Use this form to claim for Drug, Extended Heath & Vision claims.
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.
Claim forms change depending on your province of residence. Once you return from your travels, please complete a Travel Claim Form Request or call 1-800-667-4511 to have the proper travel claim form sent directly to you. 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.
If you have been involved in an accident and need to claim under the Accident Policy of your coverage, use this form.
Find all the details for your Health & Dental Benefits listed in this document.
A condensed document with your plan design and important contact information, fully-translated into different languages.
Find the details of your 365-day travel coverage here.
Full benefit details can be found on the Alberta Blue Cross® Member Website.
This form is used for students requesting special authorization for a specific drug to be covered under their benefits. *Note that submission of this form does not guarantee your request will be granted.
Submit exception requests by mailing it to Alberta Blue Cross® at 10009 108 Street NW Edmonton, AB T5J 3C5 or by fax to 1-877-828-4106.
This form is used for students requesting proof of coverage 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.