Forms

Administration

Individual insurance

PDF_32 Authorization.pdf PDF_32 Additional health declaration due to COVID-19.pdf PDF_32 Beneficiary Designation Form.pdf PDF_32 Cancellation Request Form.pdf PDF_32 Short Health Statement – Disability due to accident (Flex Plan) PDF_32 Short Health Statement PDF_32 Pre-authorized Debit (PAD) Agreement.pdf PDF_32 Method of payment.pdf

Travel insurance

PDF_32 Early Return - Premium Reimbursement Request.pdf PDF_32 Travel Insurance Modification Request.pdf

Contracting & Commissions

PDF_32 Request for Payment Direct Deposit.doc

Underwriting

PDF_32 List of occupations PDF_32 Overhead Expenses PDF_32 Information Release Form PDF_32 Arthritis questionnaire PDF_32 Aviation questionnaire PDF_32 Truck Driver questionnaire PDF_32 Cardiovascular Conditions questionnaire PDF_32 Driving questionnaire PDF_32 Motor Racing questionnaire PDF_32 Diabetes questionnaire PDF_32 Epilepsy questionnaire PDF_32 Hiking - Mountaineering questionnaire PDF_32 High Blood Pressure questionnaire PDF_32 Backache and/or Musculoskeletal Problems questionnaire PDF_32 Special questionnaire for migraines (headaches) PDF_32 Occupation questionnaire PDF_32 Scuba Diving questionnaire PDF_32 Digestive System Diseases questionnaire PDF_32 Nervous Disorder questionnaire PDF_32 Respiratory Problems questionnaire PDF_32 Alcohol Usage questionnaire PDF_32 Drug Usage questionnaire PDF_32 Tobacco Usage questionnaire PDF_32 Foreign Travel questionnaire

Claims

Health insurance

This form is used for the reimbursement of medical costs, fees for the services of a health professional, or fees for complementary health services.

These forms include the Claimant's Statement and the Hospitalization Certificate. Both are required for any claim under one of the following benefits: hospitalization, hospital allowance, or daily indemnity. They may also be used to claim ambulance transportation expenses.
Important: The Hospitalization Certificate must be completed by an authorized agent.

This form is required only if the standardized form used by dentists was not automatically provided when the services were received.

These forms include the Claimant's Statement and the Attending Physician Statement. Both are required for any claim related to an accidental fracture.

These forms include the Claimant's Statement, Attending Physician Statement, and Medical Certificate, which are required for any claim filed for medical care costs related to a critical illness covered by the contract.
Important: The Medical Certificate must be completed by an authorized agent, to attest that the insured received out-patient treatments or home health care.

These forms include the Claimant's Statement and Attending Physician Statement, which are required for any claim related to accidental loss of use or accidental dismemberment.

Disability insurance (Initial claim)

This guide provides information and forms to help the claimant file the initial claim for disability benefits and/or waiver of premiums. The guide also answers frequently asked questions (FAQ).
Important: The claim must be submitted to the Insurer within 90 days of the onset of disability.

This form is required for overhead expenses benefit claims. All supporting documents must be provided for each business expense.

The overhead expenses claim being related to a sick leave, the claimant must first complete the claim forms for disability benefits. All forms are available in the Claimant's guide - Disability insurance. If the claim is not related to a wage-replacement benefit, no proof of income is required.

Please note that supporting documents may be requested regularly during a sick leave since expenses may change during a disability period.

This form is required for any claim filed under the Mortgage Plan; proof of the last payments made to the creditor must be provided along with this form.

Since the claim is related to a leave of absence, the claimant must first complete the claim forms for disability benefits. All forms are available in the Claimant's guide - Disability insurance. If the claim is not related to a wage-replacement benefit, no proof of income is required.

In the case of a variable interest loan, payments to the creditor may vary. Supporting documentation may therefore be requested regularly during the disability period.

Please be advised that the direct deposit option is not authorized in the case of claims related to a mortgage loan or any other type of loan. Insurance benefits are paid directly to the creditor.

This form is required for any Long Term Care Insurance coverage.

Forms to be completed during a disability period

This form is required for any Long Term Care Insurance coverage.

This form is required to confirm the date of return to work. If applicable, it may serve to reinstate the automatic benefit increase option on coverage suspended during the absence from work. A Medical Certificate specifying the date of return must be attached to this form.

This form may be required if the description of the accident given in the Claimant’s Statement form and included in the initial claim is considered incomplete.

This report is necessary when a claim is filed under the overhead expenses benefit. Expense reports and supporting documents are regularly requested during a period of disability. Generally, this information is required every three months as we must ensure that current expenses are equal to the insured amount.

If the insured person has more than one job, each employer must complete this form. The form may also be used if after an attempted return to work the insured person is disabled again. In this case, the employer must complete the form once again.

If the disability has been extended, this form must be completed by the claimant’s attending physician or specialist. Updated clinical notes must be attached as well as the last medical reports in order to avoid any delays in the processing of the claim.

If this method of payment was not chosen on the initial claim, it is possible to request it at any time as long as the insurance file is active. The claimant can simply complete this form and attach a VOID cheque. However, this method of payment is not available for loan or mortgage claims as payments are made directly to the creditor.