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FORMS & DOCUMENTS

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



  • Claim Forms
  • Info Brochures
  • Registration Forms
  • Other Plan Forms

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 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

To obtain a travel claim form please call 1-800-563-4444 once you return to Canada to have the proper claim form sent 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 2017-2018 Thunder Bay   Orillia  | 2016-2017

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 Blue Cross Portal

To opt-in with ease, please visit the Online Opt-In to opt-in yourself and/or your eligible family members.


If you are unable to use the online opt-in, please complete the form below and return it to the LUSU office:


Opt-In Registration Form
 

Exception Request Form

 

This form is used for students requesting exceptions to the limitations of the drug plan.  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 Blue Cross Member portal, or by mailing it to Medavie Blue Cross at 644 Main St., PO Box 220, Moncton, NB E1C 8L3 or by fax to 1-844-661-2640.


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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