Health and dental plan
For instructions on how to Make a Claim, please click 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 assiniboine@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, for more information on the Health and Dental Plan travel coverage please click here.
For more information on the International Student Medical and Wellness Plan, please click here.

 
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

International Student Medical and Wellness Plan
If you have paid up front for medical services, you will need to submit a claim for review for reimbursement. Please click here to access the claim form. 

Once you have filled out the form above please mail or fax to:

Cowan Insurance Group:
700-1420 Blair Towers Place
Ottawa ON
K1J 9l8

Tel.: 1-888-509-7797 | Fax: 613-741-7771


* All International Student Medical and Wellness Plan claims must be submitted within on year, otherwise the claim will not be considered valid and will be denied.
* You are responsible for all fees charged for any supporting documentation.
* Failure to complete and sign this form in its entirety or submit supporting documentation will delay claim processing.

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

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

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

Health and Dental Plan

ACSA Health & Dental Benefits Opt-In Form
Students who have been charged the Health & Dental benefits fee with their tuition may opt-in family members during the designated opt-in period.

In addition, students who have NOT automatically been charged the fee on their tuition may complete the online opt-in and submit it online to enrol on the Health & Dental Benefits.

Manual Opt-In Form
Opt-In

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. 

International Student Medical and Wellness Plan 

ACSA International Student Health Plan Opt-Out Form 
Students who acquire Manitoba Health Coverage and would like to opt-out of the International Student Medical and Wellness Plan should click here to access the opt-out application form. Please submit your completed form and a copy of your Manitoba Health card to accsa@assiniboine.net.

Special Authorization Request Form
This form is used for student requesting special authorization for a specific drug to be covered under their 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.

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.