Skip to main content

The Great-West Life Assurance Company, London Life Insurance Company and The Canada Life Assurance Company have become one company – The Canada Life Assurance Company. Discover the new Canada Life

The Great-West Life Assurance Company, London Life Insurance Company and The Canada Life Assurance Company have become one company – The Canada Life Assurance Company. Discover the new Canada Life

Your web browser is out-of-date. For the best experience, please update to a modern browser like Chrome, Edge, Safari or Mozilla Firefox.

Freedom 55 Financial is a division of The Canada Life Assurance Company and the information you requested can be found here.

If you have coverage through an advisor, use our personal insurance formsOpens in a new window instead.

Use this form to request coverage of a brand name drug. 

Download this form and print it, or fill it out in Adobe Reader XI or higherOpens a new website in a new window (not your browser) and save.

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.