|Drug Prior Authorization Form
(Please use Internet Explorer (IE) to open this form)
|Complete this form to provide the medical information required to assess your request for a drug on the Prior Authorization list under your drug plan benefit coverage.
Completion of this form is not a guarantee of approval.
|Request for Approval of Brand-Name Drug Form
||Your physician will need to complete this form, if a brand name drug is prescribed instead of a generic brand, because of an adverse reaction or therapeutic failure.
|Health and Dental Change Form
||Please contact OTIP Benefits Services at 1-866-783-6847.
|Overage Dependent Student Form
||Complete this form to update overage student status.
NOTE: Once your overage dependent student(s) is no longer eligible, please contact OTIP Benefits Services to change your coverage. To confirm non-eligibility, please check your benefits booklet.
|Application for Insurance and Evidence of Insurability for RTIP/ARM members
||RTIP and ARM members, please complete this form to be approved for benefits which require proof of good health.
|Pre-Authorized Debit Authorization Form
||RTIP and ARM members, please complete this form to set up or update your premium payment information for pre-authorized debit.
|Application for Insurance and Evidence of Insurability
||Non-RTIP and non-ARM members, please complete this form to be approved for benefits which require proof of good health.