International Health Insurance Forms

Please find below the International Health Insurance (IHI) forms:

  • PDF icon Health Insurance Claim Form - Extended Health Care Benefits
    To be used to claim reimbursement after having paid for eligible medical expense. Original receipts must accompany this form.
  • PDF icon Health Insurance Claim Form - Medical Expenses
    To be used when health care provider has agreed to bill Blue Cross directly for eligible medical expense. Student has not incurred an expense related to the claim.
  • PDF icon Health Insurance Pre-Authorization Form
    To be used when physician has recommended surgery which may or may not require hospitalization. The patient must present the form to their attending physician, ensure that the form is completed and return to Blue Cross. Blue Cross will provide the doctor/medical facility with an answer (confirmation of coverage or refusal) within 5 working days. Except in cases of emergency, it is essential that this form be processed before surgery. Failure to do so may result in a refused claim.
  • Version française: PDF icon Formulaire de pré-autorisation