For instructions on how to Make a Claim, please go HERE.

Health Claim Form   ENGLISH   |   FRENCH

Use this form to claim for Drug, Extended Heath & Vision claims.
 

Dental Claim Form  ENGLISH   |   FRENCH

Take this form to your dentist for completion before submission.  Note that we recommend students show their dentist their Health Benefits Card and have the dental office submit their claim electronically, or request a "Standard Dental Claim Form" in lieu of using this form.
 

Accident Claim Form

If you have been involved in an accident and need to claim under the Accident Policy of your coverage, use this form.
 

Travel Claim Form 

For trip cancellation or interruption please complete this form. The attending physician form found here must also be completed if your trip cancellation or interruption is due to medical reasons.

For baggage claims, please complete this form.

 

International Basic Plan Claim Form 

If you have paid up front for medical services, you will need to submit a claim for review for reimbursement. Please click here to submit a claim. 

Health & Dental Benefits Brochures   2023-2024   |  2022-2023 

Find all the details for your Health & Dental Benefits listed in this document.
 

Translated Benefits Postcard   Mandarin  |  Bengali  |  Arabic 

A consensed document with your plan design and important contact information, fully-translated into different languages.
 

Travel Brochure

Find the details of your 365-day travel coverage here.
 

Full benefit details can be found on the Blue Cross Portal
 

International Medical Plan Brochures       English  |  Benjali

International Basic Plan Policy    2023/2024

Companion Plan Policy    2023/2024

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Coverage Roadmap

This form is used for students requesting special authorization for a specific drug to be covered under the plan. For students requesting a CNS Cap Removal, or Monitored Medication Request, please contact Student VIP directly.

*Note that submission of this form does not guarantee your request will be granted.

Submit exception requests by sending as an "e-Claim" on the Blue Cross Member portal, or by mailing it to Medavie Blue Cross™ at 644 Main St., PO Box 220, Moncton, NB E1C 8L3 or by fax to 1-844-661-2640.
 

For International Students/ International Basic Health Plan Only. This form can be completed to confirm eligibility of a claim prior to a student seeking the service. This form can be completed and sent in to studentvip@medavie.bluecross.ca.
 

Outbound Travel (Proof of Travel Coverage leaving Canada)

This form is used for students requesting proof of coverage for outbound travel for either a travel visa, applications for government programs or proof for other reasons.

*Note that students traveling to Cuba do NOT require a travel letter, your provincial health coverage is sufficient for entering the country.
 

Inbound Travel (Proof of International Student Medical Insurance coming to Canada)

This form is used for international students requesting proof of coverage for inbound travel to Canada for their visa, immigration or proof for other reasons.