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Forms & Documents

Please find below some useful forms & documents related to your Health & Dental Benefits.



  • Claim Forms
  • Info Brochures
  • Registration Forms
  • Other Plan Forms

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.
 

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.


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


Travel Claim Form

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

Health & Dental Benefits Brochure    2024-2025 2023-2024 

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 Blue Cross Portal

Opt-In/Out Registration Forms

All opt-in requests are processed online during the opt-in period for the term you begin your coverage.  Please visit the online opt-in for more details.

Use this form to enroll yourself and/or your family onto the Brandon Health & Dental benefits. Completed forms can be taken to the BUSU Health Plan Office for processing.

Use this form to opt-out of the Brandon Health & Dental benefits. Completed forms can be taken to the BUSU 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 Blue Cross Member 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.

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