StudentVIP.ca

Group Policy #92652

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Forms and Documents

Below you will find important forms and documents relating to your international health plan. If a form you need is not here, please contact the DSU Health Plan Office at dsuhealth@dal.ca.

POLICY

BROCHURES

FORMS

Click here to view your policy.

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 a claim 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.

Click here to access an MSI Opt-Out form.
Click here to access a Private Insurance Opt-Out form.
Click here to access a Home Country Opt-Out form.
Click here to access an Exchange Student Opt-Out form.

Click here to access a Family Opt-In form.

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. The claims team will review and respond to the student with approval or denial within 48-72 business hours.