Out-of-country claim forms
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How to make a claim
Use this form to make a claim for medical expenses you incurred while travelling outside Canada or while more than 500 kilometres from your home within Canada.
Questions? Call us at 1-800-957-9777 1 8 0 0 9 5 7 9 7 7 7.
Step 1: Enter your policy number
Enter your policy number the field below. You can find your policy number on your mailed statements, on the second page under "Key information".
Step 2: Fill out this form
Use this to make a claim for medical expenses incurred while you were outside of Canada, and authorize Canada Life to co-ordinate benefits directly with your provincial plan.
Step 3: Submit your claim
Log in to your Canada Life online account to submit your completed claim form. Unfortunately, we cannot process these claims via the app at this time.
When you’ve logged into your account, click Make a claim, and then follow the steps under Start a paper claim.
Step 2: Fill out this claim form
Use this to make a claim for medical expenses incurred while you were outside of Canada.
Step 3: Fill out the provincial authorization form for the province you live in.
Used by the Claims Branch to consent to release information to a secondary insurer.
Alberta Health requires all claim documents be received within 12 months from the date the medical treatment was provided.
In addition to the Statement of Claim – Out-of-Country Expenses (M5432) form | , British Columbia residents are required to submit the following 3 forms to Canada Life:
- #2814 (out-of-country claim)Opens a new website in a new window - Opens in a new window
- #2806 (Schedule A; medical travel assignment of payment)Opens a new website in a new window - Opens in a new window
- #2807 (Schedule B; authorization to provide medical information)Opens a new website in a new window - Opens in a new window
These Medical Services Plan (MSP) Forms should be downloaded from the official websiteOpens a new website in a new window - Opens 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.
As part of an out-of-country claim, use this form to authorize Canada Life to co-ordinate benefits directly with your provincial health plan.
Manitoba Health requires all claim documents be received within 6 months from the date the medical treatment was provided.
As part of an out-of-country claim, use this form to authorize Canada Life to co-ordinate benefits directly with your provincial health plan.
The New Brunswick Medicare Plan requires all claim documents be received within 12 months from the date the medical treatment was provided.
As part of an out-of-country claim, use this form to authorize Canada Life to co-ordinate benefits directly with your provincial health plan.
In addition to the Statement of Claim – Out-of-Country Expenses (M5432) form | , 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 - Opens in a new window .
Newfoundland and Labrador requires all claim documents be received within 12 months from the date the medical treatment was provided.
As part of an out-of-country claim, use this form to authorize Canada Life to co-ordinate benefits directly with your provincial health plan.
As part of an out-of-country claim, use this form to authorize Canada Life to co-ordinate benefits directly with your provincial health plan.
The Nova Scotia Medical Services Insurance Plan requires all claim documents be received within six months from the date the medical treatment was provided.
As part of an out-of-country claim, use this form to authorize Canada Life to co-ordinate benefits directly with your provincial health plan.
As part of an out-of-country claim, use this form to authorize Canada Life to co-ordinate benefits directly with your provincial health plan.
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.
As part of an out-of-country claim, use this form to authorize Canada Life to co-ordinate benefits directly with your provincial health plan.
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.
As part of an out-of-country claim, use this form to authorize Canada Life to co-ordinate benefits directly with your provincial health plan.
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 - Opens in a new window .
As part of an out-of-country claim, use this form to authorize Canada Life to co-ordinate benefits directly with your provincial health plan.
Saskatchewan Health requires all claim documents be received within 1 year from the date the medical treatment was provided.
As part of an out-of-country claim, use this form to authorize Canada Life to co-ordinate benefits directly with your provincial health plan.
Step 4: Submit your claim
Log in to your Canada Life online account to submit your completed claim form. We’re not able to process these claims on the app right now.
When you’ve logged into your account, click Make a claim, and then follow the steps under Start a paper claim.