Find a Form
Download and print the most common forms for group insurance claims, individual insurance claims, and investment.
The following are different forms for filing a a group insurance claim with SSQ Insurance.
To save time, opt for the personalized form available on the secure ACCESS | Plan Members website. Simply fill them out, print and sign them.
For plan members covered with a comprehensive group insurance coverage, including travel insurance
For plan members covered with travel insurance only
- Request for brand name drug coverage (PDF, 44 kB)
- Health insurance claim form (PDF, 85 kB)
- Authorization request form flash glucose monitoring system (PDF, 107 kB)
- Authorization request to increase the number of blood glucose test strips eligible for reimbursement (PDF, 219 kB)
- Form - Convalescent care (PDF, 50 kB)
- Form - Insurance for children with disabilities (PDF, 64 kB)
- Form - Exceptional Patient (QC) (PDF, 64 kB)
- Form - Medical use of Cannabis (PDF, 83 ko)
A reimbursement is possible only if your insurance contract includes the benefit “Cannabis for medical purposes”.
For any other claim information, contact us.
The following are forms for making a claim or changes to your file if you have individual insurance coverage with SSQ Insurance.
- Authorization to disclose information concerning an insured person who is deceased (PDF, 33 kB)
- Death - Declaration from the Claimant (PDF, 47 kB)
- Death - Declaration from the Physician (PDF, 44 kB)
- Foreign death questionnaire (PDF, 118 kB)
- Claim and Declaration from the Attending Physician in the Event of Accidental Fracture or Dismemberment (PDF, 40 kB)
- Disability - Declaration from the Claimant (PDF, 31 kB)
- Physical or Psychological Illness - Original request (PDF, 62 kB)
- Consent to collect, use and disclose personal information (PDF, 32 kB)
- Critical Illness - Declaration from the Claimant and the Physician (PDF, 52 kB)
Changes to your file
- Change of beneficiary (PDF, 180 kB)
- Pre-authorized debit (PDF, 60 kB)
- Transfer of ownership (PDF, 320 kB)
- Assignment of the contract (PDF, 28 kB)
- Change of name declaration (PDF, 47 kB)
- Declaration of tax residence (self-certification) - Individual (PDF, 58 kB)
- Loss of contract declaration (PDF, 47 kB)
- Policy reinstatement (PDF, 478 kB)
- Revoking cession of the contract (PDF, 41 kB)
- Verification of existence (identity) of corporations or other entities (PDF, 152 kB)
Certain forms for making changes to your file if you have investments with SSQ Insurance.
- Change of address (PDF, 57 kB)
- Change of beneficiary and estate planning (PDF, 65 kB)
- Direct deposit (PDF, 37 kB)
Please contact your financial security advisor if you:
- Change your contact information or your contract.
- Want to open an account.
- Want to make other transactions.