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Forms & Documents

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


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 durham@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, please click here for more information.


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.

Health and Dental Plan

Health & Dental Plan Brochure
   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 Plan Brochure  2025-2026 | 2024-2025

Health and Dental Plan

Students can also find the manual Health and Dental Opt-in/out forms below:
Opt-In
Opt-Out

 


International Student Medical and Wellness Plan

DCSA International Student Medical and Wellness Plan Opt-Out Form 

Students who acquire Ontario Health Coverage (OHIP) and would like to opt-out of the International Student Medical and Wellness Plan should 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


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 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
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 


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.

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