Foursquare Group Insurance

Change of Information

Whenever there is a change in salary, name change, address, or change in beneficiary, a CHANGE FORM (should be sent to FBP Administrator, in order to ensure that the employee is receiving proper entitled coverage.


Change of Address


Change in Coverage

  • Form GL3187 “Application for change”
    • Recently Married
    • Birth of children
    • Change coverage in family (with dependents) or individual (participant only)
    • Advise change in spouse’s group insurance plan
    • Cancel or reinstate health care and/or dental benefits
    • Advise a change of name
  • Send the form to the National Office FBP Administrator, who will update the changes with Manulife.

*Note: please ensure all changes to new dependents (recently married or birth of child) are received by Manulife no later than 30 days after event or they will be considered late applicants.


Maternity Leave

Form GL3187 “Application for change"

*Note: with this form you have the option of remaining on the Benefit plan during your leave if you choose to continue to pay your premiums. Or you have the option of ‘suspending or freezing’ your benefits while away. If you choose the latter option, they will be reinstated to you once you return to work and begin paying premiums again.

Maternity, parental and adoption leave options:

Two options are available to participants entitled to maternity, parental or adoption leave:

  • They may request that group insurance benefits be cancelled during their leave if they decide not to pay their premiums*. In this instance, all benefits, not only those for which the employee makes regular payments, will be cancelled.
  • They may request that group insurance benefits continue during their leave. In this event, the leave is subject to the terms and conditions of provincial Employment Insurance.

It is understood that the continuation of coverage during an authorized absence is subject to uninterrupted payment of group insurance premiums. The plan administrator is responsible for forwarding premium payments to Manulife. The plan administrator must make the necessary arrangements to obtain payment covering the period of the leave prior to the participant’s departure.

Please note that if the participant does not return to work following the leave, you must cancel their group insurance benefits. We invite you to consult the Departure of a participant section of this guide for additional information.

For the purposes of refunding premiums, any elimination period due to a disability suffered during the leave will be calculated from the start date of the disability. Disability benefits will be paid from the later of the following dates: the expected date of return to work or the end of the elimination period.


Beneficiary or change in beneficiary designation

Form GL1435 “Beneficiary Designation”


Termination/Cancellation of Coverage

Please notify the National Office with the date of the participants final day of employment (they will send in the necessary forms to Manulife)


Reinstatement of Insurance (following permanent termination)

Please notify the National Office of the date the participant returns to work.


Change in Income

Please notify the National Office of the participant’s new income and the effective date of this new income. In the case of hourly salaries, please indicate the number of working hours per week.


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