Formulaire PDF


  • (To be completed if you are applying for group insurance coverage)

  • 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

    You can send your application using our secured page here or by fax at 514 350-5071 or by mail to our Montreal office.


    The effective date of your coverage may not pre-date the date of the signature on the request for enrolment, except for enrolments that result from an end of exemption, in wich case, the applicant must prove that he/she was insured under a similar group insurance plan to the one he/she wishes to join.


    The choice of plan must remain in effect for a minimum of two (2) years and no change is possible within such period.


    For more details, please contact our Customer services team at 1 800 361-5303


    Original documents are required if your plan requires proof of good health (see criteria listed above).