Health insurance

Instructions

  1. Fill out and sign the form
  2. Gather original supporting documents
  3. Send everything to the address indicated on the form

Prior to sending one of the following forms, please contact our Customer Contact Centre since other documents may be required.

MONTRÉAL
Telephone : 1-888-558-5525 This link will launch your default phone software. ou 514-285-3000 This link will launch your default phone software.
Fax : 1-866-557-7374

TORONTO
Telephone : 1-800-278-0669 This link will launch your default phone software.
Fax : 1-888-716-4355

Critical illness insurance forms


Critical Illness claim form - Insured's statement – 17025A (PDF, 207 KB) Opens in a new window.

Important:

Your claim must include Form 17026A, duly completed by both the claimant and the attending physician.


Critical Illness claim form - Cancer, heart attack, stroke or other illness - Attending physician's statement – 17026A (PDF, 191 KB) Opens in a new window.

Important:

Must be completed by both the claimant and the attending physician. The claimant is responsible for paying any fees that may be charged for filling out the form.


Insurability Statement – 00105E02 (PDF, 77 KB) Opens in a new window.

Form to be filled when you want to declare that no change arose in the conditions of insurability of one or several persons to insure and that his or their health did not deteriorate between the moment of the signature of the relative clause to this contract and the date of the present statement.


Insurability question number 2 on pre-existing conditions - 07043E (PDF, 79 KB) Opens in a new window.

Reference table to help to fill the Insurability Question Number 2 on pre-existent Conditions.