Claim Forms

Extended Health Care Claim RC001 (44 KB)
Dental Claim RC004 (34 KB)
Cost Plus / ARB Claim RC005 (87 KB)
Attending Physician’s Statement RC027 (30 KB)
Physician’s Statement - Erectile Dysfunction Drugs RC021 (27 KB)
 
For Claims to be processed through a Health Care Spending Account Only.
Health Care Spending Account Claim RC002 (48 KB)
 
For Claims to be adjusted through an Extended Health Care Plan first with unpaid portions processed through a Health Care Spending Account Top-Up Plan.
Extended Health Care & Health Care Spending Account Claim RC020 (42 KB)


Administration

Enrolment Form RA002 (146 KB)
Electronic Deposit of Group Benefit Payments RA014 (65 KB)
Report of Employee Transactions RA028 (273 KB)
Student Eligibility RA042 (77 KB)
Student Studying Abroad RA100 (30 KB)
Change in Status/Beneficiary/Name RA077 (35 KB)
Beneficiary Designation/Change RA086 (68 KB)
Supply Request RA088 (56 KB)
 
RWAM offers products through a variety of carriers. Please refer to the provider page of your Employee Benefits Booklet, contact your Plan Administrator, or call RWAM to determine which carrier's Health Evidence form to use.

Health Evidence - Co-operators (159 KB)
Health Evidence - RBC (50 KB)
Health Evidence - La Capitale (79 KB)

Request Forms

Supply Requests