Claim forms 

Need a Claim form? Find them here!

If you need access to any of our various Claim and Reimbursement forms, they are provided below.

Why are there so many? We have Claim forms for:

  • 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 – There are different forms based on your insurer, either Delaware American Life Insurance Company (DelAm) or Voyageur Global Benefits (VGB). If you don’t know your Underwriting entity, you can look at the disclaimer information your ID card or your Schedule of Benefits. Generally, if your employer is a US-based company, you are likely insured by Delaware American Life Insurance Company (DelAm). If your employer is a Canada-based company, you are likely on a Voyageur Global Benefits plan.

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.

Claim form tips

If you fill out a Claim form rather than submitting your claim online:

  • Fill it out completely and be specific about your diagnosis or reason for treatment.
  • Remember to include your Policy Number (found on your ID card).
  • Clearly state how you would like to be reimbursed.
  • Sign and date the form.
  • Keep a copy of your forms and receipts for your records.
  • Please do not send your original receipts.

What happens next?

After you submit your claim, here is what you can expect for next steps: