La Capitale and SSQ Insurance are joining forces to become one company, but we aren’t fully integrated yet! Until then, please select the form that corresponds to your current insurer.
-
Application for direct deposit of benefits
-
Authorization for the disclosure of medical information
-
Claim for prescription drug and for medical and paramedical expenses
-
Request for Brand Name Drug Coverage
-
Application for Assessment Prior Authorization Drug
-
Request for Assessment Prior Authorization Drug
-
Dental insurance claim form
-
Group insurance application / Modifications to group insurance
-
Group insurance application / Modifications to group insurance / Advantage 2-9
-
Termination of exemption
-
Age 65 - Reimbursement of prescription drugs by Insurer
-
Notice - Temporary work interruption / Return to work
-
Designation of beneficiary
-
Information concerning dependents
-
Dependent child status for a person with a total disability or functional impairment
-
Authorization - Revocation for the disclosure of personal information
-
Preauthorized debit agreement (PAD)
-
Evidence of Insurability
-
Status statement smoker or non-smoker
-
Declaration of insurability / Dental care insurance plan / Group insurance
-
Application - Perspective Healthcare Insurance
-
Application for short and/or long term Disability Insurance Benefits / Initial Application
-
Application for extension short and/or long term / Disability Insurance
-
Application for direct deposit of benefits
Beneva
become Beneva
That means a whole lot more good people have you covered!