Forms • General practitioner

Unless otherwise noted, please complete, sign and return your form to Sogemec Insurance:

BY secure file deposit
or
to the following address:
Sogemec Assurances
2, Complexe Desjardins, C.P. 217, Succ. Desjardins
Montréal (Québec) H5B 1G9

Enrolment

• Enrollment form – Prescription Drug/Health and Dental Care Insurance | PDF 301.20 KB Enrollment form - Prescription Drug/Health and Dental Care Insurance
• Enrollment form – Life and Disability Insurance | PDF 247.45 KB Enrollment form - Life and Disability Insurance
• Declaration of Insurability – Medical Questionnaire | PDF 357.44 KB Questionnaire to complete if you are enrolled in life/disability/business expenses/critical illness insurance

Modification

• Modification or cancellation form – Life/Disability and other FMOQ | PDF 866.74 KB Modification or cancellation form – Life/Disability and other FMOQ
• Modification or cancellation form – Drug/Health/Dental Care | PDF 99.49 KB Modification or cancellation form - Drug/Health/Dental Care
• Beneficiary change request | PDF 45.00 KB Beneficiary change request form

Claims

• Disability claim form – Insured statement | PDF 968.30 KB Attending Physician’s Statement – Disability Claim – SSQ form
• Direct deposit form | PDF 35.53 KB Direct deposit form
• Health insurance benefit claim form | PDF 1.10 MB Form must be used for health claims (drugs, health care professionals, etc.)
• Disability claim form – Treating doctor statement | PDF 437.11 KB Initial Disability Insurance Medical Statement - CLHIA form