Group Insurance Forms

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.

Are you part of a public sector group?

This way for forms and information specific to your group.

 

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Are you a group plan administrator?

The Group Administrator's Centre is your go-to for quick access to all the forms relevant to your group.

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  • 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)

  • 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