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Health Insurance Pre-Authorization form

The Health Insurance Pre-Authorization form is to be used when the physician has recommended surgery that may or may not require hospitalization.

How to use the form:

1. Download the form in English or French.
2. Present the form to your attending physician. Ensure that the form is completed and submit it to Medavie Blue Cross.
3. Medavie Blue Cross will provide the doctor/medical facility with an answer (confirmation of coverage or refusal) within 5 working days.

How to submit the form:

You can submit the pre-authorization form via the Medavie Blue Cross Website, Medavie Blue Cross App or via post.聽