Use these mailing instructions for forms below:

 
 
Extended Health and Dental:

Enrollment/Change/Termination Form (BCPSA 42 Rev. 2006/6/29)
Extended Health Benefits Claim Form — Pacific Blue Cross Form

     Dental Claim Form — Pacific Blue Cross

Group Life:

Group Life Beneficiary Designation Form (BCPSA 40 rev. 2008/9/29 — formerly PSERC 40)
Group Life Insurance Plan Election — Nurses/Psychiatric Nurses (GL04 Rev. 2006/6/28)
Retired Member Group Life Beneficiary Designation — Pensioners use only (BCPSA 80 Rev. 2005/7/6)

Medical Services Plan — Do NOT mail forms to Medical Services Plan —

     Mail or fax forms to:

Benefits Service Centre
Block E, 2261 Keating Cross Road
Saanichton BC V8M 2A5
Fax: 250-652-4882

Group Application (HLTH-MSP-167)
Group Change Form (HLTH-MSP-170)

Optional Spouse and Dependent Group Life Insurance:

Election Form (BCPSA 41 rev. 2006/06/29)

Rehab and Disability Benefits:

Consent to Release Information to OHP (Occupational Health Programs)

Application to the Rehabilitation Committee (Agency and Ministry Strategic Staff only)    (BCPSA 7 Rev 2005/4/14)

Long Term Disability Plan Employer Benefit Statement (LT03 Rev 2001/03/14)

Rehabilitation Committee — Request for Transfer on Compassionate Grounds (BCPSA 7A Rev 2005/4/14)

Flexible benefits:

• Manual Enrollment Form (PDF)
• Group Life Beneficiary Designation Form
• Cost and Credit Calculator Tool (Excel file)
• Evidence of Insurability Form
• Appendices A & B
• Appendices C, D, and E
• Group Application form (HLTH-MSP-167)
• Group Change form (HLTH-MSP-170)
• Extended Health Benefits Claim Form
• Extended Health Care & Health Spending Account Claim Form

Leave Forms

Deferred Salary Leave Program:

Application (BCPSA 10 Rev. 2006/6/28)
Change/Cancellation Request (BCPSA 11 Rev. 2006/6/28)
Notification of Leave (BCPSA 17 Rev. 2006/6/28)

Payroll and Leave Forms:

Electronic Forms:

• Basic Overtime Form
• Leave Management Transaction

Fill & Print forms:

Option to Continue Employee Benefits while on Leave of Absence without Pay or Layoff (BCPSA 15 rev 2007/6/26)
Option To Continue Employee Benefits While On a Leave Without Pay To Volunteer For CUSO Projects (BCPSA 21 rev 2007/5/29)
Leave Management Transaction (BCPSA 3 — rev 2007/6/14)
Maternity, Parental and Adoption Leave / Allowance Application
(BCPSA 20 — rev 2006/6/29)
Payroll Direct Deposit Authorization (BCPSA 96 — rev 03/08/29)
Reimbursement of Incidental Expenses (BCPSA 97 — rev.2008/04/01)
TD2R — Direct Transfer of an Eligible Retiring Allowance
(BCPSA TD2R — rev 2003/08/01)

Print & Fill Forms:

Request for Tax Reduction for RRSP (rev 2002/08/20)

Certification of Death for a Spouse or Dependent Form

For mailing address see Pay Office Contacts