School Logo Image
Group Policy #0091936000 International Group Policy #92652
Forms & Documents

Please find below some useful forms & documents related to the Health and Dental plan, as well as the International Student Medical and Wellness plan.
  • Claim Forms
    •
  • Brochures
    •
  • Registration Forms
    •
  • Request Forms
    •
Health and Dental 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 Health & 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.

Direct Deposit Form
Use this form to set up direct deposit and receive your drug, extended health, and vision claim reimbursements faster. Please email your completed form to dalhousie@medavie.bluecross.ca or mail it in to one of the addresses listed on the form.
 

Travel Claim Form
If you have returned home from your trip and need to make a claim, for more information reagrding the Health and Dental Plan travel coverage please click here. For more information regarding the International Student Medical and Wellness Plan travel coverage, please click here.  


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

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. 

Health and Dental Plan

Health & Dental Plan Brochures 2025-2026 | 2024-2025 
Find all the details for your Health & Dental 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 Medavie Blue Cross Portal

International Student Medical and Wellness Plan

International Student Medical and Wellness Plan Brochures 2025-2026 | 2024-2025


Coverage Roadmap
Click here to learn more about the difference between your DSU Extended Health and Dental Plan and DSU International Student Medical and Wellness Plan.

Health and Dental Plan

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: Opt-ins can only be submitted during the enrolment period in which your studies first begin each policy year.


Health & Dental Plan Opt-Out Form
Please use this form here if you need to opt-out using a manual form.

International Student Medical and Wellness Plan

International Health Plan Opt-Out Forms - opt-outs can be submitted online.
Click here to access an MSI Opt-Out form.
Click 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.


Enrolment in the Health Plans must be completed during the appropriate period, learn more about this 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.

Submit exception requests by sending as an "e-Claim" on the Medavie Blue Cross 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.

Medical Pre-Authorization Form 
For International Students/International Student Medical and Wellness 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. 

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. 
live chat
Fall Opt-in / Opt-out
YOUR COVERAGE
BENEFITS CARD
Forms and Documents
Eligible Drug Search