Claim forms 

If you need access to any of our Claim and Reimbursement forms, they are provided below. Claim and Reimbursement forms can be completed digitally and submitted via email or fax. Claim forms capture policy details while the Reimbursement form captures payment preferences and banking information. Please submit both to us.

• Each product – Medical, Life, and Long-Term Disability (LTD) each have their own Claim form below.
• Language options – Forms are available in English and French.
• Underwriting entity – Your insurer is either Delaware American Life Insurance Company (DelAm) or Voyageur Global Benefits (VGB), depending on your employer. U.S.-based employers typically use DelAm; Canadian employers usually use VGB. To confirm, check the disclaimer on your ID card or your Schedule of Benefits.

First, pick the Claim form that you need by clicking “Download now” below. Save to your computer to fill out – you can fill out completely on the computer. Type your name in the signature line to sign. Email everything to us using the contact information on your ID card or as stated within the form. 

Then fill out the Reimbursement form to tell us how to pay you back. Send both (preferably via email) to us, along with your itemized receipts.