Claim Forms

Claim Forms

IMPORTANT : As of Aug. 24, 2021, the claiming deadline has changed. All claims must be received by Desjardins Insurance within 12 months of the date the service was incurred. E.g. If you visit a health practitioner on Sept. 30, 2021, you have until Sept. 30, 2022 to submit the claim for that visit. All claims submitted to Desjardins Insurance must also include their new carrier number: 51.

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.

Your Group Number and Certificate Number can be found here.

Where to Send Health and Dental Claims:
Desjardins Insurance (at the address indicated on the form)

Health & Vision Claim Form

Dental Claim Form

Where to Send Travel Health Claims:
For information on making travel health claims, please refer to the Travel Health Passport page.

Where to Send Tuition Insurance Claims:
Please make sure to fill out both the Student’s Statement and the Physician’s Statement Claim Forms below. Refer to the Student’s Statement Claim Form for the appropriate mailing address for your province of residence.

Health & Vision Claim Form

Tuition Insurance - Student Statement

Health & Vision Claim Form

Tuition Insurance - Physician's Statement

Please note that reimbursement for health claims may be delayed at the beginning of the fall 2021 policy period due to a change to Desjardins Insurance’s claiming system. Your claim should be processed within approximately 3 weeks.