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Forms

Here are some forms that may be useful in managing your group insurance plan.

Are you looking for other forms?
Ask our Customer Service department to give you a hand!

Health
Request for brand name drug coverage

This form has to be completed by your physician to assess your request for coverage of a non-generic drug.

Health Care Benefits

Health insurance claim (drugs, health care professionals, vision care expenses, etc.)

Foreign Nationals in Canada and Canadians Working Abroad

Health insurance claim for work abroad, whatever the nationality.

Prior Authorization - Exception Drugs or Limited Use Drugs

Prior authorization in the case of a claim for exception drugs or limited use drugs.

Dental care
Dental Care Benefits

Dental claim when you do not have access to the direct payment system. Note that a section of the form must be completed by your dentist.

Accidental Death and Dismemberment (ADD)
Notice of Claim

Report a loss in the case of accidental death or dismemberment.

Accident
Proof of Loss in the Case of Accident

Proof of loss in the case of an accident.

Student Accident Insurance - Proof of Loss

Proof of loss when an accident occurs while participating in a school activity.

Sports Accident Insurance - Proof of Loss

Proof of loss when an accident occurs while participating in a sport.

Dental Claim - Proof of Loss in the Case of a Sports Accident

Proof of loss to be filled out by the attending dentist if dental care is required following an accident that occurred while participating in a sport.

Dental Claim - Claim in the Case of an Accident

Claim to be filled out by the attending dentist for dental care received following an accident.

Others
Authorization for Direct Debit Payments - Personal PAD

Authorization for the payment of your monthly insurance premium by preauthorized debit (SSQ Privilege).

Direct Deposit of your Health and Dental Care Insurance Benefits

Registration for direct deposit of your health and dental care insurance benefits.

Consent to Collect

Consent to collect and disclose personal information to a third party.
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