Forms & Resources

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Here you'll find everything you need to manage your employee benefit plan. These forms do change from time to time, so bookmark this page for future reference. That way you’ll always be sure to have the most current versions.

General Information

Enrolment/Administration

Find everything you need to manage your coverage.

Claims

Should you ever need to submit a claim, you’ll find your forms here.

  • Cost Plus Reimbursement
  • Critical Illness Claim | * Please call (info below)
  • Dental Accident Claim
  • Dental Claim
  • Direct Deposit of Health & Dental Benefit Payments
  • Employee Reimbursement Form for ASSURE Drug Claims
  • Extended Health Claim
  • Life / Accidental Death & Dismemberment Claim | * Please call (info below)
  • Long Term Disability Claim | * Please call (info below)
  • Short Term Disability Claim | * Please call (info below)
  • Voyage Assistance

Resources

  • Employee Introduction

    Use this letter to introduce the Chambers Plan to your employees.

  • Group Benefit Plan Waiver

    If an employee declines to participate in the Plan, we recommend they complete this waiver, which you can save in your files.

  • Group Life Insurance Conversion Waiver

    If an employee leaves your company, use this waiver when they don't want to convert their group life insurance to an individual policy. Save it in your files for future reference.

  • Intent to Convert Group Life Insurance Coverage

    If a departing employee would like to convert life coverage, please send in this notice promptly so that we can get the application to the employee. Desjardins Insurance must receive the completed application and first premium within 31 days of the date the employee leaves your firm.

*Please contact the Service Centre for help submitting this type of claim. The information we need may vary so please contact a service representative so we can help speed the process for you.

Call 1-800-665-3365