealth Group Life Plan Commentary Commentary 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 2022-02-09 Administrator,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 2019-04-02 Administrator,Employee 0
 In-Scope Extended Health Care and Enhanced Dental Plan Commentary Commentary Enhanced Dental, Extended Health Care (in-scope) 2021-11-08 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) 2021-11-08 Administrator,Employee 0
 Leave 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 - 2022 The Core Dental Maximum Reimbursement Schedule lists all the codes and the maximum fee amount payable for each eligible procedures. Schedule Core Dental 2022-01-18 Administrator,Employee 0
 Maximum Reimbursement Schedule Enhanced Dental Plan - 2022 The Enhanced Dental Maximum Reimbursement Schedule lists all the codes and the maximum fee amount payable for each eligible procedures. Schedule Enhanced Dental 2022-03-17 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 Commentary 2021 3sHealth Out-of-Scope Flexible Spending Plan Commentary January 2021 Commentary Flexible Spending Plan (out-of-scope) 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 Plan (out-of-scope) 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) 2021-11-08 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) 2021-11-08 Administrator,Employee 0
 QA 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-West) with information related to the 3sHealth SEIU-West 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.

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 Canada Life’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