For instructions on how to Make a Claim, please go HERE.
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.
Travel Claim Form
Claim forms change depending on your province of residence. For medical claims abroad (doctor visits, hospital visits, x-rays, lab work, etc.) please complete a Travel Claim From Request and the proper claim form will be emailed 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.
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.
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.
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.
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.
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.