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.

Direct Deposit Form
Use this form to set up direct deposit and receive your drug, extended health, and vision claim reimbursements faster. Please email your completed form to brandon@medavie.bluecross.ca or mail it in to one of the addresses listed on the form.

Travel Claim Form
If you have returned home from your trip and need to make a claim, please click here for more information.

Accident Claim Form
If you have been involved in an Accident and need to claim under the Accident Policy of your coverage, please email info@studentvip.ca.

Health & Dental Benefits Brochure    2025-2026 | 2024-2025 
Find all the details for your Health & Dental Benefits listed in this document

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

Full benefit details can be found on the Medavie Blue Cross Portal.

Opt-In/Out Registration Forms
Students are encouraged to use the online platform to submit any opt-in/out requested to their benefits during the term in which they began their studies. 

Please visit the Frequently Asked Questions section to learn more about the opt-in/out process.

Manual opt-in/out forms can be found below:
Opt-In 

Opt-Out

*All completed forms can be emailed to the Brandon Health Plan Office for processing.

Manitoba Pharmacare Form
Pharmacare is a universal drug benefit program for eligible Manitobans, regardless of disease or age. Your Manitoba Pharmacare coverage is based on both your total family income and the amount you pay for eligible prescription drugs. Download this form to find out how to sign up.

Special Authorization Request Form
This form is used for students requesting special authorization for a specific drug to be covered under the benefits. 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 Medavie Blue Cross Portal, or by mailing it to Medavie Blue Cross at:
Medavie Blue Cross™
644 Main St.
PO Box 220
Moncton, NB
E1C 8L3

or by fax to 1-844-661-2640.

Outbound Travel (Proof of Travel Coverage leaving Canada)
If you require a Proof of Coverage letter for outbound travel for either a travel visa, applications for government programs or proof for other reasons, please email info@studentvip.ca to request this.