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ONLINE CLAIM FORMS
British Columbia:
- Medipac Claims Form A - To be completed by insured ONLY.
- Medipac Claims Form B - Use this form when another person is acting on behalf of the insured.
- Medipac Expense Sheet
- Return to Canada Benefit Affidavit & Declaration (if purchased) - Use this form if you returned to Canada due to the death of an immediate family member.
- Schedule A
- Schedule B
- BC Provincial Claim Form
Quebec:
- Medipac Claims Form A - To be completed by insured ONLY.
- Medipac Claims Form B - Use this form when another person is acting on behalf of the insured.
- Medipac Expense Sheet
- Return to Canada Benefit Affidavit & Declaration (if purchased) - Use this form if you returned to Canada due to the death of an immediate family member.
- Medipac Power of Attorney
- Quebec Claims Form
Newfoundland and Labrador:
- Medipac Claims Form A - To be completed by insured ONLY.
- Medipac Claims Form B - Use this form when another person is acting on behalf of the insured.
- Medipac Expense Sheet
- Return to Canada Benefit Affidavit & Declaration (if purchased) - Use this form if you returned to Canada due to the death of an immediate family member.
- Newfoundland and Labrador Out-of-Province Claims Form
Ontario and all other provinces:
- Medipac Claims Form A - To be completed by insured ONLY.
- Medipac Claims Form B - Use this form when another person is acting on behalf of the insured.
- Medipac Expense Sheet
- Return to Canada Benefit Affidavit & Declaration (if purchased) - Use this form if you returned to Canada due to the death of an immediate family member.
If you need help with any online claim form, call Medipac Claims at:
1-888-311-4761
If you require emergency assistance, call Medipac Assist at: 1-800-813-9374
