International Health Insurance Forms

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ISS will be closed on Mon. June 30 & Tue. July 1, 2025 for a Statutory Holiday.

ISS will resume virtual and in-person business hours on Wednesday, July 2, 2025.

International Health Insurance Forms

Except in cases of emergency, it is essential that the pre-authorization form be processed before surgery. Failure to do so聽will automatically聽result in a refused claim.

International Health Insurance Forms
Form	Details
Health Insurance Claim Form - Extended Health Care Benefits	To be used to claim reimbursement after having paid for eligible medical expenses. Original receipts must accompany this form.
Health Insurance Claim Form - Medical Expenses	To be used when health care provider has agreed to bill Medavie Blue Cross directly for eligible medical expenses. The student has not incurred an expense related to the claim.
Health Insurance Pre-Authorization Form	To be used when the physician has recommended surgery that may or may not require hospitalization. The patient must present the form to their attending physician, ensure that the form is completed and return it to Medavie Blue Cross. Medavie Blue Cross will provide the doctor/medical facility with an answer (confirmation of coverage or refusal) within 5 working days. This form is also available in French.