Health and dental plan
For instructions on how to Make a Claim, please click 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
 

International Student Medical and Wellness Plan
If you have paid up front for medical services, you will need to submit a claim for review for reimbursement. Please click here to access the claim form. 

Once you have filled out the form above please mail or fax to:

Cowan Insurance Group:
700-1420 Blair Towers Place
Ottawa ON
K1J 9l8

Tel.: 1-888-509-7797 | Fax: 613-741-7771


*All claims must be reported to Cowan within 90 days of occurrence.
* You are responsible for all fees charged for any supporting documentation.
* Failure to complete and sign this form in its entirety or submit supporting documentation will delay claim processing.

ACSA Health & Dental Benefits Opt-In Form

Students who have been charged the Health & Dental benefits fee with their tuition may opt-in family members during the designated Opt-In Period.

In addition, students who have NOT automatically been charged the fee on their tuition may complete the Online Opt-In and submit it online to enrol on the Health & Dental Benefits.

 Manual Opt In/Out Forms

ACSA International Student Health Plan Opt-Out Form 

ACSA International Student Health Plan Opt-In Form

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 student requesting special authorization for a specific drug to be covered under their 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.

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.