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Forms & Documents

Please find below some useful forms & documents related to your Health, Dental and Medical plans..



  • Claim Forms
  • International Health Plan Policy
  • Brochures
  • Registration Forms
  • Request Forms
Health and Dental Benefits Plan

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 Plan 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.


Travel


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 Form 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.
 

International Health Plan


International Health Plan Claim Form  ENGLISH

If you have paid up front for medical services, you will need to submit a claim for review for reimbursement. 

2023/24

Click here to view your International Health Plan Policy. 
Health and Dental Benefits

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

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

Translated Benefits Postcard Arabic Mandarin


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

 

Full benefit details can be found on the Blue Cross Portal

International Health Plan

International Health Plan Brochures 2024-2025 | 2023-2024

Translated Brochures Arabic Japanese Korean Mandarin


International Health Plan Policy 2023-2024


Companion Plan Brochure 2023-2024


Top 5

Top 5 things you should know about your plan.


Coverage Roadmap

Know the difference between your DSU Health Plan and DSU International Student Health (Medical) Plan.

Health and Dental Benefits

Health & Dental Plan Opt-In Form

Use this form if you are a student who has been charged the Fees on your tuition and wish to opt-in family members, or if you are a student who has not been charged the fee on their tuition, and wish to enrol yourself and/or family members. Note you may do this ONLINE as well. Note: opt-ins can only be submitted during the enrollment period in which your studies first begin each policy year. More information about enrollment can be found on the Frequently Asked Questions page.
 

 


 

International Health Plan

International Health Plan Opt-Out Forms - opt-outs can be submitted online.

Click here to access an MSI Opt-Out form.
Clike here to access a Private Insurance Opt-Out form. Private opt-outs are only eligible during the appropriate opt-out period.
Click here to access an Exchange Student Opt-Out form. Students at Dalhousie on Exchange should reach out to the Health Plan Office within their first week of arrival to opt-out from their health plan.

 

International Health Plan Opt-In Forms

Click here to access a Single / Family Opt-In form

Enrollment in the Health Plans must be completed during the appropriate enrollment period. Learn more about enrollment in the Health Plans on the Frequently Asked Questions page.

Special Authorization Request Form

This form is used for students requesting special authorization for a specific drug to be covered under the plan. 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.

Medical Pre-Authorization Form

For International Students/International Basic Health Plan Only. This form can be completed to confirm eligibility of a claim prior to a student seeking the service.
This form can be completed and sent in to 
studentvip@medavie.bluecross.ca

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. 

Proof of Coverage

Outbound Travel (Proof of Travel Coverage leaving Canada)

This form is used for students requesting proof of coverage for outbound travel 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.

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

This form is used for international students requesting proof of coverage for inbound travel to Canada for their visa, immigration or proof for other reasons. 


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