StudentVIP.ca

Forms & Documents

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

Claim Forms

Registration Forms

Info Brochures

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.

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.

DCSA International Student Health Plan Opt-Out Form

Students who acquire Ontario Health Coverage (OHIP) and would like to opt-out of the International Student Health Plan should CLICK HERE to access the OHIP Opt-Out application form. Please submit your completed form and attach a copy of your OHIP Card to info@studentvip.ca

Health & Dental Plan Brochure 2024-2025 | 2023-2024 |

Find all the details for your Health & Dental Benefits listed in this document

International Plan Brochure 2024-2025 | 2023-2024

Find all the details for your International Plan 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

Medical Pre-Authorization Form

This form can be completed to confirm eligibility of a claim prior to a student seeking the service.
Once completed please send this form to durham@medavie.bluecross.ca

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 644 Main St., PO Box 220, Moncton, NB E1C 8L3 or by fax to 1-844-661-2640.

Direct Deposit Form

Use this form to have your eligible claim payments deposited into your bank account. You must have a Canadian bank account in order to complete this form.

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.

Inbound Travel (Proof of International Student Medical Insurance coming to Canada)

If you require a Proof of Coverage letter as an international student arriving to Canada for their visa, immigration or proof for other reasons, please email info@studentvip.ca to request this.