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FORMS & DOCUMENTS

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



  • Claim Forms
  • Info Brochures
  • Other Plan Forms

For instructions on how to Make a Claim, please go HERE.


Health Claim Form   ENGLISH     

Use this form to claim for Drug, Extended Heath & Vision claims.

 

Dental Claim Form  ENGLISH   

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.

 

Travel Claim 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.

 

Accident Claim Form

If you have been involved in an accident and need to claim under the Accident Policy of your coverage, use this form.

Health & Dental Plan Brochure  2019-2020    

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

 

Travel Brochure

Find the details of your 365-day travel coverage and a removable emergency travel card

 

Full benefit details can be found on the Alberta Blue Cross® Member Website.

Special Authorization Request Form

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


Visa/Coverage Letter Request

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.

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