Request coverage for a brand name drug
Bought Freedom to Choose™ health and dental insurance coverage directly through Canada Life? You’re in the right place.
If you have coverage through your employer or plan sponsor, use our workplace benefits insurance forms. If you have coverage through an advisor, use our personal insurance forms.
Request an assesment
Use this form to request coverage of a brand name drug.
Step 1: Complete a form
Download this form and print it, or fill it out in Adobe Reader XI or higherOpens a new website in a new window - Opens in a new window (not your browser) and save.
Use this form to request coverage for a brand name drug. You’ll need the doctor to fill in some sections.
Step 2: Ask your doctor to complete the physician information section.
Step 3: Submit your form.
You’ll find instructions on how to submit your request on the form itself.