Forms

Forms 2017-09-25T12:05:09+00:00

Claim Forms

Desjardins Dental Accident Claim Form
Desjardins Dental Claim Form
Desjardins Extended Health Benefits Claim Form
Direct Deposit of Health and Dental Benefit Payments
Employee Reimbursement Form for ASSURE Drug Claims
Health Spending Account Request
my-benefits eClaims

Administration Forms

Administration Guide
Appointment of Beneficiary
Enrollment Application for Chief & Council
Enrollment Application for Group Insurance
Group Insurance Confirmation of School Attendance
Group Insurance Employee Change Request
Notice of Change – Salary, Occupation, Hours
Notice of Employee Termination, Leave, Reinstatement
Pre-Authorized Debits (PAD)
Request for Conversion
my-benefits Brochure