Please select from the list below to access the form you require.
All of the forms on OTIP Services are posted as PDF files. You will require a copy of Adobe Reader to access these files. Download your free copy. If you are unable to access these files, please contact us to have a copy of the form mailed to you.
Application for Insurance and Evidence of Insurability
When applying for coverage more than 31 days after becoming eligible, complete and submit this form along with your application. Plan members under the RTIP and ARM health plans will need to complete this form if they wish to change their coverage during the year. Plan changes made by RTIP and ARM health plan members on the renewal date (January 1) do not require evidence of insurability.
Plan members who have life coverage and wish to change their designated beneficiary must complete this form. This form must be signed and dated.
Full-Time Leave – All Benefits
Plan members whose plan allows for continuation of coverage during a leave of absence must complete this form whether or not they choose to maintain or discontinue coverage.
Part-Time Leave – Long Term Disability Insurance
Plan members approved for a part time leave of absence must complete this form to indicate whether they wish to maintain their long term disability insurance coverage based on their part or full time salary.
Complete this form if you are new member and wish to apply for coverage.
Plan members who need to change their health and dental single/family coverage status, add or remove dependants must complete this form. This form must be signed and dated.
Overage Dependant Student Form
Plan members who have dependant children over the age of 21 and still in full-time attendance at an accredited post-secondary education institution must complete this form annually to continue coverage for their dependant child until they reach the contract termination age or are no longer in full-time attendance at school.
Pre-Authorized Debit Authorization Form
Plan members may choose to have their premium deducted monthly from their bank account. Join our convenient, pre-authorized monthly payment plan by submitting a completed PAD authorization form and a personal cheque, marked VOID for verification purposes.
Claimants requiring reimbursement for dental care expenditures must have this form completed by their dentist or dental specialist. Original receipts and applicable supporting documentation must accompany all claim submissions.
Extended Health Benefit Claim Form
Claimants seeking reimbursement for extended health care benefits such as prescription drugs can complete this form and submit it by mail to the address listed on the form. Original receipts and applicable supporting documentation must accompany all claim submissions.
By completing this form, an RTIP or ARM health plan member authorizes OTIP to pay the service provider directly for the eligible costs associated with a claim. Please note that fees for services not covered under a benefit plan, and fees in excess of the coverage provided under a benefit plan will be the financial responsibility of the plan member.
Vacation Supply Form - RTIP - ARM
RTIP and ARM health plan members will need to complete this form if they wish to purchase more than a three-month supply of prescription medication to take on their vacation.
Prescription Drug Special Reimbursement Form
Certain medications and drug therapies require pre-authorization by OTIP and its Insurer prior to the commencement of treatment. The claimant's attending physician must complete this form describing the claimant's underlying medical condition, previous treatment history outcomes and medical criteria for the treatment request.