Claim Forms

Claim Forms

Use these forms to submit your health and dental claims to the insurance company. Photocopies of blank claim forms may also be used. Please allow one to two weeks for your claim to be processed.

Where to Send Claims

Health & Dental Claims:
Desjardins Financial Security
(at the address indicated on the form)

Health & Vision Claim Form

Dental Claim Form

Formulaire - soins santé

Formulaire - soins dentaires

Travel Health Claims:
For information on making travel health claims, please refer to the Travel Health Passport and detailed explanation of coverage.

For greater convenience, these forms can now be filled in electronically from within Adobe Reader. Please remember to sign claim forms before submitting them to the Insurance Company.

All our documents require the use of Adobe Reader 8 or later. Download it here for free:

Mac Users
Please note that the claim forms contain advanced features that do not work well with Mac Preview. You will also need to download and install Acrobat Reader 8 or later in order to view and print the documents correctly.

Health-care networks

Find a Health-Care Professional