Claim and administration

Simple, efficient and user-friendly!

File your claims in the Client Centre and get reimbursed faster.

Access the Client Centre

3 quick ways to submit your claim

For medical and paramedical care, including prescription drugs, dental care and vision care

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Online 

Access the electronic claim form in your Client Centre or on the La Capitale website and submit your claims 

Go to the Client Centre

 

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On the La Capitale
mobile app

 You can submit your claim by adding photos of your receipts

Download the mobile app

 

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Directly on site

Present your service card at your healthcare professional's office. They will process your claim for you!

Are you part of a public administration group?

Consult the forms and information regarding your group.

General forms

  • Medical, paramedical and dental care

  • Administration

  • Disability

Medical and paramedical care

Application for direct deposit of benefits Download (PDF - 1 page)

Authorization for the disclosure of medical information Download (PDF - 1 page)

Claim for prescription drug and for medical and paramedical expenses Download (PDF - 2 pages) 

Request for Brand Name Drug Coverage Download (PDF - 2 pages)

Request for Assessment Prior Authorization Drug Download (PDF - 2 pages)

List of drugs requiring prior authorization (PDF - 2 pages)

 

Dental care
Dental insurance claim form Download (PDF - 2 pages)

 

Enrolment or modification to you insurance
These forms must be signed and sent by your employer.
Group insurance application / Modifications to group insurance Download (PDF - 2 pages)
Group insurance application / Modifications to group insurance / Advantage 2-9 Download (PDF - 2 pages)
Age 65 - Reimbursement of prescription drugs by Insurer Download (PDF - 1 page)
Termination of exemption Download (PDF - 1 page)
These forms must be sent to the email address indicated on the form or by mail.
Designation of beneficiary Download (PDF - 1 page)
Information concerning dependents Download (PDF - 1 page)
Dependent child status for a person with a total disability or functional impairment Download (PDF - 2 pages)
 
Authorizations
Preauthorized debit agreement (PAD) Download (PDF - 1 page)
Authorization - Revocation for the disclosure of personal information Download (PDF - 1 page)
 
Declarations
Evidence of Insurability Download (PDF - 2 pages)
Status statement smoker or non-smoker Download (PDF - 1 page)
Declaration of insurability / Dental care insurance plan / Group insurance Download (PDF - 1 page)
 
Death of an insured
Declaration of the claimant Download (PDF - 1 page) | Send by email to collectif_deces@lacapitale.com or by mail

Checklist for life insurance claims (PDF - 1 page)

 
Retirement
Healthcare Insurance Application (Perspective 3992) Download (PDF - 2 pages)

Find out more on the Perspective healthcare insurance page

 
Disability
For Group Insurance
Application for short and/or long term Disability Insurance Benefits / Initial Application Download (PDF - 4 pages)
Application for extension short and/or long term / Disability Insurance Download (PDF - 4 pages) 
Application for direct deposit of benefits Download (PDF - 1 page)
For La Capitale Financial Security’s  customers of the Penncorp Series/Pillar Series’ products
I hold an individual La Capitale Financial Security disability insurance policy outside of Quebec

 

Contact us 1 800 463-4856

Monday to Thursday 8:30 a.m. to 8:00 p.m.
Friday 8:30 a.m. to 5 p.m.
Saturday 9 a.m. to 12 p.m.
Holiday Schedule