Please return the form(s) to Sogemec Assurances inc.
Option 3 requires no medical questionnaire (guaranteed acceptance). This applies to all FMSQ members.
Option 1 (prescription drug, travel and travel cancellation insurance) and Option 2 (prescription drug, health, travel and travel cancellation insurance) are subject to the insurer receiving and approving the "Insurability Report" form for all medical specialists.
- FMSQ members for over 10 years
- Those who have lost or wish to replace their coverage under a different association plan
The chosen plan is valid for a minimum of two years, and no changes are permitted within that period.
You can e-mail us your completed form at email@example.com, fax it to us at 514 350-5071, or mail it to our Montreal office. Original documents are required if your plan requires proof of good health (see criteria listed above).
Report of insurability (PDF)
(To be completed if you are applying for group insurance coverage)