Skip to main content

The Great-West Life Assurance Company, London Life Insurance Company and The Canada Life Assurance Company have become one company – The Canada Life Assurance Company. Discover the new Canada Life

The Great-West Life Assurance Company, London Life Insurance Company and The Canada Life Assurance Company have become one company – The Canada Life Assurance Company. Discover the new Canada Life

Your web browser is out-of-date. For the best experience, please update to a modern browser like Chrome, Edge, Safari or Mozilla Firefox.

Freedom 55 Financial is a division of The Canada Life Assurance Company and the information you requested can be found here.

Call us from anywhere in the world 24/7 for help with a medical emergency while travelling. 

If you have coverage through your employer or plan sponsor, use our workplace benefits insurance forms. If you have coverage through an advisor, use our personal insurance forms.  

How to make a claim

Use these forms to make a claim for medical expenses you incurred while travelling outside Canada or while more than 500 kilometres from your home within Canada before June 1 2023.

Download the form and print it, or fill it out in Adobe Reader XI or higherOpens a new website in a new window (not your browser) and save.

Download the form and print it, or fill it out in Adobe Reader XI or higherOpens a new website in a new window (not your browser) and save. 

Alberta Health requires all claim documents be received within 12 months from the date the medical treatment was provided.

In addition to the Out-of-Country M5975(IHP) claims form for expenses before June 1, 2023, British Columbia residents are required to submit the following 3 forms to Canada Life:

These Medical Services Plan (MSP) Forms should be downloaded from the official websiteOpens a new website in a new window of the Government of British Columbia, completed in full, and submitted as part of your claim. The MSP of British Columbia requires all claim documents be received within 90 days from the date of service, except for in-patient hospital services, which must be received within six months from the date the medical treatment was provided.

Manitoba Health requires all claim documents be received within 6 months from the date the medical treatment was provided.

The New Brunswick Medicare Plan requires all claim documents be received within 12 months from the date the medical treatment was provided.

In addition to the Out-of-Country M5975(IHP) claims form for expenses before June 1, 2023, Newfoundland and Labrador residents are required to submit the out-of-province claim form available from the Government of Newfoundland and Labrador websiteOpens a new website in a new window.

Newfoundland and Labrador requires all claim documents be received within 12 months from the date the medical treatment was provided.

The Nova Scotia Medical Services Insurance Plan requires all claim documents be received within six months from the date the medical treatment was provided.

The Ontario Health Insurance Plan (O.H.I.P.) requires all claim documents be received within 12 months from the date the medical treatment was provided.

The Health and Community Services Agency of Prince Edward Island requires all claim documents be received within 6 months from the date the medical treatment was provided.

The Régie de l’assurance-maladie du Québec (RAMQ) requires all claim documents be received within 1 year from the date the medical treatment was provided, except for in-patient and out-patient hospital services, which must be received within 3 years from the date the medical treatment was provided.

Quebec residents are also required to provide a completed Application for reimbursement formOpens a new website in a new window.

Saskatchewan Health requires all claim documents be received within 1 year from the date the medical treatment was provided.

Step 3: Submit your completed forms.

You'll find instructions on how to return the completed form on the form itself.